Aim: To evaluate local control for long-term prognosis in retroperitoneal soft-tissue sarcoma (primary tumors (PT) and local recurrence (LR)).Methods: A total of 110 patients underwent surgery between 1988 and 2002. Prospectively gathered clinicopathological data were analyzed. Kaplan-Meier estimations and Cox regression analyses were performed.Results: Resectability was 90%, being comparable for PT (n = 71) and LR (n = 39). Morbidity, mortality, blood loss, and operation time did not differ for PT or LR (24% vs. 31%, p = 0.41; 7.0% vs. 5.1%. p = 1.0; 1000 ml vs. 1500 ml, p = 0.17; 240 min vs. 255 min, p = 0.13). Hospitalization was comparable in both groups (median, 12 days (PT) and 13 days (LR)). Follow-up was 89 months (median, IQR 37-112 months). Local 3- and 5-year control rates after complete resection of PT were 66% and 59% (19% and 9% for LR, p < 0.001). The mean number of operations were 1.4 for PT and 2.4 for LR (p = 0.0047). The 5-year survival rates after complete resection were 51% for PT and 43% for LR (p = 0.39). The 5-year survival rates were 65%, 4%, and 0% for complete resection, incomplete resection, and exploration, respectively (p < 0.001). Multivariate analysis showed high-grade and blood loss with a poor prognosis.Conclusions: Comparable resectability rates and perioperative outcome were observed for surgery of PT and LR. Consequent reoperation leads to respectable long-term survival rates after resection of LR. The prognosis in retroperitoneal sarcomas varies significantly according to resectability, grade and blood loss. (C) 2008 Elsevier Ltd. All rights reserved.

Einleitung: Lebermetastasen treten häufig bei Patienten mit einem kolorektalen Karzinom auf und sind sehr wahrscheinlich durch disseminierte Tumorzellen in der Leber verursacht. In bisherigen Studien konnte die prognostische Bedeutung disseminierter Tumorzellen im Blut und Knochenmark von Patienten mit einem kolorektalen Karzinom bereits gezeigt werden.

Recent studies indicated that prefeeding of a glycine supplemented diet reduces the hepatic inflammatory response and liver damage in sepsis. We investigated the effect of a glycine-enriched infusion on hepatic microcirculatory disturbances and mortality in a rat model of sepsis after the onset of the disease. Male Wistar rats (240 ± 13 g) underwent cecal ligation and puncture (CLP) or laparotomy (LAP). A glycine (CLP + Gly, n = 24), valine (CLP + Val, n = 24), or sodium chlorid (CLP + Sc, n = 24) infusion was started 2 h after CLP. The LAP group received sodium chloride intravenously (LAP + Sc, n = 18 ). Five hours, 10 h, and 20 h after CLP or LAP intravital microscopy (IVM) was performed to investigate leukocyte–endothelial interaction (LEI) and mean erythrocyte velocity in liver sinusoids (sMEV) and postsinosoidal venules (vMEV). The portal blood flow (PBF), hepatic enzyme liberation, and glycine values in blood were measured. Immunohistochemical staining for ICAM-1 in liver tissue was performed and survival was observed. Glycine values were significantly elevated in the CLP + Gly vs. the CLP + Val and the CLP + Sc group at every timepoint of investigation. Glycine infusion had no beneficial effects on sMEV, vMEV, LEI, hepatic enzyme liberation, and survival. Heart rate and mean arterial pressure remained stable but PBF decreased significantly in all groups 20 h after CLP. Although glycine reduces the hepatic inflammatory response and liver damage in pretreatment of septic rats, there was no effect of intravenous glycine after the onset of sepsis in our experiments. Our animal model does not support the use of glycine in patients.

Zielsetzung: Die adjuvante Chemotherapie wird bei Patienten mit einem kolorektalen Karzinom im UICC Stadium II nicht routinemäßig empfohlen. Trotz der generell guten Prognose in diesem frühen Tumorstadium entwickelt ein beträchtlicher Teil der Patienten eine Metastasierung bzw. ein Tumorrezidiv. Daher ist die Entwicklung bzw. Etablierung patientenbezogener, prognostischer Kriterien sehr wichtig, um Patienten mit einem erhöhten Rezidivrisiko identifizieren zu können. Der Nachweis hämatogen disseminierter Tumorzellen im Blut und Knochenmark könnte einen solchen individuellen Prognosemarker für Patienten mit einem kolorektalen Karzinom darstellen. In dieser Studie haben wir daher die prognostische Bedeutung der hämatogenen Tumorzelldissemination bei Patienten mit einem kolorektalen Karzinom im UICC Stadium II untersucht.

