e15604 Background: Immune checkpoint inhibitors (ICI) do not seem to be effective in solid cancer... more e15604 Background: Immune checkpoint inhibitors (ICI) do not seem to be effective in solid cancers, which lack an immunogenic priming. Radiotherapy (RT) can induce an immunogenic cell death (ICD) and thereby restore the susceptibility to ICI, especially in microsatellite stable (MSS) cancers. This study evaluates safety, tolerability and feasibility of neoadjuvant chemoradiotherapy (CRT) with concomitant ipilimumab (IPI) and nivolumab (NIVO) in locally advanced rectal cancer (LARC). Here we present the first requisite interim analysis. Methods: This is a prospective, randomized, open-label, multicenter, phase II investigator- initiated trial (IIT). Key eligibility criteria are patients with LARC and the medical need for a neoadjuvant CRT, without metastatic disease that is considered incurable by local therapies. In total 80 patients will be randomized (ratio 30:50) to receive either neoadjuvant CRT alone (50 Gy in 2 Gy fractions over 25 working days + concurrent capecitabine 1650 m...
Fortschritte in der Chirurgie im letzten Jahrzehnt, 1992
Erweiterungsresektionen bei Klatskin Tumoren sind wegen der Tumorausbreitung im Leberparenchym, i... more Erweiterungsresektionen bei Klatskin Tumoren sind wegen der Tumorausbreitung im Leberparenchym, in den vascularen und biliaren Strukturen erforderlich. Von 66 Patienten mit Klatskintumoren wurden 27 radikal operiert (Resektabilitatsrate 41%), nur 2 von 27 Patienten sind gestroben (Letalitat: 7,4%) bei einer Morbiditatsrate von 38%, 8 Patienten (39%) wurden einer zentralen Hilusresektion unterzogen, 19 Patienten (70%) einer Erweiterungsresektion mit Lobus caudatus. R0-Resektionen (N = 20) haben eine mediane Uberlebensrate von 4,8 Jahren. R1-Resektionen nur 8 Monate. Aus onkologischen Grunden sollten daher vorzugsweise Erweiterungsresektionen (Rechts-oder Linkstrisegmentektomien) zur Anwendung kommen, wobei dem transparenchymatosen Zugangsweg der absolute Vorzug gegeben werden sollte, weil nur dieser eine hohe Sicherheit der R0-Resektion gewahrleistet.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 23, 2014
Nerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical cons... more Nerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical constraints such as obesity, the narrowness of the male pelvis or an ultra low rectal cancer or all of these. The transanal approach for total mesorectal excision has overcome the shortcomings of limited access to the rectal "no-man's land" close to the pelvic floor. The aim of this anatomical study was to define a roadmap of anatomical landmarks for the caudal to cephalic approach so as to standardize nerve sparing rectal mobilization procedures. Macroscopic dissections of the pelvis in a caudal to cephalic direction were performed in eight alcohol-glycerol embalmed cadavers. A roadmap of anatomical landmarks was created at different levels of section to demonstrate the sites of nerve injury. Extrinsic autonomic nerves to the urogenital organs and the internal sphincter muscle are closely adjacent to the lowest portion of the rectum above the pelvic diaphragm. This anatomical ...
value of endoanal sonography in the assessment of faecar incontinence. Purpose: The aim of this s... more value of endoanal sonography in the assessment of faecar incontinence. Purpose: The aim of this study was to assess the value of endoanal ultrasound (EUS) in comparison to anal manometry and operative findings in patients suffering from faecal incontinence. Patient history, localisation of sphincter defects and therapeutic modalities were analysed. Methods: Over a 3-years period, 92 patients with faecal incontinence were investigated by endoanal ultrasound. Results were compared with anal manometry in 81 cases. Results: At EUS, 27 patients (29%) showed no sphincter defect, 18 (20%) had an isolated internal sphincter defect, 13 (14%) an isolated defect of the external sphincter and 34 (37%) presented with a combined internal/external sphincter defect. Manometry correlated in 30% with endoanal ultrasound. Compared with surgery, endoanal ultrasound was correct in 100% and manometry in only 54%. An obstetric trauma was most frequently related to faecal incontinence. Conclusion: Endoanal ultrasound is a very sensitive method for localizing anal sphincter defects and is mandatory in the assessment of patients with faecal incontinence.
