Biomedical subjects

T H Schiedeck

Publications and source records attributed to T H Schiedeck.

18 recordsLinked to original sources

PubMed2001

Prognostic significance of free gastrointestinal tumor cells in peritoneal lavage detected by immunocytochemistry and polymerase chain reaction.

AIMS: The aim of our study was to identify tumor cells in peritoneal lavage comparatively with immunocytochemistry (ICC) and half-nested reverse transcriptase-polymerase chain reaction (RT-PCR) using carcinoembryonic antigen (CEA) as marker and to evaluate their prognostic significance. PATIENTS AND METHODS: In 75 patients who underwent surgery for a carcinoma of the colorectum (n=49), stomach (n=17) or pancreas (n=9) and 13 patients with an abdominal aortic aneurysm (control group) the abdomen was irrigated with saline solution immediately after laparotomy. Cells were separated by Ficoll-density centrifugation and divided into 2 equal volumes for ICC and RT-PCR. For ICC cells were spun onto slides by cytospin centrifugation and stained with a monoclonal antibody (mab) against CEA using the APAAP method. For RT-PCR total RNA was extracted from the cells, transcribed into cDNA and amplified with CEA-specific primers. Lavages of 13 patients with an abdominal aortic aneurysm and blood samples of 6 healthy donors served as controls. RESULTS: Immunostained tumor cells were found in peritoneal lavage in 23% (17/75) of all patients, whereas 63% (47/75) of patients gave a positive result by RT-PCR analysis. In the control group (n=13) no patient presented with tumor cells in ICC, however 5 of 13 (38%) showed amplified CEA-mRNA by RT-PCR, and so did one of six blood samples. Using ICC technique, we found significant correlations between detection rates and pT-, pN-, pM-categories as well as tumor stage. On the contrary, by RT-PCR significant correlations were observed only between pT- and pM-categories and detection rates. Detection of tumor cells in peritoneal lavage with both techniques was associated with poor prognosis. Moreover, these tumor cells are an independent prognostic factor and may have an influence on the development of peritoneal carcinomatosis. CONCLUSION: ICC is a useful method for detection of tumor cells in peritoneal lavage. In contrast, half-nested RT-PCR cannot be recommended, as the detection rates are unproportionally high, obviously as a result of CEA-mRNA expression in nontumor cells.

Adenocarcinoma↗

PubMed2001

Laparoscopic treatment of lymphoceles in patients after renal transplantation.

Postoperative lymphoceles after renal transplantation appear in up to 18% of patients, followed by individual indisposition, pain or impaired graft function. Therapeutic options are percutaneous drainage, needle aspiration with sclerosing therapy, or internal surgical drainage by conventional or laparoscopic approach. The laparoscopic procedure offers short hospitalisation time and quick postoperative recovery. From 1993 to 1997, 16 patients underwent laparoscopic fenestration of a post-renal transplant lymphocele, and were presented in a retrospective analysis. Three patients have had previous abdominal surgery. Following preoperative ultrasound and CT scan, 16 patients underwent laparoscopic drainage after drainage and staining of the lymphocele with methylene blue. No conversion was necessary. Mean operation time was 42 min, no intraoperative complications were seen. Oral nutrition and immunosuppression were continued on the day of surgery, and patients were discharged between the 2nd and 5th (median hospital stay 3.3 d) day after surgery. No recurrence was evident in a follow-up time of 15-54 months (median 31.4 months). Renal function remained unchanged in all patients postoperatively.

Drainage↗

PubMed2001

[Hand port-assisted laparoscopic surgery].

