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Aim. Bariatric surgery improves insulin sensitivity and glucose tolerance in obese individuals with type 2 diabetes (T2D), but there is a lack of data comparing the underlying metabolic mechanisms after the 2 most common surgical procedures Roux-en-Y gastric bypass surgery (RYGB) and sleeve gastrectomy (SG). This study was designed to assess and compare the effects of RYGB and SG on fuel metabolism in the basal state and insulin sensitivity during a two-step euglycemic glucose clamp. Materials and Methods. 16 obese individuals with T2D undergoing either RYGB ( n = 9 ) or SG ( n = 7 ) were investigated before and 2 months after surgery, and 8 healthy individuals without obesity and T2D served as controls. All underwent a 2 h basal study followed by a 5 h 2-step hyperinsulinemic euglycemic glucose clamp at insulin infusion rates of 0.5 and 1.0 mU/kg LBM/min. Results. RYGB and SG induced comparable 15% weight losses, normalized HbA1c, fasting glucose, fasting insulin, and decreased energy expenditure. In parallel, we recorded similar increments (about 100%) in overall insulin sensitivity ( M -value) and glucose disposal and similar decrements (about 50%) in endogenous glucose production and FFA levels during the clamp; likewise, basal glucose and insulin concentrations decreased proportionally. Conclusion. Our data suggest that RYGB and SG improve basal fuel metabolism and two-step insulin sensitivity in the liver, muscle, and fat and seem equally favourable when investigated 2 months after surgery. This trial is registered with NCT02713555.

Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications.

BACKGROUND: Minimally invasive gastrectomy has been introduced in Western populations during the last decade. As minimally invasive distal gastrectomy (MIDG) versus total gastrectomy (MITG) are procedures with a different complexity, outcomes may differ. The aim of this population-based cohort study was to evaluate the safety of MIDG and MITG. MATERIALS AND METHODS: All patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit (2011-2016). Propensity score matching was applied to create comparable groups of patients receiving open distal gastrectomy (ODG) versus MIDG and open total gastrectomy (OTG) versus MITG, using patient and tumor characteristics. Postoperative outcomes and short-term oncological outcomes were appraised. RESULTS: Of the 1970 eligible patients, 1138 underwent distal gastrectomy and 832 underwent total gastrectomy. For distal gastrectomy, 390 ODG were matched to 288 MIDG patients. Although overall postoperative morbidity and mortality were similar, patients who underwent MIDG encountered less intra-abdominal abscesses (4% vs. 1%, p = 0.039) and wound complications (6% vs. 2%, p = 0.021). The median hospital stay was shorter after MIDGs (9 vs. 7 days, p < 0.001). For total gastrectomy, 323 OTG patients were matched to 258 MITG patients. Overall postoperative morbidity, mortality and hospital stay were similar, whereas the anastomotic leakage rate was higher after MITGs (11% vs. 17%, p = 0.030). Short-term oncological outcomes between both groups were equal for distal and total gastrectomy. CONCLUSION: Benefits of MIG during the early introduction were demonstrated for distal gastrectomy but not for total gastrectomy. An increased anastomotic leakage rate was encountered for MITG.

Contains fulltext : 196889.pdf (Publisher’s version ) (Open Access) BACKGROUND: Although radical surgery remains the cornerstone of cure in resectable gastric cancer, survival remains poor. Current evidence-based (neo)adjuvant strategies have shown to improve outcome, including perioperative chemotherapy, postoperative chemoradiotherapy and postoperative chemotherapy. However, these regimens suffer from poor patient compliance, particularly in the postoperative phase of treatment. The CRITICS-II trial aims to optimize preoperative treatment by comparing three treatment regimens: (1) chemotherapy, (2) chemotherapy followed by chemoradiotherapy and (3) chemoradiotherapy. METHODS: In this multicentre phase II non-comparative study, patients with clinical stage IB-IIIC (TNM 8th edition) resectable gastric adenocarcinoma are randomised between: (1) 4 cycles of docetaxel+oxaliplatin+capecitabine (DOC), (2) 2 cycles of DOC followed by chemoradiotherapy (45Gy in combination with weekly paclitaxel and carboplatin) or (3) chemoradiotherapy. Primary endpoint is event-free survival, 1 year after randomisation (events are local and/or regional recurrence or progression, distant recurrence, or death from any cause). Secondary endpoints include: toxicity, surgical outcomes, percentage radical (R0) resections, pathological tumour response, disease recurrence, overall survival, and health related quality of life. Exploratory endpoints include translational studies on predictive and prognostic biomarkers. DISCUSSION: The aim of this study is to select the most promising among three preoperative treatment arms in patients with resectable gastric adenocarcinoma. This treatment regimen will subsequently be compared with the standard therapy in a phase III trial. TRIAL REGISTRATION: clinicaltrials.gov NCT02931890 ; registered 13 October 2016. Date of first enrolment: 21 December 2017.