BACKGROUND:It has long been suspected that mechanical influences may enhance the release of viable colorectal cancer cells into the circulation. The objective of this study was to determine the extent of hematogenous tumor cell spread in colorectal cancer patients during colonoscopy.METHODS:Peripheral venous blood samples were taken before and after colonoscopy from 44 patients with colorectal cancer. Blood samples were examined using a reverse-transcriptase polymerase chain reaction assay to amplify cytokeratin 20 transcripts.RESULTS:Eleven patients with colorectal cancer displayed circulating tumor cells before and after colonoscopy (25%), whereas tumor cells were detected in six of 44 patients (14%) only after the procedure (p = 0.03, McNemar's test: tumor cell detection before after colonoscopy). All control samples consistently tested negative.CONCLUSIONS:Mechanical forces may result in enhanced release of viable colorectal cancer cells into the circulation; however, the clinical significance of these results needs to be clarified.

Background: Apart from an obviously better cosmetic situation, there is controversy on the actual benefit of laparoscopic and laparoscopically assisted techniques in restorative proctocolectomy. The need for a protective ileostomy remains unclear. Methods: Fifty-nine consecutive patients with ulcerative colitis and familial polyposis were included in this prospective cohort study. The colon was mobilized laparoscopically with a four-trocar technique, facilitating vascular dissection, rectal resection, and ileoanal pouch construction to be done through a Pfannenstiel incision. A protective ileostomy was constructed only in patients where the operation was difficult or where the anastomosis was under tension. Intra- and postoperative data were recorded; statistical analyses were performed by exact logistic regression. Results: Laparoscopic mobilisation was successful in 54 patients (91.2%). Two patients had to be primarily converted because of exceeding the set time limit; 3 other patients had to have an additional median laparotomy. These 5 patients all had an increased body mass index (BMI), which was a statistically significant risk factor for failure of the laparoscopic technique. 18.6% of patients developed major complications (n = 11). Nine patients required secondary ileostomies; all of them either were under high dose immunosuppressants (n = 5) or had an increased BMI (average 28.42 kg/m2). Failure of the laparoscopic technique was associated with major complications. Conclusion: Laparoscopically assisted restorative proctocolectomy is technically feasible; an increased BMI is a relevant risk factor for failure. The minimally invasive approach probably does not reduce the need for a protective ileostomy in selected patients. The selection criteria for the addition or omission of a protective ileostomy in minimally invasive restorative proctocolectomy remain to be clearly defined.

Die chirurgische Resektion ist das Verfahren der Wahl zur Entfernung von Lebermetastasen kolorektaler Karzinome. Trotz potentiell kurativer Resektion entwickeln bis zu 75% der Patienten ein intra- oder extrahepatisches Tumorrezidiv. Die Ursache hierfür ist wahrscheinlich eine prä- bzw. intraoperative hämatogene Aussaat von Tumorzellen. Vorarbeiten unserer Arbeitsgruppe haben gezeigt, dass es während der chirurgischen Resektion von kolorektalen Lebermetastasen zu einer signifikant erhöhten intraoperativen hämatogenen Tumorzelldissemination kommt. Ziel dieser Studie war die Untersuchung der prognostischen Bedeutung des Nachweises disseminierter Tumorzellen während der Resektion kolorektaler Lebermetastasen.

In lymphocytes, the availability of cysteine is limiting for the synthesis of glutathione, which again is essential for proliferation. Physiologic concentrations of the oxidized derivative cystine cannot substitute for cysteine deficiency since uptake of cystine is low in lymphocytes. Peripheral blood monocytes (PB-MO), especially when stimulated, secrete cysteine, which can be easily taken up by lymphocytes, thereby abolishing the hyporesponsiveness of intestinal lamina propria T lymphocytes (LP-T). Because PBMO are known to infiltrate the gut in Crohn's disease and ulcerative colitis, thiol-mediated costimulation could contribute to the hyperreactivity of LP-T in inflammatory bowel disease. In contrast, resident intestinal macrophages are defective in cysteine delivery and thus contribute to the physiological hyporesponsiveness of LP-T in the normal gut.

