BACKGROUND: Unlike colon surgery, gastric surgery developed only slowly. Standardized stomach surgery can be said to have begun in 1881 with Billroth's successful gastric resection. The Department of Surgery in Graz was involved in the development and then rapid dissemination of gastric surgery, with respect to both ulcer and cancer surgery. Since the introduction of the modern proton-pump inhibitors, surgery for gastric ulcers today is mainly limited to the treatment of complications. In spite of the worldwide decrease in the incidence of stomach cancer, it is still of great clinical importance in Austria. METHODS: The development of gastric surgery at the Department of Surgery in Graz is presented on the basis of the literature. RESULTS: Still today, the only curative option for stomach cancer is radical surgical removal with lymphadenectomy as indicated. In the period of January 1, 1994 to December 31, 2004, 341 patients with stomach cancer were treated at the Division of General Surgery in Graz; 265 of them could be operated and the average 5-year survival rate was 36% without regard to tumor stage. CONCLUSIONS: It may be said that more than one hundred years of development have led to the standardization and optimization of gastric surgery, and that the contributions of surgeons in Austria and in Graz were considerable.

BACKGROUND: In liposarcoma (LS), tumor-grade, histopathologic subtype, size, and completeness of resection are important prognostic factors. METHODS: We analyzed 80 patients with LS in an unselected patient sample concerning local recurrence, metastases, and survival in relation to clinicopathological characteristics and treatment. RESULTS: The five-year event-free rate was 82%. The strongest predictive prognostic factor was tumor grading. There was a significant influence of age over 60 showing a worse prognosis. Within 5 years after diagnosis, metastases were diagnosed in 13.1% (95% CI from 2.9% to 22.2%). The mean interval from first diagnosis to metastases was 27 months (0 to 63 months). Local recurrence occurred just in patients, who were not primary treated in a tumor-center and first resection was inadequate (five LS G II and one LS G I). CONCLUSIONS: Prognosis of LS is good if surgical treatment is adequate and resection performed with clear margins. Patients with suspected LS should be referred to specialized tumor-centers.

BACKGROUND: For many years malignant fibrous histiocytoma ("MFH") was accepted to be the most common soft tissue sarcoma in adults, its histiogenesis, however, remained controversial. METHODS: Review of the current status of "MFH". RESULTS: Within the last two decades several studies demonstrated that "MFH" has been used as a "waste paper basket" for several better classifiable, poorly differentiated soft tissue sarcomas. Therefore, reclassification of these tumors could led to better prognostification. CONCLUSIONS: In the 21st century with the insight of immunohistochemistry as well as improved cytogenetic and molecular diagnostic the term high-grade undifferentiated pleomorphic sarcoma (so-called "MFH") should be restricted to a group of soft tissue malignancies without a specific line of differentiation. Better classification of various high-grade sarcomas may contribute to more specific treatment options and hence lead to improved survival for patients.

The mainstay of successful tumor therapy is early detection of neoplastic tissue. Although exfoliative cytology has proven to be a reliable tool, its importance is still underestimated. Laryngostroboscopy is the most important tool for functional investigation in laryngological and phoniatric diagnosis. Stroboscopic evaluation allows early detection of infiltrative processes of the vocal folds. Aim of our study was to demonstrate that combination of both, exfoliative cytology and stroboscopy, provides a highly sensitive and easy to perform method in differential diagnosis of epithelial hyperplastic lesions of the vocal folds. In 130 patients with varying degrees of vocal fold keratosis up to glottic cancer, preoperative layngostroboscopy was performed. Stroboscopy was classified pathological in case of reduced or abolished amplitude of vocal fold vibration and/or reduced or abolished mucosal wave propagation. Under general anaesthesia histology with corresponding cytological specimens were obtained. The latter were classified in three groups reaching from normal (I), dysplastic (II), up to malignant (III) cytology. Invasive carcinoma was diagnosed in 32 cases by histology, corresponding malignant cytology was found in 21 specimens (sensitivity: 74%). By certain combination of cytology with pathological stroboscopy, a sensitivity of more than 97% can be achieved. Combination of cytology and stroboscopy allows detection of glottic cancer with a sensitivity of 97%, in contrast to 74% as found by cytology alone. This combination can be used as preliminary or sorting procedure and gives the opportunity of early detection, as well as for follow-up examinations. For repeated biopsies can cause scars with consecutive voice impairment, this procedure is very smooth but nevertheless reliable method.