BACKGROUND: Obesity is a chronic disease and a risk factor for heart failure. In end-stage heart failure, heart transplantation may be the only available treatment option, but obesity is a contraindication for this treatment because of its unfavourable prognosis. Bariatric surgery and its subsequent weight loss may affect the indication for transplantation in patients with heart failure and morbid obesity. CASE DESCRIPTION: A 46-year-old patient with morbid obesity and heart failure underwent gastric sleeve resection in preparation of a heart transplantation. Without it, he would not have been considered eligible for transplantation because of his obesity. The bariatric intervention was also intended to use weight loss as a way to reduce the symptoms of his heart failure and to make rehabilitation possible. One year after surgery, the condition of the patient had improved so much that heart transplantation was no longer necessary. CONCLUSION: Bariatric surgery is safe for morbidly obese patients with severe heart failure and may sometimes even avoid heart transplantation.

BACKGROUND: Obesity is a chronic disease and a risk factor for heart failure. In end-stage heart failure, heart transplantation may be the only available treatment option, but obesity is a contraindication for this treatment because of its unfavourable prognosis. Bariatric surgery and its subsequent weight loss may affect the indication for transplantation in patients with heart failure and morbid obesity.CASE DESCRIPTION: A 46-year-old patient with morbid obesity and heart failure underwent gastric sleeve resection in preparation of a heart transplantation. Without it, he would not have been considered eligible for transplantation because of his obesity. The bariatric intervention was also intended to use weight loss as a way to reduce the symptoms of his heart failure and to make rehabilitation possible. One year after surgery, the condition of the patient had improved so much that heart transplantation was no longer necessary.CONCLUSION: Bariatric surgery is safe for morbidly obese patients with severe heart failure and may sometimes even avoid heart transplantation.

BACKGROUND: Obesity is a chronic disease and a risk factor for heart failure. In end-stage heart failure, heart transplantation may be the only available treatment option, but obesity is a contraindication for this treatment because of its unfavourable prognosis. Bariatric surgery and its subsequent weight loss may affect the indication for transplantation in patients with heart failure and morbid obesity. CASE DESCRIPTION: A 46-year-old patient with morbid obesity and heart failure underwent gastric sleeve resection in preparation of a heart transplantation. Without it, he would not have been considered eligible for transplantation because of his obesity. The bariatric intervention was also intended to use weight loss as a way to reduce the symptoms of his heart failure and to make rehabilitation possible. One year after surgery, the condition of the patient had improved so much that heart transplantation was no longer necessary. CONCLUSION: Bariatric surgery is safe for morbidly obese patients with severe heart failure and may sometimes even avoid heart transplantation.

BACKGROUND: Minimally invasive gastrectomy has been introduced in Western populations during the last decade. As minimally invasive distal gastrectomy (MIDG) versus total gastrectomy (MITG) are procedures with a different complexity, outcomes may differ. The aim of this population-based cohort study was to evaluate the safety of MIDG and MITG. MATERIALS AND METHODS: All patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit (2011-2016). Propensity score matching was applied to create comparable groups of patients receiving open distal gastrectomy (ODG) versus MIDG and open total gastrectomy (OTG) versus MITG, using patient and tumor characteristics. Postoperative outcomes and short-term oncological outcomes were appraised. RESULTS: Of the 1970 eligible patients, 1138 underwent distal gastrectomy and 832 underwent total gastrectomy. For distal gastrectomy, 390 ODG were matched to 288 MIDG patients. Although overall postoperative morbidity and mortality were similar, patients who underwent MIDG encountered less intra-abdominal abscesses (4% vs. 1%, p = 0.039) and wound complications (6% vs. 2%, p = 0.021). The median hospital stay was shorter after MIDGs (9 vs. 7 days, p < 0.001). For total gastrectomy, 323 OTG patients were matched to 258 MITG patients. Overall postoperative morbidity, mortality and hospital stay were similar, whereas the anastomotic leakage rate was higher after MITGs (11% vs. 17%, p = 0.030). Short-term oncological outcomes between both groups were equal for distal and total gastrectomy. CONCLUSION: Benefits of MIG during the early introduction were demonstrated for distal gastrectomy but not for total gastrectomy. An increased anastomotic leakage rate was encountered for MITG.