TPS3623 Background: Immune checkpoint inhibitors (ICI), such as ipilimumab (anti-cytotoxic T-lymp... more TPS3623 Background: Immune checkpoint inhibitors (ICI), such as ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) or nivolumab (anti-programmed cell death protein 1) have been proven to be an effective strategy in solid cancers. However, ICI seem not to be effective in microsatellite stable (MSS) cancers. As they might lack an immunogenic priming, radiotherapy (RT) is capable to induce an immunogenic cell death (ICD) and subsequently an immunogenic tumor immune microenvironment (TIME). Thus, RT might restore the susceptibility of MSS tumors to ICI and consequently leading to an effective anti-tumor immune response. Methods: This is a prospective, randomized, open-label, multicenter, phase II investigator-initiated clinical trial (IIT), including patients with locally advanced rectal cancer (LARC). Patients receive either neoadjuvant chemoradiotherapy (CRT) alone (50 Gy in 2 Gy fractions over 25 working days + capecitabine 1650 mg/m2/d PO) or in combination with ipilimuma...
Background: Anastomotic leakage represents one of the most feared complications following colorec... more Background: Anastomotic leakage represents one of the most feared complications following colorectal resection with a relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the anastomotic leak rate. We present our institutional experience[for full text, please go to the a.m. URL]
Ann Thorac Surg 1999;68:1177-1181 Raimund Jakesz and Reinhold Fugger Johannes Zacherl, Martin Imh... more Ann Thorac Surg 1999;68:1177-1181 Raimund Jakesz and Reinhold Fugger Johannes Zacherl, Martin Imhof, Erik R. Huber, Eugen G. Plas, Friedrich Herbst,hyperhidrosis Video assistance reduces complication rate of thoracoscopic sympathicotomy forhttp://ats.ctsnetjournals.org/cgi/content/full/68/4/1177 on the World Wide Web at: The online version of this article, along with updated information and services, is located
Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complicati... more Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark). Materials and Methods: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between Oc...
Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestina... more Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at
OBJECTIVE To review the value of obturator canal bypass with respect to long-term results. DESIGN... more OBJECTIVE To review the value of obturator canal bypass with respect to long-term results. DESIGN Case series and literature review. SETTING University of Vienna Medical School in Austria. PATIENTS/METHODS Personal experience with 34 consecutive patients and 125 cases published since 1982 with respect to patient data, patency, and survival are compared and jointly analyzed retrospectively. INTERVENTIONS Patients received obturator canal bypass for lesions of the pelvic or common femoral vessels precluding orthotopic reconstruction. MAIN OUTCOME MEASURES The rates of patient survival, limb salvage, and graft patency were analyzed. RESULTS The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 obturator canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. CONCLUSIONS The use of obturator canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease.