The dramatic benefits of laparoscopic cholecystectomy or appendectomy for patients encouraged surgeons to use minimal access operative technique in the treatment of other more complex surgical procedures [2, 3]. The authors report on their experiences with 14 patients operated by hand-port assisted laparoscopic technique for benign colorectal diseases. The mortality rate was zero. The operation times compared to the laparoscopically operated previous 14 patients with equal diagnosis did not differ significantly (hand-port: 124-186 min; lap.: 121-176 min). The begin of bowel movements and the postoperative hospital stay were comparable to those of laparoscopic surgery. There were no major complications. No conversion to an open procedure was necessary. As the hand-port device allows the surgeon to insert his (usually non-dominant) hand into the abdominal cavity during the procedure, the hand-port device seems to combine the laparoscopic benefits with the advantages of a conventional open approach (manual exploration, blunt dissection, control of hemostasis) without loss of pneumoperitoneum [10]. Even though hand-assisted operations have not gained widespread acceptance, they recently demonstrated their value especially in more complex laparoscopic procedures like splenic and gastric resections, nephrectomy and colorectal surgery [6, 10, 18, 21, 23-24]. The regaining of tactile sensation which is an essential surgical tool may encourage less experienced colleagues to perform more complex operations. The authors suggest that the hand-port device could be a useful tool in the armentarium for colorectal surgery. Further randomized trials are needed to evaluate the benefits of this technique.

Colectomy↗

PubMed2000

Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study.

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an anonymous registry database and analyzed by type of resection. Standard procedures were sigmoid or left colectomy, anterior resection, abdominoperineal resection, and right hemicolectomy. Follow-up information included incidence of local, distant, and port site recurrence and cancer-related death. RESULTS: A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; left colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was necessary in 6.3 percent (n = 25). Complications requiring reoperation occurred in 9 percent (n = 35). Complications that were treated conservatively occurred in 27.6 percent (n = 110). Thirty-day mortality was 1.8 percent (n = 7). First bowel movements resumed on the third postoperative day; patients did not use analgesics after a mean of five days. Mean postoperative hospitalization was two weeks. According to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative resection for Stage III cancer. Mean number of lymph nodes resected was 12.1. At a mean follow-up of 30 months, one port site recurrence was documented. No local recurrence was observed after curative resection of Stage I colorectal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patients (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer-related death occurred after abdominoperineal resection (4.9 percent). CONCLUSION: To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.

Abdomen↗

PubMed2000

Apoptosis in rectal cancer: prognostic significance in comparison with clinical histopathologic, and immunohistochemical variables.

PURPOSE: The aim of this study was to evaluate the prognostic value of the apoptotic index for recurrence and disease-free survival after curative surgery for rectal cancer, particularly in relation to clinicopathologic variables, p53- and bcl-2 expression. METHODS: Formalin-fixed, paraffin-embedded tissue samples of rectal carcinomas resected curatively within a five-year period were used (N = 160). Apoptotic cells with fragmented DNA were detected by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphatase-biotin nick-end-labeling method. The ratio of apoptotic tumor cells (in percent) was classified into low apoptotic index (less than 10 percent) and high apoptotic index (10 percent or more). Immunohistochemical analysis was performed using monoclonal antibodies (DO-1 for p53 and clone 124 for bcl-2). Statistics included univariate and multivariate analysis, and survival was calculated using the Kaplan-Meier method. RESULTS: Seventy-five percent of tumors showed a low apoptotic index, and 25 percent had a high apoptotic index. No correlation was found between apoptotic index and International Union Against Cancer stage (P > 0.05). However, significant correlations were documented with histologic differentiation (mean apoptotic index, 5.74 percent in moderately vs. 3.98 percent in poorly differentiated carcinomas; P = 0.0173), lymph node involvement (mean apoptotic index, 6.11 percent in pN1 vs. 3.72 percent in pN2; P = 0.0074), p53 status (mean apoptotic index, 6.26 percent in p53- vs. 4.42 percent in p53+; P = 0.0085), and bcl-2 expression (mean apoptotic index, 5.13 percent in bcl-2- vs. 6.51 percent in bcl-2+; P = 0.0418). Tumors of the lower rectum had a lower apoptotic index than those of the upper rectum (P = 0.0277). Neither univariate nor multivariate analysis assessed apoptotic index as predictor of prognosis: Recurrence rates did not differ between tumors related to apoptotic index (22 percent with low apoptotic index vs. 15 percent with high apoptotic index; P > 0.05), and no significant differences were found regarding survival (P > 0.05). On multivariate analysis, International Union Against Cancer stage (P = 0.0002), p53 (P = 0.0002), gender (P = 0.0136), and bcl-2 (P = 0.0243) were independent predictors of recurrence. These variables, except for bcl-2, were also independently related to disease-free survival. CONCLUSIONS: Reflecting tumor biology, apoptotic index as single variable showed no prognostic significance, whereas p53 was an independent predictor for both recurrence and survival, and bcl-2 was independently related to recurrence, but not to survival. Clinically, International Union Against Cancer stage and gender were independent prognostic factors after curative surgery for rectal cancer.