BACKGROUND: There is currently no consensus on the criteria for inclusion of new bariatric procedures into routine clinical practice. This study canvasses bariatric surgeons in an attempt to define these criteria. METHODS: Bariatric Surgeons from around the world were invited to participate in a questionnaire-based survey on SurveyMonkey ®. RESULTS: 396 bariatric surgeons, 337 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) members, took the survey. Five clinical studies conducted under the strict monitoring of an Institutional Review Board would satisfy most surgeons (67.7 %, n = 266). When asked regarding the number of patients in these studies, a cumulative number of 500 patients would satisfy 64.5 % (n = 255) of the surgeons. Most respondents regarded endorsement by their national society and IFSO as 'very important' or 'extremely important'. An overwhelming 74.4 % (n = 294) felt that every new procedure should undergo a randomized comparison against one of the established alternatives like Roux-en-Y Gastric Bypass or Sleeve Gastrectomy. CONCLUSION: Evaluation of a new bariatric procedure in at least 5 adequately supervised clinical studies (four of which must be randomized comparisons with one of the existing alternatives) reporting at least 5 years results on a minimum of 500 patients would satisfy majority of bariatric surgeons for the inclusion of a new bariatric procedure into clinical practice. The findings of this survey are simply aimed at starting a discussion on this topic and cannot be used to influence the ground reality until an international consensus can be reached amongst experts. info:eu-repo/semantics/publishedVersion

Sleeve gastrectomy represents a valid option for morbidly obese patients, either as a primary or as a staged bariatric procedure. Several variations of the technique have been reported. Herein, we report our initial experience with robot-assisted sleeve gastrectomy (RASG).A prospectively held database for patients who underwent RASG was reviewed. Data included patient demographics, operative parameters, morbidity, and follow-up outcomes. The outcomes after RASG were compared to the laparoscopic approach.From September 2007 to February 2010, 69 morbidly obese patients underwent sleeve gastrectomy. Of these, 30 (43.5%) were robot-assisted and 39 (56.5%) were laparoscopic. There was no statistically significant difference in demographics between the two groups. The RASG group underwent an oversewing of the staple line, and mean operative time was 135 minutes. In the laparoscopic group, where the staple line was not oversewn, mean operative time was 114 minutes (P = .003). Morbidity after RASG was 3.3%, and there were no gastrointestinal leaks or staple line bleeding. Mean postoperative hospital stay after RASG was 2.6 days (range: 1.6-8.3 days). Mean body mass index decrease at 1 year was 16 kg/m(2). There were no differences between the two groups in terms of morbidity, mortality, length of stay, and weight loss.RASG can be performed safely, with good outcomes. However, the exact role and the advantages of RASG require further study in larger series.

Gastric perforation into the pericardium is an extremely rare but lethal condition. Only a few case reports have been described in the literature. It is difficult to diagnose these patients with clinical evaluation. Accurate and immediate diagnosis of the intestinal perforation is vital. Herein, we present a 56-year old female patient with gastric perforation into the pericardium due to benign gastric ulcer diagnosed with computed tomography (CT). We also emphasized the imaging findings in the diagnosis of intestinal perforation into the pericardium. (C) 2017 Elsevier Inc. All rights reserved.

