Einleitung: Die Inzidenz Karzinome des gastroösophagealen Übergangs steigt in den westlichen Länd... more Einleitung: Die Inzidenz Karzinome des gastroösophagealen Übergangs steigt in den westlichen Ländern rapide an und stellt die zweithäufigste krebsbedingte Todesursache weltweit dar. Die chirurgische Resektion ist hierbei die einzige kurative Option. Bei AEG II ist allerdings noch[zum vollständigen Text gelangen Sie über die oben angegebene URL]
Einleitung: In prospektiv randomisierten Studien konnte gezeigt werden, dass die präoperative Che... more Einleitung: In prospektiv randomisierten Studien konnte gezeigt werden, dass die präoperative Chemotherapie beim lokal fortgeschrittenen Magenkarzinom die Gesamtüberlebensrate verbessern kann. Das histopathologische Ansprechen wurde als unabhängiger Prognosefaktor bei diesen Patienten[for full text, please go to the a.m. URL]
Introduction: Acute rejection is still a common complication of liver transplantation (LTx). CD4 ... more Introduction: Acute rejection is still a common complication of liver transplantation (LTx). CD4 /CD8 T cells represent a subpopulation of T lymphocytes, and are a marker for allograft rejection. It is known that lymphocyte regress after allograft transplantation depends on sphingosine 1-phosphate[for full text, please go to the a.m. URL]
FAIRY: a randomized controlled patient-blind phase III study to compare the efficacy and safety o... more FAIRY: a randomized controlled patient-blind phase III study to compare the efficacy and safety of intravenous ferric carboxymaltose saline (placebo group). Patients will be blinded to the intervention. Patients will undergo evaluation for hemoglobin level, hematology and quality of life assessment 3 and 12 weeks after randomization.
Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases si... more Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases similar to the primary tumor in esophageal adenocarcinomas (EAC). We evaluated the prognostic significance of tumor regression in LN metastases of locally advanced EAC of 239 patients treated with neoadjuvant radiochemotherapy (RCTX) or chemotherapy (CTX) followed by esophagectomy. We examined retrospectively the LN for histopathologic signs of regression, i.e., nodular fibrosis and acellular mucin. LN classification was performed according to two parameters: presence (−) or absence (+) of residual tumor and regression characteristics in the LN, resulting in four categories: LN−/REG−, LN−/REG+, LN+/REG+, LN+/REG−. In total, LN metastases with residual tumor were detectable in 117/239 (49%) cases. Regression in LN were observed in 85/239 cases (35.5%). The distribution of the LN/REG categories were as follows: 97 patients (40.6%) were LN−/REG−. A total of 25 patients (10.5%) were LN−/REG+. ...
Simple Summary The incidence of adenocarcinomas of the GE-junction (AEG) increases evermore over ... more Simple Summary The incidence of adenocarcinomas of the GE-junction (AEG) increases evermore over the recent decades in the Western world. The postoperative tumor stage with or without multimodal treatment provides important information with regard to post-therapeutic survival. However, this tumor staging may be influenced by the histologic tumor subtype. These subtypes were described by Lauren before and provide substantial prognostic information in gastric cancer patients. The Lauren classification, however, was not yet evaluated in AEG before the purpose of the present retrospective analysis. It was confirmed in a cohort of 1153 AEG patients that Lauren subtypes convey substantial prognostic information after surgical resection. Furthermore, a simplified sub-classification into differentiated and undifferentiated histotypes was developed and evaluated. This newly proposed sub-classification system requires further confirmation by multicentric re-evaluation analyses. Abstract Adeno...
Simple Summary Chemotherapy ahead of surgery is standard of care for locally advanced stomach can... more Simple Summary Chemotherapy ahead of surgery is standard of care for locally advanced stomach cancer or cancer at the junction between esophagus and stomach in Europe. However, response to chemotherapy may depend on microscopic features of the tumor. Three types were defined before: intestinal, diffuse and mixed types. The authors aimed to investigate if these characteristics influence survival after end of treatment (chemotherapy+surgery) in a large cohort treated in a University hospital. It was found that intestinal type patients demonstrate longer survival after chemotherapy+surgery than those with diffuse types. In the mixed type group no clear conclusion regarding the effect of chemotherapy ahead of surgery may be taken. Conclusively, patients with diffuse type tumors do not benefit from chemotherapy ahead of surgery. Abstract Background: the purpose of this analysis was to analyze the outcomes of multimodal treatment that are related to Lauren histotypes in gastro-esophageal ...
