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13. Impact of the new TNM Staging System (8th edition) on oral tongue cancers

Author

Ammann, Yanic, Beutner, Ulrich, Vital, Domenic Gian, Morand, Grgoire, Broglie Daeppen, Martina A; https://orcid.org/0000-0002-5573-818X, Born, Diana, Stoeckli, Sandro J, Huber, Gerhard F, Ammann, Yanic, Beutner, Ulrich, Vital, Domenic Gian, Morand, Grgoire, Broglie Daeppen, Martina A; https://orcid.org/0000-0002-5573-818X, Born, Diana, Stoeckli, Sandro J, and Huber, Gerhard F

Abstract

AIM OF THE STUDY For tumours of the oral tongue, the most recent 8th edition of the AJCC/UICC staging system has introduced depth of infiltration (DOI) as a novel parameter. With this study we wanted to investigate its impact regarding this risk stratification compared with the preceding 7th edition. METHODS Between 2008 and 2017, 161 patients of two tertiary referral centres in Switzerland (Kantonsspital St. Gallen and University Hospital Zurich) with T1 N0 or T2 N0 tongue cancers were enrolled in this study. The primary tumours were restaged according to the 8th edition of the TNM classification. Kaplan-Meier curves for overall and disease-specific survival were calculated. RESULTS According to the 7th edition, of the 161 patients, 102 were staged after surgery as pT1 (stage I) and 59 as pT2 (stage II). According to the 8th edition, 36 patients (22.4%) were re-staged to a higher stage. Of these 36 patients, 8 (22.2%) experienced a recurrence, and 9 (25%) died. In the remaining, not re-staged group, 20 patients (16.0%) experienced a recurrence (p = 0.55) and 14 (11.2%) died (p = 0.025*). The 7th edition showed a statistically significant difference between pT1 and pT2 tumours for overall survival (p = 0.025), but not for disease-specific survival (p = 0.091), whereas the 8th edition was able to well discriminate between pT1, pT2 and pT3 for both overall (pT1 vs pT2, p = 0.016*; pT2 vs pT3, p = 0.031*) and disease-specific survival (pT1 vs pT2, p = 0.037*; pT2 vs pT3, p = 0.023*). CONCLUSION The recent TNM 8th edition provides a more accurate prediction of overall and disease-specific survival for this subgroup of patients. Hence, a more aggressive treatment should be considered for patients re-staged to pT3 due to depth of infiltration.

Published
2021

18. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery

Author

Warschkow, Rene, Tarantino, Ignazio, Ukegjini, Kristjan, Beutner, Ulrich, Müller, Sascha, Schmied, Bruno, and Steffen, Thomas

Abstract

Purpose: This study assessed the diagnostic accuracy of C-reactive protein (CRP) after gastroesophageal cancer resection for postoperative inflammatory complications (PIC). Methods: The clinical data and CRP values of patients operated on for gastroesophageal cancer surgery between 1997 and 2009 were retrospectively analyzed. The results of this study were compared with published data using a meta-analytic approach for diagnostic outcomes. Results: Of 210 patients included in the study, 59 developed PIC (28.1%; 95% CI: 22.5-34.5%). On the postoperative day (POD) 4 and 7, CRP had the best diagnostic accuracy for PIC (AUC 0.77; 95% CI, 0.64-0.91, AUC 0.81; 95% CI, 0.71-0.91). Using a cut-off value of 141mg/L (95% CI, 131-278mg/L) for CRP on POD 4, the sensitivity was 0.78 (95% CI, 0.55-0.91), the specificity was 0.70 (95% CI, 0.53-0.83) and the NPV was 0.89 (95% CI, 0.77-0.95). The in-hospital mortality rate was 3.3% (95% CI, 1.5-6.9%). In a diagnostic meta-analysis that included two additional studies, CRP had a significant predictive value after POD 3. Conclusion: There is limited evidence for the diagnostic accuracy of CRP levels for PIC after gastroesophageal cancer surgery. CRP levels on POD 4 might be useful to rule out PIC, but its diagnostic accuracy is moderate at best. For clinical routine use CRP levels are clearly not sufficient to predict PIC and have to be interpreted in the context of the whole clinical picture