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. Objetivo A gastrectomia vertical é o procedimento cirúrgico para tratamento da obesidade que mais cresce em indicações. No entanto, esse procedimento pode causar ou agravar a doença do refluxo gastresofágico. Este artigo buscou descrever originalmente a adição de procedimentos antirrefluxo (remoção de coxins gordurosos do hiato, hiatoplastia, pequena plicatura e fixação do remanescente na posição anatômica), além de relatar seus resultados precoces e tardios. Métodos Foram submetidos à gastrectomia vertical com medidas antirrefluxo 88 oito pacientes obesos com sintomas de doença do refluxo gastresofágico. Dentre esses pacientes, 50 foram submetidos também à bipartição do trânsito. A perda de peso destes foi comparada àquela ocorrida em 360 pacientes consecutivos submetidos à gastrectomia vertical usual e à de 1.140 pacientes submetidos à gastrectomia vertical + bipartição do trânsito. Os sintomas do refluxo gastresofágico foram investigados por meio de questionário em todos os submetidos à gastrectomia vertical com medidas antirrefluxo e comparados com os resultados obtidos em 50 pacientes submetidos à gastrectomia vertical usual e a 60 submetidos à gastrectomia vertical + bipartição do trânsito, também com sintomas prévios de doença do refluxo gastresofágico. Resultados O percentual de perda do excesso de índice de massa corporal após gastrectomia vertical antirefluxo não foi inferior a gastrectomia vertical usual. Além disso, a gastrectomia vertical antirefluxo + bipartição do trânsito não foi inferior a gastrectomia vertical + bipartição do trânsito. Não houve aumento da morbidade na gastrectomia vertical antirefluxo, porém notou-se redução significativa dos sintomas da doença e do uso de inibidores de bomba prótons para tratar a condição. Conclusão A adição de procedimentos antirrefluxo, como a hiatoplastia e a cardioplicatura, à gastrectomia vertical usual não acrescentou morbidade nem piorou a perda de peso obtida, mas diminuiu de modo significativo a ocorrência de sintomas da doença do refluxo no pós-operatório, assim como a utilização de inibidores de bomba de prótons.

Minimally invasive approach for gastric cancer has gained increasing acceptance. Introduction of the da Vinci robotic system has allowed overcoming the technical limitations of standard laparoscopy. To date, several studies have been published reporting the feasibility of robot-assisted gastrectomy (RAG). The aim of this study is to extensively review all the published literature concerning RAG and to assess its value. Since 2003, this systematic review of the literature shows that 10 original studies reporting 199 RAG for cancer have been published worldwide. The authors analyzed operative time, blood loss, conversion rate, lymph nodes retrieval, complications, mortality, length of hospital stay and follow-up through a systematic review. Mean age was 63 years (range: 25-96). Mean operative times were 265 minutes and 334 minutes for total and subtotal gastrectomy respectively. Mean blood loss reported was 113 mL (range: 12-1400). Conversion rate was 2.5%. Average lymph nodes retrieval was 32 (range: 11-83). Twenty-nine complications were reported (14.6%). Mortality rate was 1.5%. Mean length of stay was 10 days (range: 3-175).This review demonstrates that RAG for cancer is not only feasible but also seems to be safe, with low mortality and acceptable morbidity. However, due to the lack of long-term follow-up and the limited number of published studies, it is relatively too early to draw definitive conclusions and/or to recommend the use of RAG for oncologic gastrectomy. Randomized controlled trials with long-term follow up are needed before this promising approach can eventually be generalized.

Follicular dendritic cell (FDC) sarcomas are rare tumours, typically seen in lymph nodes. However, in about one third of the reported cases, a FDC sarcoma presents as an extranodal mass. Involvement of the gastrointestinal tract is extremely rare, and only 3 cases have been described to date. We report on a 40-year-old female patient with a follicular dendritic cell sarcoma located in the stomach and the presence of a metastasis in the liver at the time of diagnosis. Severe asthenia, nausea, back pain and loss of weight were the presenting symptoms. A CT scan of the abdomen and an upper gastrointestinal endoscopy revealed a tumour mass in the stomach. The diagnosis of a FDC sarcoma was made on histological and immunohistochemical findings. We report the second case of a FDC sarcoma presenting in the stomach. Due to its rarity, a FDC sarcoma seldom enters the differential diagnosis of spindle cells neoplasms of the gastrointestinal tract. Complete surgical resection is the treatment of choice for FDC sarcoma.

