-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: In the recent years natural orifice transluminal endoscopic surgery (NOTES) has been an increasingly popular topic
with rising numbers of papers and surgeries. We have developed in 2007 a technique of hybrid transvaginal cholecystectomy
(TVC) that can be used in daily routine. METHODS: From June 2007 until September 2010, 165 female patients underwent TVC.
Data about patients, indications, operations and follow-up were collected prospectively. RESULTS: One hundred and sixty-four
TVC could be performed successfully. We had one case of conversion to conventional laparoscopic cholecystectomy. We report
about one intraoperative complication and one postoperative complication. All other postoperative courses were uneventful
and the gynecological examination one week postoperatively without pathological findings. CONCLUSIONS: This technique of TVC
is as successful as the conventional laparoscopic cholecystectomy and can be used in daily routine.
KeywordsTransvaginal cholecystectomy–NOTES–Hybrid
European Surgery 04/2012; 43(3):130-134. · 0.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: NOTES („natural orifice transluminal endoscopic surgery“) hat das Potenzial, minimal-invasive Operationen zu optimieren. Mit
dem transvaginalen Zugang zum Bauchraum bestehen in der Gynäkologie reichlich Erfahrungen. Er ist einfach anzulegen und zu
verschließen und birgt ein geringes Infektrisiko. Insofern bietet er sich am ehesten für NOTES an. Mithilfe starrer Instrumente
der laparoskopischen Chirurgie lassen sich z.B. Cholezystektomien routinemäßig durchführen. In unserer Klinik gelangen bisher
149 dieser Operationen; im NOTES-Register der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie sind über 900 transvaginale
Operationen registriert.
NOTES („natural orifice transluminal endoscopic surgery“) has the potential to optimize minimally invasive surgery. In gynecology
there is extensive experience with the transvaginal approach to the abdominal cavity. It is easy to perform, closure is safe
and there is little risk of infection. Hence, this is the approach most suitable for NOTES. By means of rigid laparoscopic
instruments cholecystectomy can be routinely performed. Such operations could be performed in 149 patients in our hospital
and the NOTES register of the DGAV has data on more than 900 transvaginal operations.
SchlüsselwörterNOTES-Transvaginale Cholezystektomie-Starre Instrumente
KeywordsNOTES-Transvaginal cholecystectomy-Rigid instruments
Der Chirurg 04/2012; 81(5):426-430. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Die Nutzung natürlicher Körperöffnungen als Zugangsweg für Operationen im freien Bauchraum (NOTES) könnte sich als konsequente
Fortentwicklung der minimal-invasiven Chirurgie erweisen. Im Israelitischen Krankenhaus Hamburg wurden von Beginn der 1990er
Jahre an Erfahrungen mit der hinteren Kolpotomie als Bergeweg in der laparoskopischen Chirurgie gesammelt. Aus diesem Grund
wurde bei der Anwendung von NOTES der transvaginale Weg mit einem im Nabel gelegenen Zugang kombiniert. So wurde eine Cholezystektomie
ohne sichtbare Narben möglich. Die routinemäßige Durchführung dieser Operation war auch dadurch gegeben, dass die gewohnten
starren Instrumente und Optik zum Einsatz kamen. Von Juni 2007 bis April 2008 wurden 57Patientinnen in dieser Technik operiert.
Alle Operationen waren erfolgreich, die durchschnittliche Operationszeit lag bei 54min. Es gab eine Komplikation in Form
eines Douglas-Abszesses nach 3Wochen, der laparoskopisch drainiert wurde. Alle übrigen Verläufe waren unauffällig. In einer
Befragung nach mindestens 3Monaten gab keine Patientin Beschwerden im Bereich der Scheide oder beim Geschlechtsverkehr an.
The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES)
could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior
colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine
it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The
operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until
April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time
was 54min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative
courses were uneventful. After a minimum follow-up of 3months, none of the patients had symptoms in the vagina or during
sexual intercourse.
Der Chirurg 04/2012; 80(4):364-369. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: NOTES ("natural orifice transluminal endoscopic surgery") has the potential to optimize minimally invasive surgery. In gynecology there is extensive experience with the transvaginal approach to the abdominal cavity. It is easy to perform, closure is safe and there is little risk of infection. Hence, this is the approach most suitable for NOTES. By means of rigid laparoscopic instruments cholecystectomy can be routinely performed. Such operations could be performed in 149 patients in our hospital and the NOTES register of the DGAV has data on more than 900 transvaginal operations.
Der Chirurg 04/2010; 81(5):426-30. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used. We report our experience in all patients treated over a 1-year period.
