[TNM--current status. 2. General rules of the TNM system. German Speaking TNM Committee].
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Germany↗
Biomedical subjects
P Hermanek
Publications and source records attributed to P Hermanek.
[Quality management in diagnosis and therapy of colorectal carcinoma].
The objectives of medical quality management are optimal diagnosis and patient care. Establishment of quality indicators and respective documentation are prerequisites for quality analysis which is followed by actions to improve quality and renewed evaluation. Internal quality management is increasingly supplemented by external quality management.
Colorectal Neoplasms↗
[Current TNM staging: 1. Clinical significance and current status. The German Speaking TNM Committee].
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Humans↗
[Lymphadenectomy from the viewpoint of pathology].
The histopathological examination of lymphadenectomy specimens is an important task in oncological diagnosis. For staging purposes a minimal program of lymph node examination has been defined. It provides a reliable pN classification. The numbers of nodes examined and involved have to be stated in the pathology report. An extended examination program is required to analyse the topography of lymphatic spread and to substantiate the extent of lymphadenectomy for quality assurance.
Humans↗
[Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group].
In a prospective multicenter study an analysis of postoperative morbidity and mortality of 1224 patients with colon carcinoma treated in 7 departments of surgery was performed. The postoperative morbidity rate was 23.2% in elective surgery and 39.1% in emergency surgery. Postoperative mortality was 3.4% in elective cases and 11.6% in emergency cases. Preoperative associated diseases, which are more frequent in higher age, advanced tumor stage, and postoperative non-surgical complications rise operative mortality. However, surgical complications increase postoperative mortality only in cases of anastomotic leaks. The rates of postoperative complications depended on different surgical departments. Departments performing a delayed tumor resection in emergency surgery had better results. In elective cases the standard of oncological resections should be observed. In emergency cases operative procedure and extension of the resection should be planed in consideration of preoperative risk factors of the individual patient.
Adult↗
Classification and regression trees (CART) for estimation of prognosis in patients with gastric carcinoma.
A total of 961 patients who had received resective surgery for gastric carcinoma were grouped according to prognosis by classification and regression trees (CART). This grouping was compared to the present UICC stage grouping. For patients resected for cure (R0) the CART approach allows a better discrimination of patients with poor prognosis (5-year survival rates 15%-30%) from patients with a 5-year survival of 50%, on the one hand, and from patients with extremely poor prognosis (5-year survival rates below 5%) on the other. In the present investigation CART grouping was not influenced by the differentiation between pT1 and pT2 or between pT3 and pT4.
Decision Trees↗
[Is acrolentiginous melanoma (ALM) more malignant than superficially spreading melanoma (SSM) at a high-risk site? A matched-pair comparison between 113 ALM and SSM within the scope of a multicenter study].
Even today, the prognosis of acrallentiginous melanoma (ALM) remains a controversial topic. We present a large case study including all known factors relevant for prognosis. 113 ALMs in 3616 melanoma patients were paired as precisely as possible with their twins, i.e. with 113 superficial spreading melanomas (SSM) from a group of 619 SSMs with high-risk location. The ALMs and SSMs were equivalent in tumor thickness, patient gender and mode of treatment. The follow-up period was for at least 5 years. The 5-year Kaplan-Meier survival curve in both groups are identical. The poor prognosis often ascribed to ALM results from the prognostic factor location. ALM should therefore be regarded as acral localized melanoma.
Aged↗
[Prognostic advantage for defined risk groups by lymphocyte dissection. Long-term study of 3,616 melanoma patients].
Nine medical centres with different practices in elective lymph node dissection (ELND) but comparable standards regarding diagnosis, excision of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producing an unbiased analysis of the prognostic benefit of ELND. The multivariate risk analysis (Cox's proportional hazard model) revealed tumour thickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy ("yes" or "no") as independent prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1.5 to 4 mm thick on head, neck, thorax, and in acral locations; and finally men with melanomas over 2.5 to 4 mm thick on abdomen and extremities. Further investigations and the discovery of additional prognostic factors would help in more precisely formulation of guidelines for ELND.
Adult↗
What's new in TNM?