Adult↗

PubMed2000

p53 and Bcl-2 as significant predictors of recurrence and survival in rectal cancer.

The aim of this study was to evaluate the prognostic value of p53 nuclear accumulation and Bcl-2 expression after curative surgery for rectal cancer. Immunohistochemistry was performed using monoclonal antibodies (MAb) (DO-1 for p53; anti-human Bcl-2 MAb, clone 124, for Bcl-2) on formalin-fixed, paraffin-embedded tissues of 160 rectal carcinomas (UICC stages I-III), and results were compared with data from the prospective registry of rectal cancer by univariate and multivariate logistic regression model focusing specifically on recurrence. Survival was calculated by the Kaplan-Meier method and proportional hazards model. p53 nuclear accumulation was documented in 39% (n=63) of tumours and was associated with a higher incidence of tumour progression (local or distant recurrence) and poorer disease-free survival (P<0.0001). Bcl-2 expression was detected in 29% (n=47), and was associated with longer disease-free survival and lower incidence of recurrence (P<0.0086). Multivariate logistic regression analysis demonstrated that gender (P=0.0136), UICC stage (P=0.0002), p53 expression (P=0.0002) and Bcl-2 expression (P=0. 0243) were independent factors predictive of recurrence. The proportional hazards model identified p53 (P=0.0009), UICC stage (P=0.0480), gender (P=0.0049), but not Bcl-2 (P=0.1503), as independently related to disease-free survival. Looking at the p53/Bcl-2 subgroups, the poorest prognosis was observed in the p53+/Bcl-2- subgroup, whereas patients whose tumours were p53-/Bcl-2+ had the best prognosis (P<0.0001). Immunohistochemical assessment of both p53 and Bcl-2 status may be valuable in predicting recurrence and survival after curative surgery for rectal cancer. Therefore, they play a role as prognostic factors in rectal cancer. p53 is a stronger predictor of prognosis than Bcl-2.

Adult↗

PubMed1999

Ordinary colorectal adenocarcinoma vs. primary colorectal signet-ring cell carcinoma: study matched for age, gender, grade, and stage.

PURPOSE: This study contributes to the characterization of primary colorectal signet-ring cell cancer in contrast to ordinary colorectal carcinoma. Primary colorectal signet-ring cell cancer is a rare but distinctive primary neoplasm of the large bowel with still-controversial clinicopathologic features. METHODS: Clinicopathologic features and survival data are evaluated in comparison with those of the ordinary colorectal adenocarcinoma (non-signet colorectal carcinoma) in a retrospective study matched for age, gender, grade, and stage. RESULTS: In a series of 1,600 consecutive colorectal cancer patients since 1979, 14 patients (0.88 percent) with a signet-ring cell cancer were identified. Gender ratio was balanced, and mean age was 67.5 years. The majority of patients had an advanced tumor stage at the time of diagnosis (57.1 percent Stage IV and 35.7 percent Stage III). Median survival time was only 16 months. In a study matched for age, gender, grade, and stage, a lower survival rate was found for patients with signet-ring cell cancer, but the difference did not reach statistical significance. In contrast to non-signet colorectal carcinoma, signet-ring cell cancer was characterized by a significantly higher incidence of peritoneal tumor spread (64.3 percent) and a lower incidence of hepatic metastases (14.3 percent). CONCLUSIONS: Signet-ring cell cancer represents a rare but distinctive primary neoplasm of the large bowel. It is frequently diagnosed in an advanced tumor stage, thus showing an overall poorer prognosis than nonsignet colorectal carcinoma. Usually only palliative surgery is possible. A high incidence of peritoneal seeding and a low incidence of hepatic metastasis is characteristic of signet-ring cell cancer.