Between June 2007 and June 2008, 68 patients (mean age 50 years) underwent transvaginal cholecystectomy with an additional 5-mm umbilical trocar using rigid laparoscopic instruments. Data about symptoms, operation, and postoperative course were prospectively collected, as were findings of a gynecological follow-up examination 1 week after surgery and the results of an interview at least 3 months after surgery.
All 68 operations were finished successfully without conversion, with a mean operation time of 51 minutes; in three additional cases severe pelvic adhesions prevented further transvaginal progress. There were no intraoperative or immediately postoperative complications, but one patient presented with a Douglas pouch abscess 3 weeks after surgery. Gynecologic follow-up exams 1 week after surgery were unremarkable. All patients were interviewed 3-10 months after surgery and had no abdominal or gynecological complaints including in relation to sexual intercourse.
Transvaginal NOTES cholecystectomy with rigid instruments can be safely and effectively performed in daily routine.
Endoscopy 06/2009; 41(5):391-4. · 5.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time was 54 min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative courses were uneventful. After a minimum follow-up of 3 months, none of the patients had symptoms in the vagina or during sexual intercourse.
Der Chirurg 12/2008; 80(4):364-9. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall and might further improve minimal invasive surgery of patients, but might also increase surgical risk when used by a transgastric or transcolonic approach with flexible endoscopes. Therefore we decided to use a transvaginal approach using rigid laparoscopic instruments for cholecystectomies.
Through a 5-mm incision deep in the umbilicus a pneumoperitoneum was created. The optic and a dissector were inserted through the posterior fornix of the vagina under laparoscopic control from the umbilicus and a transvaginal gallbladder removal was performed.
20 patients were successfully operated in a 4.5-month period. Operating time was 62 (35-100) min. No intra- or postoperative complications occurred in any patient. Gynecological examination after 8 days showed no negative findings and the cosmetic result was ideal with no visible scars.
In our series we showed that cholecystectomies can be routinely performed in a NOTES technique without visible scar. The transvaginal approach is the safe in NOTES and common laparoscopic instruments can be used as long as there are no better flexible endoscopes for this purpose.
Surgical Endoscopy 07/2008; 22(6):1427-9. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360 degrees ) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure (270 degrees ) in these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia).
200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview, endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry.
After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the Nissen procedure.
Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux.
Surgical Endoscopy 01/2008; 22(1):21-30. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic surgery has decreased trauma and improved results and natural orifice transluminal endoscopic surgery (NOTES) should be a further step in this direction. However the use of flexible gastroscopes in the abdomen is difficult and the generally chosen transgastric approach is not without risk. Therefore we have carried out a cholecystectomy with a combined transvaginal and transumbilical approach, using laparoscopic instruments. The optic and a dissector were inserted in the posterior fornix of the vagina, and a 5-mm trocar was inserted deep in the umbilicus. After dissection the gallbladder was removed through the vagina. The operation was done without problems within 85 minutes and left no visible scar. The postoperative course was uneventful. In NOTES the transvaginal approach has important advantages over the transgastric method (e. g. regarding sterilization and closure); standard laparoscopic instruments can be used whilst there are no flexible endoscopes that are easier to handle.
Endoscopy 11/2007; 39(10):913-5. · 5.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present the findings of a 67 year old male patient with an intestinal leiomyomatosis localized in the rectum. To our knowledge, this is the fifth case of intestinal leiomyomatosis reported so far. The most characteristic findings of this rare disease include a cuff-like tumorous proliferation of smooth muscle within the bowel wall which may extend into extramural tissue and result in a stenosis of a longer bowel segment. Because of severe obstructive symptoms over 5 years, the patient had to undergo surgery with resection of the rectum. The histological examination revealed a morphology and immunophenotype comparable to usual leiomyomas with the exception of hyalinosis-like changes in the blood vessels, apparently a special feature of leiomyomatosis. A novel finding in our case was the occurrence of skeinoid fibers which have so far only been reported in gastrointestinal stromal tumors.
Der Pathologe 04/2007; 28(2):161-5. · 0.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vorgestellt wird der bei unserem 67-jhrigen mnnlichen Patienten im Rektum lokalisierte 5.Fall einer intestinalen Leiomyomatose. Dabei handelt es sich um eine manschettenartig intramural und teilweise auch extramural entwickelte und lngerstreckig stenosierende tumorse oder tumorartige glattmuskulre Proliferation der Darmwand. Bei unserem Patienten musste nach ber 5Jahre bestehender massiver obstruktiver Symptomatik eine Rektumamputation durchgefhrt werden. Histologisch und immunhistologisch fanden sich gleichartige Befunde wie bei Leiomyomen. Ein Merkmal der Leiomyomatose scheint jedoch das Auftreten von fr Leiomyome untypischen hyalinisierenden Gefwandvernderungen zu sein. Eine weitere Besonderheit unseres Falls bestand im Nachweis von sonst nur bei gastrointestinalen Stromatumoren zu beobachtenden skeinoid fibers.We present the findings of a 67year old male patient with an intestinal leiomyomatosis localized in the rectum. To our knowledge, this is the fifth case of intestinal leiomyomatosis reported so far. The most characteristic findings of this rare disease include a cuff-like tumorous proliferation of smooth muscle within the bowel wall which may extend into extramural tissue and result in a stenosis of a longer bowel segment. Because of severe obstructive symptoms over 5years, the patient had to undergo surgery with resection of the rectum. The histological examination revealed a morphology and immunophenotype comparable to usual leiomyomas with the exception of hyalinosis-like changes in the blood vessels, apparently a special feature of leiomyomatosis. A novel finding in our case was the occurrence of skeinoid fibers which have so far only been reported in gastrointestinal stromal tumors.