The hospital scene is changing. In Germany, the conversion of the existing system of reimbursement to one based on diagnosis-related groups for virtually all illnesses is casting an ominous shadow. A system that has been tested in Australia on no more than 40 per cent of illnesses is now to be introduced in Germany for all patients. While the all-inclusive compensation takes into consideration the needs of the individual patient, together with risks and the corresponding expenses, this happens only up to a point. One can see the need for increased salaries for healthcare personnel. Furthermore, the development of diagnostic and therapeutic procedures will also require financial investment that cannot happen in a cost-neutral fashion, at least not in the early stages. With this scenario it seems that working practices in hospitals will need to be made more efficient. One possibility is to relinquish certain service areas to external agents (outsourcing), allowing shorter periods of bed occupation. A reduction of bed occupancy of at least 30–40 per cent over the next 3–4 years seems probable, as the old system of reimbursement based on bed usage will cease to exist. Two points must be borne in mind if we are to cope successfully with the coming budgetary burdens. First, the mission of hospitals to provide care must be taken into consideration in calculating costs; unpredictable financial burdens, particularly in the area of emergency surgery, are to be expected. Second, the work routine in the hospital, particularly in surgical departments, must be adapted to the new conditions. The surgical unit, as the area of greatest cost intensity, must cooperate completely and smoothly with the units responsible for outpatient care and preoperative assessment, and with the intensive care, intermediate care and short-stay wards. Success will only be achieved by planning a ‘lean’ work routine in surgery1. This concept requires reliable, rapid cooperation with the patient’s family doctor, external specialists, non-surgical departments and, possibly, with rehabilitation centres. A core feature of this surgical work routine is the continuous compilation of patient data; anaesthesiology, radiology and complementary clinical areas (gastroenterology, cardiology, endocrinology, oncology etc.) must be enabled to contribute. An intelligent system of organization is required to integrate microbiology and laboratory medicine into the new working arrangement. The next step is to establish units within the surgical work flow, some oriented toward specific illnesses and others toward individual organs; for example, inflammatory bowel disease and oncology, and specific organ focal points such as the pancreas, liver, colon/rectum, oesophagus/stomach, soft tissues and endocrinology. The surgical patient can thus be fitted into a routine system according to the illness and involved organ. However, he or she is neither a ‘case’ nor a ‘customer’, but a person with specific problems, who is in need of competent treatment and who may be ill to the point of being unable to function, possibly afflicted with polymorbidity, family worries and concerns about the future, even fears for his or hers very existence. Continuous psychosocial and nursing care must be synchronized with medical therapies with the goal of allowing the patient a feeling of both security and hope, while being ‘put through the routine’. In the end, the qualitative result of the surgical operation settles the question of success, while the ‘lean’ routine is intended to attain an economic result. In the final analysis, the increased efficiency has the goal of providing the best treatment possible in the most realistic economic manner2,3. In the new system there will no longer be room for certain types of professional politics or professionally motivated egocentricity; cooperation of individual institutions and functional units is crucial. The administrative department must be involved, as the body that understandably expects profits and fears losses, but it must subordinate itself in a supportive way to the new procedure. It has been shown that the thorough documentation required in the new scheme cannot be accumulated accurately enough by administrators. While documentation per se is not a medical act, the surgeon must nonetheless take responsibility for this task as it often demands sophisticated medical knowledge, and because perfect data collection is necessary for success. The surgeon must become a data administrator in the interest of economic benefit, with the assistance of the administrative department in the area of electronic data processing. Planning the organization of work is not just an arithmetic exercise involving numbers of patients, doctors and hours. The training and competence of the individual surgeon, a profound knowledge of the therapeutic

BACKGROUND:Despite the wide range of surgical approaches for pouch salvage, septic complications are among the main causes of pouch failure.METHODS:This study analysed the mode and outcome of various therapeutic approaches for pouch salvage and the impact of time of diagnosis, localization and form of septic complications on the risk of pouch failure in 131 patients with septic complications of a total of 706 patients undergoing a J pouch procedure.RESULTS:Septic complications consisted of 76.3 per cent fistulas, 15.3 per cent anastomotic breakdowns and 8.4 per cent pelvic abscesses. A total of 107 patients (81.7 per cent) with septic complications required a mean of 2.2 surgical procedures. The frequency of permanent defunctioning and excision of the pouch in the 131 patients with septic complications was 23.7 and 6.1 per cent respectively. The estimated cumulative 3-, 5- and 10-year rate of pouch failure in patients with septic complications was 19.6, 31.1 and 39.2 per cent respectively. The risk of pouch failure was significantly affected by the site of origin of septic complications (P = 0.02). The 5-year pouch failure rate increased in a subgroup of patients with septic complications at the pouch-anal anastomosis when the anal sphincter was involved (50.1 versus 29.2 per cent; P = 0.18).CONCLUSION:Pouch failure as a result of septic complications may occur several years after ileal pouch-anal anastomosis. For prevention of pouch failure, surgery for septic complications is required in a high percentage of patients and repeated attempts are justified. Follow-up studies are required for further analysis of pouch failure.