As other parameters of tumor classification, TNM as well can never be considered definitive because advances in diagnosis and treatment as well as in knowledge of prognostic factors require adaption of current classifications. On the other side, the need for stability in tumor classification is obvious for accumulation of data in an orderly way over reasonable periods of time. The last edition of TNM, i.e. the fourth edition has been published in 1987 and was the result of an international effort to unify the classifications of Union Internationale Contre le Cancer (UICC) and American Joint Commission on Cancer (AJCC). Since 1987 changes in the classification for corpus uteri and vulva have been made by the Fédération Internationale de Gynécologie et d'Obstetrique (FIGO). This made a revision of the TNM classification necessary to ensure the complete agreement of TNM and FIGO classifications. In the revision 1992 some further changes were added for improvement. A further publication, namely the TNM Supplement 1993, available from November 1993, contains explanatory notes to enable a uniform use of TNM, proposals for new classifications and optional proposals for testing new telescopic ramifications. The latter are a way to collect data for further improvement of TNM and will be the first step for the preparation of the 5th edition, which will not be published until the year 2000. The aim of this publication is to inform pathologists on the essential changes in TNM as far as pathological classification is involved.
Humans↗
The pathologist and the residual tumor (R) classification.
The R classification, adopted in 1987 by the UICC, denotes absence or presence of residual tumor after treatment. Residual tumor may be localized in the area of the primary tumor and/or as distant metastases. R0 corresponds to resection for cure or complete remission. R1 to microscopic residual tumor, R2 to macroscopic residual tumor. The R classification takes into account clinical and pathological findings. A reliable classification requires the pathological examination of resection margins. The R classification has considerable clinical significance, particularly being a strong predictor of prognosis. General and specific procedures for performing pathological R classification on resection specimens of different organs will be described. New methods in R classification comprise imprint cytology, cytolocial examination of ascites, examination of bone marrow biopsy. The importance of these methods will have to be established in the future.
Humans↗
Prophylaxis of complications after pancreatic surgery: results of a multicenter trial in Germany.
Major pancreatic resection still carries a considerable risk for morbidity and even mortality. Complications occurring after pancreatic surgery are chiefly linked with exocrine pancreatic secretion. Therefore to inhibit exocrine pancreatic secretion perioperatively seems to be a promising concept in the prevention of complications following pancreatic resection. The hormone somatostatin and its synthetic analogue octreotide have been demonstrated to inhibit exocrine pancreatic secretion profoundly, particularly the secretion of proteases is decreased. In a randomized placebo-controlled multicentric and double-blind trial we analyzed the role of octreotide in the prevention of post-operative complications after major pancreatic surgery. A significant reduction of complications (fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, postoperative acute pancreatitis) could be demonstrated in patients receiving octreotide (3 x 100 micrograms/day s.c.). The effect of octreotide was particularly true in patients undergoing a Whipple resection for cancer.
Austria↗
[Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group].
In a prospective multicentre observation study with free choice of treatment 1157 patients with solitary colonic carcinoma were entered free of selection between August 1984 and November 1986. The 5-year-survival rate for all patients was observed 45.7 +/- 3.0%, relative (age-corrected) 60.2 +/- 4.0%. Multivariate analysis using multiple logistic regression analysis identified R-classification, stage, institution and timing of surgery as independent prognostic factors regarding survival. In R0 resected patients occurrence of locoregional recurrence was the strongest prognostic factor. Study data could demonstrate a substantial variability in frequency of locoregional recurrence and survival among the participating institutions. The data support the importance of application of principles of radical surgery and gives evidence for the outstanding importance of surgery for the prognosis of colonic carcinoma.
Adenocarcinoma↗
[Risk of surgical therapy of stomach cancer in Germany. Results of the German 1992 Stomach Cancer Study. German Stomach Cancer Study Group ('92)].
The German Gastric Cancer Study (GGCS '92) permits a representative pictures of the current situation in surgery for gastric carcinoma at university centers in Germany. The analysis of frequency of resection, complication rate and mortality provides a quality measure for anybody who performs surgical therapy for gastric carcinoma. The results of multivariate analyses will have therapeutic consequences.
Cause of Death↗
[To what extent are laparoscopic procedures defensible in oncologic surgery?].
Successful oncological standard procedures can only be replaced by new methods if their value has been proven by long-term results. Laparoscopic tumor resections with curative intention have to be considered experimental, especially because long-term results are not yet available. These operations require two preconditions: 1) the oncological quality of tumor resection must be assessed by special methods of pathohistological examinations; and 2) long-term follow-up care must be guaranteed. In most cases, these preconditions are only secured within clinical trials.
Abdominal Neoplasms↗
Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study 1992.