Der Pathologe 02/2007; 28(2):161-165. · 0.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nissen fundoplication (360 degrees ) is the standard operation for the surgical management of gastroesophageal reflux disease (GERD). To avoid postoperative dysphagia, it has been proposed that antireflux surgery be tailored according to the degree of preexisting esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and the Toupet procedure (270 degrees ) has been recommended for these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques in terms of reflux control and complication rate (dysphagia). Our objective was to determine the impact of preoperative esophageal motility on the clinical and objective outcome, following Toupet vs Nissen fundoplication and to evaluate the success rate of these procedures.
From May 1999 until May 2000, 200 patients with GERD were included in a prospective randomized study. After preoperative examinations (clinical interview, endoscopy, 24-h pH study and esophageal manometry), 100 patients underwent either a laparoscopic Nissen (50 with and 50 without motility disorders), or a Toupet procedure (50 with and 50 without motility disorders). Postoperative follow-up after 4 months included clinical interview, endoscopy, 24-h pH study and esophageal manometry.
Interviews showed that 88% (Nissen) and 90% (Toupet) of the patients, respectively, were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication than after a Toupet (30 vs 11, p <0.001) and did not correlate with preoperative motility. In terms of reflux control, the Toupet proved to be as effective as the Nissen procedure.
Tailoring antireflux surgery to esophageal motility is not indicated, since motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation because it has a lower rate of dysphagia and is as effective as the Nissen fundoplication in controlling reflux.
Surgical Endoscopy 05/2002; 16(5):758-66. · 4.01 Impact Factor
-
British Journal of Surgery 11/2001; 88(10):1417. · 4.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine whether esophageal dysmotility affects symptoms of gastroesophageal reflux disease or clinical outcome after laparoscopic fundoplication and whether esophagus motor function changes postoperatively.
Two hundred patients with a history of long-standing gastroesophageal reflux disease were investigated by clinical assessment, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH monitoring between May 1999 and May 2000. Patients were stratified according to presence or absence of esophageal dysmotility (each n = 100) and randomized to either 360 degrees (Nissen) or 270 degrees (Toupet) fundoplication. At a 4-month postoperative follow-up, preoperative tests were repeated.
Preoperative esophageal dysmotility was associated with more severe reflux symptoms, more frequent resistance to medical treatment (64% vs. 49%; P < 0.05), and greater decrease in lower esophageal sphincter pressure (9.5 +/- 5.3 vs. 12.4 +/- 6.7 mm Hg; P < 0.0005) compared with normal motility. Postoperatively, clinical outcome and reflux recurrence (21% vs. 14%) were similar. Esophageal motility remained unchanged in 85% of patients and changed from pathologic to normal in 20 (10 Nissen/10 Toupet) and vice versa in 9 (8 Nissen/1 Toupet) patients.
Esophageal dysmotility (1) reflects more severe disease; (2) does not affect postoperative clinical outcome; (3) is not corrected by fundoplication, independent of the surgical procedure performed; (4) may occur as a result of fundoplication; and (5) requires no tailoring of surgical management.
Gastroenterology 08/2001; 121(1):5-14. · 11.68 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present a 78-year-old patient who suffered from symptomatic transitory psychotic syndrome after laparotomy. Persisting somnolence appeared with cardiopulmonary decompensation and gastrointestinal atony. Due to prolonged hypercalcemia primary hyperparathyreoidism was diagnosed. Resection of a large carcinoma of the parathyroids led to continuous clinical improvement.
Der Chirurg 01/2001; 71(12):1489-92. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Splenectomy is of great benefit for patients with idiopathic thrombocytopenia (ITP), when medical therapy has failed. It was the aim of this retrospective study to evaluate the results of laparoscopic splenectomy.
All patients with ITP, who had a laparoscopic splenectomy between 1992 and 1999, were included in this study.