Abdominal surgical wound infections cause significant morbidity and expenses and double the lengt... more Abdominal surgical wound infections cause significant morbidity and expenses and double the length of postoperative hospital stays. The role of antimicrobial therapy in the outcome of infection of the abdominal cavity is difficult to assess. This is primarily because of the often dramatic response to surgical drainage when there is localized infection. Nevertheless, appropriate antimicrobial therapy has been shown to reduce the mortality significantly [11,72]. Antimicrobial drugs are expected to control bacteremia and to reduce suppurative complications if given early. Once suppuration has occurred it may be difficult to cure infection if antimicrobial drugs are used without drainage. Cultures of peritoneal fluid or abscess pus often yield the responsible organisms. However, antimicrobial therapy should be started immediately, and this means that it has to be initiated before the completion of in vitro antimicrobial sensitivity testing of any specific
e15604 Background: Immune checkpoint inhibitors (ICI) do not seem to be effective in solid cancer... more e15604 Background: Immune checkpoint inhibitors (ICI) do not seem to be effective in solid cancers, which lack an immunogenic priming. Radiotherapy (RT) can induce an immunogenic cell death (ICD) and thereby restore the susceptibility to ICI, especially in microsatellite stable (MSS) cancers. This study evaluates safety, tolerability and feasibility of neoadjuvant chemoradiotherapy (CRT) with concomitant ipilimumab (IPI) and nivolumab (NIVO) in locally advanced rectal cancer (LARC). Here we present the first requisite interim analysis. Methods: This is a prospective, randomized, open-label, multicenter, phase II investigator- initiated trial (IIT). Key eligibility criteria are patients with LARC and the medical need for a neoadjuvant CRT, without metastatic disease that is considered incurable by local therapies. In total 80 patients will be randomized (ratio 30:50) to receive either neoadjuvant CRT alone (50 Gy in 2 Gy fractions over 25 working days + concurrent capecitabine 1650 m...
Fortschritte in der Chirurgie im letzten Jahrzehnt, 1992
Erweiterungsresektionen bei Klatskin Tumoren sind wegen der Tumorausbreitung im Leberparenchym, i... more Erweiterungsresektionen bei Klatskin Tumoren sind wegen der Tumorausbreitung im Leberparenchym, in den vascularen und biliaren Strukturen erforderlich. Von 66 Patienten mit Klatskintumoren wurden 27 radikal operiert (Resektabilitatsrate 41%), nur 2 von 27 Patienten sind gestroben (Letalitat: 7,4%) bei einer Morbiditatsrate von 38%, 8 Patienten (39%) wurden einer zentralen Hilusresektion unterzogen, 19 Patienten (70%) einer Erweiterungsresektion mit Lobus caudatus. R0-Resektionen (N = 20) haben eine mediane Uberlebensrate von 4,8 Jahren. R1-Resektionen nur 8 Monate. Aus onkologischen Grunden sollten daher vorzugsweise Erweiterungsresektionen (Rechts-oder Linkstrisegmentektomien) zur Anwendung kommen, wobei dem transparenchymatosen Zugangsweg der absolute Vorzug gegeben werden sollte, weil nur dieser eine hohe Sicherheit der R0-Resektion gewahrleistet.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 23, 2014
Nerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical cons... more Nerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical constraints such as obesity, the narrowness of the male pelvis or an ultra low rectal cancer or all of these. The transanal approach for total mesorectal excision has overcome the shortcomings of limited access to the rectal "no-man's land" close to the pelvic floor. The aim of this anatomical study was to define a roadmap of anatomical landmarks for the caudal to cephalic approach so as to standardize nerve sparing rectal mobilization procedures. Macroscopic dissections of the pelvis in a caudal to cephalic direction were performed in eight alcohol-glycerol embalmed cadavers. A roadmap of anatomical landmarks was created at different levels of section to demonstrate the sites of nerve injury. Extrinsic autonomic nerves to the urogenital organs and the internal sphincter muscle are closely adjacent to the lowest portion of the rectum above the pelvic diaphragm. This anatomical ...
value of endoanal sonography in the assessment of faecar incontinence. Purpose: The aim of this s... more value of endoanal sonography in the assessment of faecar incontinence. Purpose: The aim of this study was to assess the value of endoanal ultrasound (EUS) in comparison to anal manometry and operative findings in patients suffering from faecal incontinence. Patient history, localisation of sphincter defects and therapeutic modalities were analysed. Methods: Over a 3-years period, 92 patients with faecal incontinence were investigated by endoanal ultrasound. Results were compared with anal manometry in 81 cases. Results: At EUS, 27 patients (29%) showed no sphincter defect, 18 (20%) had an isolated internal sphincter defect, 13 (14%) an isolated defect of the external sphincter and 34 (37%) presented with a combined internal/external sphincter defect. Manometry correlated in 30% with endoanal ultrasound. Compared with surgery, endoanal ultrasound was correct in 100% and manometry in only 54%. An obstetric trauma was most frequently related to faecal incontinence. Conclusion: Endoanal ultrasound is a very sensitive method for localizing anal sphincter defects and is mandatory in the assessment of patients with faecal incontinence.
