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Hans Lippert

Publications and source records attributed to Hans Lippert.

At least 37 records · Page 2Linked to original sources
PubMed2004

Radioresistance-related proteins in rectal cancer.

Radiation therapy (RT), combined with chemotherapy, is currently the standard adjuvant approach for UICC-stage II and III rectal cancer patients. Individual rectal tumors display wide ranges of radiosensitivity (RS). The aim of the present study was to identify proteins associated with radioresistance (RR), with the final aim of predicting tumor response. Seventeen patients were recruited between July 1998 and November 2001. All patients suffered from a locally advanced adenocarcinoma of the rectum. Tumor biopsies were taken before RT. All patients received preoperatively 50 Gray or a biologically equivalent total dose. Surgery was performed after 6 weeks, and response assessed histopathologically. Seven tumors showed complete response, seven a partial response, and in three patients only microscopic disease remained. Proteins were separated using narrow pH gradient two-dimensional polyacrylamide gel electrophoresis and silver staining. Automatic gel comparison allowed matching a mean number of 497 +/- 280 spots. Forty-four spots showing significant differential expression in RR tumors were localized on the pH 4.5-5.5 gels, 33 out of them being identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Twenty-two out of 37 spots of interest could be identified on the pH 5.5-6.7 gels. The expression of the following proteins correlates with RR: tropomodulin (p = 0.01), heat shock protein 42 (p = 0.03), beta-tubulin (p = 0.10), annexin V (p = 0.10), calsenilin (p = 0.10), or with radiosensitivity (RS): keratin type I (p = 0.03), notch 2 protein homolog (p = 0.05) and DNA repair protein RAD51L3 (p = 0.11). A further RR-related protein is so far only hypothetical: XP_030188 (NCBI Database accession number, p = 0.14). We consider the fact that several of these proteins of interest are known to be associated with RR as a valid proof of principle for this proteomics approach. These results will serve as a basis for developing an assay for testing rectal cancers for radioresistance.

Adenocarcinoma↗
PubMed2004

Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients.

BACKGROUND: The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis. METHODS: The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures). RESULTS: Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates. CONCLUSION: An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.

Anastomosis, Surgical↗
PubMed2004

Expression and functional proteomics studies in colorectal cancer.

Cell dysfunction results from multiple rather than from single gene interactions in the majority of colorectal cancers (CRC). Proteins, not mRNA, are the functional molecules in the cell, and the relationship between gene expression measured at the mRNA level and the corresponding protein level is not linear. Current proteomics tools allow for the determination of post-translational modifications, and hence the presence of protein isoforms--some of them being disease-relevant. Thus, proteomics approaches are a welcome complement to traditional genetic approaches. In CRC, expression proteomics studies were carried out with colorectal cell lines, whole tissue biopsies, and purified epithelial cells. For CRC, two-dimensional electrophoresis reference maps, protein, and membrane protein databases are available on the internet. Functional proteomics studies have been performed to better understand signaling pathways, to characterize the molecular targets of novel drugs, and to identify tumor-associated antigens in CRC. The increasing use of proteomics technologies, when addressing clinical problems, will accelerate the evolution towards personalized medicine in CRC.

Adenocarcinoma↗
PubMed2004

Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery.

BACKGROUND: Recurrent laryngeal nerve monitoring (RLNM) has been suspected to reduce postoperative RLN paralysis (RLNP). However, functional outcome of RLNM in comparison with no nerve identification and visual nerve identification only has not been analyzed. METHODS: Analysis of 16,448 consecutive multi-institutional operations resulted in 29,998 nerves at risk. Three groups of different RLN treatment were compared: group 1, no RLN identification; group 2, visual RLN identification; and group 3, visual RLN identification and electromyographic monitoring. RLNM was performed with a bipolar needle electrode that was placed through the cricothyroid ligament into the vocal muscle. RESULTS: Risk factors for permanent RLNP were recurrent benign and malignant goiter (odds ratios, [ORs]), 4.7, and 6.7, respectively), primary surgery in thyroid malignancy (OR, 2.0), lobectomy (OR, 1.8), no nerve identification (OR, 1.4), low or medium volume hospital (OR, 1.3), and low volume surgeons (OR, 1.2). CONCLUSIONS: Based on these data, visual nerve identification was identified to be the gold standard of RLN treatment in thyroid surgery. RLNM is a promising tool for nerve identification and protection in extended thyroid resection procedures. However, because of the overall low frequency of RLNP, no statistical difference compared with visual nerve identification only was reached in the setting of this study.