.An angiosarcoma arising after kidney transplant with subsequent immunosuppression is a rare occurrence. An epitheloid angiosarcoma developed in a defunctionalized arteriovenous fistula in a 60-year-old patient 9 years after a kidney transplant and 7 years after arteriovenous fistula ligation. In spite of aggressive surgical therapy remote metastases grew rapidly. If, as experimental studies postulate, a turbulent flow leads to an endothelial proliferation by means of up-regulation of growth peptides and, thus, the development of malignant tumors is favored, defunctionalized arteriovenous fistulas should be surgically removed in patients receiving immunosuppression.

Cerebrotendinous xanthomatosis is a rare hereditary lipid storage disease characterised by deposits of cholestanol. In a female patient with bilateral swelling of the Achilles tendon who underwent biopsy, cerebrotendinous xanthomatosis was confirmed by combining disease patterns. She suffered from ataxia, depression, epilepsy, reduced intelligence, bilateral cataracts, gallstones, and atherosclerosis. Concentration of serum cholestanol was 10 times higher than normal. As causal therapy, ursodeoxycholic acid and statin drugs were prescribed to halt progression.

Zerebrotendinöse Xanthomatose ist eine seltene hereditäre Stoffwechselkrankheit mit Ablagerung von Cholestanol im Organismus. Wir berichten über eine Patientin mit bilateralen Xanthomen der Achillessehnen. Hier konnte nach bioptischer Abklärung und in Zusammenschau primär nicht zusammenhängender Erkrankungen besagte Diagnose gesichert werden. Es zeigte sich bereits das Vollbild der Erkrankung mit Ataxie, Depression, Epilepsie, Intelligenzverminderung, beidseitigem Katarakt, Gallensteinleiden und Arteriosklerose. Als kausale Therapie wurden ein Desoxycholsäurederivat und Statin verordnet.

Angiosarkome nach Nierentransplantation mit anschließender Immunsuppression sind ein selten auftretendes Krankheitsbild. Bei einem 60-jährigen Patienten entwickelte sich 9 Jahre nach Nierentransplantation und 7 Jahre nach Shuntligatur im thrombosierten Shunt ein epitheloides Angiosarkom. Trotz aggressiver chirurgischer Therapie kam es rasch zur Entstehung von Fernmetastasen. Wenn, wie experimentelle Studien postulieren, eine turbulente Strömung über eine vermehrte Ausschüttung von Wachstumspeptid zu einer endothelialen Proliferation führt und damit die Entstehung von malignen Tumoren begünstigt wird, sollten bei immunsupprimierten Patienten stillgelegte AV-Fisteln operativ entfernt werden.

Aktivitätsindizes und Scoring-Systeme für Morbus Crohn und Colitis ulcerosa nehmen eine wichtige Rolle in der Beurteilung der Krankheitsaktivität in klinischen Studien ein, speziell in Studien zum Effekt von medikamentösen Therapien. Andererseits wäre es jedoch wünschenswert, auf reliable und reproduzierbare Systeme zur Einschätzung der Krankheitsaktivität bei der chirurgischen Indikationsstellung und Planung zurückgreifen zu können. Der vorliegende Artikel liefert daher eine Übersicht über die derzeit verfügbaren Index- und Score-Systeme zu beiden Krankheiten, dem Morbus Crohn und der Colitis ulcerosa und ihren potenziellen sinnvollen Anwendungsmöglichkeiten bei der Planung und Durchführung chirurgischer Eingriffe.

Aims: To investigate platelet-derived growth factor receptor (PDGFR)alpha and PDGFR beta expression and a mutational analysis of PDGFR alpha (exons 11, 12, 17 and 18) and PDGFR beta (exon 12) genes in endometrial stromal sarcomas (ESS). Gastrointestinal stromal tumours (GISTs), which have somatic mutations of the transmembrane tyrosine kinase receptor, respond to tyrosine kinase inhibitors, which act through an inhibitory effect on class 3 receptor tyrosine kinase members such as PDGFR alpha, PDGFR beta and c-kit.Methods and results: The immunohistochemical expression of PDGFR alpha and PDGFR beta was investigated in 37 archival c-kit- ESS. Staining was scored as negative (0-10% positive tumour cells) and positive (weakly positive 11-50% positive cells; strongly positive > 50% positive cells). PDGFR alpha was expressed in 24/37 ESS [65%; strongly by 19/37 (51.5%) and weakly by 5/37 ESS (13.5%)]. ESS tumour cells were negative for PDGFR beta, but endothelial cells stained positive. A mutational analysis of PDGFR alpha (exons 11, 12, 17 and 18) and PDGFR beta (exon 12) genes on frozen metastatic ESS from three patients detected no mutations leading to amino acid changes in the mature protein.Conclusions: Patients with PDGFR alpha+ ESS may benefit from treatment with tyrosine kinase inhibitors by blocking autocrine and paracrine stimulation loops, blocking neovascularization and enhancing the effects of chemotherapy.

