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J Göhl

Publications and source records attributed to J Göhl.

At least 19 recordsLinked to original sources
PubMed2004

[Interdisciplinary aspects of surgery of the pelvis minor and retroperitoneum].

Surgery of diseases of the pelvis minor and retroperitoneum such as inflammatory disease, malignant tumours, or trauma of pelvic organs need the close interdisciplinary collaboration of visceral surgeons, gynaecologists, and urologists. This collaboration begins in planning diagnostic and therapeutic procedures. It has to be clear who performs which operative step and when. Excellent long-term results in malignant disease show that the greater effort is worthwhile. The rate of postoperative morbidity after these multivisceral resections is high also in specialised centers, but mortality is below 5%. Because of the growing number of long-term survivors, preservation of quality of life becomes more and more important.

Abdominal Injuries↗
PubMed2004

Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer.

OBJECTIVES: Anterior rectal resection with partial removal of the internal sphincter is an option for low rectal cancer. The objective of this study was to evaluate the functional outcome after this intersphincteric rectal resection. METHODS: Anal continence was evaluated by anorectal manometry and a standardized questionnaire (Wexner Score) in 33 patients 28+/-15 weeks and 100+/-45 weeks, respectively, after intersphincteric resection. Nineteen of the 33 patients were reconstructed with a straight anastomosis; 12 received a colonic J-pouch. RESULTS: Post-operatively, 25.8% of the patients were incontinent to solid stool and 54.8% were incontinent to liquid stool at least once a week. Mean and maximum resting tone (24+/-10 and 40+/-13 mmHg), maximum tolerable volume (77+/-28 ml) and rectal compliance (1.4+/-1.2 ml/mmHg) were reduced in anorectal manometry. Squeeze pressures remained unchanged. Only the maximum tolerable volume correlated significantly with the continence score (r=-0.45, p<0.05). The Wexner score and maximum tolerable volume were significantly better after colonic J-pouch reconstruction than after straight anastomosis (9.9+/-4.5 vs 13.4+/-4.0, p<0.05, 65+/-20 ml vs 100+/-27 ml, p<0.01). CONCLUSION: Intersphincteric resection of the rectum leads to impaired post-operative continence. The functional outcome is improved with a colonic J-pouch.

Adult↗
PubMed2003

Can neoadjuvant radiochemotherapy improve the results of multivisceral resections in advanced rectal carcinoma (cT4a).

OBJECTIVE: To investigate the influence of neoadjuvant radiochemotherapy (nRCT) in advanced rectal carcinoma (cT4a), the prospectively collected data of all patients treated by extended multivisceral resections during the last 16 years were analysed. METHODS: Between 1985 and 2000, 113 patients with clinical T4a rectal carcinoma (invasion of adjacent organs or structures), were treated by extended multivisceral surgery. In 1995 nRCT was introduced as a standardized treatment modality in cT4a carcinomas and applied in 32 patients. Six weeks after completion of nRCT, resection was performed. In all patients at least one additional organ was removed because of clinically evident tumour infiltration. In one third of patients (36/113) more than one organ had to be removed. RESULTS: The rate of curative (R0) resections was 89% (101/113). It was similar in patients with and without nRCT (91 vs. 89%). In 40 (35%) patients histopathological examination could verify tumour invasion in adjacent organs (34% with vs. 36% without nRCT). The 3-year rate of locoregional recurrence after R0-resection was 12.7%. In multivariate Cox regression analysis the regional lymph node status was the most important prognostic factor (relative risk 5.8, P = 0.007). Neoadjuvant or adjuvant treatment reduced the risk by factor 0.4 (P = 0.211). The 3-year cancer-related survival rate of all patients with curative resection was 72.9%. It was 89.4% in the series treated with nRCT, while it was only 66.7% in patients with neither neoadjuvant nor adjuvant therapy. The relative risk for patients with lymph node metastases was 7.0 (P < 0.001) while it was only 0.2 in patients treated with nRCT (P = 0.049). CONCLUSIONS: Together with curative extended multivisceral resection nRCT can improve prognosis in patients with advanced rectal carcinoma (cT4a).

Adult↗
PubMed2003

[Angiomyolipoma of the colon - case report and review of the literature].