Adolescent↗
PubMed2004

Perioperative granulocyte colony-stimulating factor does not prevent severe infections in patients undergoing esophagectomy for esophageal cancer: a randomized placebo-controlled clinical trial.

OBJECTIVE: Esophagectomy for esophageal cancer is associated with substantial postoperative morbidity as a result of infectious complications. In a prior phase II study, granulocyte colony-stimulating factor (G-CSF) was shown to improve leukocyte function and to reduce infection rates after esophagectomy. The aim of the current randomized, placebo-controlled, multicenter phase III trial was to investigate the clinical efficacy of perioperative G-CSF administration in reducing infection and mortality after esophagectomy for esophageal cancer. PATIENTS AND METHODS: One hundred fifty five patients with resectable esophageal cancer were randomly assigned to perioperative G-CSF at standard doses (77 patients) or placebo (76 patients), administered from 2 days before until day 7 after esophagectomy. The G-CSF and placebo groups were comparable as regards age, gender, risk, cancer stage, frequency of neoadjuvant radiochemotherapy, and type of esophagectomy (transthoracic or transhiatal esophageal resection). RESULTS: Of 155 randomized patients, 153 were eligible for the intention-to-treat analysis. The rate of infection occurring within the first 10 days after esophagectomy was 43.4% (confidence interval 32.8-55.9%) in the placebo and 44.2% (confidence interval 32.1-55.3%) in the G-CSF group (P = 0.927). 30-day mortality amounted to 5.2% in the G-CSF group versus 5.3% in the placebo group (P = 0.985). Similar results were found in the per-protocol analysis. CONCLUSION: Perioperative administration of G-CSF failed to reduce postoperative morbidity, infection rate, or mortality in patients with esophageal cancer who underwent esophagectomy.

Adult↗
PubMed2004

Using human samples in proteomics-based drug development: bioethical aspects.

Human samples and related medical data are expected to play an elevated role in application-based biomedical proteomics research. Against this framework, some facts should be kept in mind by academic and industrial researchers: international framework conditions on the use of human samples for research purposes are heterogeneous. For example, the value added by the use of human samples for product development is significant and the patient's personal and property rights may be affected. The body of national laws is growing and these laws are binding; guidelines published by international organizations should be respected. The most important aspect regards the informed consent of the patient, which is addressed in detail.

Animals↗
PubMed2003

Marginal effects of regional intra-arterial chemotherapy as an alternative treatment option in advanced pancreatic carcinoma.