Adenocarcinoma↗

PubMed1999

Advanced age--indication or contraindication for laparoscopic colorectal surgery?

PURPOSE: It has been proposed that laparoscopic colorectal surgery offers several benefits to patients. The aim of this study was to evaluate particularly whether older patients can benefit by laparoscopic colorectal procedures or if minimally invasive procedures are contraindicated. METHODS: All patients who underwent elective surgery were divided into age-related groups: patients 50 years of age or younger, patients ranging from 51 to 70 years of age, and patients older than 70 years. The groups by age were compared with each other relative to their cardiopulmonary status, indication, procedure, conversion, morbidity, mortality, duration of surgery, perioperative blood transfusion, stay on the intensive care unit, and hospitalization. Statistical analysis included univariate analysis by chi-squared tests and Student's t-tests comparing patients older than 70 years with patients 50 years of age or younger and with patients ranging from 51 to 70 years of age (statistical significance was defined as P < 0.05). RESULTS: Within five years 298 patients (male/female ratio, 0.38) underwent a laparoscopic or laparoscopic-assisted colorectal procedure. Of these, 95 (31.9 percent) patients were older than 70 years, 138 (46.3 percent) patients ranged from 51 to 70 years of age, and 65 (21.8 percent) patients were 50 years of age or younger. Pathologic findings in cardiopulmonary function increased with age. There were no statistically significant differences among the younger, middle-aged, and older patients relative to the incidence of conversion (3.1 vs. 9.4 vs. 7.4 percent, respectively), major complications (4.6 vs. 10.1 vs. 9.5 percent, respectively), minor complications (12.3 vs. 15.2 vs. 12.6 percent, respectively) or total laparotomy rate (7.7 vs. 12.3 vs. 12.6 percent, respectively). P > 0.05 for all comparisons. However, duration of surgery, stay on the intensive care unit, and postoperative hospitalization were significantly prolonged in patients older than 70 years (P < 0.05 for all comparisons) but were reduced during the five years of experience with these procedures. CONCLUSIONS: If preoperative assessment of comorbid conditions and perioperative care was ensured, laparoscopic procedures were shown to be safe options in the elderly. The outcome of laparoscopic colorectal surgery in patients older than 70 years is similar to that noted in younger patients. Advanced age is no contraindication for laparoscopic colorectal surgery.

Adult↗

PubMed1999

A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer.

This study compared laparoscopic with open surgery for the cure of cancer of the rectosigmoid and rectum. Results of surgery, postoperative recovery, and oncological follow-up were compared between 32 laparoscopic curative procedures (19 laparoscopic-assisted anterior resections for cancer of the rectosigmoid or upper rectum and 13 laparoscopic abdominoperineal resections for low rectal cancer) and 32 controls matched for age, UICC stage, tumor site, and type of resection who underwent open surgery during the same observation period. Morbidity was identical after laparoscopic and open resection (31.3%). Surgery was equally radical in the two groups regarding yield of lymph nodes and lateral and distal margins. Survival, recurrence, and cancer-related mortality showed no statistical differences. There was no port-site recurrence. The benefits of laparoscopic surgery were shown with a reduction in perioperative blood transfusion and earlier return of bowel function. However, the operative time was significantly increased in the laparoscopic group. This study shows that laparoscopic surgery for the cure of colorectal cancer is technically feasible, and that oncological short-term outcome does not differ from the results achieved by open techniques. However, prospective randomized trials are mandatory to evaluate the definite role of laparoscopic surgery for malignancy.

Aged↗

PubMed1999

Actual standards and controversies on operative technique and lymph-node dissection in colorectal cancer.

