Purpose The aim of this study was to clarify the surgical supply situation of oncological colorec... more Purpose The aim of this study was to clarify the surgical supply situation of oncological colorectal patients in Germany during limitations of the OR caseload due to the COVID-19 pandemic. Methods Between 11th and 19th April 2020, all members of a consortium of German colorectal cancer centers were invited to participate in a web-based survey on the current status of surgical care situation of colorectal cancer patients in Germany. Results A total of 112 colorectal surgeons of 101 German hospitals participated in the survey. Eighty-seven percent of the participating hospitals had to reduce their total surgical caseload and 34% their surgical volume for oncological colorectal patients during COVID-19 pandemic. Restrictions of the surgical caseload were independent of the size of the hospital and the number of cases of COVID-19 in the federal state of the hospital. Sixteen percent of colorectal surgeons consider surgical limitations to be not justified and 78% to be justified only if ...
ZusammenfassungFür die Nutzung vorhandener Versorgungsdaten gibt es immer mehr gute Gründe, wobei... more ZusammenfassungFür die Nutzung vorhandener Versorgungsdaten gibt es immer mehr gute Gründe, wobei v. a. die Nutzung von Registerdaten im Fokus steht. Das zugehörige, klar strukturierte methodische Vorgehen ist bisher noch unzureichend zusammengeführt, aufbereitet und transparent dargestellt. Das Deutsche Netzwerk Versorgungsforschung (DNVF) hat deswegen eine Ad hoc Kommission zur Nutzung versorgungsnaher Daten (RWE/RWD) ins Leben gerufen. Der vom IQWiG erstellte Rapid Report über die wissenschaftliche Ausarbeitung von Konzepten zur „Generierung versorgungsnaher Daten und deren Auswertung zum Zwecke der Nutzenbewertung von Arzneimitteln nach § 35a SGB V“ ist ein wesentlicher Schritt für die Nutzung von Registerdaten zur Evidenzgenerierung. Das vom DNVF 2020 veröffentlichte „Memorandum Register – Update 2019“ beschreibt Anforderungen und methodische Grundlagen von Registern. Best Practice Beispiele aus der Onkologie, die auf dem einheitlichen onkologischen Basisdatensatz für die Klini...
Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths... more Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. Methods This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. Results A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of v...
Background Complete mesocolic excision (CME) for right colonic cancer is a more complex operation... more Background Complete mesocolic excision (CME) for right colonic cancer is a more complex operation than standard right hemicolectomy but evidence to support its routine use is still limited. This prospective multicentre study evaluated the effect of CME on long-term survival in colorectal cancer centres in Germany (RESECTAT trial). The primary hypothesis was that 5-year disease-free survival would be higher after CME than non-CME surgery. A secondary hypothesis was that there would be improved survival of patients with a mesenteric area greater than 15 000 mm2. Methods Centres were asked to continue their current surgical practices. The surgery was classified as CME if the superior mesenteric vein was dissected; otherwise it was assumed that no CME had been performed. All specimens were shipped to one institution for pathological analysis and documentation. Clinical data were recorded in an established registry for quality assurance. The primary endpoint was 5-year overall survival f...
1 Deutsche Krebsgesellschaft e.V., Berlin 2 Klinik für Allgemein-, Viszeralund Kinderchirurgie, K... more 1 Deutsche Krebsgesellschaft e.V., Berlin 2 Klinik für Allgemein-, Viszeralund Kinderchirurgie, Klinikum Böblingen, Böblingen 3 Klinik für Hämatologie, Onkologie und Gastroenterologie, Kliniken Maria Hilf GmbH, Mönchengladbach Peer reviewed article eingereicht: 25.08.2014, akzeptiert: 26.09.2014 DOI 10.3238/zfa.2014.0464–0468 Zusammenfassung: Die Behandlung onkologischer Patienten setzt eine sektorenübergreifende, interdisziplinäre und interprofessionelle Zusammenarbeit der Fachdisziplinen voraus. Auf diese Weise wird im Sinne der Patienten ein Netzwerk gebildet, das alle Phasen und Bereiche einer Krebserkrankung umfasst. Im Rahmen der Zertifizierung der onkologischen Versorgungsstrukturen durch die Deutsche Krebsgesellschaft stellen die Partner des Netzwerkes ihre Behandlungsqualität auf der Basis evidenzbasierten Leitlinien und daraus abgeleiteter Kennzahlen und Qualitätsindikatoren dar. Die Ergebnisse werden im Vergleich zu den Ergebnissen der anderen Zentren analysiert und durch...
