Zentralblatt fur Chirurgie最新文献

{"title":"[For Whom, How and to What End - Neoadjuvant Therapy for Rectal Cancer?]","authors":"Franziska Willis, Thilo Schwandner, Martin Reichert, Anca-Laura Amati, Daniel Habermehl, Martin Schneider","doi":"10.1055/a-2539-5533","DOIUrl":"https://doi.org/10.1055/a-2539-5533","url":null,"abstract":"<p><p>Over the past few decades, considerable progress has been made in the treatment of rectal cancer, leading to a reduction in local recurrence rates and an improvement in prognosis. The current German S3 guideline on colorectal cancer recommends neoadjuvant therapy for UICC stage II and III tumours of the middle and lower rectum. Primary surgery is still recommended for UICC I tumours, although exceptions are being discussed for certain subgroups, such as cT1/2 tumours with questionable nodal involvement. Current trials are focusing on multimodality treatment concepts, in particular total neoadjuvant therapy (TNT), which has been examined in several phase II and phase III trials. Therapies with selective omission of neoadjuvant radiotherapy and organ-preserving approaches are also being investigated. This review provides a comprehensive overview of the current evidence on neoadjuvant treatment of rectal cancer, highlights new multimodal treatment approaches, and discusses future challenges and opportunities to optimise treatment according to stage and to provide patients with the best possible individualised treatment.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"140-150"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Extended Complete Mesocolic Excision in right-sided Colon Cancer - An Overview].","authors":"Sven Flemming","doi":"10.1055/a-2537-7546","DOIUrl":"https://doi.org/10.1055/a-2537-7546","url":null,"abstract":"<p><p>Surgical resection with systematic lymphadenectomy remains the standard of care for non-metastasised colon cancer. After the article of Hohenberger et al. in 2009 describing the surgical technique of complete mesocolic excision (CME), D2 lymphadenectomy has been called into doubt after the finding of a better oncological outcome. However, there has been also a controversial discussion about the oncological value of CME, since intraoperative complications may increase. Additional evidence has been provided in recent years from randomised controlled multicentre studies showing that the reported improved oncological long-term outcome after CME is more than questionable. The reported increased rate of intraoperative (vascular) complications could be not confirmed.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"158-162"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: Staging and Diagnostics of Rectal Cancer].","authors":"Omar Al-Bourini, Lorenz Biggemann, Ali Seif Amir Hosseini","doi":"10.1055/a-2542-5089","DOIUrl":"10.1055/a-2542-5089","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"e1"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Innovations in the German Guideline for Pancreatic Cancer].","authors":"Lennart von Fritsch, Kim Honselmann, Tobias Keck","doi":"10.1055/a-2529-5372","DOIUrl":"10.1055/a-2529-5372","url":null,"abstract":"<p><p>After several revisions and updates since its last publication, the third German S3 guideline \"Exocrine pancreatic cancer\" was published in 2024. In this article, we provide an overview of the most important innovations in diagnosis and treatment.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"167-169"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arztanmerkungen – Das Kleingedruckte (2. Teil).","authors":"Albrecht Wienke","doi":"10.1055/a-2445-0986","DOIUrl":"https://doi.org/10.1055/a-2445-0986","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"130-132"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rectal Cancer: Optimal Preoperative Diagnostics].","authors":"Katharina Beyer, Johannes C Lauscher","doi":"10.1055/a-2557-4857","DOIUrl":"https://doi.org/10.1055/a-2557-4857","url":null,"abstract":"<p><p>Preoperative diagnostics for rectal cancer aim to determine the extent of local and systemic spread. Local staging includes rectoscopy with accurate height localisation, histological confirmation, MRI of the pelvis and, particularly in the case of localised tumours, endosonography. In addition to tumour height and possible infiltration of adjacent organs, MRI findings should include minimum tumour distance from the mesorectal fascia and MR morphological criteria for extramural vascular invasion. In the case of lower rectal cancer, the relationship to the various components of the sphincter muscle is important in planning the surgical strategy; in the case of upper rectal cancer, the MRI findings should include possible infiltration of the peritoneal fold. As outlined in the German guidelines, the basic diagnostic tests required to detect or exclude distant metastases are a chest X-ray and an abdominal ultrasound. If unclear findings are observed, these should be supplemented by a chest and abdominal CT. In addition to the carcinoembryonic antigen (CEA) test, which is primarily used for follow-up, a complete colonoscopy should be performed to rule out a second malignancy in the colon. If this is not possible due to an obstructive tumour, the colonoscopy should be performed three months postoperatively. Additionally, a preoperative CT or MR colonoscopy can reliably detect larger polyps and carcinomas.