53 patients with an average age of 41.8 years had a laparoscopic splenectomy: 48 of these operations were finished laparoscopically, while conversion to the open technique was necessary in five patients. The mean operation time was 95 minutes. In the last 38 cases it was 76 minutes. There were no deaths and no reoperations were necessary. The average postoperative hospital stay was 3.9 days. After a mean follow-up of 24 (1-75) months thrombocytopenia recurred in eight patients, of whom five received medical therapy.
Splenectomy can be easily performed laparoscopically in patients with ITP and has a low morbidity. The results of therapy of ITP are good. Because of the quick convalescence the patients' comfort is better than with the conventional operation.
DMW - Deutsche Medizinische Wochenschrift 05/2000; 125(15):452-4. · 0.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis-e.g., peptic ulcer perforation. This study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum in perforation-induced peritonitis.
Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia-d; IIa-d) or to sham perforation (groups IIIa-d, IVa-d). In group I (a-d) and III (a-d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a-d) and IV (a-d), simple puncture of the abdominal cavity was performed, and specimens were taken at corresponding times.
In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly, scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation (groups Ib-c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups IIa-c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly completely vanished and the mesothelium was breaking apart into multiple soils.
In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.
Surgical Endoscopy 08/1999; 13(7):683-8. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Tonometry is widely used in the diagnosis of sepsis and splanchnic ischemia. This study was devised to analyze the predictive value of gastric tonometry for outcome of experimental viscus perforation-induced peritonitis. The impact of conventional and laparoscopic intervention on tonometric measurements was the main scope.
This randomized controlled intervention trial was performed in a University experimental laboratory, using 24 female Duroc pigs. Pigs were subjected to gastric perforation followed by a 12 h interval of peritonitis, and then to either laparoscopic or conventional surgical repair of the defect with peritoneal lavage. Gastric tonometry and cardiocirculatory monitoring were performed.
Septic shock associated with peritonitis and subsequent lethal outcome was accurately predicted with gastric tonometry. Changes of gastric mucosal pH correlated significantly with decreases of MAP (r2=0.880; P<0.001) and SVR (r2=0.678; P<0.001), increase of QT (r2=0.486; P=0.013), and mortality (r=0.752; P<0.001). Mortality was significantly higher in laparoscopically treated animals compared to those subjected to the open procedure (78% vs 22%; P<0.045).
Gastric tonometry accurately predicted mortality in experimental peritonitis. The decline of gastric mucosal pH in the laparoscopic group was more than double that of to conventionally treated animals. This finding not only reflected the increase of systemic CO2 due to higher absorption during CO2-pneumoperitoneum, but probably also indicated a more severe form of splanchnic ischemia during laparoscopic surgery. Even though tonometry can be used to accurately predict mortality and separate the high risk group, extreme caution should be applied under conditions associated with severe peritonitis.
Langenbeck s Archives of Surgery 02/1999; 384(1):76-83. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Twenty patients with gastric stromal sarcomas underwent surgery at the University Hospital of Hamburg-Eppendorf from 1979 to 1995. Symptoms were nonspecific. Exact preoperative diagnosis was difficult because of submucosal tumor growth. Operations varied from excision of the gastric wall to extended gastrectomy (pancreas, spleen, partial liver resection).
In 16 cases, tumor could be resected with wide margins (R0). In four cases, tumor was found at the resection line (R1). After a median follow-up of 69 months, 12 patients with R0 resections (including tumors with poor differentiation or infiltration of surrounding organs) lived tumor free, and two died due to other causes. All four patients with R1 resections died because of tumor disease within 40 months. All patients had a mean survival time of 59 months and a 5-year-survival rate of 69%.
Our series shows that not all gastric malignancies have a dismal prognosis, but that gastric stromal sarcomas have a favorable follow-up if resected with wide margins at initial surgery.
Langenbeck s Archives of Surgery 01/1999; 383(6):442-6. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Between 1987 and 1996 302 patients were treated for colorectal liver metastases. Out of this pool 252 completely documented cases were analysed. Forty-five patients (18%) of this population were 70 years or older at time of admission. In this population 17 major resections and 8 minor liver resections were performed. In 9 patients irresectable metastases were diagnosed during treatment of the primary tumor. In 3 cases laparotomy had to be finished as exploration. Eight patients were treated without surgery. Mortality after liver resection was 4%, morbidity 28%. The 5-year-survival-rate (Kaplan-Meier) of the R0 resected patients (n = 21) was 44%. Comparison between the elderly patients and the younger population shows no significant differences in type and extent of treatment or in stage of disease. Survival, morbidity and mortality after liver resection also show no significant differences. These results show that even in elderly patients liver resection for colorectal metastases can be performed efficently and with a curative intention.
Der Chirurg 01/1999; 69(12):1334-9. · 0.70 Impact Factor
