A Altendorf-Hofmann

Friedrich-Schiller-University Jena, Jena, Thuringia, Germany

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Publications (92)168.54 Total impact

  • T Knösel, E Kampmann, T Kirchner, A Altendorf-Hofmann
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    ABSTRACT: The development of therapeutic agents that specifically target the molecular alterations critical for tumorigenesis has a tremendous impact on the management of cancer patients. The successful treatment of advanced gastrointestinal stromal tumors (GIST) with receptor tyrosine kinase (RTK) inhibitors has raised the hope that other malignancies could also benefit from a similar treatment. Tyrosine kinase receptors are promising targets for personalized medicine and new drugs are currently in phase 2 and phase 3 clinical trials. We analyzed a large cohort of soft tissue sarcomas for different tyrosine kinase receptors and correlated the results with clinicopathological parameters. A total of 275 soft tissue sarcomas from the Ludwig-Maximilians University (LMU) were revisited and catagorized according to the current World Health Organization (WHO) classification system. Different entities showed distinct survival curves in 10-year long-term survival. Furthermore, different subtypes of sarcomas showed distinct expression profiles at the protein level. The expression of vascular endothelial growth factor (VEGF) receptors is associated with tumor progression. Due to the fact that not all patients respond to RTK inhibitor therapy, protein signatures should be evaluated before targeting therapy to give a rationale for a viable personalized therapy.
    Der Pathologe 09/2014; · 0.62 Impact Factor
  • S Schüle, A Altendorf-Hofmann, Y Dittmar, F Rauchfuß, U Settmacher
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    ABSTRACT: Even in patients with a history of solid malignant tumors, especially of gastrointestinal origin, newly diagnosed solid liver lesions do not necessarily correspond to metastases of the respective primary tumor. A reliable diagnosis can only be made by definitive histological examination. Data of all patients who underwent liver resection under the preoperative diagnosis of liver metastases between 1997 and 2011 and for whom liver specimens were examined histologically, were extracted from the prospectively maintained cancer registry. An unexpected histological result occurred in 47 out of 770 patients (6.1 %). Primary tumors in these patients included renal cell (n=12), colorectal (n=11), breast (n=8), gastric (n=4), pancreatic (n=3), skin (n=3) and other cancers (n=6). Liver lesions were diagnosed synchronously in 15 cases or metachronously after a median of 17 months following primary therapy in 32 patients. Histology revealed a benign tumor in 38 cases (81 %) as well as 6 cases of HCC, 2 cases of CCC and in 1 case metastasis of a previously unknown colorectal cancer in a patient with known esophageal carcinoma. Suspicion of metastatic disease was based on four different imaging modalities in two cases and on three different imaging modalities in nine cases. Either computed tomography (CT) or magnetic resonance imaging (MRI) was combined with ultrasound in another 23 patients and with positron emission tomography (PET) CT in 6 more cases. In two patients CT plus MRI and CT only, respectively, was performed. In the remaining three patients, suspicion of metastases occurred intraoperatively after macroscopic examination of the liver. Preoperative percutaneous biopsy was attempted in four patients with indeterminate results. Even with modern diagnostics the risk of treating a benign or other form of malignant tumor with neoadjuvant or palliative chemotherapy persists. The same holds true for local ablative procedures. Prior to local ablation or definitive palliative chemotherapy histological confirmation of metastases should be attempted.
    Der Chirurg 01/2014; · 0.52 Impact Factor
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    ABSTRACT: PURPOSE: Despite the development of modern chemotherapeutics and target-specific drugs as well as improved surgical techniques, prognosis of metastatic breast cancer remains poor. Only a small number of selected patients will be eligible for liver resection and/or alternative metastatic ablation. Data on prognostic factors for patients with surgically resectable liver metastases of breast cancer are scarce at present. METHODS: From 1997 to 2010, 50 patients with hepatic metastases of breast cancer have undergone laparotomy with the intention to undergo a curative liver resection at our institution. Data from these patients were collected in a prospectively maintained standardized liver resection data base. RESULTS: Liver resection was performed in 34 patients. Resection margins were clear in 21 cases (R0). Nine patients lived for more than 60 months after liver resection. The observed 5-year survival rate was 21 % for all 50 patients, 28 % for resected patients and 38 % after R0-resection. On univariate analysis, survival rates of the resected patients were statistically significantly influenced by R-classification, age, extrahepatic tumour at the time of liver resection, size of metastases and HER2 expression of liver metastases. Multivariate analysis revealed absence of HER2 expression, presence of extrahepatic tumour and patient's age ≥50 years as independent factors of poor prognosis. CONCLUSIONS: Breast cancer patients younger than 50 years with technically resectable hepatic metastases, minimal extrahepatic tumour and positive HER2 expression appear to be suitable candidates for liver resection with curative intent. An aggressive multi-disciplinary management of those patients including surgical treatment may improve long-term survival.
