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Biomedical subjects

P Hermanek

Publications and source records attributed to P Hermanek.

At least 91 records · Page 5Linked to original sources
PubMed1993

Operative mortality in carcinoma of the rectum. Results of the German Multicentre Study.

An analysis of operative mortality for carcinoma of the rectum in the German Study Group Colo-Rectal Carcinoma (SGCRC) comprising 1115 operated patients, found a total operative mortality rate of 4.3% and a 30-day-mortality rate of 2.8%. Advanced age, severe concurrent disease, anastomotic leakage in anterior resections and institution were found to be factors with independent significant influence. In anterior resections, especially low anterior resections, with protective enterostomy, the lower rates of anastomotic leakage and mortality emphasize the advantages of protective enterostomy.

Aged↗
PubMed1993

[Further development in TNM classification of laryngeal cancers].

To prepare an improved TN classification of laryngeal carcinomas, a great number of serial sections of laryngeal cancers and neck dissection specimens has been investigated and corresponding studies of clinical relevance were performed. Our proposals have been accepted in the 1993 supplement of the TNM-UICC classification and will be tested within the frame of so-called ramification studies. The authors propose that the T-category of laryngeal carcinomas should no longer be determined by anatomical areas of different sizes, but by millimetres only (up to 15 mm T1, 15-25 mm T2 a, 25 mm and more without impaired mobility T2 b, to impaired mobility or fixation of vocal cords T3, or T4 if the tumour extends beyond the larynx. The pT categories correspond to the T categories. A histological depth of or less than 5 mm is pT 1 or 2. It is proposed that the differentiation into glottic and subglottic tumours of the larynx should be abandoned. In lymph node metastases, the size, number, level and extranodular spread are considered. N1 and N2 are metastases in the upper two thirds of the neck without fixation (extranodal spread). N1 are one or two ipsilateral metastases of 2 cm or less in diameter, N2 are metastases of more than 2 cm diameter or bilateral metastases. N3 are fixed metastases or metastases in the lower third of the neck. Our proposals are presented in tables, ramification tables, conversion tables and a documentation sheet.

Humans↗
PubMed1993

[Systematic extended lymph node dissection in curative therapy of stomach cancer].

On 545 patients with gastric carcinoma treated surgically for cure during June, 1, 1982 and December, 31, 1989 the value of the systematic extended lymph node dissection (SELD) was studied prospectively. In SELD neither surgical mortality nor postoperative complications were observed with increasing frequency. In stage II survival was significantly improved in patients with SELD, in stages IA, IB and IIIA an analogous trend was seen. Patients in stage IIIB and IV showed with and without SELD identical survival.

Adult↗
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↗