Aim: To determine the platelet-derived growth factor (PDGF) alpha and beta status of desmoid tumours. Desmoid tumours are rare monoclonal neoplasms that appear to have no metastatic potential. Surgical resection and radiotherapy in the event of a positive surgical margin is the first-line treatment. Recurrences are frequent. Treatment results using non-steroidal anti-inflammatory agents, anti-oestrogen compounds and other agents such as Imatinib mesylate have been published. Therapy with Imatinib has been proposed as a therapeutic option, although in most reports desmoid tumours are reported to be c-kit-.Methods and results: We performed immunohistochemical analysis on 124 archived samples (85 patients) of desmoid tumours using antibodies to PDGF alpha, PDGF beta, PDGFR alpha and PDGFR beta. All desmoid tumours showed immunoreactivity with antibodies to PDGF alpha and PDGFR alpha, whereas with antibodies to PDGF beta and PDGFR beta no specific reaction could be detected. Mutational analysis of PDGFR alpha (exons 11, 12, 17 and 18) and PDGFR beta (exon 12) on frozen material from 14 patients was performed, but no mutations leading to amino acid changes in the mature protein were identified.Conclusion: The absence of an activating mutation in a protooncogene does not exclude the efficacy of tyrosine kinase inhibitors through other possible mechanisms, and these might be a therapeutic option for patients with desmoid tumours in whom established local and systemic approaches fail to control the disease.

Ziel: Methode: Ergebnisse: Fazit: Aim: Methods: Results: Conclusions:

AIM:To evaluate survival in patients undergoing palliative resection versus non-resection surgery for primary colorectal cancer in a retrospective analysis.METHODS:Demographics, TNM status, operating details and survival were reviewed for 67 patients undergoing surgery for incurable colorectal cancer. Palliative resection of the primary tumor was performed in 46 cases in contrast to 21 patients with non-resection of the primary tumor and bypass surgery. Risk factors for postoperative mortality and poor survival were analyzed with univariate and multivariate analyses.RESULTS:The two groups were comparable in terms of age, gender, preoperative presence of ileus and tumor stage. Multivariate analysis showed that median survival was significantly higher in patients with palliative resection surgery (544 vs 233 d). Differentiation of the tumor and tumor size were additional independent factors that were associated with a significantly poorer survival rate.CONCLUSION:Palliative resection surgery for primary colorectal cancer is associated with a higher median survival rate. Also, the presence of liver metastasis and tumor size are associated with poor survival. Therefore, resection of the primary tumor should be considered in patients with non-curable colon cancer.

Background: Crohn’s disease (CD) patients with increased disease activity may reveal an increased risk for perioperative complications. The ‘Crohn’s disease activity index’ (CDAI) and the ‘Vienna classification’ (VC) were developed for standardized disease activity estimations. The significance of these scores to predict extent, type and early outcome of surgery in CD patients was analyzed. Methods: In 179 surgically treated CD patients, the CDAI and VC were assessed from a prospective database. Relations of the scores with CD risk factors, type, number, location and complications of surgery were analyzed. Results: VC behavior and location subtypes were associated with distinct types of surgery (i.e. ‘strictureplasty’ in ‘stricturing disease’, ‘colon surgery’ in ‘colon involvement’), but not with surgery type and extent or outcome. Surgery extent (i.e. with 5 vs. 3 ‘surgical sites’ 425 ± 25 vs. 223.3 ± 25) and complications (357.1 ± 36.9 (with) vs. 244.4 ± 13 (without)) were associated with elevated CDAI levels; however, nicotine abuse remained the only significant risk factor for perioperative complications after multiple logistic regression. Conclusion: The significance of VC or CDAI for predicting the extent of surgery or complications is limited. None of the tested variables except preoperative nicotine abuse influenced the likelihood for perioperative complications.