Angiomyolipoma is one of the benign hamartomas that is found sporadically or associated with tuberous sclerosis. It is a rare soft tissue tumor involving mostly the kidneys, sometimes other visceral organs. The tumor is composed of smooth muscle cells, adipocytes and small sized hyalinized vessels. We present the case of a 74-year-old man with a bifocal angiomyolipoma of the colon. This diagnosis was confirmed at surgery, where a partial colectomy was performed. Histologic examination disclosed the tumor. The patient had no signs of family history of tuberous sclerosis. Extrarenal angiomyolipoma is rare and this may be the first report of bifocal colonic angiomyolipoma.

Aged↗
PubMed2003

[Changes and complication rate in surgery for thoracic esophageal carcinoma].

AIM: In an analysis over 22 years it was investigated which parameters have changed in the operative treatment of thoracic esophageal carcinoma over time and in how far they have influenced complication rate. PATIENTS AND METHODS: Between 1978 and 1999 386 patients (350 men, 36 women) underwent resection for thoracic esophageal carcinoma (squamous cell carcinoma n=300, adenocarcinoma n=86). Cervical tumors were excluded from analysis. The time periods from 1978 to 1988 (n=242) and from 1989 to 1999 (n=144) were separately analyzed and compared with respect to age, sex, histological type, main tumor location, neoadjuvant therapy, method of operation, esophageal substitute and positioning of the substitute, R-status, pT/pN classification, UICC stage, number of dissected lymph nodes, complication rate, postoperative mortality and survival. RESULTS: Comparison of the two time periods showed a significant increase in adenocarcinomas and main tumor location in the lower thoracic third of the esophagus. Furthermore, significant changes concerning the indication of neoadjuvant chemoradiation, operative approach, esophageal substitute, R-status and number of dissected lymph nodes were observed. Tumor stage (pT/pN classification and UICC stage) significantly shifted towards earlier stages. Total complication rate dropped tendentially form 68.5 % to 59.0 % (p=0.061). Hospital mortality was significantly reduced from 24 % to 12.5 %, whereas anastomotic leakages and multiorgan failure remained on a constant level. Median survival of R0 resected patients was significantly prolonged from 19 months to 34 months. CONCLUSIONS: The increase of esophageal adenocarcinoma, a more strict patient selection (staging, functional status), standardization of operative technique as well as an optimized intensive care management are among the important changes in the operative management of thoracic esophageal carcinoma that have resulted in an improvement of prognosis of curatively resected patients. In spite of a more aggressive operative approach, i. e. lymph node dissection, operative mortality could be reduced by nearly 50 % in the face of a tendentially declining total complication rate.

Adenocarcinoma↗
PubMed2002

Testing a new staging system for cutaneous melanoma proposed by the American Joint Committee on Cancer.

The American Joint Committee on Cancer (AJCC) recently proposed a new staging system for cutaneous melanoma. We tested its practicability and its prognostic value was compared with the currently used TNM classification. The data of 1976 melanoma patients were used for the testing. 1218 patients (61.6%) could be assigned to the proposed pT classification, 136 patients (90.1%) with lymph node metastases and/or in-transit metastases to the proposed pN classification and all 14 patients with distant metastases to the proposed pM classification. Proposed pathological staging was possible for 971 patients (49%). The number of pT1 patients (399 versus 230) and stage I patients (544 versus 393) was distinctly higher in the proposed classification. In proposed stage II and III groups, subgroups with different prognosis could be identified. The new staging system includes more detailed information on clinical and pathohistological findings. Nevertheless, it is practicable and enables more patients with excellent prognosis to be identified.

Adolescent↗
PubMed2002

Late locoregional recurrence in rectal carcinoma.

AIMS: Locoregional recurrence in rectal carcinoma usually occurs within the first five years of treatment. In recent years we have increasingly diagnosed patients with late locoregional recurrence more than 5 years after primary treatment. METHODS: The data of 978 patients with invasive stage I-III rectal carcinoma who underwent curative resection (R0) between 1978 and 1990 were analysed retrospectively. The median follow-up time was 10 years. RESULTS: The earliest locoregional recurrence was observed at 2 months, the latest at 148 months (extramural locoregional recurrence) after primary treatment. Within 1, 2 and 5 years 34, 64 and 91 per cent of all locoregional recurrences had been diagnosed. The 2-, 5- and 10-year locoregional recurrence rates of all patients increased from 11.3 to 16.7 to 18.8 per cent. The time lapse to diagnosis of locoregional recurrence was significantly influenced by the pN category (pN0: later), grading (low grade: later) and tumour cell dissemination (present: earlier). Locoregional recurrence was also diagnosed significantly earlier in patients undergoing regular follow-up. The curative reoperation rate was 22 per cent (n=37), being higher in patients with intramural locoregional recurrence (49 per cent), after primary anterior resection (32 per cent) and in the absence of distant metastases (29 per cent). CONCLUSION: Long-term follow-up beyond five years demonstrates increasing numbers of late locoregional recurrences.