Published
2018

20. C-Reactive Protein 2 Days After Laparoscopic Gastric Bypass Surgery Reliably Indicates Leaks and Moderately Predicts Morbidity

Author

Warschkow, Rene, Tarantino, Ignazio, Folie, Patrick, Beutner, Ulrich, Schmied, Bruno, Bisang, Philipp, Schultes, Bernd, and Thurnheer, Martin

Abstract

Background: The aim of the present study was to evaluate whether serum C-reactive protein (CRP) is a useful predictor of early post-operative complications, particularly of intestinal leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Methods: The present study was a retrospective analysis of a prospectively maintained database with 809 patients who underwent LRYGB from 2002 until 2011. For 410 of these patients, at least one CRP measurement within the first seven post-operative days was available. The diagnostic value was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: Forty-nine of 410 patients (12.0%; 95% confidence intervals [95% CI], 9.2-15.5%) developed surgery-related complications. Leaks occurred in 17 patients (4.1%; 95% CI, 2.6-6.5%) at a median of 5days after surgery. CRP levels 2days after surgery showed the highest diagnostic value for post-operative complications (AUC, 0.74; 95% CI, 0.60-0.89). Sensitivity was 0.53 (95% CI, 0.31-0.74) and specificity was 0.91 (95% CI, 0.79-0.96) on day 2 (cutoff level, 229mg/l). The sensitivity for intestinal leaks was 1.00 (95% CI, 0.51-1.00). Conclusion: CRP on post-operative day 2 is a valuable predictor of post-operative complications, in particular intestinal leaks. Radiological imaging studies for intestinal leaks could be restricted to patients with CRP values exceeding 229mg/l

Published
2018

23. Functional outcome after perineal stapled prolapse resection for external rectal prolapse

Author

Borovicka Jan, Beutner Ulrich, Wolf Katja, Roushan Amir H, Hetzer Franc H, Lange Jochen, and Marti Lukas

Subjects
Surgery, RD1-811
Abstract

Abstract Background A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. Methods From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. Results 32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported. Conclusions The PSP is an elegant, fast and safe procedure, with good functional results. Trial registration ISRCTN68491191

Published
2010
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28. Body Packing: From Seizures to Laparotomy

Author

Janczak, Joanna M., Beutner, Ulrich, and Hasler, Karin

Subjects
Article Subject
Abstract

Body packing is a common method for illegal drug trafficking. Complications associated with body packing can be severe and even lead to rapid death. Thus, a timely diagnosis is warranted. As most body packers initially do not show any symptoms, making a correct diagnosis can be rather challenging. We describe a case of a 41-year-old male, who was admitted with an epileptic seizure and who turned out to be a cocaine intoxicated body packer. Due to neurological and cardiovascular deterioration an emergency surgery was performed. Four bags of cocaine could be removed. We discuss the current management regimen in symptomatic and asymptomatic body packers and highlight pearls and pitfalls with diagnosis and treatment.

Published
2015
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29. Does caffeine reduce postoperative bowel paralysis after elective laparoscopic colectomy? (CaCo trial): study protocol for a randomized controlled trial

Author

Kruse, Christina, primary, Müller, Sascha A., additional, Warschkow, René, additional, Lüthi, Cornelia, additional, Brunner, Walter, additional, Marti, Lukas, additional, Sulz, Michael Christian, additional, Schmied, Bruno M., additional, Tarantino, Ignazio, additional, and Beutner, Ulrich, additional

Published
2016
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33. Diagnosis and treatment of small follicular thyroid carcinomas

