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Open access

Olof Jannasch, Christian Voigt, Kirsten Reschke, Hans Lippert and Paweł Mroczkowski

Abstract

The aim of the study was to compare preoperative findings, serum levels of calcium and parathormone (PTH) and outcome of patients undergoing surgery for primary hyperparathyroidism (pHPT) aged over 70 years with younger patients.

Material and methods. Between January 1, 1996 and September 30, 2011 186 patients underwent surgery for pHPT. Patient data were collected from chart reviews and an electronically stored database. Groups were defined as patients aged 70 years or older and patients younger than 70 years. Outcome comparison included operation time, tumor size, pre- and postoperative serum levels of calcium and PTH and length of stay in hospital. Complications were defined as clinical and laboratory signs of hypocalcemia, persistent elevated serum calcium, temporary or persistent recurrent laryngeal nerve paralysis, bleeding with need for reoperation, surgical site infection or need of tracheotomy.

Results. Parathyroidectomy alone was performed in 39.2% of patients. In 60.8% partial or total thyroidectomy was conducted simultaneously. More older patients had history of stroke and/or suffered from diabetes. Preoperative serum calcium and PTH did not differ between groups, but older patients displayed higher postoperative serum calcium (p=0.01). No significant differences between the two groups were observed regarding duration of surgery, surgical success rates, postoperative complications and hospitalization time.

Conclusions. Even though older patients had more risk factors, our data suggest that there was no difference in surgical management and outcome. Decision for surgical management of pHPT should be done regardless of age.

Open access

Andrej Udelnow, Manfred Schönfelder, Peter Würl, Zuhir Halloul, Frank Meyer, Hans Lippert and Paweł Mroczkowski

The aim of the study.

The overall survival (OS) of patients suffering From various tumour entities was correlated with the results of in vitro-chemosensitivity assay (CSA) of the in vivo applied drugs.

Material and methods. Tumour specimen (n=611) were dissected in 514 patients and incubated for primary tumour cell culture. The histocytological regression assay was performed 5 days after adding chemotherapeutic substances to the cell cultures. n=329 patients undergoing chemotherapy were included in the in vitro/in vivo associations. OS was assessed and in vitro response groups compared using survival analysis. Furthermore Cox-regression analysis was performed on OS including CSA, age, TNM classification and treatment course.

Results. The growth rate of the primary was 73-96% depending on tumour entity. The in-vitro response rate varied with histology and drugs (e.g. 8-18% for methotrexate and 33-83% for epirubicine). OS was significantly prolonged for patients treated with in vitro effective drugs compared to empiric therapy (log-rank-test, p=0.0435). Cox-regression revealed that application of in vitro effective drugs, residual tumour and postoperative radiotherapy determined the death risk independently.

Conclusions. When patients were treated with drugs effective in our CSA, OS was significantly prolonged compared to empiric therapy. CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.

Open access

Henning Dralle, Andreas Machens, Carsten Sekulla, Kerstin Lorenz, Ingo Gastinger, Pawel Mroczkowski and Hans Lippert

Prospective Multicentric Evaluation Studies for Analysis of Surgical Risk Factors in Thyroid Surgery

Open access

Paweł Mroczkowski, Stanisław Hać, Michał Mik, Maciej Berut, Łukasz Dziki, Rainer Kube, Zbigniew Śledziński, Hans Lippert and Adam Dziki

Preliminary Results of the First Quality Assurance Project in Rectal Cancer in Poland

When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.

The aim of the study was to present the results obtained during the first two years of research.

Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.

Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.

Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.

Open access

Olof Jannasch, Philip Büschel, Christin Wodner, Max Seidensticker, Roger Kuhn, Hans Lippert and Paweł Mroczkowski

Abstract

Retroperitoneal bronchogenic cysts (BC) are rare clinical entities and may mimic an adrenal mass. Laparoscopic and retroperitoneoscopic approach is widely-used in adrenal surgery. However minimally- invasive resection of a periadrenally located BC has been reported rarely.

Material and methods. A systematic review of PubMed has been performed using the following search strategy: bronchogenic cyst AND (adrenal OR retroperitoneal OR subdiaphragmatic). 18 BC being removed via minimally invasive approach have been found. Including our own case 7 were removed retroperitoneoscopically and 12 laparoscopically.

Results. An index case of a 50 year old male is presented. CT revealed 2 masses above the left adrenal area. A control demonstrated an increase in size. Retroperitoneoscopic resection was performed. Pathologic finding showed a multilocular cystic lesion with a diameter of 4cm. The cysts were lined by pseudostratified ciliated epithelium. The wall contained hyaline cartilage, seromucous glands and smooth muscle.

Conclusions. Because exact preoperative diagnosis of hormonally inactive adrenal masses is not possible surgical resection is recommended in case of tumor growth, symptoms and to obtain definitive histological diagnosis. Minimal invasive approach seems to be a safe way for resection of BC in experienced hands. There is no clear evidence if laparoscopic or retroperitoneoscopic approach is favourable