How to Select Patients with Peri- toneal Neoplasms for Cytoreductive Sur- gery and Intraperitoneal Hyperthermic Chemoperfusion. Performance status and se- vere comorbidities, age, the localization of the primary tumor, and the presence or absence of distant metastases allow a rough decision of whether a multimodal treatment with cytoreduc- tive surgery and intraperitoneal hyperthermic chemoperfusion is feasible. The 2 most informa- tive selection criteria, Peritoneal Cancer Index and involvement of the small bowel, usually are evaluated intraoperatively. Presence or absence of lymph node metastases, histological grading, and ascites may add a decision-making help on the borderline. Interdisz Onkol 2012; 1 (2): 30- 3.

PURPOSE: Synopsis about the curative possibilities of an aggressive multimodal therapeutic approach for peritoneal metastases using positive prognostic selection criteria. PATIENTS AND METHODS: Published data concerning cytoreductive surgery in combination with intraoperative intraperitoneal hyperthermic chemotherapy and/or early postoperative intraperitoneal chemotherapy ± systemic chemotherapy in patients suffering from peritoneal carcinomatosis were analyzed with regard to subgroups with long-term survivors. RESULTS: Extent of peritoneal carcinomatosis and completeness of cytoreductive surgery are the most important prognostic factors predicting long-term survival. Histological differentiation, lymph node status, performance status, extent of prior therapy and age are further independent factors influencing the outcome. CONCLUSION: Strictly selecting patients with multiple positive prognostic factors might result in 5-year survival rates of 50% and more.

Background: Hypocalcaemia after thyroidectomy is thought to result from surgical damage to the parathyroid glands. This study analysed postoperative outcomes related to perioperative parathyroid hormone (PTH) levels.Methods: Some 402 consecutive patients undergoing thyroid surgery were studied prospectively to monitor perioperative changes in serum PTH and Ca2+ levels, and clinical symptoms of hypocalcaemia.Results: Transient symptomatic hypocalcaemia and persistent hypoparathyroidism occurred in 61 (15 per cent) and six (1.5 per cent) of 402 patients respectively. The intraoperative decline in PTH was 20.2 per cent; the trough (63.8 per cent of preoperative value) was reached 3 h after surgery. Before surgery, PTH levels were correlated inversely with scrum Ca2+ concentration. The correlation remained Positive from 3 h after surgery until postoperative day 14. Thus, PTH secretion was reduced, but remained sufficient to prevent symptomatic hypocalcaemia in most patients. A low serum PTH level was predictive of persistent hypoparathyroidism (sensitivity and negative predictive value 100 per cent, but poor specificity of 54.1 percent).Conclusion: Thyroid surgery, impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.