ZusammenfassungDie Evaluation von Interventionseffekten ist eine wichtige Domäne der Versorgungsf... more ZusammenfassungDie Evaluation von Interventionseffekten ist eine wichtige Domäne der Versorgungsforschung. Die vom Deutschen Netzwerk Versorgungsforschung (DNVF) ins Leben gerufene Ad hoc Kommission zur Nutzung versorgungsnaher Daten beschäftigt sich in diesem zweiten Teil des Manuals deshalb mit der Nutzung dieser Daten zur Evaluation von Interventionseffekten. Zunächst erfolgt dabei eine Aufarbeitung der Begriffsbestimmung und Diskussion zur Bedeutung von Kontextfaktoren. Anschließend werden sowohl allgemeine Anforderungen an Planung, Datenerhebung und Auswertung sowie konkrete Beispiele zur Evaluation von Interventionseffekten für die 3 Anwendungsfelder Arzneimitteltherapie, nicht-medikamentöse Maßnahmen sowie komplexe Interventionen herausgearbeitet. Dabei werden sowohl Szenarien betrachtet, bei denen bisher keine Informationen aus direkt vergleichenden randomisierten kontrollierten Studien (RCTs) vorliegen bzw. bereits RCTs vorhanden sind, jedoch eine Erweiterung der Fragestell...
Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed lapa... more Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. Methods The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable sur...
Cancer control : journal of the Moffitt Cancer Center
Improvements in health care depend on research involving health-care providers (HCPs) and health-... more Improvements in health care depend on research involving health-care providers (HCPs) and health-care organizations (HCOs). Existing research suggests that involvement in research studies is still much lower than it could be. This study investigates factors that may impede or facilitate research involvement. A standardized online questionnaire was used to carry out a survey, in 3 countries, of key informants in colorectal cancer centers that hold certification in accordance with the requirements of the German Cancer Society. A total of 184 individuals responded (response rate 65%). The respondents found it difficult to identify studies suitable for their patients (40% agreement), criticized the small overall number of studies available (48%), and found that many studies are not worthwhile financially (56%). Among respondents who were not involved in studies as the principal investigators (PIs), 66% agreed they lacked the research infrastructure needed and 81% that they did not have ...
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
Exocrine pancreatic secretion is regulated by gastrointestinal hormone and the autonomic nervous ... more Exocrine pancreatic secretion is regulated by gastrointestinal hormone and the autonomic nervous system. The interaction of both systems is still unclear. In humans CCK mediated regulation of exocrine pancreatic secretion requires a cholinergic tonus. The CCK receptor is thought to be localized on the acinuscell and modulated by cholinergic neurons. Pancreas transplantation and percutaneous diversion of the pancreatic juice offers the opportunity to investigate pancreatic secretion under the condition of complete extrinsic denervation. In the present study the influence of denervation on exogene CCK stimulation and simultaneous cholinergic stimulation or suppression with atropine, respectively, was investigated. CCK stimulation alone showed a reduced, dose dependent increase in enzyme secretion. Simultaneous stimulation with bethachenol resulted in a 2-fold increased secretion. Atropine suppressed the low dose CCK effect completely. Whereas CCK at high doses caused a 1.5 fold increase despite atropine. After extrinsic denervation the human pancreas remains sensitive to exogene stimulation. The intrinsic system remains also intact and is sensitive to cholinergic stimulation. The extrinsic nervous system seems to be necessary for an adequate CCK response. The results are in line with the hypothesis that CCK receptors are only partly localized on the acinuscell, whereas the majority is localized in extrinsic cholinergic neurons.