BACKGROUND: Radical lymphadenectomy for colorectal cancer according to its arterial supply seems to remove potentially metastatic lymph nodes and highlights the impact on prognosis. STANDARDS AND CONTROVERSIES: Systematic lymph-node dissection in colorectal cancer requires knowledge of normal anatomy of lymphatic drainage and spreading of lymph-node metastases. Oncological standards of curative surgery for colorectal cancer include en bloc resection, no-touch isolation technique, primary ligation of the vessels and systematic lymphadenectomy. In rectal cancer, total mesorectal excision and irrigation of the rectal stump is mandatory. Potential improvements in prognosis achieved by extended lymph-node dissection have to compete with procedure-related morbidity. High-tie ligation of the inferior mesenteric artery is a controversial issue. Prediction of prognosis is essential for planning a treatment schedule for patients. CONCLUSIONS: At present, clinicopathological stage is the single most reliable factor in prediction of outcome. New encouraging methods for detecting micrometastases of lymph nodes and new surgical technologies such as immune corrective surgery are challenging and have to be critically assessed. The results of laparoscopic surgery for the cure of colorectal cancer have to be proven within prospective randomised trials.

Colonic Neoplasms↗

PubMed1999

The role of conversion in laparoscopic colorectal surgery: Do predictive factors exist?

BACKGROUND: This study was performed to analyze the reasons for conversion of laparoscopic colorectal procedures to open surgery and to identify risk factors. METHODS: All patients who underwent laparoscopic colorectal surgery at our institution were enrolled in a prospective trial. The causes of conversion were analyzed. Statistical analysis, including a logistic regression model, was performed to identify factors that would predict an increased risk of conversion. RESULTS: A total of 300 laparoscopic or laparoscopic-assisted procedures for both benign and malignant diseases were performed within 5 years. Mean patient age was 61.4 years (range, 17-93). There were 218 women and 82 men. Major complications occurred in 8.6%, and 30-day-mortality rate was 1.1%. Postoperative hospitalization was 13.9 days (range, 6-47). Conversion occurred in 22 cases (7.3%). The mean age of the converted group was 64.7 years (range, 31-93). Postoperative hospital stay was 15.0 days (range, 10-25). The main reasons for conversion to open surgery were inflammation, obesity, anesthetic problems, technical difficulties, intraoperative complications, and intraoperative decisions concerning oncological resection. The conversion rate was 14.6% in patients who underwent sigmoid resection for diverticular disease. By univariate analysis, statistically significant factors defining a higher risk of conversion were male gender (p = 0.0029), age from 55 to 64 years (p = 0.0015), extreme body status (p = 0.0001), and diagnosis of diverticular disease (p = 0.0011). According to the logistic regression model, all four factors combined would give a probability of conversion of 70.3%. CONCLUSIONS: The risk factors contributing to the possibility of conversion included male gender, age between 55 and 64 years, extreme body status, and diverticular disease. Using these data, patients with an increased likelihood of conversion can be identified. However, if conversion is necessary, laparoscopic colorectal surgery can be safely applied to the patients with no additional morbidity.

Adolescent↗

PubMed1999

Laparoscopic colorectal surgery: A five-year experience.