Submucosal Cancer of the Gastrointestinal Tract - State Adapted Therapy of Gastric Cancer Diagnos... more Submucosal Cancer of the Gastrointestinal Tract - State Adapted Therapy of Gastric Cancer Diagnostics and therapy of early gastric cancer have been crucially determined by intensive research and screening activities of Japanese specialists. Thus specific distinguished therapies have been developed. Meanwhile endoscopic mucosa resection is the treatment of choice for early gastric cancer in Japan, whereas surgical therapy is considered to be standard in Europe and the USA. This paper is determined to outline the treatment of early gastric cancer with a special view to a high-volume German center.
Neoadjuvant/perioperative chemotherapy (CT) for locally advanced gastric cancer has become a rout... more Neoadjuvant/perioperative chemotherapy (CT) for locally advanced gastric cancer has become a routine clinical procedure on the base of recent randomized controlled trials. This chapter describes the European prospective randomized controlled trials and focuses on their surgical results. Outcome-related measures are described from a surgical point of view. Numerous aspects are discussed, and the influence of surgical outcomes on oncologic results is critically reviewed.
TPS4149 Background: The main reason for treatment failure after curative surgical resection of ga... more TPS4149 Background: The main reason for treatment failure after curative surgical resection of gastric cancer is intra-abdominal spread, with 40- 50% peritoneal seeding as primary localization of recurrence. Peritoneal relapse is seen in 60-70% of tumors of diffuse type, compared to only 20-30% of intestinal type. Hyperthermic IntraPEritoneal Chemoperfusion (HIPEC) is an increasingly used therapy method for patients with peritoneal metastases. The preventive use of HIPEC could represent an elegant approach for patients (pts) before macroscopic peritoneal seeding, since patients with operable disease are fit and may have potential risk of microscopic involvement, thus having a theoretical chance of cure with HIPEC even without the need for cytoreduction. No results from a PCRT from the Western hemisphere have yet been published. Methods: This is a multicenter, randomized, controlled, open-label study including a total of 200 pts with localized and locally advanced diffuse and mixed t...
TPS353Background: Radical surgical resection represents the only potentially curative treatment o... more TPS353Background: Radical surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) and Gallbladder Carcinoma (GBC). Nevertheless, 5-year OS is onl...
In den letzten Jahren zeigte sich eine rasche Entwicklung der minimal-invasiven chirurgischen Met... more In den letzten Jahren zeigte sich eine rasche Entwicklung der minimal-invasiven chirurgischen Methoden im Zusammenhang mit der Therapie des Magenkarzinoms. Insbesondere im asiatischen Raum, wo Magenkarzinome mit einer bis zu 10-fach höheren Inzidenz vorkommen als in Europa, unterliegt die Magenchirurgie einem stetigen Progress, vor allem im Hinblick auf laparoskopische und robotisch assistierte Verfahren. In diesem Review werden zunächst die verschiedenen Möglichkeiten der Rekonstruktion der Magen-Darm-Passage nach Magenresektion, beginnend von den Rekonstruktionsverfahren nach Billroth hin zu neueren Entwicklungen wie der Double-tract-Rekonstruktion, erläutert. Besonders werden hier die Möglichkeiten subtotaler Magenteilresektionen wie der proximalen und distalen Magenresektion und die entsprechenden Rekonstruktionsformen dargestellt. Es werden die neuesten Studien und technischen Entwicklungen in Bezug auf laparoskopisch assistierte, vollständig laparoskopische und robotisch assistierte Gastrektomien vorgestellt.
