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Biomedical subjects

P Hermanek

Publications and source records attributed to P Hermanek.

At least 19 recordsLinked to original sources
PubMed1992

Morphological predictors of survival in early and advanced gastric carcinoma.

In 351 patients with gastric carcinomas resected for cure, the relationship between macroscopic and microscopic features and survival was studied by univariate and multivariate analyses. In the multivariate survival analysis with covariates according to the Cox regression model, in early cancer all significant correlations to survival rate are covered by the stage grouping according to the UICC schedule of 1987. In advanced gastric carcinoma the UICC stage and, in addition, the Borrmann type and the intensity of cellular infiltration are effective. By additional consideration of these two variables an extended pathological staging schedule is proposed. It has the advantage of better discrimination between patients who differ in prognosis and seems to improve the prognostic prediction of outcome. Testing of this extended staging system in larger collectives is recommended.

Analysis of Variance↗
PubMed1992

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗
PubMed1992

[The dysplasia-carcinoma sequence in the colorectum].

The concept of dysplasia-carcinoma sequence has been established for the gastrointestinal tract. Dysplasia is defined as unequivocal neoplastic proliferation of epithelium without invasion and represents the precancerous lesions of the colon and rectum. The most common appearance of dysplasia is polypoid adenoma, however, flat adenomas are increasingly diagnosed. During the last 20 years, new pathological and biological methods including molecular genetics showed the stepwise evolution of colorectal carcinoma from normal mucosa to dysplasia of increasing grade and to invasive carcinoma. Of course, dysplasia-carcinoma sequence does not imply the development of carcinoma in every focus of dysplasia. In fact, the incidence of carcinomas from adenomas is 5-10%. A new molecular or genetic epidemiology promises an improved selection of high risk individuals.

Animals↗
PubMed1992

[1992 tumor classification/developments].

Surgical oncology must consider some new international and national publications: 1. New fascicles of the 2nd edition of the WHO International Histological Classification of Tumors. 2. The 1992 revision of the 4th edition of the UICC TNM Classification and of the UICC TNM Atlas. 3. The TNM Supplement 1992/93 (UICC), which includes, among other things, explanatory notes for uniform use, proposals for further development, and a compilation of prognostic factors other than TNM and R to be considered in clinical studies. 4. The fully revised and enlarged tumor documentation system of the Working Group of German Cancer Centers (Arbeitsgemeinschaft Deutscher Tumorzentren).

Documentation↗
PubMed1992

[Abdominal multivisceral resection of colonic cancer].

Multivisceral resection in combination with extended lymph node dissection is used in the surgical treatment of locally advanced colon carcinoma without distant metastases. This also applies to tumours with marked peritumorous inflammation in contact with neighbouring organs where an intraoperative diagnostic attempt could result in tumour seeding. The low mortality and complication rate following multivisceral resection justifies this concept. The 5-year survival rate following multivisceral resection in advanced colon carcinoma is over 80%.

Abdominal Neoplasms↗
PubMed1992

[Pelvic multivisceral resection from the viewpoint of surgery].

Even rectal carcinomas, carcinomas of the female genital tract, and retroperitoneal sarcomas of the pelvis with invasion of adjacent organs are potentially curable by extending the operation to the relevant structures. In the Surgical Department of the University of Erlangen, 1535 patients with a first diagnosis of rectal carcinoma were treated from 1978 to 1988. Among these patients, 97 multivisceral pelvic resections (patients with distant metastases excluded) were performed. True tumor invasion had occurred in 48%, the others were operated on for inflammatory adhesion. In 54 patients, the anal sphincter was preserved. Postoperative mortality was 7%. The 5-year survival of those patients with tumor invasion of adjacent organs and R0-resection (n = 26) was 32%. Excluding the five patients with a tear or incision of the tumor (n = 5), the 5-year survival of the remaining patients was 44%. One patient who was operated on for a leiomyosarcoma of the rectum with a multivisceral resection of the rectum, prostate, and urine bladder is still alive 9 years after the operation without recurrence. The history of this patient argues for pelvic exenteration also in males, if a R0 resection can be performed.