BACKGROUND: Locoregional intra-arterial (i.a.) chemotherapy may provide high levels of cytostatic concentrations within the tumour and, simultaneously, a low rate of systemic side effects compared with systemic administration of anti-neoplastic drugs. In addition, this may lead to an increase of tumour response rate and prolongation of survival time. The aim of the study was (1) to evaluate the benefit of an i.a. infusion of cytostatic drugs via the coeliac trunk on tumour response rate and survival time, (2) to elucidate problems and risks, and finally (3) to achieve an improvement of overall therapeutic management in pancreatic carcinoma. PATIENTS AND METHODS: In 22 patients (12 female; 10 male; mean age 57.1 years) with locally advanced pancreatic carcinoma, which was confirmed by histopathology, i.a. chemotherapy was administered. Through a catheter, which was inserted via the femoral artery by the Seldinger technique and placed with the tip in the coeliac trunk, two different drug combinations were given. Group A ( n=12) were given a bolus injection of a mixture (chemo-occlusion) consisting of amilomer (Spherex) and epirubicin (Farmorubicin) followed by short-time infusion of folic acid and 24-h infusion of 5-FU. Group B ( n=10) were given treatment over 5 days: mitoxantrone (Novantrone, day [d] 1), 5-FU and folic acid (Haemato-folin, d 2-4), and cisplatin (d 5). Treatment was repeated in both groups every 4 weeks. Tumour response was assessed by computed tomography every 8 weeks. RESULTS: In group A, there was one complete and one partial remission, resulting in a remission rate of 16.6%. Two patients showed stable disease, while in two-thirds of the patients ( n=8), progressive disease was found. Median survival time was 3 months; 1-year survival rate was 33.3% (4 of 12 patients). In group B, again, one complete and one partial remission were observed (remission rate 20%). In three cases, stable disease, and in 50% of patients ( n=5), progressive disease, were documented. Median survival was 7.0 months; 1-year survival rate was 20% (2 of 10 patients). If both groups were compared, there was no difference in survival. In addition, no prolongation of survival time was found in comparison with patients of a historical study group treated with established systemic chemotherapy using gemcitabine monotherapy ( n=28; median survival time 9 months). Though a tendency for poorer outcome of i.a. chemotherapy was seen when the Kaplan-Meier curves of survival were compared, this difference was not statistically significant (log rank test, P=0.08). CONCLUSION: Despite conceptual and pharmacokinetic advantages of locoregional i.a. chemotherapy, better outcome with regard to tumour response rate and survival time could not be found. I.a. chemotherapy is, therefore, still an experimental treatment option in pancreatic carcinoma and can, currently, not be recommended for routine use.

Adult↗
PubMed2003

Low-molecular-weight heparin (reviparin) diminishes tumor cell adhesion and invasion in vitro, and decreases intraperitoneal growth of colonadeno-carcinoma cells in rats after laparoscopy.

BACKGROUND: Metastases, adhesion and invasion of tumor cells involve a cascade of complex phenomena, which potentially can be affected by glycosaminoglycans. We studied the influence of a low-molecular-weight heparin, reviparin, on the intraabdominal tumor growth in rats undergoing laparoscopy. We also studied cytotoxicity, anti-adhesive, and anti-invasive effects of reviparin in vitro using adenocarcinoma cells CC531. METHODS: In vitro assays: Adhesion of 1 x 10(5) CC531 adenocarcinoma cells onto microtiter plates coated with 10 microg/ml collagen type I or 10 microg/ml Matrigel was studied in the presence of 0.55; 1.10 and 2.76 mg/ml reviparin, and compared to saline. The cytotoxicity of 1 x 10(4) adenocarcinoma cells was studied in a similar assay. Transwell dual chambers with polycarbonate filters coated with 100 microg/cm2 Matrigel were used to investigate the effect of 0.55; 1.10 and 2.76 mg/ml reviparin on the invasion of 1 x 10(5) adenocarcinoma cells/ml. In vivo experiments: CC531 adenocarcinoma cells (5 x 10(6) cells/ml) were intraperitoneally applied to Wistar Albino Glaxo rats (n=150, Harlan, Germany) with a median weight of 278 g. The rats were divided into 15 groups with 10 animals in each group, underwent laparoscopy, and 1 ml saline containing 0, 0.5, 2.0, 4.0, and 10 mg reviparin per kg b.w. was introduced for intraperitoneal lavage or s.c. After 21 days the animals underwent an autopsy, and the tumor weight was determined. RESULTS: In vitro experiments: We found a highly significant inhibition of tumor cell adhesion and invasion (p<0.001) by all reviparin concentrations used in the assays. There was no effect of reviparin on the viability of cells in the cytoxicity assay. In vivo experiments: We found that application of 4.0 and 10.0 mg/kg b.w., but not 0.5 or 2.0 mg/kg b.w. significantly (p<0.01) decreased the tumor mass compared to controls, receiving only saline. This effect was most pronounced after the combined i.p. and s.c. application, whereas after a sole i.p. application, only the highest dose of 10 mg/kg b.w. caused a significant inhibition of tumor growth. CONCLUSION: Low-molecular-weight heparin, reviparin, given in combination of i.p. lavage and s.c. injections, significantly diminishes intraabdominal tumor growth of CC531 adenocarcinoma cells in rats undergoing laparoscopy. This may offer additional therapeutic options for patients undergoing laparoscopic cancer surgery.

