J. R. Izbicki

Disseminated Tumor Cells in Lymph Nodes as a Determinant for Survival in Surgically Resected Non–Small-Cell Lung Cancer

PURPOSE In recent years, the detection of even a few tumor cells in lymph nodes of patients with surgically resected non-small-cell lung cancer (NSCLC) became possible with immunohistochemical staining procedures. Tumor cells in lymph nodes have been shown to be associated with an increased rate of early recurrence. However, the prognostic significance of this minimal tumor cell spread for overall survival remains unclear. PATIENTS AND METHODS We used the epithelium-specific monoclonal antibody Ber-EP4, which recognizes the 17-1A antigen (also called EGP40 or Ep-CAM), to discover small tumor cell deposits (< or = three cells) in 565 regional lymph nodes judged as tumor-free by conventional histopathology in patients with NSCLC staged as pT1-4, pN0-2, M0, R0. In a prospective analysis, we studied the influence of the detected tumor cells on the cancer recurrence rate and survival of 117 patients. RESULTS Ber-EP4-positive cells were found in 27 of 125 patients (21.6%). After an observation period of 64 months, patients with disseminated tumor cells had reduced disease-free survival (P < .0001) and overall survival (P = .0001) rates in univariate analyses (logrank test). Multivariate analysis (Cox model) showed a 2.7 times increased risk for tumor relapse and a 2.5 times increased risk for shorter survival in patients with disseminated tumor cells compared with patients without such cells. Patients without any evidence of histopathologic and immunohistochemical lymph node involvement had an overall survival rate of 78%. CONCLUSION The immunohistochemical detection of disseminated tumor cells in lymph nodes of patients with completely resected NSCLC is an independent prognostic factor for overall survival.

Arterial en bloc resection for pancreatic carcinoma.

Surgery for locally advanced pancreatic cancer with arterial involvement of the hepatic artery, coeliac trunk and superior mesenteric artery (SMA) is highly controversial. In a retrospective review, the benefits and harms of arterial en bloc resection (AEBR) for pancreatic adenocarcinoma with arterial involvement were analysed.

Lack of prognostic significance of serum DNA methylation of DAPK, MGMT, and GSTPI in patients with non‐small cell lung cancer

To further improve the screening, diagnosis and therapy of patients with non‐small cell lung cancer (NSCLC) additional diagnostic tools are desperately warranted. Aim of this study was to investigate the potential of the DNA methylation of DAPK, MGMT, and GSTPI in serum of patients with NSCLC as a prognostic molecular marker in this disease.

Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction.

Owing to controversial staging and classification of adenocarcinoma of the oesophago‐gastric junction (AOG) before surgery, the choice of appropriate surgical approach remains problematic. In a retrospective study, preoperative staging of AOG and the impact of preoperative misclassification on outcome were analysed.

Late morbidity after duodenum‐preserving pancreatic head resection with bile duct reinsertion into the resection cavity

Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum‐preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.

Optimizing surgical therapy for chronic pancreatitis.

Treatment of patients suffering from complications of chronic pancreatitis remains a major challenge [1]. The most distressing symptom for the patient is pain, which in many instances has already lead to a considerable analgesics abuse before a specialist is even consulted. Current therapeutic concepts, accordingly, aim at alleviating pain and at management of organ complications. Abstaining from excessive alcohol consumption does not interrupt the process of organ destruction [2]. On the other hand, surgical intervention has its inherent risks. Endoscopic treatment may have lower risks than surgical intervention but results from randomized studies are not yet available [3]. Endoscopic treatment is consequently not compared to data available on surgical therapy in this review. Surgical treatment of chronic pancreatitis has seen its ups and downs over the past decades [4-7]. The risk of pancreatic surgery were initially high [8-12], but many surgeons were impatient enough to approach the chronically inflamed and enlarged pancreas. The pathophysiology of the disease was, and partially still is, poorly understood. An appropriate surgical procedure was therefore

Hemostasis with the ultrasonically activated scalpel. Effective substitute for electrocautery in surgical patients with pacemakers.