Female↗
PubMed1992

[Multivisceral resection of colorectal cancer--experiences of the Colorectal Cancer Study Group].

Between 1984 and 1986, 2341 patients with colorectal carcinoma from 7 German institutions entered the colorectal carcinoma study group (SGCRC). In 197 of 2053 patients with radical resections, the operation was extended by multivisceral resection. The two groups of patients were comparable in age, preoperative risk factors, postoperative morbidity, and mortality. Long-term results showed no statistically significant difference in survival according to the 5-year survival rates, calculated by the actuarial method when curative resections in UICC stage II and III were compared. After curative resection (R0), the presence or absence of intraoperative tumor-cell dissemination could be identified as a significant prognostic factor. The analysis of T4 tumors without distant metastases or serosal penetration showed a significant correlation between the percentage of patients treated by R0 resection and long-term survival in the different participating institutions.

Abdominal Neoplasms↗
PubMed1991

[International documentation system for colorectal cancer-- reporting pathological findings].

An international Working Party has achieved agreement on an "International Documentation System for Colorectal Cancer (IDS for CRC)". It includes the essential clinical and pathological data required for estimation of prognosis and evaluation of treatment results. These data are subdivided into 3 types of information: (i) basic patient information; (ii) variables of proven prognostic significance (anatomical extent of disease, i.e. pTNM, and residual tumor classification, some other independent variables); and (iii) information of probable prognostic significance. Recommendations for data collection, pathological techniques and reporting pathology are added.

Colonic Neoplasms↗
PubMed1991

[Oncologic surgery/pathologic-anatomic viewpoint].

Important progress achieved during the last years in four fields is reported: (1) Preoperative histological diagnosis: use of immunohistology, improvements by the 2nd edition of the WHO International Histological Classification of Tumors; (2) pathology of lymphatic spread: detailed classification according to topography and number of involved nodes, increased knowledge of factors influencing lymphatic spread and standardization of examination methods with statements on the number of examined and involved nodes; (3) publication and worldwide acceptance of the uniform 4th edition of the TNM Classification; and (4) introduction of the residual tumor (R) classification.

Breast Neoplasms↗
PubMed1991

Staging of exocrine pancreatic carcinoma.

After many years of attempting to stage exocrine pancreatic carcinoma, the fourth edition of the UICC TNM Classification of Tumours is now the international uniform system; it has been accepted by all national TNM committees. The TNM/pTNM-defined stage grouping is complemented by the R classification, which describes the presence or absence of residual tumour following treatment. With this, it is possible to make a good assessment of the prognosis following resection of ductal adenocarcinoma. Multivariate studies must definitively clarify whether additional parameters are of significance for prognosis. A further subdivision of Category pN1 into pN1a (metastasis in single node) and pN1b (two or more nodes) is recommended.

Carcinoma↗
PubMed1991

Surgical treatment of ductal pancreatic carcinoma.

Among 587 patients with ductal pancreatic carcinoma who were examined between 1969 and 1987, 260 (44.3%) had distant metastases at the time of diagnosis. Tumour resections, mostly subtotal duodenopancreatectomies, were performed in 138 patients (23.5% of all patients, or 39.8% of all patients without distant metastases); in 91 patients the resection was for cure (R0). Operative mortality following tumour resection was 6% for all patients. The age-corrected 5-year survival rate was 2.9% for all patients and 16% where the resection was curative; of these 46% were in Stages I and II and 6% in Stage III. In non-curative resections, the median survival time was 7.2 months, which was significantly longer than the 3.4 months following bypass operation. Cure for pancreatic carcinoma can be achieved only through surgery, and a negative attitude towards surgery must be resisted.

Carcinoma↗