    Journal of Cancer Research and Clinical Oncology 05/2013; · 2.91 Impact Factor
  • W Sendt, C Wurst, U Settmacher, A Altendorf-Hofmann
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    ABSTRACT: Small bowel adenocarcinoma is a rare disease. The diagnosis is often disguised by nonspecific and varied presenting symptoms. Adenocarcinoma of the small bowel is typically detected at a late stage and with a poor prognosis. The records of 42 patients with small bowel adenocarcinomas diagnosed in 2 surgical clinics between 1995 and 2009 were reviewed for patient and tumor characteristics, treatment effects and survival. The tumor locations were the duodenum (50%), jejunum (38%) and ileum (12%). In comparison to patients seen before 2004 the observed frequency of emergency operations or palliative procedures as well as stage distribution did not change. The median overall survival was 19 months with a 5-year overall survival of 20%. For patients with resections, reduced performance status, higher stage and residual disease after resection predicted decreased overall survival in univariate analysis. Residual disease and pT category were predictive of survival in multivariate analysis. Complete resection provides the only means of a cure. In cases where curative resection cannot be performed the prognosis remains poor. Further study on the methods for early detection and effective adjuvant chemotherapy should be investigated, however, the available data are limited.
    Der Chirurg 09/2011; 83(4):374-80. · 0.52 Impact Factor
  • M Benkel, F Brasch, J D Neumann, A Altendorf-Hofmann, W Sendt
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    ABSTRACT: BACKGROUND: Neuroendocrine tumours of the gastroenteropancreatic system (GEP-NETs) are rare, in particular those of the gallbladder. Due to the limited therapeutic options, surgical resection is favoured. CASE REPORT AND METHODS: Described below is the case of a 69-year-old male with a lymphogenically metastasising, poorly differentiated neuroendocrine carcinoma of the gallbladder who presented with unspecific abdominal pain. RESULTS AND CLINICAL COURSE: Following complete surgical resection of the tumour and the lymph node metastases he developed a recurrence 6  weeks post-operatively. The recurrence was treated with chemotherapy. Re-staging after three courses, however, showed further tumour progression. Prior to the start of a second-line treatment the patient died 13  weeks after surgery. CONCLUSIONS: This case demonstrates the complexity of this rare disease with diagnosis in advanced tumour stage and poor prognosis.
    Zentralblatt für Chirurgie 03/2011; 137(1):71-2. · 0.69 Impact Factor
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    ABSTRACT: The Jena Institute of Pathology has been serving as a consultation and reference center for soft tissue tumors in Germany since 1978. The present study provides an overview of the clinicopathological data from a two-year period and an update on diagnostics and research. Retrospectively, 7043 cases sent to the institute in the years 2006 and 2007 were analyzed. The majority of cases (>77.7%) were soft tissue tumors, of which 49% were categorized as malignant, 11.4% as intermediate, 35% as benign and 4.6% as tumors of uncertain biological potential. Neoplasms with fibroblastic differentiation were the most frequent. The mean age of patients with a sarcoma was 63 years. The molecular pathological analysis of soft tissue tumors has attained a major role in diagnosis. This is further advanced at the Jena institute in the context of a German Federal Ministry of Education and Research (BMBF) project for molecular sarcoma diagnosis with the aim of developing and validating DNA probes for in situ hybridization detection of translocations and their associated chromosomal breaks on the one hand, and DNA chips for the detection of fusion transcripts on the other. Research projects relate to the analysis of specific biomarkers in large tumor collectives and the pathomechanisms in several sarcoma entities.