OBJECTIVE: The aim of this study was to assess the feasibility and outcome of 300 laparoscopic colorectal procedures performed within 5 years for both benign and malignant disorders. The specific purpose was to identify the impact of the learning curve on reducing morbidity and on improving the outcome of laparoscopic colorectal surgery. PATIENTS AND METHODS: All cases were divided into 3 groups: the first 100, the second 100 and the third 100 procedures were analyzed. Statistical analysis was performed by Student's t test and chi2 test. RESULTS: The laparoscopic procedure had to be converted to open surgery in 22 cases (mean conversion rate 7.3%). Thus, a total of 278 procedures could be performed laparoscopically. The mean major complication rate was 8.6%, minor complications occurred in 9.7%. The overall morbidity rate was 18.3%. In 44 cases, laparoscopic resections were performed for the cure of colorectal malignancy. The mean lymph node harvest was 12.8 nodes, no port-site recurrence was documented at a mean follow-up of 22 months. Analyzing our 5-year experience, the incidence of conversion showed a decline from 8.0% (1st and 2nd 100) to 6.0% in the last 100 procedures (p > 0.05). The major complication rate was significantly decreased from 15 to 6.0% (1st vs. 2nd 100) and was 5.0% in the 3rd group. The minor complication rate, overall morbidity rate and laparotomy rate have also been reduced (p > 0.05). The duration of surgery was shortened from 251.4 to 213.5 min (1st vs. 2nd 100, p < 0.05) and was 196.9 min in the last 100 procedures. Postoperative hospital stay was decreased from 16.3 to 14.3 days (1st 100 vs. 2nd 100, p > 0.05) and could be shortened to 11.2 days (2nd vs. 3rd 100, p < 0.05). CONCLUSION: With increasing experience, laparoscopic colorectal surgery can be performed with reduced morbidity and improved outcome. To evaluate the role of laparoscopic colorectal procedures, particularly for the cure of malignancy, prospective randomized trials are necessary.

Adolescent↗

PubMed1999

[Laparoscopic therapy of chronic constipation].

Chronic constipation is a common complaint. Clinical presentation varies with each individual. This study reports the results of laparoscopic therapy in 92 patients with chronic constipation. In two patients conversion was necessary. The majority of patients were female (n = 84, 93.3%). Mean age was 60.3 years (+/- 15.7). In three patients with slow-transit constipation a laparoscopic assisted subtotal colectomy was performed. In patients with outlet obstruction a laparoscopic assisted sigmoid resection was carried out, whereas in 79 a rectopexy with reconstruction of the pouch of douglas was added. In 6 of 8 patients with concomitting diverticulitis an anterior resection was necessary. Mean stay on ICU was 0.5 days. OR time ranged from 100 up to 490 minutes. In 21 patients (23.4%) postoperative complications were observed; however only in 7.8% (n = 7) this lead to additional surgical intervention. The postoperative follow-up is 24 months (6-52 mon). In 76.3% of patients with outlet obstruction and rectal prolapse chronic constipation postoperatively improved or patients felt "symptomfree". In patients with outlet obstruction but without rectal prolapse constipation postoperatively was better in 75.8%. After subtotal colectomy 2 of 3 patients (66%) felt cured after surgery. Careful patients selection by thorough preoperative physiologic testing is mandatory for successful outcome in surgery of chronic constipation. Based on this by laparoscopic surgery same functional results as with conventional open technique could be achieved.

Adult↗

PubMed1998

[Laparoscopic sigmoid resection in diverticulitis].

Between September 1992 and May 1997 in the Department of Surgery at the Medical University of Lübeck 240 colorectal procedures were performed by laparoscopic techniques. Fifty-seven patients underwent laparoscopic colectomy for diverticulitis. In 52 cases sigmoid resections were performed laparoscopically, including 4 cases with simultaneous laparoscopic rectopexy. Anterior resections were necessary in 3 patients, whereas 2 patients with extended localization of diverticula required left hemicolectomies. Using atraumatic instruments and an ultrasound dissector, laparoscopic resection involved tubular dissection and preperitoneal anastomosis. The mean operative time was 234 min. In 8 cases (14%) conversion to an open procedure was necessary. Complications occurred in 6 patients (10.5%). One patient died because of an anastomotic leakage. In conclusion, with increasing experience laparoscopic resection for diverticulitis can be performed without additional morbidity in comparison to open colectomy. In particular, the benefits of the minimally invasive method are quicker reconvalescence with reduced postoperative pain and improved cosmesis.

Adult↗

PubMed1998

Stoma creation for fecal diversion: is the laparoscopic technique appropriate?