BACKGROUND:F18-deoxyglucose (FDG) positron emission tomography (PET) is a promising imaging technique. The aim of this study was to investigate the use of FDG PET in patients with suspected liposarcomas (LS).PATIENTS AND METHODS:Forty-two masses were studied. The FDG uptake was estimated in tumor (T) and normal tissue (NT). The data were analyzed with respect to pathological findings.RESULTS:Pathology revealed 11 primary LS, 14 locally recurrent LS, 5 other sarcomas, 1 inflammation, 1 lymphoma and 10 benign lesions. FDG uptake (T-to-NT ratio) in 25 LS corresponded with the histological subtype. Pleomorphic, mixed and myxoid LS showed an increased T-to-NT ratio and were thus visualized. Four out of six well-differentiated LS presented a low FDG uptake. Like subtype, the tumor grade also corresponded to FDG uptake. The T-to-NT ratio of higher grade LS, contrary to low grade LS, was uniformly increased. Primary LS were distinguishable from benign tumors, while other sarcomas, inflammation and lymphoma were not. Recurrence was detected with a sensitivity of 86% and a specificity of 100%. False-negative diagnoses occurred only in well-differentiated recurrences.CONCLUSION:FDG uptake in LS correlates with the histological subtype and tumor grade. The diagnostic value of FDG PET in LS, therefore, is influenced by histomorphological parameters. Our data suggest that pleomorphic, mixed and higher-grade LS recurrences are preferentially amenable to FDG PET imaging.

Das schnelle Wachstum und die Komplexität des chirurgischen Wissens sowie die Notwendigkeit der ständigen, schnellen und kostengünstigen Aktualisierung der zur Verfügung stehenden Informationen stellen Anforderungen an die in der Fort- und Weiterbildung eingesetzten Medien, die nur durch ein datenbankgestütztes, multimediales und netzwerkfähiges Informationssystem zu erfüllen sind. In diesem Projekt soll eine solche multimediale digitale Bibliothek mit chirurgischen Inhalten vorgestellt werden.

Aim of this study was to evaluate a new histidine-tryptophan-ketoglutarate (HTK)-based preservation solution on chronic isograft injury in comparison to traditional HTK solution.Hearts of C57BL/6J (H-2b) mice were stored for 15 h in 0–4 °C cold preservation solution and then transplanted heterotopically into C57BL/6J (H-2b) mice. Three groups were evaluated: HTK, the base solution of a new preservation solution and hearts without cold ischemia (control). Time to restoration of heartbeat was measured (re-beating time). Strength of the heartbeat was palpated daily and scored on a 4-level scale (palpation score). Animals were sacrificed after 60 days of observation (24 h for TGF-β expression). The transplanted hearts were evaluated histologically for myocardial damage, vasculopathy and interstitial fibrosis. TGF-β expression was assessed immunohistologically. All investigators were blinded to the groups. ANOVA and LSD post hoc test were used for statistical analysis.The re-beating time was significantly shorter in hearts stored in the new solution (10.3 ± 2.6 min vs. HTK 14.2 ± 4.1 min; p < 0.05). The palpation score was significantly higher in hearts stored in the new solution (2.3 ± 0.4 vs. HTK 1.6 ± 0.5; p < 0.01). Hearts stored in the new solution showed a lower myocardial injury score (1.8 ± 0.2 vs. HTK 2.2 ± 0.7), less interstitial fibrosis (4.8 ± 1.9% vs. HTK 8.5 ± 3.8%, p < 0.05), less vasculopathy (14.7 ± 6.9% vs. 22.0 ± 23.2%; p = 0.06) and lower TGF-β1-expression (6.6 ± 1.4% vs. HTK 12.0 ± 4.6%).The new HTK-based solution reduces the chronic isograft injury. This protective effect is likely achieved through several modifications and supplements into the new solution like N-acetyl-l-histidine, glycine, alanine, arginine and sucrose.