TPS3623 Background: Immune checkpoint inhibitors (ICI), such as ipilimumab (anti-cytotoxic T-lymp... more TPS3623 Background: Immune checkpoint inhibitors (ICI), such as ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) or nivolumab (anti-programmed cell death protein 1) have been proven to be an effective strategy in solid cancers. However, ICI seem not to be effective in microsatellite stable (MSS) cancers. As they might lack an immunogenic priming, radiotherapy (RT) is capable to induce an immunogenic cell death (ICD) and subsequently an immunogenic tumor immune microenvironment (TIME). Thus, RT might restore the susceptibility of MSS tumors to ICI and consequently leading to an effective anti-tumor immune response. Methods: This is a prospective, randomized, open-label, multicenter, phase II investigator-initiated clinical trial (IIT), including patients with locally advanced rectal cancer (LARC). Patients receive either neoadjuvant chemoradiotherapy (CRT) alone (50 Gy in 2 Gy fractions over 25 working days + capecitabine 1650 mg/m2/d PO) or in combination with ipilimuma...
Background: Anastomotic leakage represents one of the most feared complications following colorec... more Background: Anastomotic leakage represents one of the most feared complications following colorectal resection with a relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the anastomotic leak rate. We present our institutional experience[for full text, please go to the a.m. URL]
Ann Thorac Surg 1999;68:1177-1181 Raimund Jakesz and Reinhold Fugger Johannes Zacherl, Martin Imh... more Ann Thorac Surg 1999;68:1177-1181 Raimund Jakesz and Reinhold Fugger Johannes Zacherl, Martin Imhof, Erik R. Huber, Eugen G. Plas, Friedrich Herbst,hyperhidrosis Video assistance reduces complication rate of thoracoscopic sympathicotomy forhttp://ats.ctsnetjournals.org/cgi/content/full/68/4/1177 on the World Wide Web at: The online version of this article, along with updated information and services, is located
Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complicati... more Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark). Materials and Methods: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between Oc...
Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestina... more Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at
OBJECTIVE To review the value of obturator canal bypass with respect to long-term results. DESIGN... more OBJECTIVE To review the value of obturator canal bypass with respect to long-term results. DESIGN Case series and literature review. SETTING University of Vienna Medical School in Austria. PATIENTS/METHODS Personal experience with 34 consecutive patients and 125 cases published since 1982 with respect to patient data, patency, and survival are compared and jointly analyzed retrospectively. INTERVENTIONS Patients received obturator canal bypass for lesions of the pelvic or common femoral vessels precluding orthotopic reconstruction. MAIN OUTCOME MEASURES The rates of patient survival, limb salvage, and graft patency were analyzed. RESULTS The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 obturator canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. CONCLUSIONS The use of obturator canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease.
Abdominal surgical wound infections cause significant morbidity and expenses and double the lengt... more Abdominal surgical wound infections cause significant morbidity and expenses and double the length of postoperative hospital stays. The role of antimicrobial therapy in the outcome of infection of the abdominal cavity is difficult to assess. This is primarily because of the often dramatic response to surgical drainage when there is localized infection. Nevertheless, appropriate antimicrobial therapy has been shown to reduce the mortality significantly [11,72]. Antimicrobial drugs are expected to control bacteremia and to reduce suppurative complications if given early. Once suppuration has occurred it may be difficult to cure infection if antimicrobial drugs are used without drainage. Cultures of peritoneal fluid or abscess pus often yield the responsible organisms. However, antimicrobial therapy should be started immediately, and this means that it has to be initiated before the completion of in vitro antimicrobial sensitivity testing of any specific
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Papers by Friedrich Herbst