Abdominal Neoplasms↗
PubMed2003

Combined endoscopic and open inguinal dissection for malignant melanoma.

BACKGROUND: Positive sentinel node biopsy or clinically/radiologically demonstrable lymph node metastases in patients with malignant melanoma establishes the indication for inguinal dissection. Currently the deep (pelvic) part of the dissection is the subject of lively discussion. For the past 3 years we have been carrying out all pelvic lymph node dissections using an endoscopic extraperitoneal approach in combination with conventional superficial inguinal dissection. METHODS: In analogy to endoscopic extraperitoneal hernia repair we open the extraperitoneal space with the aid of a dissection balloon and then perform a complete dissection of the para-iliac and obturator lymph nodes. The superficial part of inguinal dissection is then carried out in the conventional manner. RESULTS: Among a total of 31 consecutive dissections performed on 30 malignant melanoma patients between April 1999 and June 2002 neither intraoperative nor postoperative complications of the endoscopic part of the dissection were observed. CONCLUSIONS: While enabling better local tumor control as a result of the complete dissection, this modification entailing the use of endoscopic pelvic dissection also appreciably reduces the extent of operative trauma without compromising oncological radicalness or increasing morbidity. We recommend this approach to all surgeons with experience with endoscopic extraperitoneal procedures for use in patients requiring inguinal dissection.

Adult↗
PubMed2003

Ethical and regulatory issues arising from proteomic research and technology.

Over the last two decades, medical research has begun to make extensive use of products of human origin in therapeutics, oncology, and most recently, in genetic diseases. This has raised many ethical issues involving patient rights, including issues of consent. Besides informed consent, researchers should address several topics when designing studies using human tissues. Reward for the patient should be kept minimal. Sample transfer should be organized along non-profit lines, at least in Europe. Sampling procedures should be at no risk for human volunteers, and at minimal risk for patients. Biosafety aspects should be addressed, in particular when international collaborations are intended or when collaboration is existing between academia and industry. Regulations on importation and exportation of human tissues should be observed. Data acquisition and storage should be addressed in accordance with national data protection regulations, in particular when using computerized databases. If follow-up information is to be taken, the authorization for such information should be requested. The right for patient's information (or for no information) on the research results should also be addressed. The issues of validation and patenting should be also solved, usually by informing the patient that he/she will have no commercial rights on potential research results. The patient should be told if the samples are transferred to another research laboratory or private company. Samples and related data should be destroyed on request at any time point during the course of the study. If possible, traceability of the donor should be ensured.

Ethics, Research↗
PubMed2003

Intermuscular chondrolipoma of the thigh: the diagnostic way of a rare entity.

Cartilaginous metaplasia in lipomas (chondrolipoma) is rare and mainly encountered in large-sized, long-standing lipomas. Chondrolipomas can be found at almost any site of the body, particularly in the connecting tissue of the skeletal system, breast, pharynx, and nasopharynx. We report on an intermuscular tumor of the thigh in a patient who suffered from lipomatosis in his past medical history. We describe how the diagnosis of chondrolipoma was reached and discuss the differential diagnoses.

Adult↗
PubMed2003

Informed consent for molecular-based diagnostic and prognostic studies in the cancer patient.

The consent of the subject who is donating cells, tissues, organs or body fluid for research purposes is a precondition for biomedical research on human samples. Before such consent can be obtained, comprehensive information should be provided to the subject by the investigators. This information includes the scope of research, the intended use of subject's body parts and associated data, the risks and benefits associated with the research project, and the right to withdraw their consent at any time without prejudice. Consent is free and must not be obtained under any kind of pressure. The traditional practice of obtaining consent for unspecified future use of biological samples and data generated from clinical trials is no longer adequate for genetic research. However, the investigator has still interest to keep the definition of the field of research as broad as possible. Privacy is an issue of importance for the patient, who is the primary supplier of human samples, and for his relatives. Benefit sharing is another field of contradictory discussion. Normal volunteers are a special case among gene expression studies. An example of informed consent form is provided.