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"151-157"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aktuelle Funktionsdiagnostik am Verdauungstrakt bei Motilitätsstörungen und neurogastroenterologischen Erkrankungen.","authors":"Thomas Frieling","doi":"10.1055/a-2531-6601","DOIUrl":"https://doi.org/10.1055/a-2531-6601","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"117-126"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ten Years of the Molecular Tumour Board: Genome Sequencing to Personalised Therapies].","authors":"Benedikt Färber, Jan Morf, Jan Vorwerk, Johanna Schwandt, Paul Lennart Tiemann, Niklas Gebauer, Cyrus Khandanpour, Nikolas Christian Cornelius von Bubnoff","doi":"10.1055/a-2549-7283","DOIUrl":"10.1055/a-2549-7283","url":null,"abstract":"<p><p>Twenty years ago, the human genome was first fully sequenced. The Human Genome Project was carried out at 20 centres in the USA, the UK, Germany, France, China, and Japan, took 13 years, and had costs amounting to 2.6 billion €. Thanks to the development of Next Generation Sequencing (NGS), however, just a few years later, the entire human genome can now be sequenced in just a few hours for under 1000 €. This is a stark contrast to the enzymatic Sanger sequencing or the chemical Maxam-Gilbert method. The clinical implementation of these molecular insights nonetheless presents a challenge, as precise interpretation of genetic data is absolutely essential. This requires a multidisciplinary team of clinicians, molecular biologists, pathologists, and bioinformaticians to place the relevance of identified genetic changes in the clinical context. At this point, the molecular tumour board comes to the forefront. It enables personalised treatment decisions by integrating genetic and molecular findings and evaluating them in relation to available therapies and clinical trials.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 2","pages":"175-182"},"PeriodicalIF":0.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Results of RATS and VATS Anatomical Resections in the Initial Phase].","authors":"Tamas Szöke, Christian Großer, Rudolf Schemm, Martin Bruckmeier, Hans Stefan Hofmann","doi":"10.1055/a-2351-4297","DOIUrl":"10.1055/a-2351-4297","url":null,"abstract":"<p><p>Robot-assisted (RATS) anatomical resection is a new method in the treatment of lung tumours, but is controversial due to its cost. The aim of our retrospective study was to compare the clinical results of the RATS and VATS anatomical resections.The first 100 VATS and RATS resections were analysed with regard to tumour stage, intra- and postoperative complications, conversion, operation time, hospital stay and length of drainage treatment, postoperative pain (numerical rating scale, NRS) and mortality. The results were compared using the chi-square, Fisher and independent t tests.In the VATS group, stage I was more frequent, stage II less frequent (stage I: 73.4%, stage II: 19.2%) than in the RATS group (stage I: 65.5%, stage II. 23%, p = 0.695). The operating time was longer with RATS (213.5 min vs. 190.3 min, p = 0.008), due to the docking and undocking time of the robotic system to the patient. The proportion of sublobar resections was significantly higher in the RATS group (28% vs. 7%, p < 0.001). The proportion of intraoperative complications (7% vs. 14%, p = 0.073) and conversion rate (9% vs. 11%, p = 0.407) were lower in the RATS surgery. The number of lymph nodes removed was high in both groups and not significantly different (VATS: 21.6, RATS: 22.1). The hospital stay was shorter after RATS (8.8 days) than after VATS (12.5 days, p < 0.001), as was the length of postoperative drainage treatment (5.6 vs. 8 days, p < 0.001). In the RATS group, postoperative pain on the 1st and 2nd postoperative day was significantly lower, as based on the numeric rating scale (1.68 vs. 2.83, p < 0.001, 0.99 vs. 2.41, p < 0.001). The complication rate was significantly higher after VATS than after RATS (57% vs. 33%, p = 0.001), and fewer reoperations were necessary after RATS (3%) than in the VATS group (8%, p = 0.121). Four patients died in the VATS group, none after RATS (p = 0.043).The robot-assisted technique enables anatomical resections with lower conversion, complication rates and mortality, as well as less postoperative pain. Robotic surgery has proven to be safe and oncologically comparable to anatomical VATS resections for lung cancer.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 1","pages":"28-34"},"PeriodicalIF":0.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with Pulmonary Artery Reconstruction or Double Sleeve Resection Show Inferior Survival than Patients with Bronchial Sleeve Resection for Non-small Cell Lung Cancer.","authors":"Dominik Herrmann, Plamena Gencheva-Bozhkova, Urim Starova, Luiza Alexandra Luta, Shadi Hamouri, Santiago Ewig, Melanie Oggiano, Erich Hecker, Robert Scheubel","doi":"10.1055/a-2348-0694","DOIUrl":"10.1055/a-2348-0694","url":null,"abstract":"<p><p>Sleeve lobectomy or resection with pulmonary artery reconstruction is a technique that allows for resection of locally advanced central lung carcinoma, preserving lung function, and is associated with lower morbidity and mortality than pneumonectomy. This survey aimed to assess the long-term survival comparing different types of sleeve lobectomy and identify risk factors affecting survival.All consecutive patients who underwent anatomical resection for primary non-small cell lung cancer with bronchial sleeve or pulmonary artery reconstruction in our department between September 2003 and September 2021 were included in this study. Cases with carinal sleeve pneumonectomy were excluded. Data were evaluated retrospectively.Bronchial sleeve resection was performed in 227 patients, double sleeve resection in 67 patients, and 45 cases underwent isolated lobectomy with pulmonary artery reconstruction. The mean follow-up was 33.5 months. The 5-year survival was 58.5% for patients after bronchial sleeve, 43.2% after double sleeve, and 36.8% after resection with vascular reconstruction. The difference in overall survival of these three groups was statistically significant (p = 0.012). However, the UICC stage was higher in cases with double sleeve resection or resection with vascular reconstruction (p = 0.016). Patients with lymph node metastases showed shorter overall survival (p = 0.033). The 5-year survival rate was 60.1% for patients with N0 and 47% for patients with N1 and N2 status. Induction therapy, vascular sleeve resection, and double sleeve resection were independent adverse predictors for overall survival in multivariate analysis.Sleeve lobectomy and resection with vascular reconstruction are safe procedures with good long-term survival. However, double sleeve resection and vascular sleeve resection were adverse predictors of survival, possibly due to a higher UICC stage in these patients.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"61-70"},"PeriodicalIF":0.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}