27th Annual Meeting of the Surgical Working Group of Endocrine Surgery (CAEK) of the German Society of General and Visceral Surgery, 13–15 November 2008, Rostock, Germany Scientific Chairman and Organization Prof. Dr. Ernst Klar University Hospital of Rostock Department of General, Thoracic, Vascular and Transplant Surgery Schillingallee 35 18057 Rostock, Germany Organization Dr. Leif Schiffmann University Hospital of Rostock Department of General, Thoracic, Vascular and Transplant Surgery Schillingallee 35 18057 Rostock, Germany Phone:+49 (0)381 4946003 Fax:+49 (0)381 4946002 Email: leif.schiffmann@med.uni-rostock.de Location Yachthafenresidenz Hohe Düne Hohe Düne/Am Yachthafen 1 18119 Rostock-Warnemünde Germany 1 INTRAOPERATIVE PARATHYROID HORMONE MEASUREMENT FOR DETECTION OF MULTIPLE GLAND DISEASE Ayman Agha, Klaus Kienle, Christian Moser, Igors Iesalnieks, Hans J. Schlitt Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Germany Background: The value of intraoperative parathyroid hormone measurement for detection of multiple gland disease is still discussed controversially. Patients and methods: From 01/2003 to 12/2007 we operated on 87 patients with pHPT. IPTH was measured routinely before anaesthesia started and 10 and 15 min after extirpation of the adenoma. We retrospectively analysed the rate of detected multiple gland diseases by IPTH-testing. Results: Single gland disease has been found in 78 (91.7%) patients. Double adenoma or hyperplasia occurred in nine patients (10.3%). In each of these nine cases there was an adequate decrease of PTH only after removal of the second adenoma. All patients were monitored attentive after operation. Conclusion: iPTH allows for differentiation between singleand multiple-gland disease and helps in an minimal-invasive approach of surgical treatment of pHPT. 2 OVARIAN METASTASES AS INITIAL DIAGNOSIS OF NEUROENDROCINE CARCINOMA (NEC) OF THE ILEUM (CASE REPORTS) Aycan Akca, A. Starke, Bernhard J. Lammers, Peter E. Goretzki Chirurgische Klinik, Lukaskrankenhaus Neuss, Neuss, Germany Insulinom & GEP-Tumorzentrum Neuss-Düsseldorf, Medizinische Klinik, Universität Düsseldorf, Neuss, Germany Background: Neuroendocrine carcinoma (NEC) develops to 65–85% in the gastrointestinal tract. In this NEC of the small intestine occurs in up to 38% and in the ileum in up to 80%. The classic symptoms consist of non-specific tumor complaints, ileus and carcinoid syndrome in case of metastases. Often the diagnosis is found accidentally. Patients and methods: We report on three female patients with NEC, who suffered primarily from an ovarian tumor. The average age was 64 years. The patients were examined because of suspected ovarian tumor. The histology showed evidence of NEC. The primary tumor location was unknown. Further diagnosis (laboratory findings, radiological and nuclear-medical tests) revealed lymph node metastases of the NEC near the pancreas and the primary tumor in the ileum. Results: In all three patients a right hemicolectomy was accomplished, in two cases also resection of the ileum and the lymph node metastasis was performed. The postoperative course was uneventful in each case. Conclusion: The clinical manifestation of ileum NEC may show an ovarian metastasis, as primary finding. NEC of the ovary is rare and a NEC in the ovary should be regarded a possible metastases of a GITNEC of unknown primary location. 3 MINIMALLY INVASIVE RADIO-GUIDED REOPERATIONS WITH INTRAOPERATIVE IPTH ASSAY IN PRIMARY HYPERPARATHYROIDISM Marcin Barczynski, Alicja Hubalewska-Dydejczyk, Aleksander Konturek, Anna Sowa-Staszczak, Stanislaw Cichon Department of Endocrine Surgery, Jagiellonian University, College of Medicine, Krakow, Poland Department of Endocrinology, Jagiellonian University, College of Medicine, Krakow, Poland Langenbecks Arch Surg (2008) 393:1021–1035 DOI 10.1007/s00423-008-0416-1 DO00416; No of Pages © Springer-Verlag 2008 Background: Parathyroidectomy in the reoperative neck is a challenge with much higher morbidity rates and lower success rate than firsttime surgery. This study aimed to evaluate minimally invasive radioguided parathyroidectomy (MIRP) in the reoperative neck. Patients and methods: Twelve consecutive patients with primary hyperparathyroidism (HPT) who had undergone at least one previous neck operation were referred for re-exploration (six persistent, one recurrent, five following thyroidectomy). All patients underwent preoperative SPECT scanning and high-resolution ultrasound of the neck. Operations consisted of MIRP (GammaFinder II) performed 1 h after iv injection of 10 mCi of Tc99m-MIBI. Intraoperative iPTH assay (Future Diagnostics) was used to determine cure. Results: All patients were cured after reoperation. A solitary parathyroid adenoma was found in retroesophageal space (four), in tracheoesophageal groove (five), within thyreothymic ligament (one) and within thymus (two). Mean operative time was 49±10 min, mean incision length 3.5±0.5 cm. There was no morbidity. Conclusion: MIRP was effective in the reoperative neck of patients with HPT. The intraoperative scan-directed focused approach offered limited and safe dissection through a small incision. 4 CHASE THE PRIMARY – NEW ALGORITHME IN NEUROENDOCRINE CARCINOMA (NEC) WITH UNKNOWN PRIMARY? Nehara Begum, Katharina Auerswald, Hans-Peter Bruch, Conny Bürk Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany Background: The therapeutic options of metastatic neuroendocrine carcinoma with surgery in curative intention can only be performed if the primary can be removed. What can we do surgically to reach this goal in rare cases without detection of the primary in standard diagnostic procedure? Patients and methods: Case report of two patients with history over 5 and 20 years with peritoneal and hepatic metastasis of neuroendocrine carcinoma of unknown primary. Explorative laparotomy revealed the primary in the ileum. In one case complete tumor resection including partial peritoneumectomy was performed. Retrospective view of the own databank was done to detect more of this cases. Results: Out of 155 patients with NEC of lung and gastroenteropancreatic tract nine cases (5.8%) were of unknown primary. In two cases (22%) the primary was detected in the ileum due to explorative laparotomy. Before presentation in our department this patient had only a diagnostic laparoscopy. In four cases metastasis was only in isolated lymph nodes. In 33% a tumor free situation could be achieved after open surgery.

BACKGROUND: Hypoparathyroidism still remains an underestimated complication after thyroidectomy; the kinetics of parathyroid hormone (PTH) are poorly understood. It is generally assumed that careful surgical preparation reduces the risk for postoperative persistent hypocalcaemia, but the standard of surgical care is illdefined. METHODS: We designed three protocols in order to (i) define the perioperative PTH- and Ca2+-kinetics, (ii) delineate intraoperatively the anatomic location of the parathyroid glands, (iii) correlate the temporal evolution of clinical symptoms of hypocalcaemia with the plasma levels of Ca2+ and PTH. RESULTS: The objective is to define perioperative parameters that may be predictive of persistent hypocalcemia. We tested the feasibility of our approach in a patient undergoing thyroidectomy for multinodular goitre: during surgery, PTH declined from 36.1 pg/ml to only 8.3 pg/ml (i.e. 23%). Two parathyroid glands were detected by the surgeon and carefully preserved, 2 glands remained invisible. However, parathyroid function recovered within 14 days. Calcium-levels fell from 2.21 mmol/l to a minimum of 1.98 mmol/l on the first postoperative day, but hypocalcaemia-related symptoms were not observed. CONCLUSIONS: Parathyroid gland function can be markedly impaired by surgical manipulation during thyroidectomy but this does not necessarily translate into postoperative clinical symptoms. Our protocols are suitable for collection of large prospective data series to better understand the mechanism of long-lasting or persistent hypocalcaemia.

Sling suspension is a treatment option for intrinsic sphincter deficiency after radical prostatectomy. Using the retropubic pathway for implanting sling systems risks bladder perforation or bleeding, as is also the case in women. The male perineal sling described and used currently needs bone anchors and sutures to tighten the sling, using a perineal approach [1–5]. Comiter et al. [1] reported the effectiveness of the perineal bone-anchored sling in a prospective study, and Dikranian et al. [6] that the synthetic mesh graft is better than allogenic grafts. However, the question remains; are bone anchors really necessary to place a perineal sling?