Abstract. In patients with implanted pacemaker/cardioverter defibrillator (ICD), the use of electrocautery can lead to serious pacemaker dysfunction. The ultrasonically activated scalpel, however, which has been introduced mainly for the use in laparoscopic surgery, could potentially avoid the outlined problem, since no electrical current flows while in use. This hypothesis was tested in a pacemaker patient undergoing laparoscopic cholecystectomy. During the procedure, no abnormal rhythms or ECG interferences were detected while working in close vicinity to the device. Thus, the ultrasonically activated scalpel provides adequate hemostasis and does not bear the risk of pacemaker dysfunction.

Her2 expression and gene amplification is rarely detectable in patients with oral squamous cell carcinomas

PURPOSE Her2 (ErbB2) transforms cells when overexpressed and is an important therapeutic target in breast cancer. Contrary to breast cancer, studies on Her2 overexpression and gene amplification in squamous cell carcinomas of the head and neck region described largely different results. This study was undertaken to learn more on the prevalence and clinical significance of HER2 amplification and overexpression in squamous cell carcinomas of the head and neck. MATERIALS AND METHODS Her2 expression and gene amplification was analyzed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) on two tissue microarrays composed of 427 squamous cell carcinomas of the head and neck region and 222 oral squamous cell carcinomas. Results were compared with clinicopathological features. RESULTS Her2 expression and gene amplification was rarely detectable in squamous cell carcinomas of the head and neck region and unrelated to tumor phenotype or survival of the patients with oral squamous carcinoma. DISCUSSION Our results demonstrate that Her2 protein and gene amplification was only detectable in a small subset of squamous cell carcinomas of the head and neck region as well as oral squamous cell carcinomas. However, it can be speculated that those few patients with Her2 overexpressing and gene amplificated tumors may possibly benefit from an anti-Her2 therapy.

Haeme oxygenase‐1 promoter polymorphism is an independent prognostic marker of gastrointestinal stromal tumour

Aims:  Gastrointestinal stromal tumours (GISTs) display genetic alterations on chromosome 22. GTn repeat (GTn) length polymorphism in the promoter of haeme oxygenase‐1 gene (HMOX‐1) is located on chromosome 22 and associated with malignant growth. The aim was to investigate the role of HMOX‐1 promoter polymorphism in GIST patients.

Ambulatory long-term pH monitoring in pigs

Background: pH monitoring has been established as the “gold standard” in the diagnosis of gastroesophageal reflux. Evaluation of experimental antireflux therapy should therefore also include this technique, but a suitable technique in an experimental model did not exist so far. The aim of our study was to establish a reliable method for the evaluation of an experimental reflux model in pigs. Methods: A total of 33 German Landrace pigs with an average body weight of 56 (50.2–67.2) kg were included. pH monitoring was performed before and after open cardiomyotomy in each animal. All manipulations were performed under general anesthesia. After manometric localization of the gastroesophageal high-pressure zone, a standard pH probe was inserted into the pharynx through a small needle-punctured canal on the side of the animal’s snout and placed under endoscopic guidance with the proximal sensor 3 cm above the lower esophageal sphincter (LES) and the distal sensor in the stomach for reference. The harness to carry the pH recorder on the animal’s back consisted of a modified belly strap that enabled the animal to move around without limitation. For analysis the same threshold levels were defined as in humans. Gastroesophageal reflux was induced by cardiomyotomy. Results: The placement of the standard pH probe was possible in all cases. Inserting the probe on the side of the snout left the animals free to nuzzle, which complies with the normal habits of pigs, without breaking the probes and without being compromised in their natural behavior. Repeated punctures for multiple measurements were easily feasible. We performed up to three examinations in each individual animal. Recording was performed for 48 h. A mean number of 67.3 (±9.7) acidic refluxes were registered. The mean number of long acidic refluxes was 3.2 (±0.75). For an average total time of 75.5 (±14.3) min the pH was below 4 accounting for a fraction time pH below 4 of 3.5% (±0.68%). Following cardiomyotomy the number of acidic refluxes increased significantly to 166.1 (±21.8) and the number of long refluxes to 17.74 (±3.35). The total time of pH below 4 increased to 371.3 (±62) min so that the fraction time pH below 4 was 14.5% (p = 0.0006). Conclusion: pH monitoring should be mandatory in any investigation of antireflux therapy. Our method is easy and secure to perform. It is suitable for other gastrointestinal investigations (Bilitec, long-term manometry) that could be carried out using the same technique. The described data represent the basis for other investigations of experimental antireflux therapy.