Author

Clerici, Thomas, Kolb, Walter, Beutner, Ulrich, Bareck, Evelyne, Dotzenrath, Cornelia, Kull, Christof, Niederle, Bruno, and German Association of Endocrine Surgeons

Subjects
Adult, Male, medicine.medical_specialty, Adenoma, medicine.medical_treatment, Population, Medizin, Thyroid carcinoma, Germany, Adenocarcinoma, Follicular, medicine, Humans, Thyroid Neoplasms, Overdiagnosis, education, Thyroid cancer, Aged, Completion thyroidectomy, education.field_of_study, business.industry, Thyroid, Thyroidectomy, Middle Aged, medicine.disease, Tumor Burden, Surgery, medicine.anatomical_structure, Austria, Female, Radiology, Neoplasm Recurrence, Local, business, Switzerland
Abstract

Background Follicular thyroid microcarcinomas (mFTCs) of 10 mm or less in size rarely manifest clinically and their clinical significance is controversial. This study assessed their characteristics and incidence, and analysed treatment modalities used for mFTC. Methods Members of the German Association of Endocrine Surgeons were asked to review patients with mFTC operated on between 1990 and 2005. Results Data for 90 patients from 26 institutions were reported. Histopathological slides were available for re-evaluation in 35 patients. Most initial diagnoses had to be revised because of incorrect size assessment or incorrect diagnosis (benign adenoma, papillary thyroid carcinoma (PTC), follicular variant of PTC). The diagnosis of mFTC was confirmed in only four patients. As a result of the incorrect histopathological diagnosis, unnecessary completion thyroidectomy and radioiodine ablation were performed in 17 and 20 patients respectively. The incidence of mFTC was calculated to be 0·12 per million population per year. Conclusion mFTC is exceptionally rare. Such tumours are overdiagnosed, resulting in unnecessary treatment associated with avoidable morbidity. Histopathological re-evaluation by an experienced pathologist is recommended before embarking on further treatments when a diagnosis of mFTC is made.

Published
2010

50. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery

Author

Warschkow, Rene, Tarantino, Ignazio, Ukegjini, Kristjan, Beutner, Ulrich, Müller, Sascha, Schmied, Bruno, Steffen, Thomas, Warschkow, Rene, Tarantino, Ignazio, Ukegjini, Kristjan, Beutner, Ulrich, Müller, Sascha, Schmied, Bruno, and Steffen, Thomas

Abstract

Purpose: This study assessed the diagnostic accuracy of C-reactive protein (CRP) after gastroesophageal cancer resection for postoperative inflammatory complications (PIC). Methods: The clinical data and CRP values of patients operated on for gastroesophageal cancer surgery between 1997 and 2009 were retrospectively analyzed. The results of this study were compared with published data using a meta-analytic approach for diagnostic outcomes. Results: Of 210 patients included in the study, 59 developed PIC (28.1%; 95% CI: 22.5-34.5%). On the postoperative day (POD) 4 and 7, CRP had the best diagnostic accuracy for PIC (AUC 0.77; 95% CI, 0.64-0.91, AUC 0.81; 95% CI, 0.71-0.91). Using a cut-off value of 141mg/L (95% CI, 131-278mg/L) for CRP on POD 4, the sensitivity was 0.78 (95% CI, 0.55-0.91), the specificity was 0.70 (95% CI, 0.53-0.83) and the NPV was 0.89 (95% CI, 0.77-0.95). The in-hospital mortality rate was 3.3% (95% CI, 1.5-6.9%). In a diagnostic meta-analysis that included two additional studies, CRP had a significant predictive value after POD 3. Conclusion: There is limited evidence for the diagnostic accuracy of CRP levels for PIC after gastroesophageal cancer surgery. CRP levels on POD 4 might be useful to rule out PIC, but its diagnostic accuracy is moderate at best. For clinical routine use CRP levels are clearly not sufficient to predict PIC and have to be interpreted in the context of the whole clinical picture

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