Katrin Schwameis

The prevalence of hemorrhoids in adults

IntroductionExact data on the prevalence of hemorrhoids are rare. Therefore, we designed a study to investigate the prevalence of hemorrhoids and associated risk factors in an adult general population.MethodsBetween 2008 and 2009, consecutive patients were included in a prospective study. They attended the Austrian national wide health care program for colorectal cancer screening at four medical institutions. A flexible colonoscopy and detailed examination were conducted in all patients. Hemorrhoids were defined according to a standardized grading system. Independent variables included baseline characteristics, sociodemographic data, and health status. Potential risk factors were calculated by univariate and multivariate analysis.ResultsOf 976 participants, 380 patients (38.93%) suffered from hemorrhoids. In 277 patients (72.89%), hemorrhoids were classified as grade I, in 70 patients (18.42%) as grade II, in 31 patients (8.16%) as grade III, and in 2 patients (0.53%) as grade IV. One hundred seventy patients (44.74%) complained about symptoms associated with hemorrhoids, whereas 210 patients (55.26%) reported no symptoms. In the univariate and multivariate analysis, body mass index (BMI) had a significant effect on the occurrence of hemorrhoids with p = 0.0391 and p = 0.0282, respectively. Even when correcting for other potential risk factors, an increase in the BMI of one increased the risk of hemorrhoids by 3.5%.ConclusionHemorrhoids occur frequently in the adult general population. Notably, a considerable number of people with hemorrhoids do not complain about symptoms. In addition, a high BMI can be regarded as an independent risk factor for hemorrhoids.

Haemorrhoids and quality of life

Aim  There are few studies into the quality of life of patients with haemorrhoids. The aim of this study was to assess the quality of life of patients with haemorrhoids in an adult general population.

Surgical treatment of GIST – An institutional experience of a high-volume center

BACKGROUND Discovery of the molecular pathogenesis of Gastrointestinal stromal tumors led to the development of targeted therapies, revolutionizing their treatment. However, surgery is still the mainstay of GIST therapy and the only chance for cure. AIM Here we present a single institutional consecutive case series of 159 GIST-patients. METHODS AND PATIENTS A total of 159 GIST-patients who underwent resection between 1994 and 2011 were reviewed for clinicopathohistological data, informations on surgical and medical therapy and further follow-up, outcome and survival data. RESULTS Laparoscopic (25.2%) and open (71.1%) GIST surgery achieved complete resection rates of 97.5% and 85.2%, whereas 44.4% of incomplete and 6.6% of complete resected patients died from GIST. Compared to open surgery laparoscopy significantly reduced duration of operation (183.4 vs. 130.6 min), length of hospitalization (16.1 vs. 8.3 d) and morbidity (23% vs. 7.5%). Mean survival time was 3.7 ± 2.7 years (R0: 5.1 a and R1: 2.6 a) and the mean overall survival was 4.5 ± 3.8 years. CONCLUSION Complete surgical resection is the primary goal and laparoscopy can be performed safely in a subset of GIST-patients with potential perioperative advantages. Although not proven by the present study the authors assume that multimodal GIST-treatment, as performed in reference-centers, is required for advanced or high risk disease. Our data suggest the potential for minimally invasive GIST resection to achieving comparable oncological outcomes as after open surgery while providing low morbidity rates.

Haemorrhoids, constipation and faecal incontinence: is there any relationship?

Aim  Little is known about the association of haemorrhoids and anorectal function. Moreover, available data on the impact of constipation on the presence of haemorrhoids are conflicting. The present study aimed to assess any potential relationship between haemorrhoids and anorectal dysfunction.

MicroRNA Profiles of Barrett's Esophagus and Esophageal Adenocarcinoma: Differences in Glandular Non-native Epithelium