BACKGROUND: The impact of patient- and tumor-dependent factors and the postoperative course on the prognosis of patients who underwent resection for gastric carcinoma between 1986 and 1989 were analyzed in a prospective multicenter observation study. METHODS: Resection techniques, the extent of lymph node dissection, and the histopathologic assessment of the specimen were standardized at all participating centers. A total of 1654 patients were enrolled. Follow-up is complete for 99.2% of the patients, with a median follow-up time of 48 months. Prognostic factors were assessed by multivariate analysis. RESULTS: In the total patient population there was an independent prognostic effect of nodal status, a International Union Against Cancer (UICC)-R0 resection, distant metastases, the pT category, three or more risk factors on preoperative risk analysis, and the presence of postoperative complications. Multivariate analysis in the subgroup of patients who had a UICC-R0 resection confirmed the nodal status as the major independent prognostic factor. CONCLUSION: These data suggest that the prognosis of patients who undergo gastrectomy for gastric carcinoma may be improved by a complete resection of the primary tumor and its lymphatic drainage, resulting in a UICC-R0 resection. In addition, a detailed preoperative risk analysis and identification of high-risk patients and meticulous attention to the technical details of the surgical procedure to reduce the frequency of postoperative complications may improve the prognosis.
Adult↗
Benefit of elective lymph node dissection in subgroups of melanoma patients. Results of a multicenter study of 3616 patients.
BACKGROUND: The benefit of elective lymph node dissection (ELND) for the treatment of the nonmetastasized malignant melanoma has been assessed differently until today. METHODS: Nine medical centers with a different ELND practice but comparable standards regarding diagnosis, excision of the primary tumors, classification, and follow-up, have collected their data (primarily ascertained prospectively) of 3616 patients of the tumor categories pT2 to pT4N0M0 to produce an unbiased analysis of the prognostic benefit of ELND, and to find the indications for its application. The data are based on patients 70 years of age and younger with a primary melanoma of the skin, who have been followed for at least 4 years (median, 9.6 years). The stratification (according to pT category [alternatively, tumor thickness], sex, anatomic site) was in accordance with the results of the multivariate risk analysis (Cox hazard model). Imbalances of other criteria such as ulceration, type, and age were excluded by chi-square tests of the individual strata. The results are based on the observed survival rates according to Kaplan-Meier analysis of the different strata. RESULTS: A prognostic benefit of the ELND group (improvement of the 5-year survival rate of about 20%) can be claimed for male patients with axial and acral melanomas (excluding lentigo maligna melanoma [LMM] and ulcerated tumors) of the categories pT3a up to pT4a (tumor thickness of > 1.5-4.5 mm, respectively) (P < 0.001). As to the rest of the nonulcerated tumors of male patients, only those of the categories pT3b and 4a benefited from ELND (P < 0.01). A benefit from ELND for women was statistically verified (improvement of the 5-year survival rate of about 5%-10%) only for the subgroup with a tumor thickness > 2.5-5 mm, excluding LMM) (P = 0.016). CONCLUSIONS: This retrospective study strongly suggests the efficacy of ELND in subgroups of melanoma patients.
Adult↗
[The epidemiology of stomach carcinoma from the surgical viewpoint. The results of the German Stomach Carcinoma Study 1992. The German Stomach Carcinoma Study Group].
In a prospective multi-centre study data were collected on 1,999 patients (1273 men, 726 women; mean age 62.3 [19-99] years) with gastric carcinoma, admitted to one of 19 surgical departments in Germany between 1.4. 1986 to 30. 6. 1989. Previously treated patients as well as those with synchronous or metachronous tumours and carcinoma of the gastric stump had been excluded. The resection rate for gastric carcinoma was 82.7%, i.e. resection was no longer possible because of the advanced tumour stage in nearly 20%. The tumour was located in the upper third of the stomach in 30%, the antrum in 26.3%. An intestinal type of growth was present in 51.9%. An early carcinoma was diagnosed in 16.9% of operated patients; it had already metastasized to regional lymph nodes in 16.5%. Nearly 70% of patients with resectable tumours had metastases to the regional lymph-nodes, with distant metastases in 30%. An advanced tumour stage (UICC stage IIIB or IV) was present in 43%. Exclusively surgical treatment is not effective in these cases.
Adult↗
Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group.
In a prospective multicentre study of 2394 patients with gastric carcinoma the prognostic relevance of systematic lymph node dissection was evaluated. Of 1654 patients undergoing resection, 558 had a standard lymph node dissection, defined as fewer than 26 nodes in the specimen, and 1096 underwent radical lymphadenectomy, i.e. 26 or more nodes in the specimen. Radical dissection significantly improved the survival rate in patients with Union Internacional Contra la Cancrum (UICC) stages II and IIIA tumours. Multivariate analysis identified radical dissection as an independent prognostic factor in the subgroups of patients with UICC tumour stages II and IIA. Radical dissection conferred no survival advantage in patients with pN2 tumours. There was no significant difference in morbidity and mortality rates between radical and standard lymph node dissection. Radical lymphadenectomy improves survival in patients with UICC gastric cancer stages II and IIIA, and should be the recommended treatment for such patients.
Female↗