    Der Pathologe 02/2011; 32(1):40-6. · 0.62 Impact Factor
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    ABSTRACT: Head and neck in situ carcinoma is seldom diagnosed. Our knowledge about in situ cancer is limited. This study describes the epidemiology and prognosis of head and neck in situ cancer in Thuringia, Germany. We analyzed the cancer data of the Thuringian cancer registry database from 1996 to 2005. The database contained 3821 patients with primary head and neck cancer. Thirty-four patients (0.88%) had an in situ carcinoma. They were evaluated for patient's characteristics, tumor stage, incidence, treatment and trends in overall survival (OS) and recurrence-free survival (RFS). During 1996-2005, the average annual incidence of head and neck in situ carcinoma was 0.14 per 100,000 persons. Half of the cases were localized in the larynx. The patients were treated by local excision. Six patients (18%) developed a local recurrence. Only one recurrent tumor was diagnosed in early stage (rT1), but the other five tumors in advanced stage (rT3/rT4). The median time to recurrence was 27.43 months. For all 34 patients with in situ carcinoma, the 5-year OS was 84% and the 5-year RFS 60.4%. OS was better for laryngeal in situ cancer than for oral cavity or pharyngeal in situ cancer (p=0.031). The surveillance of patients with head and neck in situ carcinoma after treatment should be performed like in patients with invasive cancer, because nearly one fifth of patients developed a recurrence, predominantly in advanced stage.
    Oral Oncology 03/2010; 46(4):e5-9. · 2.70 Impact Factor
  • W Sendt, T Weber, S Retschke, A Altendorf-Hofmann
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    ABSTRACT: Symptomatic congenital cysts of the liver, whether solitary or multiple in appearance, can be treated by a laparoscopic approach. Here we present our single centre experience encompassing a rather large cohort of patients. From our prospective surgical database, introduced for quality management and surveillance, we identified 34 consecutive patients who were operated on for congenital liver cysts between 1995 and 2004. Using a questionnaire, the patients were contacted to assess actual complaints, the recurrence of operated cysts or the frequency of newly developed cysts. During follow-up two patients had died of other diseases. Of the remaining 32 patients 30 answered the questionnaire (94 %). The median postoperative follow-up was 55 months (range: 8-121). There were 29 women and 5 men with solitary (n = 10) or multiple (n = 20) liver cysts and polycystic liver disease (n = 4), all complained of unspecific upper abdominal pain. Due to previous operations or coexisting diseases open laparotomy was performed in 7 patients and laparoscopic unroofing was performed in 27 patients. The conversion rate to open laparotomy was 7 % (n = 2). Solitary cysts were unroofed in 25 patients and multiple cysts in 8 patients. The resected cysts had a median diameter of 10.5 cm (solitary cysts: 7-19 cm, multiple cysts: 4-23 cm). The only postoperative complications were 3 cases of bilioma (8.9 %), which required open revision in one case. There were no cysts recurrences, but persisting upper gastrointestinal pain, backache or problems arising from the scars were reported by 9 patients (30 %). In cases of symptomatic congenital liver cysts laparoscopic unroofing should be considered the treatment of choice.
    Zentralblatt für Chirurgie 05/2009; 134(2):149-54. · 0.69 Impact Factor
  • U. Settmacher, A. Altendorf-Hofmann, K. Jandt, M. Heise
    Onkologe. 01/2009; 15(6):575-588.
  • W. Sendt, T. Weber, S. Retschke, A. Altendorf-Hofmann
    Zentralblatt Fur Chirurgie - ZBL CHIR. 01/2009; 134(02):149-154.
  • K Krobot, D Yin, Q Zhang, S Sen, A Altendorf-Hofmann, J Scheele, W Sendt
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    ABSTRACT: To assess the significance of initial empiric parenteral antibiotic therapy in patients requiring surgery for community-acquired secondary peritonitis, 425 patients hospitalized between January 1999 and September 2001 in 20 clinics across Germany were followed for a total of 6,521 patient days. Perforated appendix (38%), colon (27%), or gastroduodenum (22%) were the most common sites of infection. Escherichia coli was the most common pathogen. A total of 54 (13%) patients received inappropriate initial parenteral therapy not covering all bacteria isolated, or not covering both aerobes and anaerobes in the absence of culture results. Clinical success, predefined as the infection resolving with initial or step-down therapy after primary surgery, was achieved in 322 patients (75.7%; 95% confidence interval (CI), 70.6-81.2). Patients were more likely to have clinical success if initial antibiotic therapy was appropriate (78.6%; 95% CI, 73.6-83.9) rather than inappropriate (53.4%; 95% CI, 41.1-69.3). Patients having clinical success were estimated to stay 13.9 days in hospital (95% CI, 13.1-14.7), while those who had clinical failure stayed 19.8 days (95% CI, 17.3-22.3). In conclusion, appropriateness of initial parenteral antibiotic therapy was a predictor of clinical success, which in turn was associated with length of stay.