Hintergrund: Bei postischamischen Zustanden des Pankreas wird eine Calciumuberladung der Azinusze... more Hintergrund: Bei postischamischen Zustanden des Pankreas wird eine Calciumuberladung der Azinuszellen als mitauslosende Ursache des Ischamie/Reperfusionsschadens diskutiert. Ergebnisse auf Organebene liegen nicht vor.
Background CME is a radical resection for colon cancer, but the procedure is technically demandin... more Background CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways. Methods Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus. Results Twenty-three recommendations for CME procedure were agreed on, describing the technique a...
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, 2014
ABSTRACT Background: Complete mesocolic excision (CME) and central vascular ligation (CVL) for ri... more ABSTRACT Background: Complete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer may be superior to standard hemicolectomy in terms of oncological results. This hypothesis is currently being investigated in a large multicentre trial conducted by the authors of this paper (Resektatstudie). Because CVL in right-sided hemicolectomy is technically rather demanding the incidence of central node involvement is of special interest. Therefore, during the single centre pilot phase of our multicentre trial we have analysed the incidence of central lymph node metastasis in CME specimens. Patients: In 51 patients with right-sided colon adenocarcinoma (cT1-3, cM0) an open CME with CVL was performed. In the fresh specimen the central four centimetres of the ileocolic vessels that would have been presumably left in place during a standard hemicolectomy were marked with a suture. The lymph nodes in this segment were separately analysed. Results: In the CME specimen the mean lymph node count was 52.6 (range: 27-171). 35.0 % (range: 13.1-65.6 %) of the nodes were located in the central 4 cm segment. The proportion of patients with positive nodes was 25.5 % (13/51). Of all nodes 1.97 % (53/2686) were metastatic. In 3/51 (5.8 %) patients the central nodes were involved. In one patient the central nodes were the only metastatic site. UICC stage was influenced in two of the three patients who had central involvement (stage migration: UICC IIB to IIIB, UICC IIIB to IIIC). Conclusion: CME with CVL in right-sided colon adenocarcinoma increases the probability of complete removal of the local lymph node drainage and thus local metastatic lymph nodes. Considering this result an improvement of long-term survival by the CME procedure seems conceivable but needs to be confirmed by the current multicentre trial.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2016
Following the adoption of the Cancer Screening and Registry Act (KFRG) to advance the development... more Following the adoption of the Cancer Screening and Registry Act (KFRG) to advance the development of the early detection of cancer and to promote quality assurance through Clinical Cancer Registries according to Sect. 65c SGB V, the question is raised as to what extent population-based clinical cancer registries may contribute not only to direct patient treatment benefits, but also to the requirements of health research and to other issues such as, for example, the evaluation of the benefit of new pharmaceutical products. Efforts to improve a nationwide quality management for oncology have so far not been successful in the development of comprehensive documentation at all levels of care. New organizational structures such as population-based clinical cancer registries were supposed to solve this problem more sufficiently, but they must be accompanied by valid trans-sectorial documentation and evaluation of clinical data. The need for specific real-life outcomes (effectiveness) of specific therapies has led to calls for data from outside randomised clinical trials (efficacy). First results are demonstrated in the present article.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 15, 2015
Current evidence suggests that complete mesocolic excision (CME) for right sided colon cancer cou... more Current evidence suggests that complete mesocolic excision (CME) for right sided colon cancer could be beneficial in terms of long term survival (1]. CME is, however, a considerably more complex operation than standard right hemicolectomy and this is especially true for the laparoscopic approach. Consequently, we have developed an approach that provides surgical radicality at the mesenteric root on the one hand with maximum safety on the other [2]. The key feature of this "uncinate process first approach" is the commencement of the dissection at the duodeno-jenunal flexure with small bowel being shifted into the upper right quadrant. This article is protected by copyright. All rights reserved.