A common pathway in the pathogenesis of acute pancreatitis is the generation of free oxygen radicals. The most important defense mechanisms are free radical scavengers, especially glutathione. This study evaluates the influence of the inhibition of glutathione synthesis with l-buthionine-(S,R)-sulfoximine (BSO) on the course of experimentally induced acute pancreatitis in rats and the effects on isolated pancreatic acini and their secretion pattern. Thus acute necrotizing pancreatitis was induced with intraductal infusion of low-dose glycodeoxycholic acid and subsequent hyperstimulation with cerulein with and without pretreatment with BSO. In vitro pancreatic acini were isolated and stimulated with different concentrations of cerulein with and without BSO. The BSO-treated group showed a significantly reduced survival, more necrosis, and a decreased secretion of amylase in vivo. No effect on secretion pattern in either groups was seen in vitro and BSO did not exert toxic effects. Based on the data presented, this study demonstrates deleterious effects of scavenger depletion on the course of experimental pancreatitis. This is due to the systemic effects of free oxygen radicals rather than to local effects.

BACKGROUND:Peritoneal seeding or liver metastases found at laparotomy usually preclude curative treatment in patients with gastric adenocarcinoma. Such exploratory laparotomies may be avoided by diagnostic laparoscopy. However, routine diagnostic laparoscopy does not benefit those patients who proceed to laparotomy after negative laparoscopy. The aim of this study was to evaluate prospectively the selective use of laparoscopy in uncertain situations.METHODS:One hundred and twenty consecutive patients with primary gastric adenocarcinoma were studied prospectively. Diagnostic laparoscopy was performed in patients with clinical T4 tumours or suspected metastases, unless laparotomy was required for symptomatic disease.RESULTS:Ninety-six of 120 patients were selected for immediate laparotomy with curative intent (n = 81) or for palliation (n = 15). In two of the 81 patients gastrectomy was abandoned because of unexpected peritoneal carcinomatosis. Fifteen patients underwent diagnostic laparoscopy, which identified intra-abdominal metastases in six; the other nine patients proceeded to laparotomy, which revealed peritoneal metastases not detected at laparoscopy in four patients. The remaining nine patients had overt metastases and were referred for systemic chemotherapy without abdominal exploration.CONCLUSION:Diagnostic laparoscopy in selected patients effectively limits the number of unnecessary invasive staging procedures. Routine use of diagnostic laparoscopy in all patients with gastric adenocarcinoma is not warranted.

Einleitung: Eine Laparotomie ist bei Patienten mit Magenkarzinom, wenn eine Peritonealkarzinose oder diffuse Lebermetastasierung vorliegt, nicht indiziert. Diese Befunde entgehen jedoch oft der präoperativen bildgebenden Diagnostik. Verbesserung der präoperativen Diagnostik durch den Einsatz der Laparoskopie könnte die explorative Laparotomie vermeiden. Die routinemäßige Anwendung der Laparoskopie bei allen Patienten mit Magenkarzinom könnte zur unnötigen Erweiterung der invasiven Diagnostik und zum Anstieg der damit verbundenen Komplikationen führen. Patienten und Methode: Alle Patienten, die im Zeitraum von 6/99 bis 8/01 in der Chirurgischen Universitätsklinik Heidelberg mit einem primären Magenkarzinom behandelt wurden, wurden prospektiv erfasst. Bei allen Patienten wurde präoperativ eine Gastroskopie, EUS, Sonographie des Abdomens und Röntgen-Thorax durchgeführt und ggf. durch CT und MRT ergänzt. Die Indikation zur Laparoskopie wurde gestellt, wenn die bildgebenden Verfahren (EUS, CT, MRT) bei asymptomatischen Patienten eine lokale Infiltration, Peritonealkarzinose oder diffuser Lebermetastasierung nicht sicher ausschließen konnten. Bei symptomatischen Patienten (Stenose, Perforation, Blutung) mit Indikation zu palliativen Maßnahmen, wurde auf die diagnostische Laparoskopie verzichtet. Ergebnisse: Seit Juni 1999 bis September 2001 wurden in unserer Klinik 130 Patienten wg. eines primären Magenkarzinoms behandelt. 105 Patienten (81%) wurden nach o.g. Kriterien primär laparotomiert: 77 mal mit kurativer Zielsetzung, 28 mal mit palliativer Zielsetzung. Bei 2 Patienten (1,5%), die mit kurativer Zielsetzung laparotomiert wurden, zeigte sich intraoperativ eine Peritonealkarzinose. Zehn weitere Patienten mit weit fortgeschrittenem, nicht resektablem Tumorleiden wurden direkt einer palliativen Chemotherapie zugeführt. 15 mal stellten wir die Indikation zur diagnostischen Laparoskopie. In 6 Fällen wurde nach der diagnostischen Laparoskopie die Operabilität als gegeben angesehen und es konnte eine potentiell kurative Operation durchgeführt werden. Bei 6 Patienten (5%) haben wir bei der diagnostischen Laparoskopie eine Peritonealkarzinose bzw. Lebermetastasen nachweisen können, so dass auf eine Laparotomie verzichtet werden konnte. Bei 3 weiteren Fällen wurde laparoskopisch eine Peritonealkarzinose nicht erkannt, die erst bei der nachfolgenden explorativen Laparotomie gesichert werden konnte. Schlussfolgerung: Bei sorgfältiger klinischer und bildgebender Diagnostik hat sich die selektive Indikationsstellung zur diagnostischen Laparoskopie bewährt.