    European Journal of Clinical Microbiology 10/2004; 23(9):682-7. · 3.02 Impact Factor
  • A Altendorf-Hofmann, E Schulze, D Katenkamp, J Scheele, P Hermanek
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    ABSTRACT: Current tumor management is increasingly founded on interdisciplinary cooperation. The main partners in cases of solid tumors are oncologic surgery, medical oncology,and radiotherapy, guided by pathology. The cooperative concept, particularly the individual strategy and selection of the most adequate approach, oriented on guidelines and therapeutic standards, depends on the quality of the involved components as well as personal abilities of the "actors." In addition to the personal qualification, decision making depends on both tumor stage and completeness of tumor removal. In this point, the overall quality of the therapeutic concept is based on an interaction between the operating surgeon and clinical pathologist that had seldom been taken into consideration. The basic rules of their cooperation and quality-focused implementation regarding tumor dignity, stage, and R classification are discussed based on the example of colorectal carcinoma. In particular, those pitfalls in tumor documentation are emphasized,which may appear less relevant for each partner individually, but bear the risk of misinterpretation and therefore misleading conclusions.
    Der Chirurg 05/2003; 74(4):375-80. · 0.52 Impact Factor
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    ABSTRACT: Experts on different specialties (surgery, pathology, molecular biology and medical statistics) discussed the evaluation of prognostic factors during a workshop. The most important results presented are: (1) the prognostic relevance of new biological or molecular markers must be evaluated in a phase-III prognostic study. To establish such a marker in the UICC-TNM-classification in at least two different centers, two multivariate analyses according to defined criteria are necessary; (2) the standards of laboratory methods have to be defined, e.g.,which method to apply for RNA-analysis,which materials to used, etc; (3) intensive data analysis should be done before using methods of multivariate analysis. The criteria for the presentation of survival curves are given in detail; (4) in multivariate analysis, the Cox proportional hazard regression for survival outcomes is discussed with explanations and examples of the terms relative risk, odds-ratio, hazard and relative hazard. The arrangement and interpretation of a good prognostic study should be performed as an interdisciplinary approach.
    Der Chirurg 03/2003; 74(2):139-44. · 0.52 Impact Factor
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    Annelore Altendorf-Hofmann, Johannes Scheele
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    ABSTRACT: Hepatic resections for metastatic colorectal cancer have dramatically increased, and there is clear evidence of the effectiveness of this type of surgery. Controversy, however, persists regarding appropriate patient selection, extent and timing of liver resection, and adjuvant or alternative therapeutic options. This article reviews the authors' experience with more than 600 hepatic resections and the relevant literature is discussed. The results underscore the importance of macroscopically and histologically complete tumor clearance, a so-called "R0 resection."
    Surgical Oncology Clinics of North America 02/2003; 12(1):165-92, xi. · 1.22 Impact Factor
  • A. Altendorf-Hofmann, E. Schulze, D. Katenkamp, J. Scheele, P. Hermanek
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    ABSTRACT: Zusammenfassung Tumortherapie gestaltet sich zunehmend in interdisziplinrer Kooperation.Die tragenden Partner bei den soliden Tumoren sind onkologische Chirurgie, medizinische Onkologie und Strahlentherapie unter Wegweisung der Pathologie.Das gemeinschaftliche Konzept, besonders die an Richtlinien und Standards orientierte individuelle Strategie und Verfahrenswahl, lebt von der Qualitt der Einzelkomponenten und der persnlichen Fhigkeit der jeweiligen “Akteure”. Neben der persnlichen Qualifikation spielen bei der Entscheidungsfindung Tumorstadium und Vollstndigkeit der operativen Tumorentfernung zentrale Rollen. In diesem Punkt grndet die Gesamtqualitt des gemeinschaftlichen Therapiekonzepts auf einer bisher wenig beachteten Interaktion von operierendem Chirurg und klinisch orientiertem Pathologen. Die wesentlichen Regeln dieser Zusammenarbeit und ihre qualittsorientierte Umsetzung in Bezug auf Dignitt, Stadium und R-Klassifikation wird am Beispiel des kolorektalen Karzinoms abgehandelt.An Beispielen werden gerade jene Fallstricke in der Tumordokumentation herausgestellt, die fr den einzelnen Partner zunchst weniger relevant erscheinen mgen, im Zusammenspiel jedoch die Gefahr von Fehlinterpretationen und damit irrigen Folgerungen bergen.