Purpose The aim of this study was to clarify the surgical supply situation of oncological colorec... more Purpose The aim of this study was to clarify the surgical supply situation of oncological colorectal patients in Germany during limitations of the OR caseload due to the COVID-19 pandemic. Methods Between 11th and 19th April 2020, all members of a consortium of German colorectal cancer centers were invited to participate in a web-based survey on the current status of surgical care situation of colorectal cancer patients in Germany. Results A total of 112 colorectal surgeons of 101 German hospitals participated in the survey. Eighty-seven percent of the participating hospitals had to reduce their total surgical caseload and 34% their surgical volume for oncological colorectal patients during COVID-19 pandemic. Restrictions of the surgical caseload were independent of the size of the hospital and the number of cases of COVID-19 in the federal state of the hospital. Sixteen percent of colorectal surgeons consider surgical limitations to be not justified and 78% to be justified only if ...
ZusammenfassungFür die Nutzung vorhandener Versorgungsdaten gibt es immer mehr gute Gründe, wobei... more ZusammenfassungFür die Nutzung vorhandener Versorgungsdaten gibt es immer mehr gute Gründe, wobei v. a. die Nutzung von Registerdaten im Fokus steht. Das zugehörige, klar strukturierte methodische Vorgehen ist bisher noch unzureichend zusammengeführt, aufbereitet und transparent dargestellt. Das Deutsche Netzwerk Versorgungsforschung (DNVF) hat deswegen eine Ad hoc Kommission zur Nutzung versorgungsnaher Daten (RWE/RWD) ins Leben gerufen. Der vom IQWiG erstellte Rapid Report über die wissenschaftliche Ausarbeitung von Konzepten zur „Generierung versorgungsnaher Daten und deren Auswertung zum Zwecke der Nutzenbewertung von Arzneimitteln nach § 35a SGB V“ ist ein wesentlicher Schritt für die Nutzung von Registerdaten zur Evidenzgenerierung. Das vom DNVF 2020 veröffentlichte „Memorandum Register – Update 2019“ beschreibt Anforderungen und methodische Grundlagen von Registern. Best Practice Beispiele aus der Onkologie, die auf dem einheitlichen onkologischen Basisdatensatz für die Klini...
Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths... more Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. Methods This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. Results A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of v...
Background Complete mesocolic excision (CME) for right colonic cancer is a more complex operation... more Background Complete mesocolic excision (CME) for right colonic cancer is a more complex operation than standard right hemicolectomy but evidence to support its routine use is still limited. This prospective multicentre study evaluated the effect of CME on long-term survival in colorectal cancer centres in Germany (RESECTAT trial). The primary hypothesis was that 5-year disease-free survival would be higher after CME than non-CME surgery. A secondary hypothesis was that there would be improved survival of patients with a mesenteric area greater than 15 000 mm2. Methods Centres were asked to continue their current surgical practices. The surgery was classified as CME if the superior mesenteric vein was dissected; otherwise it was assumed that no CME had been performed. All specimens were shipped to one institution for pathological analysis and documentation. Clinical data were recorded in an established registry for quality assurance. The primary endpoint was 5-year overall survival f...
1 Deutsche Krebsgesellschaft e.V., Berlin 2 Klinik für Allgemein-, Viszeralund Kinderchirurgie, K... more 1 Deutsche Krebsgesellschaft e.V., Berlin 2 Klinik für Allgemein-, Viszeralund Kinderchirurgie, Klinikum Böblingen, Böblingen 3 Klinik für Hämatologie, Onkologie und Gastroenterologie, Kliniken Maria Hilf GmbH, Mönchengladbach Peer reviewed article eingereicht: 25.08.2014, akzeptiert: 26.09.2014 DOI 10.3238/zfa.2014.0464–0468 Zusammenfassung: Die Behandlung onkologischer Patienten setzt eine sektorenübergreifende, interdisziplinäre und interprofessionelle Zusammenarbeit der Fachdisziplinen voraus. Auf diese Weise wird im Sinne der Patienten ein Netzwerk gebildet, das alle Phasen und Bereiche einer Krebserkrankung umfasst. Im Rahmen der Zertifizierung der onkologischen Versorgungsstrukturen durch die Deutsche Krebsgesellschaft stellen die Partner des Netzwerkes ihre Behandlungsqualität auf der Basis evidenzbasierten Leitlinien und daraus abgeleiteter Kennzahlen und Qualitätsindikatoren dar. Die Ergebnisse werden im Vergleich zu den Ergebnissen der anderen Zentren analysiert und durch...