Adult↗
PubMed2001

[Regional chemotherapy--perfusion of the extremities].

Hyperthermic isolated limb perfusion with cytostatic drugs (HILP) is indicated in locoregional recurrences of malignant melanoma of the limbs. As a neoadjuvant treatment it is also used for non-curatively resectable soft tissue sarcoma or their recurrences on the extremities. Up to now, melphalan is still the standard drug in HILP for malignant melanoma. With melphalan, complete response can be achieved in 65-80% for clinically detectable in transit metastases (+/- regional lymph node metastases). The combination of tumor necrosis factor (TNF) alpha with melphalan has considerably improved response rates of HILP in sarcoma. In more than 80% of the patients the otherwise necessary amputation of the limb can be avoided. The combination of TNF with other drugs than melphalan could possibly further improve results of HILP in sarcoma patients. The high rate of local recurrences of malignant melanoma after HILP poses an unsolved problem yet.

Antineoplastic Agents↗
PubMed1999

Low bone mineral density after total gastrectomy in males: a preliminary report emphasizing the possible significance of urinary net acid excretion, serum gastrin and phosphorus.

The bone mineral density (BMD) and the associated extracellular status of mineral and acid-base metabolism were evaluated in 11 males, 3-18 years after total gastrectomy (GX). In the lumbar spine, but not in the femoral neck, BMD was decreased in seven, normal in three, and falsely high in one individual. Relative to the limits of normalcy, fasting serum levels of gastrin were low, but normal for calcium, phosphorus, parathyroid hormone, calcitonin and vitamin D, while the level of total alkaline phosphatase was elevated; fasting urine pH and calcium were low, while phosphorus and net acid were high. Regression analyses revealed serum gastrin and phosphorus, and urinary net acid as possible predictors of BMD. It was concluded that over the long-term GX evokes low BMD, but not hyperparathyroidism and deranged vitamin D metabolites. Future studies may focus on gastrin, parathyroid hormone-independent hyperphosphaturia and disturbed acid-base metabolism as indicators of a new extra-cellular equilibrium of minerals.

Acid-Base Equilibrium↗
PubMed1999

[Intraabdominal abscesses. Intervention versus surgical treatment].

As the diagnosis of intraabdominal abscesses has been continuously facilitated by the use of ultrasound and CT-scan, interventional management by percutaneous drainage provides an excellent alternative treatment concept to conventional open surgery. With the use of special flow-suction-catheters which are placed into the abdomen under sonographic or computertomographic guidance, the success rates in the literature are ranging between 33% and 100%, depending on the initial situation, etiology and morphology of the findings. Studies performed with comparable patient collectives showed that interventional treatment methods had equal results to conventional surgery. Under favorable conditions such as in lesions situated in the periphery of the abdomen, with uncomplicated access ways through the abdominal wall and with an etiology of postoperative complications without a primary intraabdominal disease, with homogenous fluid collections in undivided or communicating spaces, the success rates can be raised to above 80%. A close cooperation between radiologists and surgeons in indication, conduct and course of treatment is indispensible for a successful application of these well tolerable interventional treatment concepts.

Abdominal Abscess↗
PubMed1998

Mesorectal lymph node dissection: is it beneficial?

Locoregional recurrences and distant metastases are the determinants of the long-term prognosis following curative resection of rectal carcinoma. While distant metastases cannot be affected by the surgical treatment of the primary tumor, avoidance of local recurrence by the surgeon is of special significance as the predominant prognostic factor. Analysis of the long-term results achieved by various surgeons led to the concept of mesorectal excision - the removal of the rectum together with all additional tissue invested by the adjacent visceral fascia, that is, fatty tissue, lymph nodes, and lymphatic vessels, by sharp dissection of the appropriate anatomical plane. In our own patient material the 5-year survival rate following R0 resection was 85% for all stages, provided no local recurrence developed. This contrasts with a figure of only 23% in those who did develop local recurrence. The local recurrence rate decreased from 39.4%, with a 50% 5-year survival rate in 1974, to 9.8% and a 71% survival rate in 1991, although the rate of distant metastases remained constant. Among the patients treated between 1988 and 1994 the local recurrence rate was determined by depth of infiltration (1987 UICC classification: pT1 0%, pT2 10%, pT3 14%, pT4 28%), extent of lymph node infiltration (pN0 6%, pN1 15%, pN2 26%, pN3 25%), grading (G1 9%, G2 12%, G3 21%), and location within the rectum (upper third 13%, middle third 8%, lower third 17%), with combinations of unfavorable initial factors leading to higher local recurrence rates. The elevated local recurrence rates seen in the 1970s, in particular in the case of tumors of the lower third, were traced retrospectively to incomplete mesorectal excision, the implementation of which reduced the local recurrence rate initially to less than 10%, and then to the current 4.1%. From the oncological point of view, mesorectal excision must be considered to confer considerable benefit. In the case of carcinomas of the upper third of the rectum, mesorectal resection carried out to just 5 cm below the lower tumor edge is sufficient, however, without coning, while deeper carcinomas mandate total mesorectal excision.