Confidentiality↗
PubMed2003

Differences in loss of p16INK4 protein expression by promoter methylation between left- and right-sided primary colorectal carcinomas.

The p16INK4 gene, encoding a cyclin-dependent kinase inhibitor, is frequently methylated in colorectal cancer, and a side-specific methylation frequency was suggested. To clarify the frequency of real loss of tumor suppressor function dependent on anatomical localization, we investigated 43 primary colorectal carcinomas by determining aberrant promoter methylation using methylation-specific PCR. In addition, we evaluated the p16INK4 protein expression immunohistochemically. P16INK4 methylation was found in 18 of 43 (41.9%) cases. Fourteen of 43 cases (32.6%) were negative for p16INK4 protein, whereas 10 of these 14 cases showed methylation of the promoter region of the p16INK4 gene. Methylation of the promoter region was significantly correlated with loss of p16INK4 protein (p<0.01). P16INK4 tumor suppressor inactivation was significantly correlated with proximal location (p=0.031 for methylation and p=0.028 for immunostaining). The groups characterized by tumors with and without aberrant promoter methylation or loss of p16INK4 immunostaining showed no significant difference in either Dukes' stage and grade or age and gender. This is further evidence that p16INK4 methylation causes gene silencing. Loss of p16INK4 tumor suppressor function in colorectal tumors was associated with proximal location in the gut.

Aged↗
PubMed2002

Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation.

BACKGROUND: The problems associated with rectal surgery are frequently discussed with no reference being made to the distance of the tumor from the anal verge. This study examined the effect of the location of the tumor on early postoperative results. PATIENTS AND METHODS: This was a multicenter study involving 75 German hospitals and 3756 patients, of whom 1463 had rectal carcinoma. On the basis of the location of the tumor (distance from the anal verge), four groups were distinguished: <4, 4-7.9, 8-11.9, and 12-16 cm. RESULTS: Resection and abdominoperineal resection rates and the incidence of postoperative complications depended on the location of the tumor. Significantly higher resection rates and fewer specific complications, and a significant reduction in overall postoperative morbidity were found with tumor locations more than 8 cm from the anal verge. The highest anastomotic leak rate was observed with anastomoses less than 7 cm from the anal verge. The logistic regression showed that the distance of the tumor from the anal verge is an independent variable for the development of an anastomotic leak. CONCLUSIONS: Early results are greatly affected by the location of the rectal carcinoma. This applies to both abdominoperineal resection rates and specific postoperative complications, such as anastomotic leak rate and operation morbidity in general.

Adult↗
PubMed2002

Intraoperative and early postoperative chemotherapy into the abdominal cavity using gemcitabine may prevent postoperative occurence of peritoneal carcinomatosis.

BACKGROUND AND OBJECTIVES: Malignant tumors of various abdominal organs are blamed to be the cause of death in approximately 40% of cases per year in Western Europe. At the time of death, about half of them show peritoneal carcinomatosis which is considered an unfavorable prognostic factor. In case of peritoneal carcinomatosis, there is no curative treatment available for any of the tumors in the abdominal cavity. The aim of this experimental study was to evaluate the preventive potential of intra-operative or early postoperative local administration of gemcitabine into the abdominal cavity against peritoneal carcinomatosis. METHODS: Peritoneal carcinomatosis was induced in male WAG rats (n = 18) by transfer of 5 x 10(6) cells of the adenocarcinoma cell line CC-531 via minilaparotomy carried out in all rats under general anesthesia. Thirty days after cell transfer, rats were sacrificed and peritoneal carcinomatosis was confirmed using histologic investigation in specimens obtained from the peritoneal site. Extension of this carcinomatosis was quantified by (i) counting tumor nodes per square centimeter (mean of several counts) and (ii) determining tumor weight (weight of the greater omentum plus the resected mesentery). Rats were subdivided into three groups (n = 6 per group): group 1 (controls); group 2, simultaneously with tumor cell transfer 24 mg/kg of gemcitabine were administered into the abdominal cavity; group 3, postoperative intraperitoneal irrigation with 24 mg/kg of gemcitabine was achieved via a previously implanted port-a-cath on days(d) 15, 21, and 27. RESULTS: On the 30th postoperative day, all six animals of the control group showed extensive tumor growth at the peritoneum and greater omentum, indicating carcinomatosis. In contrast, none of the rats of group 2 revealed any traces of intraperitoneal tumor growth. While all rats of group 3 demonstrated intraperitoneal tumor growth, but early postoperative treatment with gemcitabine, however, resulted in a significant reduction of the number of tumor nodes and tumor weight in comparison with group 1 (controls). CONCLUSIONS: Immediate, i.e., simultaneous intraoperative application of a cytostatic agent such as gemcitabine into the abdominal cavity may completely prevent the generation of peritoneal carcinomatosis from occuring tumor cells, whereas early postoperative locoregional chemotherapy into the abdominal cavity can only reduce the severity of the peritoneal carcinomatosis.

