Search

The SAWHI study showed that negative pressure wound therapy (NPWT) reduced treatment time by 7.8 days and had a 20.2% higher wound closure rate, but required a 2.1-day longer hospital stay than conventional wound treatment (CWT). The majority of study participants began treatment in the hospital and were discharged within 42 days.As an add-on to a multicenter randomized clinical trial, selected aspects of hospital discharge, outpatient treatment continuation, and subsequent wound closure outcomes are compared between the treatment arms in patients with subcutaneous abdominal wound healing impairment after surgery without fascia dehiscence in the per protocol population.Within 42 days, wound closure rates were higher for outpatients in the NPWT arm than for outpatients in the CWT arm (27 of 55 [49.1%]) for both outpatient continuation of NPWT (8 of 26 [30.8%]) and outpatient CWT after NPWT was finished (27 of 121 [22.3%]). Time to wound closure was shorter for outpatients in the NPWT arm (outpatient transfer with: NPWT Mean ± standard error 28.8 ± 8.0 days; CWT 28.9 ± 9.5 days) than in the conventional treatment arm (30.4 ± 8.0 days). Nevertheless, within 30 study sites with patient enrollment, outpatient NPWT was performed in only 20 study sites for 65 of 157 study participants in the treatment arm.Outpatient NPWT of postsurgical abdominal wounds with healing impairment is feasible and successful and should be encouraged whenever possible. Study site specific avoidance of outpatient NPWT emerges as an additional reason for the prolonged hospitalization time. Trial Registration ClinicalTrials.gov Identifier NCT01528033. Date of registration: February 7, 2012, retrospectively registered.

Die Analyse der Versorgungsqualitat beim kolorektalen Karzinom ist ein wesentlicher Baustein fur deren Weiterentwicklung und basiert auf dem Vergleich der gesteckten Ziele mit der tatsachlichen Versorgungsqualitat. In dieser Publikation soll die Versorgungsrealitat im Bundesland Brandenburg in der gesamten Breite aller versorgenden Kliniken auf der Basis der Daten des Klinischen Krebsregisters dargestellt werden. Analysiert wurden die Anzahl der entnommenen und untersuchten Lymphknoten, die TME(totale mesorektale Exzision)-Qualitat, die R0(Residualtumor)-Resektionsrate und der Anteil der adjuvanten Therapie des Kolonkarzinoms im UICC(Union internationale contre le cancer)-Stadium III in Abhangigkeit von der Operationszahl der Krankenhauser bzw. deren Zertifizierung als Darmkrebszentrum nach Onkozert. Die Analysen zeigten bis auf den R‑Status keine Unterschiede in den vom Klinischen Krebsregister erfassten qualitativen Operationsdaten in Abhangigkeit vom Hospitalvolumen.

This NEUROmonitoring System (NEUROS) trial assessed whether pelvic intraoperative neuromonitoring (pIONM) could improve urogenital and ano-(neo-)rectal functional outcomes in patients who underwent total mesorectal excisions (TMEs) for rectal cancer.High-level evidence from clinical trials is required to clarify the benefits of pIONM.NEUROS was a two-arm, randomized, controlled, multicenter clinical trial that included 189 patients with rectal cancer who underwent TMEs at eight centers, from February 2013 to January 2017. TMEs were performed with pIONM (n=90) or without it (control, n=99). The groups were stratified according to neoadjuvant chemoradiotherapy and sex, with blocks of variable length. Data were analyzed according to a modified intention-to-treat protocol. The primary endpoint was urinary function at 12 months after surgery, assessed with the International Prostate Symptom Score, a patient-reported outcome measure. Deterioration was defined as an increase of at least five points from the preoperative score. Secondary endpoints were sexual and anorectal functional outcomes, safety, and TME quality.The intention-to-treat analysis included 171 patients. Marked urinary deterioration occurred in 22/171 (13%) patients, with significantly different incidence between groups (pIONM: n=6/82, 8%; control: n=16/89, 19%; 95% confidence interval, 12.4-94.4; P=0.0382). pIONM was associated with better sexual and ano-(neo)rectal function. At least one serious adverse event occurred in 36/88 (41%) in the pIONM group and 53/99 (54%) in the control group, none associated with the study treatment. The groups had similar TME quality, surgery times, intraoperative complication incidence, and postoperative mortality.pIONM is safe and has the potential to improve functional outcomes in rectal cancer patients undergoing TME.