    Der Chirurg 01/2003; 74(4):375-380. · 0.52 Impact Factor
  • A. Altendorf-Hofmann, J. Scheele
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    ABSTRACT: Indication and Prognosis Factors in the Resection of Non-Colorectal Liver MetastasesLiver resection presently represents the gold standard in the treatment of colorectal hepatic metastases. In metastases from neuroendocrine tumors, resection is primarily focused at symptomatic control. Recent reports suggested improved survival rates not only after complete tumor clearance, but also in patients undergoing debulking procedures. The role of hepatectomy for metastases from non-colorectal, non-neuroendocrine (NCNN) tumors has not yet been defined. Although liver metastases are frequently seen in breast cancer and gastric cancer patients, resection is possible in less than 1% of patients. The indications and outcomes of hepatic resection for metastatic NCNN cancers remain unclear because reports on this issue are rare, the number of patients involved is very limited, a broad variety of tumors with different natural histories is included, and only few articles are addressing long-term results of surgical treatment based on sufficient follow-up periods. This led to a broad variety of possible prognostic factors in the literature. There is some argument that R0 resection may prolong survival times in patients with isolated hepatic metastases originating from breast cancer, Wilms’ tumors, hypernephroma, and possibly gastric cancer. However, even most radical surgery is unlikely to improve the prognosis in patients with liver metastases from adenocarcinoma originating from the lungs, pancreas, gallbladder, and the biliary tract.
    Chirurgische Gastroenterologie 01/2003; 19(4):324-331. · 0.14 Impact Factor
  • J. Scheele, A. Altendorf-Hofmann
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    ABSTRACT: Indication and Prognosis Factors in the Resection of Colorectal Liver MetastasesLiver resection presently represents the gold standard in the treatment of colorectal hepatic metastases. Patient selection is based on a rational evaluation of prognostic factors and the definition of contraindications. Various series worldwide have proven a R0 resection the paramount prerequisite of long-term survival. In borderline situations this goal can be reached with adequate patient safety using portal vein embolization, neoadjuvant chemotherapy, and splitting of the procedure. If by all these means a R0 situation is impossible to be achieved, liver resection is not indicated. Within the R0 group a large number of indicators of prognosis have been described, both by univariate and multivariate analysis. Many of them improve the assessment of long-term success, but even unfavorable findings do allow a reduced, but real chance of long-term disease-free survival. Therefore, these indicators are not suitable as absolute contraindications. Classic constellations such as a number of ≥4 metastases or a narrow clear margin have shown little if any effect on the patients’ survival in recent studies. Despite an overall impaired prognosis, extrahepatic disease should also be looked at more specifically. Direct tumor invasion of adjacent structures, simultaneous or subsequent lung metastases, and a resectable local recurrence have only marginal impact on patient prognosis. In contrast, other discontinuous metastases, hilar lymph node involvement, and limited peritoneal carcinomatosis have been found almost unequivocally dismal. With respect to all these results, the indication for liver resection should be quite liberal as long as a R0 situation can be reached. Along with this active surgical approach, multimodal therapeutic concepts have to be established, and local tumor destruction should be evaluated as supplement as well as an alternative to resection.
    Chirurgische Gastroenterologie 01/2003; 19(4):315-323. · 0.14 Impact Factor
  • A Altendorf-Hofmann, J Scheele
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    ABSTRACT: From 1995 to 2001, 243 patients with hepatocellular carcinoma were recorded at Jena University Hospital, 59 (24%) underwent curative hepatic resection or orthotopic liver transplantation. 28 tumors (12%) showed microvascular invasion, and 29 (12%) presented with gross vascular invasion. 32 patients (13%) had regional lymph node metastases. In one patient (0.4%) CT scan showed involvement of the extrahepatic bile duct. Curative removal of the tumor was possible in 61%, 21%, 3% and 0%, respectively. Vascular invasion did not influence survival statistically significant. 3 year survival rates in patients with and without regional lymph node involvement were 0% and 38% (p < 0.01).