Introduction: Postoperative pancreatic fistula (POPF) is the most dreaded complication after dist... more Introduction: Postoperative pancreatic fistula (POPF) is the most dreaded complication after distal pancreatectomy (DP). This multicenter randomized trial evaluated the efficacy, safety, and tolerance of Hemopatch in preventing clinically relevant (grades B/C according to the ISGPS classification) POPF after DP. Material and methods: After stump closure, patients were randomized to affix Hemopatch to the stump or not. Statistical significance was set at 0.025. Clinical significance was defined as the number of patients needed to treat (NNT) to avoid 1 B/C POPF. Results: Of 631 eligible patients, 360 were randomized and 315 analyzed per protocol (155 in the standard closure group; 160 in the Hemopatch group). The rates of B/C POPF (the primary endpoint) were 23.2% and 16.3% (P = 0.120), while the number of patients with 1 or more complications (including patients with B/C POPF) was 34.8% and 24.4% (P = 0.049) in the standard and Hemopatch groups, respectively. In patients with hand-sewn stump and main duct closure, the rates were 26.2% versus 10.0% (P = 0.014) and 23.3% versus 7.7% (P = 0.015) in the standard and Hemopatch groups, respectively. The NNT in these 2 subgroups was 6 and 6.4, respectively. Conclusion: The results of the first randomized trial evaluating Hemopatch-reinforced pancreatic stump after DP to prevent type B/C POPF do not allow us to conclude that the risk of B/C POPF was lower. Based on the NNT, however, routine use of Hemopatch after DP may result in fewer complications (including POPF) overall, especially in cases with hand-sewn closure of the pancreatic stump or main pancreatic duct. Mini-abstract: This multicenter randomized study evaluated the efficacy, safety, and tolerance of Hemopatch in preventing clinically relevant (types B and C) postoperative pancreatic fistula (B/C POPF) after distal pancreatectomy (DP). Clinical significance was defined as the number of patients needed to treat to avoid 1 POPF. Hemopatch reduced the rate of POPF after DP. Although the difference was statistically significant only in patients with hand-sewn stumps and when the main pancreatic duct was closed, the clinical signification was that routine use after DP would result in fewer complications and less associated costs in these 2 settings.
Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted wor... more Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy for gastric cancer. Methods: The protocol-based, international IMIGASTRIC (International study group on Minimally Invasive surgery for Gastric Cancer) registry was queried to retrieve data on patients undergoing laparoscopic or open gastrectomy with D2 lymphadenectomy for gastric cancer with curative intent from January 2000 to December 2014. Eleven predefined, demographical, clinical, and pathological variables were used to conduct a 1:1 propensity score matching (PSM) analysis to investigate intraoperative and recovery outcomes, complications, pathological findings, and survival data between the two groups. Pre...
Background Infectious complications are common after gastrointestinal surgery. Selective decontam... more Background Infectious complications are common after gastrointestinal surgery. Selective decontamination of the digestive tract (SDD) might reduce their incidence. SDD is used widely in colorectal resections, but its role in upper gastrointestinal resection is less clear. The aim of this study was to investigate the impact of SDD on postoperative outcome in upper gastrointestinal surgery. Methods Studies investigating SDD in upper gastrointestinal surgery were included after search of medical databases (PubMed, Ovid, Cochrane Library and Google Scholar). Results were analysed according to predefined criteria. The incidence of perioperative overall complications and death was pooled. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Results Some 1384 studies were identified, of which four RCTs were included in the final analysis. These studies included 415 patients, of whom 213 (51·3 per cent) received standard treatment/placebo and 202 (48·7 per cent) had SDD. ...
Zusammenfassung. Die Peritonitis ist ein heterogenes Krankheitsbild. Man unterscheidet eine primä... more Zusammenfassung. Die Peritonitis ist ein heterogenes Krankheitsbild. Man unterscheidet eine primäre Form, bei der keine sonstigen abdominellen Begleiterkrankungen vorliegen und die häufig konservativ therapiert werden kann, von der wesentlich häufigeren sekundären Form, welche auf eine eigenständige Diagnose wie die Perforation oder Nekrose eines Bauchorgans zurückzuführen ist und meist einer chirurgischen Therapie bedarf. Darüber hinaus ist die erst später definierte tertiäre Peritonitis abzugrenzen, die als eine trotz adäquater Therapie über 48 Stunden anhaltende oder rezidivierende Infektion ohne chirurgisch sanierbaren Fokus definiert ist. In diesem Artikel sollen drei bedeutsame Manifestationsformen hervorgehoben werden: die spontan bakterielle Peritonitis als Hauptvertreter der primären Peritonitis; die postoperative Peritonitis als Sonderform der sekundären Peritonitis; sowie die mit Bauchfelldialyse assoziierte Peritonitis als separates Krankheitsbild.