Bei zahlreichen gastrointestinalen Tumoren, wie dem Osophaguskarzinom, dem Magenkarzinom, dem Rektumkarzinom, sowie bei der Behandlung kolorektaler Lebermetastasen fuhrt eine perioperative multimodale Therapie zu einer Prognoseverbesserung. Durch praoperative Therapien soll u. a. die Chance auf eine R0-Resektion des Tumors steigen, somit ist das Ausmas einer histopathologischen Tumorregression von prognostischer Bedeutung. Die chirurgische Resektion ist hierbei nach wie vor zentraler Bestandteil einer kurativ intendierten Therapie. Diese Arbeit basiert auf einer selektiven Literaturrecherche der Datenbanken PubMed, National Comprehensive Cancer Network (NCCN) und den aktuellen S3-Leitlinien zum Thema „Perioperative/neoadjuvante Chemo‑, Immun- und Radiotherapie“. Moderne onkologische Therapiekonzepte umfassen besonders die perioperative Chemotherapie und/oder die Radiochemotherapie und erhohen nach aktuellen Studiendaten masgeblich die Rate der Resektabilitat (generell und speziell R0), ohne die postoperative Morbiditat oder Mortalitat wesentlich zu erhohen. Die Auswahl und Kombination der entsprechenden multimodalen Therapieansatze erfordert eine umfassende interdisziplinare Abstimmung hinsichtlich der zeitlichen Abfolge der Therapiemodalitaten. Daneben ist ein umfassendes Management von Nebenwirkungen essenziell. Therapiestandards unterliegen einem stetigen Wandel; der vorliegende Uberblick uber multimodale Therapiekonzepte und ihre Bedeutung fur das chirurgische Vorgehen soll dazu beitragen, bei Therapieentscheidungen zu unterstutzen.

Background: Postoperative pancreatic fistula (POPF) is a major cause of morbidity after pancreaticoduodenectomy. There is no consensus on the best technique to protect the pancreato-enteric anastomosis and reduce the rate of POPF. This study investigated the feasibility and efficiency of external suction drainage of the pancreatic duct to improve the healing of pancreaticogastrostomy.Methods: Between July 2019 and June 2021, 21 consecutive patients undergoing elective pancreaticoduodenectomy were included. In all patients we performed a pancreaticogastrostomy and inserted a negative pressure drainage into the pancreatic duct. The length and diameter of the pancreatic duct were measured and the texture of the pancreas was evaluated. The daily secretion volume and the lipase value via pancreatic duct drainage were documented. The occurrence of POPF was evaluated.Results: None of the patients had drainage-related complications. In 4 patients we registered a dislocation of the drainage from the pancreas duct into the stomach. 17/21 Patients showed no signs of POPF. A biochemical leak was measured in one patient. Furthermore, 2 patients had a POPF grade B. In one patient, POPF grade C required reoperation and resection of the remnant pancreas. All 4 cases of POPF met the risk criteria soft pancreas, high volume and high lipase value in the duct drainage.Conclusion: The insertion of the pancreatic duct drainage was feasible and caused no drainage-related morbidity. POPF-rate was moderate in the risk population of soft pancreas and small duct.

IMPORTANCE: Negative pressure wound therapy (NPWT) is an established treatment option, but there is no evidence of benefit for subcutaneous abdominal wound healing impairment (SAWHI). OBJECTIVE: To evaluate the effectiveness and safety of NPWT for SAWHI after surgery in clinical practice. DESIGN, SETTING, AND PARTICIPANTS: The multicenter, multinational, observer-blinded, randomized clinical SAWHI study enrolled patients between August 2, 2011, and January 31, 2018. The last follow-up date was June 11, 2018. The trial included 34 abdominal surgical departments of hospitals in Germany, Belgium, and the Netherlands, and 539 consecutive, compliant adult patients with SAWHI after surgery without fascia dehiscence were randomly assigned to the treatment arms in a 1:1 ratio stratified by study site and wound size using a centralized web-based tool. A total of 507 study participants (NPWT, 256; CWT, 251) were assessed for the primary end point in the modified intention-to-treat (ITT) population. INTERVENTIONS: Negative pressure wound therapy and conventional wound treatment (CWT). MAIN OUTCOMES AND MEASURES: The primary outcome was time until wound closure (delayed primary closure or by secondary intention) within 42 days. Safety analysis comprised the adverse events (AEs). Secondary outcomes included wound closure rate, quality of life (SF-36), pain, and patient satisfaction. RESULTS: Of the 507 study participants included in the modified ITT population, 287 were men (56.6%) (NPWT, 155 [60.5%] and CWT, 132 [52.6%]) and 220 were women (43.4%) (NPWT, 101 [39.5%] and CWT 119 [47.4%]). The median (IQR) age of the participants was 66 (18) years in the NPWT arm and 66 (20) years in the CWT arm. Mean time to wound closure was significantly shorter in the NPWT arm (36.1 days) than in the CWT arm (39.1 days) (difference, 3.0 days; 95% CI 1.6-4.4; P