AIM:"Fast-track" multimodal rehabilitation is increasingly entering the perioperative management strategies in colon surgery aiming at minimized perioperative morbidity and accelerated recovery. So far little is known about the complementary effects of minimally invasive surgery along with "fast-track" rehabilitation in the treatment of rectal cancer. The aim of this pilot study was to investigate the influence of "fast-track" perioperative management on morbidity, recovery and length of hospital stay in laparoscopically-assisted rectum resections and to compare those data to earlier results.METHODS:An interdiciplinary "fast-track" multimodal rehabilitation strategy with avoidance of mechanical bowel cleansing, with a restrictive intravenous intra- and postoperative fluid regimen, forced mobilisation, and early enteral nutrition was introduced into clinical practice and applied in 16 laparoscopically-assisted rectum resections. Data were collected in the course af a prospective analysis. The mean patient age was 62 (42-79) years.RESULTS:Mean time of surgery was 245 (SD 46) min, and the mean intraoperative infusion rate was 11.2 (SD 2.6) ml/kg/BW. On day 2, 14 of the 16 patients tolerated solid food and 12 patients had had bowel movements. All patients returned to their initial body weight by day 4. The median postoperative hospital stay was 7.5 days (6-20), 12 patients were discharged between day 6 and 8. Two patients were readmitted for intestinal atony, one patient developed an anastomotic leakage.CONCLUSIONS:"Fast-track" rehabilitation is feasible in rectum surgery and seems to complement the beneficial effects of minimally invasive surgery without increasing the complication rate.

Background/Aims:Although the standard treatment for desmoid tumours is complete surgical resection with wide margins, the optimal adjuvant treatment for recurrent or inoperable disease is unclear, often being based on sporadic immunohistochemical reports with a low number of cases. Therefore, a large immunohistochemical study was performed, to provide a theoretical basis for adjuvant treatment regimens.Methods:One hundred and sixteen tissue samples from 80 patients (49 female, 31 male; mean age, 34 years; range, 0–83) with desmoid tumours (46 extra-abdominal, 21 abdominal, 13 intra-abdominal) were tested for oestrogen receptors α and β, progesterone and androgen receptors, and somatostatin, in addition to HER2, cathepsin D, Ki-67, and c-KIT by immunohistochemistry.Results:All samples were negative for oestrogen receptor α, HER2, and the progesterone receptor. Positive staining for the androgen receptor was found in six extra-abdominal cases. Staining for oestrogen receptor β was positive in four extra-abdominal, two abdominal, and one intra-abdominal case. Staining for somatostatin was positive in six extra-abdominal, two abdominal, and one intra-abdominal case, and staining for cathepsin D was positive in all cases. Positive staining for Ki-67 was found in 14 extra-abdominal, three abdominal, and three intra-abdominal cases. C-KIT was detectable in one abdominal case only.Conclusions:The data from this immunohistochemical study show that the published effects of antioestrogens and imatinib mesylate in the treatment of aggressive fibromatoses may not be attributable to oestrogen receptor α or c-KIT expression.

Background. Primary graft dysfunction due to ischemia and reperfusion injury represents a major problem in liver transplantation. The related cell stress may induce apoptosis, which can be suppressed by bcl-2. The purpose of the study was to investigate the effect of adenoviral bcl-2 gene transfer on early graft function and survival in rat liver transplantation. Methods. An adenoviral construct that transfers bcl-2 under the control of a tetracycline inducible promoter was generated (advTetOn bcl-2) and used with a second adenovirus that transfers the repressor protein (advCMV Rep). Forty-eight hours before explantation, donor rats were treated with advTetOn bcl-2/ advCMV Rep (n=7) and doxycyclin, with the control adenoviral construct advCMV GFP (n=8) or with doxycyclin alone (n=8). Liver transplantation was performed following 16 hours of cold storage (UW). Bcl-2 expression and intrahepatic apoptosis was assessed. Bile flow was monitored 90 min posttransplantation. The endpoint for survival was 7 days. Results. Bcl-2 was expressed in hepatocytes and sinusoidal lining cells. This was associated with a significant reduction of apoptotic sinusoidal lining cells and hepatocytes after 24 hours and 7 days. Bile production was significantly higher following bcl-2 pretreatment. Furthermore, bcl-2 transfer resulted in significantly improved survival (100% vs. 50% both control groups). Conclusions. Adenoviral bcl-2 transfer results in protein expression in hepatocytes and sinusoidal lining cells resulting in early graft function and survival enhancement after prolonged ischemia and reperfusion injury. The inhibition of apoptosis in the context of liver transplantation might be a reasonable approach in the treatment of graft dysfunction.

In einer nicht-randomisierten Vergleichsstudie untersuchten wir die chirurgisch-onkologischen Ergebnisse von Rektumkarzinompatienten, die in der konventionellen oder laparoskopischen Operationstechnik operiert wurden.