Einleitung: Die Inzidenz Karzinome des gastroösophagealen Übergangs steigt in den westlichen Länd... more Einleitung: Die Inzidenz Karzinome des gastroösophagealen Übergangs steigt in den westlichen Ländern rapide an und stellt die zweithäufigste krebsbedingte Todesursache weltweit dar. Die chirurgische Resektion ist hierbei die einzige kurative Option. Bei AEG II ist allerdings noch[zum vollständigen Text gelangen Sie über die oben angegebene URL]
Einleitung: In prospektiv randomisierten Studien konnte gezeigt werden, dass die präoperative Che... more Einleitung: In prospektiv randomisierten Studien konnte gezeigt werden, dass die präoperative Chemotherapie beim lokal fortgeschrittenen Magenkarzinom die Gesamtüberlebensrate verbessern kann. Das histopathologische Ansprechen wurde als unabhängiger Prognosefaktor bei diesen Patienten[for full text, please go to the a.m. URL]
Introduction: Acute rejection is still a common complication of liver transplantation (LTx). CD4 ... more Introduction: Acute rejection is still a common complication of liver transplantation (LTx). CD4 /CD8 T cells represent a subpopulation of T lymphocytes, and are a marker for allograft rejection. It is known that lymphocyte regress after allograft transplantation depends on sphingosine 1-phosphate[for full text, please go to the a.m. URL]
FAIRY: a randomized controlled patient-blind phase III study to compare the efficacy and safety o... more FAIRY: a randomized controlled patient-blind phase III study to compare the efficacy and safety of intravenous ferric carboxymaltose saline (placebo group). Patients will be blinded to the intervention. Patients will undergo evaluation for hemoglobin level, hematology and quality of life assessment 3 and 12 weeks after randomization.
Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases si... more Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases similar to the primary tumor in esophageal adenocarcinomas (EAC). We evaluated the prognostic significance of tumor regression in LN metastases of locally advanced EAC of 239 patients treated with neoadjuvant radiochemotherapy (RCTX) or chemotherapy (CTX) followed by esophagectomy. We examined retrospectively the LN for histopathologic signs of regression, i.e., nodular fibrosis and acellular mucin. LN classification was performed according to two parameters: presence (−) or absence (+) of residual tumor and regression characteristics in the LN, resulting in four categories: LN−/REG−, LN−/REG+, LN+/REG+, LN+/REG−. In total, LN metastases with residual tumor were detectable in 117/239 (49%) cases. Regression in LN were observed in 85/239 cases (35.5%). The distribution of the LN/REG categories were as follows: 97 patients (40.6%) were LN−/REG−. A total of 25 patients (10.5%) were LN−/REG+. ...
Simple Summary The incidence of adenocarcinomas of the GE-junction (AEG) increases evermore over ... more Simple Summary The incidence of adenocarcinomas of the GE-junction (AEG) increases evermore over the recent decades in the Western world. The postoperative tumor stage with or without multimodal treatment provides important information with regard to post-therapeutic survival. However, this tumor staging may be influenced by the histologic tumor subtype. These subtypes were described by Lauren before and provide substantial prognostic information in gastric cancer patients. The Lauren classification, however, was not yet evaluated in AEG before the purpose of the present retrospective analysis. It was confirmed in a cohort of 1153 AEG patients that Lauren subtypes convey substantial prognostic information after surgical resection. Furthermore, a simplified sub-classification into differentiated and undifferentiated histotypes was developed and evaluated. This newly proposed sub-classification system requires further confirmation by multicentric re-evaluation analyses. Abstract Adeno...
Simple Summary Chemotherapy ahead of surgery is standard of care for locally advanced stomach can... more Simple Summary Chemotherapy ahead of surgery is standard of care for locally advanced stomach cancer or cancer at the junction between esophagus and stomach in Europe. However, response to chemotherapy may depend on microscopic features of the tumor. Three types were defined before: intestinal, diffuse and mixed types. The authors aimed to investigate if these characteristics influence survival after end of treatment (chemotherapy+surgery) in a large cohort treated in a University hospital. It was found that intestinal type patients demonstrate longer survival after chemotherapy+surgery than those with diffuse types. In the mixed type group no clear conclusion regarding the effect of chemotherapy ahead of surgery may be taken. Conclusively, patients with diffuse type tumors do not benefit from chemotherapy ahead of surgery. Abstract Background: the purpose of this analysis was to analyze the outcomes of multimodal treatment that are related to Lauren histotypes in gastro-esophageal ...