Rektumkarzinomrezidive werden bei 3 - 50% der Patienten nach Primäroperation beschrieben. Wir untersuchten den Einfluß des operativen Vorgehens und des Einsatzes multimodaler Therapieverfahren intervallbezogen (82 - 89 und 90 - 97) im Hinblick auf das rezidivfreie und Gesamtüberleben. Patienten und Methodik:In die retrospektive Auswertung der prospektiv dokumentierten Patientendatei (82 - 97) wurden insgesamt 247 Patienten mit einem Rektumkarzinomrezidiv (Primär-OP: 121 [49%] in HD, 126 [51%] auswärts) eingeschlossen. Darüberhinaus erfolgte eine Einteilung in konservativ (n = 96) und operativ (n = 151) behandelte Patienten sowie in 2 gleichgroße Zeitintervalle (Int. I: 82 - 89, n = 119; Int. II: 90-97, n = 128). Die Daten wurden auf einem eigens konzipierten Erhebungsbogen erfasst und computergestützt ausgewertet. Die Berechung der üLR erfolgte nach dem Verfahren von Kaplan-Meier. Ergebnisse:Für alle Patienten betrug das mittlere rezidivfreie überleben nach Primäroperation 22,8 Monate (I: 19,1 ± 17,3 vs II: 23,9 ± 19,8). Knapp 70% der Rezidive traten innerhalb der ersten 2 Jahre (34,5% asymptomatisch) auf. Sie waren in 34% auf die Anastomose beschränkt, bei 66% lag ein extraluminales Rezidiv vor. Insgesamt wurden 151 Patienten (61%) mit einem Rezidiv operiert. R-Status: RO: n = 44 (33%), Rl:n = 9, R2: n = 79 (60%), keine Resektion: n= 19 (13%). Für die mit Rezidiv RO-resezierten Patienten lag das mittl. rezidivfreie überleben bei 20,7 ± 18,1 (Int. I) vs 24,3 ± 13,3 (Int. II) und mit einer 18% 5J.-üLR signifikant Über den inoperablen/R1/R2- Patienten (5J.-ÜLR: 0 -7%) (p < 0,001). Die Zahl der RO- resezierten Patienten stieg von 12/60 (Int.I: 20%) auf 32/91 (Int.II: 35%) verbunden mit einer Verbesserung der 5 J. ÜLR von 8 auf 23% (p < 0,05).Bei kurativem Ansatz wurde nahezu durchwegs eine abdomino-perineale Exstirpation (insgesamt bei 40%) durchgeführt. Dabei stieg die Anzahl der erweiterten Eingriffe von 25% (Int.I) auf über 80% (Int.II). Wenngleich bereits knapp 47% zum Zeitpunkt der Diagnose Fernmetastasen aufwiesen wurde als Hauptursache für die nicht kurative Einschätzung zu 75% das regionale Tumorwachstums genannt. Der intra-und postoperative Blutverlust lag im Mittel bei 1530 ml, die postoperative Komplikationsrate bei 34%. Die 30 Tage Letalität war rückläufig (Int.I: 6%, Int.II: 3,9%, R0-resezierte Patienten: 0%). Zusammenfassungg:Die Prognose RO-resezierter Patienten ist mit den Ergebnissen nach primär OP vergleichbar. Die Radikalität (RO-Resektionen) nahm im Intervall zwischen 1990 - 97 am ehesten auch infolge der neoadjuvanten Radiochemotherapie (+ IORT) zu. Gleichzeit kam es zu einem Abfall der Mortalität bei signifikantem Anstieg der 5 J. ÜLR.