Humans↗
PubMed1998

Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. European Organization for Research and Treatment of Cancer Malignant Melanoma Cooperative Group Protocol 18832, the World Health Organization Melanoma Program Trial 15, and the North American Perfusion Group Southwest Oncology Group-8593.

PURPOSE: Patients with primary cutaneous melanoma > or = 1.5 mm in thickness are at high risk of having regional micrometastases at the time of initial surgical treatment. A phase III international study was designed to evaluate whether prophylactic isolated limb perfusion (ILP) could prevent regional recurrence and influence survival. PATIENTS AND METHODS: A total of 832 assessable patients from 16 centers entered the study; 412 were randomized to wide excision (WE) only and 420 to WE plus ILP with melphalan and mild hyperthermia. Median age was 50 years, 68% of patients were female, 79% of melanomas were located on a lower limb, and 47% had a thickness > or = 3 mm. RESULTS: Median follow-up duration is 6.4 years. There was a trend for a longer disease-free interval (DFI) after ILP. The difference was significant for patients who did not undergo elective lymph node dissection (ELND). The impact of ILP was clearly on the occurrence-as first site of progression - of in-transit metastases (ITM), which were reduced from 6.6% to 3.3%, and of regional lymph node (RLN) metastases, with a reduction from 16.7% to 12.6%. There was no benefit from ILP in terms of time to distant metastasis or survival. Side effects were higher after ILP, but transient in most patients. There were two amputations for limb toxicity after ILP. CONCLUSION: Prophylactic ILP with melphalan cannot be recommended as an adjunct to standard surgery in high-risk primary limb melanoma.

Adolescent↗
PubMed1998

[Malignant melanoma of the skin: is there a curative surgical approach in locoregional metastasis?].

Between 1969 and 1993 at the Surgical University Hospital of Erlangen, 273 patients with synchronous or metachronous locoregional metastases were operated on with curative intent; patients with distant metastases at the time of primary operation or first recurrency were excluded. In 216 patients (79.1%) a curative operation was performed and we achieved a statistically significant improvement of the 5-year-survival rate compared with those patients treated only palliatively (39.3% vs. 21.1%, p < 0.01). If regional lymph node metastases occur, the prognosis becomes significantly worse (5-year survival rate 45.2% vs. 25.2%, p < 0.01); hyperthermic isolated limb perfusion shows a high importance in the treatment of locoregional metastases and the 5-year survival rate of patients treated with hyperthermic limb perfusion is significantly higher (39.0 vs. 64.2%, p < 0.05).

Adolescent↗
PubMed1996

[Lymph node dissections in malignant melanoma].

Elective lymph node dissection and its potential as a staging procedure, the prognosis of established lymph node metastases and the sentinel lymph node identification procedure are the most important aspects of lymph node dissection in malignant melanoma. It is widely accepted that subgroups of patients benefit from elective lymph node dissection. The question of which parameters identify the relevant patients properly is still under discussion. pT-categories are the most important prognostic factor; however, localisation and type of tumour and the sex of the patients are additional parameters influencing patient selection. Recently, the first studies have identified subgroups of nodal positive patients who would profit from adjuvant chemo-/immunotherapy. Therefore, lymph node dissection as a staging procedure has to be discussed in the future. Identification of the sentinel lymph node is receiving increasing attention because of its potential influence on the reassessment of elective lymph node dissection. However, this method needs further evaluation. If lymph node metastases have occurred, the prognosis of malignant melanoma decreases by 20%-50%, depending on the extent of metastasis in the individual case. The relevant topics and results are discussed on the basis of data of the Surgical Department of the University Hospital of Erlangen-Nuremberg.

Female↗