Submucosal Cancer of the Gastrointestinal Tract - State Adapted Therapy of Gastric Cancer Diagnos... more Submucosal Cancer of the Gastrointestinal Tract - State Adapted Therapy of Gastric Cancer Diagnostics and therapy of early gastric cancer have been crucially determined by intensive research and screening activities of Japanese specialists. Thus specific distinguished therapies have been developed. Meanwhile endoscopic mucosa resection is the treatment of choice for early gastric cancer in Japan, whereas surgical therapy is considered to be standard in Europe and the USA. This paper is determined to outline the treatment of early gastric cancer with a special view to a high-volume German center.
Neoadjuvant/perioperative chemotherapy (CT) for locally advanced gastric cancer has become a rout... more Neoadjuvant/perioperative chemotherapy (CT) for locally advanced gastric cancer has become a routine clinical procedure on the base of recent randomized controlled trials. This chapter describes the European prospective randomized controlled trials and focuses on their surgical results. Outcome-related measures are described from a surgical point of view. Numerous aspects are discussed, and the influence of surgical outcomes on oncologic results is critically reviewed.
TPS4149 Background: The main reason for treatment failure after curative surgical resection of ga... more TPS4149 Background: The main reason for treatment failure after curative surgical resection of gastric cancer is intra-abdominal spread, with 40- 50% peritoneal seeding as primary localization of recurrence. Peritoneal relapse is seen in 60-70% of tumors of diffuse type, compared to only 20-30% of intestinal type. Hyperthermic IntraPEritoneal Chemoperfusion (HIPEC) is an increasingly used therapy method for patients with peritoneal metastases. The preventive use of HIPEC could represent an elegant approach for patients (pts) before macroscopic peritoneal seeding, since patients with operable disease are fit and may have potential risk of microscopic involvement, thus having a theoretical chance of cure with HIPEC even without the need for cytoreduction. No results from a PCRT from the Western hemisphere have yet been published. Methods: This is a multicenter, randomized, controlled, open-label study including a total of 200 pts with localized and locally advanced diffuse and mixed t...
TPS353Background: Radical surgical resection represents the only potentially curative treatment o... more TPS353Background: Radical surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) and Gallbladder Carcinoma (GBC). Nevertheless, 5-year OS is onl...
In den letzten Jahren zeigte sich eine rasche Entwicklung der minimal-invasiven chirurgischen Met... more In den letzten Jahren zeigte sich eine rasche Entwicklung der minimal-invasiven chirurgischen Methoden im Zusammenhang mit der Therapie des Magenkarzinoms. Insbesondere im asiatischen Raum, wo Magenkarzinome mit einer bis zu 10-fach höheren Inzidenz vorkommen als in Europa, unterliegt die Magenchirurgie einem stetigen Progress, vor allem im Hinblick auf laparoskopische und robotisch assistierte Verfahren. In diesem Review werden zunächst die verschiedenen Möglichkeiten der Rekonstruktion der Magen-Darm-Passage nach Magenresektion, beginnend von den Rekonstruktionsverfahren nach Billroth hin zu neueren Entwicklungen wie der Double-tract-Rekonstruktion, erläutert. Besonders werden hier die Möglichkeiten subtotaler Magenteilresektionen wie der proximalen und distalen Magenresektion und die entsprechenden Rekonstruktionsformen dargestellt. Es werden die neuesten Studien und technischen Entwicklungen in Bezug auf laparoskopisch assistierte, vollständig laparoskopische und robotisch assistierte Gastrektomien vorgestellt.