Background: The tissue specificity and robustness of miRNAs may aid risk prediction in individuals diagnosed with Barretts esophagus. As an initial step, we assessed whether miRNAs can positively distinguish esophageal adenocarcinoma from the precursor metaplasia Barretts esophagus. Methods: In a case–control study of 150 esophageal adenocarcinomas frequency matched to 148 Barretts esophagus cases, we quantitated expression of 800 human miRNAs in formalin-fixed paraffin-embedded tissue RNA using NanoString miRNA v2. We tested differences in detection by case group using the χ2 test and differences in expression using the Wilcoxon rank-sum test. Bonferroni-corrected statistical significance threshold was set at P < 6.25E−05. Sensitivity and specificity were assessed for the most significant miRNAs using 5-fold cross-validation. Results: We observed 46 distinct miRNAs significantly increased in esophageal adenocarcinoma compared with Barretts esophagus, 35 of which remained when restricted to T1b and T2 malignancies. Three miRNAs (miR-663b, miR-421, and miR-502-5p) were detected in >80% esophageal adenocarcinoma, but <20% of Barretts esophagus. Seven miRNAs (miR-4286, miR-630, miR-575, miR-494, miR-320e, miR-4488, and miR-4508) exhibited the most extreme differences in expression with >5-fold increases. Using 5-fold cross-validation, we repeated feature (miR) selection and case–control prediction and computed performance criteria. Each of the five folds selected the same top 10 miRNAs, which, together, provided 98% sensitivity and 95% specificity. Conclusion: This study provides evidence that tissue miRNA profiles can discriminate esophageal adenocarcinoma from Barretts esophagus. This large analysis has identified miRNAs that merit further investigation in relation to pathogenesis and diagnosis of esophageal adenocarcinoma. Impact: These candidate miRNAs may provide a means for improved risk stratification and more cost-effective surveillance. Cancer Epidemiol Biomarkers Prev; 25(3); 429–37. ©2015 AACR.

Small bowel adenocarcinoma ‑ terra incognita: A demand for cross‑national pooling of data

To date, due to the rarity, tumor biology and carcinogenesis of small bowel adenocarcinoma (SBA), the disease has been explored insufficiently and immunophenotyping and molecular characterization have not been finalized. This knowledge gap consecutively leads to an overt lack of diagnostic and therapeutic recommendations. In the current study, we provide our experience with the treatment of SBA, and demand for cross-national data pooling to enable unlimited information transfer and higher powered study. A comprehensive database of all patients with SBA was established and consecutively reviewed for clinicopathohistological data, information concerning preoperative evaluation, surgical and chemotherapeutical treatment, as well as outcome parameters. Patients underwent curative intended surgery (42.4%; n=14), adjuvant chemotherapy (CTX) following resection (36.4%; n=12) or palliative care (21.2%; n=7). The majority of patients were diagnosed at an advanced disease stage (pT3, 36.4%; pT4, 39.4%) and the duodenum was the most common tumor site (57.1%; n=20). Complete surgical resection was achieved in 88.5% of patients, while postoperative complications occurred in 19.4%. Within a mean follow-up period of 31.4 months, 17 patients succumbed to the disease following a median survival time of 11 months. Mean overall survival (OS) was 47.4, 25.3 and 9.8 months for surgically, surgically and chemotherapeutically and palliatively treated patients, respectively. Early surgical resection remains the mainstay in the treatment of localized SBA, since it is associated with a prolongation of OS. The role of neoadjuvant and adjuvant CTX has not yet been defined. Thus, since no consensus exists on the adequate treatment of these malignancies, we demand an international collaboration and cross-national data pooling to pave the way for the implementation of evidence-based standard care operating procedures.

Trabectedin in patients with metastatic soft tissue sarcoma: a retrospective single center analysis.

The aim of this study was to retrospectively evaluate the efficacy and safety of trabectedin treatment in patients with metastatic soft tissue sarcoma (STS) in the routine clinical setting. Further, the type and frequency of systemic treatments before commencing treatment with trabectedin and after its discontinuation, as well as the frequency of pulmonary metastasectomies, were analyzed. The current analysis includes retrospective data from consecutive STS patients treated with trabectedin at the Department of Medicine I, Division of Oncology, Medical University of Vienna, between January 2008 and December 2012. Patients were analyzed for median progression-free survival, overall survival (OS), and therapy-related toxicity. Data of 60 STS patients were included in the present analysis. In total, 198 cycles of trabectedin were administered, whereas the median number of cycles administered per patient was two (range 1–25). The median progression-free survival was 2.2 months and the median OS (mOS) was 11.8 months. mOS calculated from the first time point of detection of metastatic disease was 35.8 months. The 18 patients (30%) who underwent pulmonary metastasectomy had an mOS of 50.2 months. Further, trabectedin had a manageable toxicity profile comparable to data reported in previous phase II trials. Our findings support the use of trabectedin as an active and feasible therapeutic option among advanced, metastatic, and refractory STS patients. The good safety profile and lack of cumulative toxicity allow prolonged administration in highly pretreated patients. As visible from the present data, a considerable percentage of patients with advanced/metastatic STS benefit from sequential lines of drug therapy as well as pulmonary metastasectomy.