This study assessed the results of laparoscopic stoma creation for fecal diversion. All patients who underwent elective laparoscopic stoma creation as the sole procedure were evaluated prospectively. Univariate analysis was performed to determine whether previous abdominal surgery, age, gender, body mass index, indication, or surgeons' experience has an effect on the outcome. Between November 1992 and May 1998, 42 patients (17 males, 25 females) with a mean age of 62.1 years (range 17-91) underwent laparoscopic stoma formation. Fecal diversion included loop ileostomy (n = 7), loop sigmoid colostomy (n = 32), and end-sigmoid colostomy (n = 3). Most common indications were unresectable rectal cancer, rectal obstruction caused by advanced pelvic tumors and benign disorders such as perianal Crohn's disease, and fecal incontinence. Of the 42 procedures 41 were completed laparoscopically (97.6%). Complications occurred in four patients (9.5%) requiring reoperation in two (4.8%). Mean length of surgery was 74.4 min (range 30-200). First bowel movements resumed on the 3rd day (range 2nd-7th) after surgery and patients were discharged from hospital after 13 days (range 6-47). Short-term results (> 30 days-1 year) indicated that no further stoma-related complications occurred. Analyzing factors potentially predictive of outcome, no statistically significant differences were documented in relation to previous abdominal surgery, age, gender, body mass index, indication, or surgeons' experience (P > 0.05). Laparoscopic stoma creation is appropriate to achieve fecal diversion because it is technically feasible and can be performed with low morbidity. In addition to the benefits of the minimally invasive technique for the patients, laparoscopic stoma formation can be ideal for the surgeon as basic and initial step to perform laparoscopic colorectal procedures.

Adolescent↗

PubMed1998

[Detection of hL6-mRNA: new possibilities in serologic tumor diagnosis of colorectal carcinomas].

A study was performed to detect circulating tumor cells in patients with colorectal cancer using mRNA coding for the tumor associated antigen L6. The mRNA was determined by Reverse Transcriptase Polymerase Chain Reaction and gel-electrophoresis. The L6 results were compared with the CEA levels. Peripheral blood samples were taken from 109 patients with histologically verified colorectal cancer. Statistics were carried out using CHI Square and Sokal and Rohlf's-test. Preoperatively 81.65% showed positive L6 mRNA, whereas only 58.7% had elevated CEA titers (p < 0.05). In all patients of the control group (n = 52) no L6 was detectable. Concerning our results L6 seems to be a sensitive and precise tool for diagnosing circulating tumor cells in colorectal cancer.

Antigens, Surface↗

PubMed1997

[Laparoscopic surgery of rectal carcinoma].

Laparoscopic colorectal procedures for treatment of benign disorders are increasingly appreciated. However, laparoscopic resections for rectal cancer are controversial. In the Department of Surgery at the Medical University of Lübeck 25 patients with rectal cancer were treated by laparoscopic procedures within four years. Using four trocars the intraabdominal dissection of the sigmoid colon and rectum including mobilisation of the left flexure were performed. A complete lymphadenectomy with high ligation of the inferior mesenteric artery and dissection of the mesocolon and colon were accomplished by laparoscopic techniques. There was no case requiring conversion to open surgery attributable to intraoperative complications. Apart from stoma complications one venous bleeding occurred postoperatively requiring laparotomy. The median lymph node harvest were 12 nodes. Laparoscopic colorectal surgery for rectal cancer is oncologically feasible. Concerning long-term outcome and due to the problem of port site recurrences laparoscopy for rectal cancer should be offered only to patients enrolled in a prospective randomized trial.

Aged↗

PubMed1997

[Functional disorders of the rectum and pelvic floor--surgical diagnosis].

Pelvic-floor disorders present themselves as isolated entities or, often, in combination with other ano-rectal diseases. In each case, the basis for individual therapy has to be a precise diagnosis. For differentiation of pelvic-floor disorders, we use a step by step diagnostic cascade: the first step is a basic proctological evaluation, including history, scoring, inspection, palpation, proctorectoscopy and anorectal manometry. Secondary special diagnostics, such as endosonography, neurological examination, transit-time studies and defecography are also used. In special individual problems, CT scan, MRI, urological or gynecological examination complete the diagnostic route, resulting in the definite coloproctological therapy.

Colonic Diseases, Functional↗