    Kongressband / Deutsche Gesellschaft für Chirurgie. Deutsche Gesellschaft für Chirurgie. Kongress. 01/2002; 119:635-41.
  • B Böhm, H Helfritzsch, M Thiele, A Altendorf-Hofmann, J Scheele
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    ABSTRACT: Despite of advanced surgical technique and multimodality therapy results following secondary resection of local recurrence after rectal cancer are discussed controversially. Between 1990 and 1999 81 patients with local recurrence of rectal cancer were treated at our surgical department. Median age was 63 years, 62 % of patients were male. 98 % of recurrences were in local advanced stage (74 % = rT4, 25 % = rT3), 44 % of patients had synchronous distant metastases. 32 patients underwent resection of recurrent rectal cancer. Potential curative surgery was possible in 56 % of resections. Extended resections of adjacent organs were necessary in 21 patients. The 4-year survival in the curative group was 44 % compared to 19 % in patients with microscopic or gross residual disease. Optimistic long-term results in recurrent rectal cancer can only be achieved after curative resection. Preoperative radiochemotherapy in advanced cancers increases curative resection and probably survival rate.
    Zentralblatt für Chirurgie 09/2001; 126(8):596-601. · 0.69 Impact Factor
  • J Scheele, A Altendorf-Hofmann, T Grube, W Hohenberger, R Stangl, K Schmidt
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    ABSTRACT: Based on a consecutive series of patients undergoing liver resection for colorectal metastases, indicators of prognosis and selection criteria were evaluated. From 1960 to 1998, a total of 654 patients underwent resection of colorectal liver metastases. In 516 patients (78.9%) this was an R0 resection for initial metastatic disease. These patients form the basis for the investigation. 30-day mortality in this group was 5.8%, while the total procedure-related mortality was 8.3%. Significant morbidity was observed in 16% of patients. Follow-up information until 1 January, 2000 was achieved in 99.5% of patients. Including operative mortality, the actuarial 5-, 10-, and 20-year survival is 38 +/- 5%, 27 +/- 6% und 24 +/- 24%, rising to 41 +/- 5%, 29 +/- 6% and 26 +/- 26% after excluding operative deaths. Tumor-free survival is 35 +/- 5% at 5 years. In the multivariate analysis the following factors are associated with decreased crude survival: extrahepatic tumor (P < 0.0001), intraoperative hypotension (P = 0.0001), non-anatomical procedures (P = 0.0002), a metastasis diameter > or = 5 cm (P = 0.0002), unfavourable grading of the primary tumor (P = 0.0003), satellite metastases (P = 0.0069), mesenteric lymph node involvement (P = 0.0260), use of FFP (P = 0.0307) and synchronous diagnosis of metastases (P = 0.1240). With respect to disease-free survival metastasis diameter is first, followed by extrahepatic disease (P < 0.0001 each). Satellite metastases are removed, while the primary tumor site becomes important with inferior results for rectal cancer (P = 0.0188). The other factors remain stable and in the same order. The number of independent tumor nodules as well as the width of resection margin fail to be significant in both univariate and multivariate analysis. These results underline the paramount importance of an R0 resection, but diminish the relevance of most commonly used "contraindications". For the actual decision on liver resection, beside the possibility of achieving an R0 situation, safety aspects regarding comorbidity and acceptable extent of parenchyma loss represent the prime limitation.
    Der Chirurg 05/2001; 72(5):547-60. · 0.52 Impact Factor

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3k Citations
168.54 Total Impact Points

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Institutions

  • 1995–2010
    • Friedrich-Schiller-University Jena
      • Clinic of General, Visceral and Vascular Surgery
      Jena, Thuringia, Germany
  • 2002
    • Universitätsklinikum Jena
      Jena, Thuringia, Germany
  • 1999
    • Alfried Krupp Krankenhaus
      Essen, Lower Saxony, Germany
  • 1991–1999
    • Klinikum Bayreuth GmbH
      Bayreuth, Bavaria, Germany
  • 1989–1999
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Experimental and Clinical Pharmacology and Toxicology
      Erlangen, Bavaria, Germany
  • 1990–1997
    • Universitätsklinikum Erlangen
      • Department of Surgery
      Erlangen, Bavaria, Germany