Gastrointestinal reconstructions in 1200 patients with cancer at the pharyngesophageal junction

ZusammenfassungGRUNDLAGEN: Karzinome am pharyngoösophagealen Übergang haben eine schlechte Prognose aufgrund der späten Symptommanifestation und Diagnose. Therapie der Wahl die Ösophagusresektion mit gastrointestinaler Rekonstruktion bei resektablen Tumoren. Ziel dieser retrospektiven Studie war die Evaluation der Rekonstruktionsmethoden und deren Einfluss auf die postoperative Letalität, postoperative Komplikationen und funktionelle Ergebnisse. METHODIK: Von 114 evaluierten Publikationen zwischen 1956 und 2008, wurden 33 Arbeiten in den Review inkludiert. Die postoperative Spitalsletalität, nichtchirurgische und chirurgische Komplikationen wurden ausgewertet. Weiters wurde der funktionelle Erfolg beurteilt. ERGEBNISSE: Von 1200 evaluierten Patienten erhielten 60,8 % einen Magenhochzug, 24,5 % erhielten ein Dünndarminterponat und 14,7 % ein Dickdarminterponat. Die gesamte Spitalsletalität betrug 10,7 %. Patienten mit Dünndarminterponat hatten die niedrigste Spitalsletalität und die wenigsten nichtchirurgischen Komplikationen. Die geringsten chirurgischen Komplikationen und die besten funktionellen Resultate erzielten Patienten mit Magenhochzug. SCHLUSSFOLGERUNGEN: Die segmentale Ösophagusresektion mit Dünndarminterponat kann empfohlen werden, wobei diese Operation erfahrenen Spezialisten vorbehalten bleiben soll, da erhöhte chirurgische Komplikationen ein Risiko darstellen.SummaryBACKGROUND: Carcinomas at the pharyngesophageal junction have a poor prognosis due to late symptom manifestation and diagnosis. Treatment of choice includes gastrointestinal replacement after esophagectomy. The aim of this retrospective study was to evaluate whether the type of reconstruction influences postoperative mortality, complications and functional outcome. METHODS: Out of 114 reviewed papers between 1956 and 2008, 33 papers were included in the review. Postoperative hospital mortality, non-surgical and surgical complications were assessed. Furthermore, functional success rates were compared. RESULTS: A total of 1200 patients were evaluated, out of whom 60.8% were reconstructed with gastric pull-up, 24.5% with jejunal autograft and 14.7% with colon interposition. The overall hospital mortality was 10.7%. In particular, patients with jejunal autograft presented reduced hospital mortality and fewest non-surgical complications. Lowest surgical complications and best functional success rates were reported in the gastric pull-up group. CONCLUSIONS: Cervical segmental esophagectomy with jejunal autograft can be recommended but it has to be performed by highly experienced professionals due to risky surgical complications.

Update: 10 Years of Sleeve Gastrectomy—the First 103 Patients

BackgroundSleeve gastrectomy (SG) has been the most frequently performed bariatric procedure worldwide since 2014. Therefore, it is vital to look at its outcomes in a long-term follow-up based on a large patient collective. Main points of discussion are weight regain, reflux, and patients’ quality of life at 10+ years after the procedure.ObjectivesThe aim of this study is to present an update of data that have been published recently and, thus, achieve more conclusive results. The number of patients has been doubled, and the length of the follow-up is still 10+ years.SettingMulti-center study, medical university clinic, AustriaMethodsThis study includes all patients who had SG before December 2006 at the participating bariatric centers. At 10+ years, non-converted patients (67%) were examined using gastroscopy, manometry, 24-hour pH-metry, and questionnaires. Patients’ history of weight, comorbidities, and reflux were established through interviews.ResultsAt 10+ years after SG, the authors found a conversion rate of 33%, an %EWL in non-converted patients of 50.0 ± 22.5, reflux in 57%, and Barrett’s metaplasia in 14% of non-converted patients. Gastroscopies revealed that patients with reflux were significantly more likely to have de-novo hiatal hernia. A significantly lower quality of life was detected through GIQLI and BAROS in patients with reflux.ConclusionThe authors recommend gastroscopies at 5-year intervals after SG to detect the possible sequelae of reflux at an early stage. Conversion to Roux-en-Y-gastric bypass (RYGB) works well to cure patients from reflux but may not be as efficient at treating weight regain.

Gastric cancer in the young: An advanced disease with poor prognostic features

Gastric cancer in young patients is rare. We analyzed the clinicopathological features and prognosis of early‐onset gastric carcinoma.