Adenocarcinoma↗
PubMed2002

Impact of age on the short-term postoperative outcome of patients undergoing surgery for colorectal carcinoma.

BACKGROUND: Patient age has a decisive impact on the short-term postoperative results in surgery for carcinoma. PATIENTS AND METHODS: This prospective multicenter study involved 75 German hospitals and 3756 patients undergoing treatment in 1999: 1447 aged under 65 years, 1847 aged 65-79 years, and 458 aged over 80 years. RESULTS: In the oldest patient group, there was a significantly higher proportion of extensive, localized tumors (UICC stage II: 25.9%, 28.4%, and 36.1%, respectively) and significant differences were found among the three groups in operation rates (98.8%, 98.6%, and 96.5%), resection rate (94.2%, 93.2%, and 83.9%), general postoperative complications (21.5%, 28.6%, and 41.2%), morbidity (36.5%, 42.6%, and 50.0%) and mortality (2.7%, 6.6%, and 11.8%). CONCLUSION: In the elderly, locally advanced tumors, but not metastasizing tumors, are to be expected. The increase in postoperative morbidity and mortality rates with increasing age was due to the increase in general postoperative complications. Surgery for colorectal carcinoma in patients of advanced age is not associated with any increase in intraoperative or specific postoperative complications.

Adenocarcinoma↗
PubMed2002

Value of a protective stoma in low anterior resections for rectal cancer.

INTRODUCTION: Anastomotic leakage is a major problem in colorectal surgery and in particular in operations for low rectal cancer. The present study investigates the question whether a protective stoma can reduce the (clinical and radiologic) anastomotic leakage rate and/or the rate of leakage requiring surgery. METHODS: The investigation took the form of a prospective multicenter study involving 75 German hospitals and was performed between January 1, 1999, and December 31, 1999. A comparison was made of the postoperative results of procedures performed with and those performed without a protective stoma in patients undergoing low anterior rectal resection. In addition, logistic regression using the target criteria, overall anastomotic leakage and anastomotic leakage requiring surgery, was applied. RESULTS: Among the 3,695 operations performed for carcinoma of the rectum or colon, 482 were low anterior resections. In 334 patients (69.3 percent) no protective stoma was constructed, whereas 148 (30.7 percent) received such protection. Age, American Society of Anesthesiologists physical status, and body mass index were identical in both groups. In the group receiving a protective stoma, however, neoadjuvant radiochemotherapy was more common, the tumors were lower-and thus the total mesorectal excision rate higher, the intraoperative complication rate was higher, and the duration of the operation was longer. The differences were all significant. The major criterion (overall anastomotic leakage rate) was identical in the two groups, but the rate of leakage requiring surgery was significantly lower in patients receiving a protective stoma (p = 0.028). The logistic regression revealed that use of a protective stoma is a predictor of protection against anastomotic leakage requiring surgery. The distance of the tumor from the anal verge and the duration of the operation are further predictors. CONCLUSION: The particular benefit of a covering stoma is reduction in the rate of leaks requiring surgery and thus in the severe consequences of an anastomotic leakage.

Adult↗