Introduction: Postoperative pancreatic fistula (POPF) is the most dreaded complication after dist... more Introduction: Postoperative pancreatic fistula (POPF) is the most dreaded complication after distal pancreatectomy (DP). This multicenter randomized trial evaluated the efficacy, safety, and tolerance of Hemopatch in preventing clinically relevant (grades B/C according to the ISGPS classification) POPF after DP. Material and methods: After stump closure, patients were randomized to affix Hemopatch to the stump or not. Statistical significance was set at 0.025. Clinical significance was defined as the number of patients needed to treat (NNT) to avoid 1 B/C POPF. Results: Of 631 eligible patients, 360 were randomized and 315 analyzed per protocol (155 in the standard closure group; 160 in the Hemopatch group). The rates of B/C POPF (the primary endpoint) were 23.2% and 16.3% (P = 0.120), while the number of patients with 1 or more complications (including patients with B/C POPF) was 34.8% and 24.4% (P = 0.049) in the standard and Hemopatch groups, respectively. In patients with hand-sewn stump and main duct closure, the rates were 26.2% versus 10.0% (P = 0.014) and 23.3% versus 7.7% (P = 0.015) in the standard and Hemopatch groups, respectively. The NNT in these 2 subgroups was 6 and 6.4, respectively. Conclusion: The results of the first randomized trial evaluating Hemopatch-reinforced pancreatic stump after DP to prevent type B/C POPF do not allow us to conclude that the risk of B/C POPF was lower. Based on the NNT, however, routine use of Hemopatch after DP may result in fewer complications (including POPF) overall, especially in cases with hand-sewn closure of the pancreatic stump or main pancreatic duct. Mini-abstract: This multicenter randomized study evaluated the efficacy, safety, and tolerance of Hemopatch in preventing clinically relevant (types B and C) postoperative pancreatic fistula (B/C POPF) after distal pancreatectomy (DP). Clinical significance was defined as the number of patients needed to treat to avoid 1 POPF. Hemopatch reduced the rate of POPF after DP. Although the difference was statistically significant only in patients with hand-sewn stumps and when the main pancreatic duct was closed, the clinical signification was that routine use after DP would result in fewer complications and less associated costs in these 2 settings.
Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted wor... more Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy for gastric cancer. Methods: The protocol-based, international IMIGASTRIC (International study group on Minimally Invasive surgery for Gastric Cancer) registry was queried to retrieve data on patients undergoing laparoscopic or open gastrectomy with D2 lymphadenectomy for gastric cancer with curative intent from January 2000 to December 2014. Eleven predefined, demographical, clinical, and pathological variables were used to conduct a 1:1 propensity score matching (PSM) analysis to investigate intraoperative and recovery outcomes, complications, pathological findings, and survival data between the two groups. Pre...
Background Infectious complications are common after gastrointestinal surgery. Selective decontam... more Background Infectious complications are common after gastrointestinal surgery. Selective decontamination of the digestive tract (SDD) might reduce their incidence. SDD is used widely in colorectal resections, but its role in upper gastrointestinal resection is less clear. The aim of this study was to investigate the impact of SDD on postoperative outcome in upper gastrointestinal surgery. Methods Studies investigating SDD in upper gastrointestinal surgery were included after search of medical databases (PubMed, Ovid, Cochrane Library and Google Scholar). Results were analysed according to predefined criteria. The incidence of perioperative overall complications and death was pooled. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Results Some 1384 studies were identified, of which four RCTs were included in the final analysis. These studies included 415 patients, of whom 213 (51·3 per cent) received standard treatment/placebo and 202 (48·7 per cent) had SDD. ...
Zusammenfassung. Die Peritonitis ist ein heterogenes Krankheitsbild. Man unterscheidet eine primä... more Zusammenfassung. Die Peritonitis ist ein heterogenes Krankheitsbild. Man unterscheidet eine primäre Form, bei der keine sonstigen abdominellen Begleiterkrankungen vorliegen und die häufig konservativ therapiert werden kann, von der wesentlich häufigeren sekundären Form, welche auf eine eigenständige Diagnose wie die Perforation oder Nekrose eines Bauchorgans zurückzuführen ist und meist einer chirurgischen Therapie bedarf. Darüber hinaus ist die erst später definierte tertiäre Peritonitis abzugrenzen, die als eine trotz adäquater Therapie über 48 Stunden anhaltende oder rezidivierende Infektion ohne chirurgisch sanierbaren Fokus definiert ist. In diesem Artikel sollen drei bedeutsame Manifestationsformen hervorgehoben werden: die spontan bakterielle Peritonitis als Hauptvertreter der primären Peritonitis; die postoperative Peritonitis als Sonderform der sekundären Peritonitis; sowie die mit Bauchfelldialyse assoziierte Peritonitis als separates Krankheitsbild.
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