ZusammenfassungDie Evaluation von Interventionseffekten ist eine wichtige Domäne der Versorgungsf... more ZusammenfassungDie Evaluation von Interventionseffekten ist eine wichtige Domäne der Versorgungsforschung. Die vom Deutschen Netzwerk Versorgungsforschung (DNVF) ins Leben gerufene Ad hoc Kommission zur Nutzung versorgungsnaher Daten beschäftigt sich in diesem zweiten Teil des Manuals deshalb mit der Nutzung dieser Daten zur Evaluation von Interventionseffekten. Zunächst erfolgt dabei eine Aufarbeitung der Begriffsbestimmung und Diskussion zur Bedeutung von Kontextfaktoren. Anschließend werden sowohl allgemeine Anforderungen an Planung, Datenerhebung und Auswertung sowie konkrete Beispiele zur Evaluation von Interventionseffekten für die 3 Anwendungsfelder Arzneimitteltherapie, nicht-medikamentöse Maßnahmen sowie komplexe Interventionen herausgearbeitet. Dabei werden sowohl Szenarien betrachtet, bei denen bisher keine Informationen aus direkt vergleichenden randomisierten kontrollierten Studien (RCTs) vorliegen bzw. bereits RCTs vorhanden sind, jedoch eine Erweiterung der Fragestell...
Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed lapa... more Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. Methods The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable sur...
Cancer control : journal of the Moffitt Cancer Center
Improvements in health care depend on research involving health-care providers (HCPs) and health-... more Improvements in health care depend on research involving health-care providers (HCPs) and health-care organizations (HCOs). Existing research suggests that involvement in research studies is still much lower than it could be. This study investigates factors that may impede or facilitate research involvement. A standardized online questionnaire was used to carry out a survey, in 3 countries, of key informants in colorectal cancer centers that hold certification in accordance with the requirements of the German Cancer Society. A total of 184 individuals responded (response rate 65%). The respondents found it difficult to identify studies suitable for their patients (40% agreement), criticized the small overall number of studies available (48%), and found that many studies are not worthwhile financially (56%). Among respondents who were not involved in studies as the principal investigators (PIs), 66% agreed they lacked the research infrastructure needed and 81% that they did not have ...
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
Exocrine pancreatic secretion is regulated by gastrointestinal hormone and the autonomic nervous ... more Exocrine pancreatic secretion is regulated by gastrointestinal hormone and the autonomic nervous system. The interaction of both systems is still unclear. In humans CCK mediated regulation of exocrine pancreatic secretion requires a cholinergic tonus. The CCK receptor is thought to be localized on the acinuscell and modulated by cholinergic neurons. Pancreas transplantation and percutaneous diversion of the pancreatic juice offers the opportunity to investigate pancreatic secretion under the condition of complete extrinsic denervation. In the present study the influence of denervation on exogene CCK stimulation and simultaneous cholinergic stimulation or suppression with atropine, respectively, was investigated. CCK stimulation alone showed a reduced, dose dependent increase in enzyme secretion. Simultaneous stimulation with bethachenol resulted in a 2-fold increased secretion. Atropine suppressed the low dose CCK effect completely. Whereas CCK at high doses caused a 1.5 fold increase despite atropine. After extrinsic denervation the human pancreas remains sensitive to exogene stimulation. The intrinsic system remains also intact and is sensitive to cholinergic stimulation. The extrinsic nervous system seems to be necessary for an adequate CCK response. The results are in line with the hypothesis that CCK receptors are only partly localized on the acinuscell, whereas the majority is localized in extrinsic cholinergic neurons.