Gastric cancer is still a major health problem and a leading cause of cancer mortality despite a worldwide decline in incidence. Environmental and Helicobacter pylori (Hp) acting early in life in a multistep and multifactorial process may cause intestinal type carcinomas, whereas genetic abnormalities are related more to the diffuse type of disease. Primarily due to early detection of the disease, the results of treatment for gastric cancer have improved in Japan, Korea and several specialized Western centres. Surgery offers excellent long-term survival results for early gastric cancer (EGC). Advances in diagnostic and treatment technology have contributed to a trend towards minimal invasive surgery such as endoscopic mucosal resection (EMR) and laparoscopic surgery for selected mucosal cancers. In the Western world, however, more than 80% of patients at diagnosis have an advanced gastric cancer with a poor prognosis. The aim of surgery is complete removal of the tumour (UICC R0-resection), which is known to be the only proven, effective treatment modality and the most important treatment-related prognostic factor. Gastrectomy with preservation of the spleen and pancreas in most cases is the standard procedure. However, at present there is no consensus about the optimal extent of lymph-node dissection. The hypothesis that extended (D2) lymph-node dissection leads to improved survival has not been confirmed in randomized trials. Results from specialized centres and ongoing multi-institutional randomized trials, however, indicate that D2 dissection, with preservation of the spleen and pancreas, can be performed with the same safety as a D1 dissection. Furthermore, in 50% of patients with node-positive disease, the extraperigastric N2 nodes are involved (N2 disease) and thus an R0-resection is achievable only by a D2 node dissection resulting in a 5-year survival of about 30% for such patients. However, even after a D2 node dissection with curative potential, disease recurs in two-thirds of patients with locally advanced gastric cancer (LAGC) and is rapidly fatal. The need for an adjuvant treatment is obvious, but at present there is no such treatment of proven effectiveness. Promising results with preoperative chemotherapy, which increases the R0-resection rate, and intra-or early postoperative intraperitoneal chemohyperthermia to prevent peritoneal dissemination have been reported. However, randomized trials are necessary before these combined treatments become widely accepted. Present data indicate that the treatment of gastric cancer has become more and more sophisticated with a tailored therapy for individual cases. Treatment includes a broad spectrum of therapeutic options from EMR for selected mucosal cancers to aggressive combined treatment for LAGC. Precise knowledge of patterns of recurrence and metastases, critical evaluation of clinicopathologic variables, integration of high technology into diagnosis to predict accurately pre-treatment staging, and the surgeon's ability to perform minimally invasive surgery and D2 node dissection technique are necessary for an appropriate treatment option. All these prerequisites are best ensured by management in experienced surgical oncology units. Cancer Treat Rev

To report the authors' experience in extensive abdominal surgery after caustic ingestion, and to clarify its indications.After caustic ingestion, extension of corrosive injuries beyond the esophagus and stomach to the duodenum, jejunum, or adjacent abdominal organs is an uncommon but severe complication. The limit to which resection of the damaged organs can be reasonably performed is not clearly defined.From 1988 to 1997, nine patients underwent esophagogastrectomy extended to the colon (n = 2), the small bowel (n = 2), the duodenopancreas (n = 4), the tail of the pancreas (n = 1), or the spleen (n = 1). Outcome was evaluated in terms of complications, death, and function after esophageal reconstruction.Five patients required reintervention in the postoperative period for extension of the caustic lesions. There were two postoperative deaths. Seven patients had secondary esophageal reconstruction 4 to 8 months (median 6 months) after initial resection. Three additional patients died 8, 24, and 32 months after the initial resection. Three survivors eat normally, and one has unexplained dysphagia.An aggressive surgical approach allows successful initial treatment of extended caustic injuries. Early surgical treatment is essential to improve the prognosis in these patients.

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.

Data on 25 early and 227 advanced gastric cancer patients treated surgically in our clinic over an eight-year period from 1979 to 1986 have been analyzed retrospectively. In 45.5% (n = 110) curative resection and in 27.3% (n = 66) palliative resection was performed. In another 27.3% (n = 66) only a non-resecting procedure was possible. The overall hospital mortality was 10.7% (26/242). It was 9.1% (16/176) after resection and 15% (10/66) after non-resecting procedures. Total gastrectomy "de principe" with compartment II lymphadenectomy was performed in 70.5% (124/176). Total hospital mortality was 8.9% (n = 11) and leakage of the proximal anastomosis was observed in 8.1% (n = 10). Hospital mortality of the remaining resected patients was 3.2% (1/31) after distal resection, 20% (3/15) after proximal resection and 16.7% (1/6) after total esophagogastrectomy with colon interposition. All patients were staged according to UICC classification and staging was I 8.5%, II 14%, III 23% and IV 54.5%. Actuarial 5-year survival in all patients surviving resection was depending on stage of disease at operation (stage I 100%, II 53.3%, III 29% and IV 0%). It differed most significantly (p less than 0.001) for curative (49%) and palliative resections (0%). These results indicate that improvement of results requires early diagnosis with immediate surgical intervention. Schweiz Med Wochenschr