Background Gender-specific differences may gain increasing importance in clinical medicine and also in oncology. Methods By means of a narrative review, gender-specific differences of selected cancer entities of the gastrointestinal (GI) tract and neighboring structures as well as the precancerous lesions are described with respect to patient, findings and treatment-associated aspects. Results (corner points) In men the frequency of newly diagnosed malignant diseases seems to be higher in general (exception: carcinoma of the thyroid gland; same frequency: pancreatic cancer, melanoma of the skin). The survival rates are predominantly better in female patients, but there is a better compliance and higher care expectations for women than men versus more hospital deaths and more frequent admissions to hospital in men than women. In some malignant diseases with a distinct gender preference, a close association to the hormone status has been assumed for a long time. The male gender is associated with a worse prognosis in colorectal cancer (CRC) in addition to other factors. Together with precancerous lesions and risk factors, gender, various genotypes, polymorphisms, socioeconomic and behavioral psychological factors also play a role. Discussion Gender-dependent differences can be classified into incidence, risk profile, socioeconomic aspects, symptomatology, diagnostics, surgical approach options, frequency and spectrum of complications as well as prognosis. Conclusion Taken together, not only biological prerequisites but also gender-specific behavioral patterns as complex interacting aspects may have a substantial impact on the prognosis and long-term survival.

Background/Aim: Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. Methods: By means of a prospective nationwide registry (n = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer <12 cm from the anal verge with a negative (>1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, n = 25; nCRT+TME, n = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). Results: In the TME-alone group, tumors were located closer to the anal verge (p = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (p = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; p = 0.268). Local recurrences occurred at a similar rate in the TME-alone (n = 1; 5.3%) and nCRT+TME groups (n = 3; 5.5%) (p = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (p = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. Conclusions: In this cohort of patients with rectal cancer located <12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

Ziel Eruierung des DM-Einflusses auf das früh-postop./Langzeit-onkochir. Outcome nach Colon-Ca-Operation.

Der Stellenwert der simultanen Splenektomie im Rahmen einer onkologisch adäquaten Magenresektion wurde in den letzten Jahrzehnten häufig kontrovers diskutiert. Innerhalb einer prospektiven multizentrischen Beobachtungsstudie wurden vom 01.01.2007 bis zum 31.12.2009 in 141 Kliniken jeglichen Versorgungsprofils Daten von Patienten erfasst, die mit histologisch gesichertem, primärem Magenkarzinom oder Karzinom des ösophagogastralen Übergangs (AEG) stationär aufgenommen und einer operativen Therapie zugeführt wurden. Insgesamt wurden 2897 Patienten (Tumorresektionen n = 2545) in die Studie eingeschlossen. Die Rate der Splenektomie lag im gesamten Patientengut bei 11,1 % (n = 283), der prozentual höchste Anteil fand sich bei AEG-Tumoren mit 19,4 %. Sowohl im Gesamtkrankengut als auch in Abhängigkeit von der Tumorlokalisation zeigte sich in der Splenektomiegruppe eine höhere präoperative Begleitmorbidität. Während die Rate der allgemeinen postoperativen Komplikationen nach Splenektomie in der Gesamtgruppe und auch in Abhängigkeit von der Tumorlokalisation signifikant erhöht war, gab es hinsichtlich der spezifischen postoperativen Komplikationen keine Unterschiede. Eine signifikant höhere Hospitalletalität nach Milzentfernung im Vergleich mit nichtsplenektomierten Patienten war nur in der Gruppe der AEG-Tumoren festzustellen (15,2 % vs. 5,0 %). Alle splenektomierten Patienten zeigten ein kürzeres Langzeitüberleben (p < 0,001) im Vergleich zu den Resektionen mit Milzerhalt (18 vs. 36 Monate). Im Rahmen der operativen Therapie des Magenkarzinoms erwies sich die Splenektomie als negativer Prädiktor für ein schlechteres perioperatives Outcome sowie ein schlechteres Langzeitüberleben.