Hintergrund: Bei postischamischen Zustanden des Pankreas wird eine Calciumuberladung der Azinusze... more Hintergrund: Bei postischamischen Zustanden des Pankreas wird eine Calciumuberladung der Azinuszellen als mitauslosende Ursache des Ischamie/Reperfusionsschadens diskutiert. Ergebnisse auf Organebene liegen nicht vor.
Background CME is a radical resection for colon cancer, but the procedure is technically demandin... more Background CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways. Methods Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus. Results Twenty-three recommendations for CME procedure were agreed on, describing the technique a...
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, 2014
ABSTRACT Background: Complete mesocolic excision (CME) and central vascular ligation (CVL) for ri... more ABSTRACT Background: Complete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer may be superior to standard hemicolectomy in terms of oncological results. This hypothesis is currently being investigated in a large multicentre trial conducted by the authors of this paper (Resektatstudie). Because CVL in right-sided hemicolectomy is technically rather demanding the incidence of central node involvement is of special interest. Therefore, during the single centre pilot phase of our multicentre trial we have analysed the incidence of central lymph node metastasis in CME specimens. Patients: In 51 patients with right-sided colon adenocarcinoma (cT1-3, cM0) an open CME with CVL was performed. In the fresh specimen the central four centimetres of the ileocolic vessels that would have been presumably left in place during a standard hemicolectomy were marked with a suture. The lymph nodes in this segment were separately analysed. Results: In the CME specimen the mean lymph node count was 52.6 (range: 27-171). 35.0 % (range: 13.1-65.6 %) of the nodes were located in the central 4 cm segment. The proportion of patients with positive nodes was 25.5 % (13/51). Of all nodes 1.97 % (53/2686) were metastatic. In 3/51 (5.8 %) patients the central nodes were involved. In one patient the central nodes were the only metastatic site. UICC stage was influenced in two of the three patients who had central involvement (stage migration: UICC IIB to IIIB, UICC IIIB to IIIC). Conclusion: CME with CVL in right-sided colon adenocarcinoma increases the probability of complete removal of the local lymph node drainage and thus local metastatic lymph nodes. Considering this result an improvement of long-term survival by the CME procedure seems conceivable but needs to be confirmed by the current multicentre trial.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2016
Following the adoption of the Cancer Screening and Registry Act (KFRG) to advance the development... more Following the adoption of the Cancer Screening and Registry Act (KFRG) to advance the development of the early detection of cancer and to promote quality assurance through Clinical Cancer Registries according to Sect. 65c SGB V, the question is raised as to what extent population-based clinical cancer registries may contribute not only to direct patient treatment benefits, but also to the requirements of health research and to other issues such as, for example, the evaluation of the benefit of new pharmaceutical products. Efforts to improve a nationwide quality management for oncology have so far not been successful in the development of comprehensive documentation at all levels of care. New organizational structures such as population-based clinical cancer registries were supposed to solve this problem more sufficiently, but they must be accompanied by valid trans-sectorial documentation and evaluation of clinical data. The need for specific real-life outcomes (effectiveness) of specific therapies has led to calls for data from outside randomised clinical trials (efficacy). First results are demonstrated in the present article.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 15, 2015
Current evidence suggests that complete mesocolic excision (CME) for right sided colon cancer cou... more Current evidence suggests that complete mesocolic excision (CME) for right sided colon cancer could be beneficial in terms of long term survival (1]. CME is, however, a considerably more complex operation than standard right hemicolectomy and this is especially true for the laparoscopic approach. Consequently, we have developed an approach that provides surgical radicality at the mesenteric root on the one hand with maximum safety on the other [2]. The key feature of this "uncinate process first approach" is the commencement of the dissection at the duodeno-jenunal flexure with small bowel being shifted into the upper right quadrant. This article is protected by copyright. All rights reserved.
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