The German Experience

Hermanek, P; Mansmann, Ulrich; Staimmer, D.; Riedl, S

doi:10.1016/s1055-3207(18)30167-4

Cited by 65 publications

(8 citation statements)

References 2 publications

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“…It is still under discussion how many LN are necessary for accurate tumor staging according to the TNM classification in CRC [5-10]. An increasing number of LN harvested by the surgeon and analysed by the pathologist has a positive influence on the patients' survival [5,11-13]. Nevertheless about 20% of initially node-negative stage UICC I and II CRC patients suffer from recurrent disease within five years after surgery [14,15].…”

Section: Introductionmentioning

confidence: 99%

One Step Nucleic Acid Amplification (OSNA) - a new method for lymph node staging in colorectal carcinomas

et al. 2010

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BackgroundAccurate histopathological evaluation of resected lymph nodes (LN) is essential for the reliable staging of colorectal carcinomas (CRC). With conventional sectioning and staining techniques usually only parts of the LN are examined which might lead to incorrect tumor staging. A molecular method called OSNA (One Step Nucleic Acid Amplification) may be suitable to determine the metastatic status of the complete LN and therefore improve staging.MethodsOSNA is based on a short homogenisation step and subsequent automated amplification of cytokeratin 19 (CK19) mRNA directly from the sample lysate, with result available in 30-40 minutes. In this study 184 frozen LN from 184 patients with CRC were investigated by both OSNA and histology (Haematoxylin & Eosin staining and CK19 immunohistochemistry), with half of the LN used for each method. Samples with discordant results were further analysed by RT-PCR for CK19 and carcinoembryonic antigen (CEA).ResultsThe concordance rate between histology and OSNA was 95.7%. Three LN were histology+/OSNA- and 5 LN histology-/OSNA+. RT-PCR supported the OSNA result in 3 discordant cases, suggesting that metastases were exclusively located in either the tissue analysed by OSNA or the tissue used for histology. If these samples were excluded the concordance was 97.2%, the sensitivity 94.9%, and the specificity 97.9%. Three patients (3%) staged as UICC I or II by routine histopathology were upstaged as LN positive by OSNA. One of these patients developed distant metastases (DMS) during follow up.ConclusionOSNA is a new and reliable method for molecular staging of lymphatic metastases in CRC and enables the examination of whole LN. It can be applied as a rapid diagnostic tool to estimate tumour involvement in LN during the staging of CRC.

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Section: Introductionmentioning

confidence: 99%

One Step Nucleic Acid Amplification (OSNA) - a new method for lymph node staging in colorectal carcinomas

et al. 2010

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“…This variability is not only evident in postoperative mortality and morbidity, ranging from 0.5% to 6% and 15% to 25%, respectively, 1,[5][6][7] but also in oncologic outcomes, with disease recurrence varying from 5% to 50% of patients and 5-year survival rates ranging from 32% to 64%. [8][9][10][11] The importance of quality assurance to reduce this variability is recognized and several quality improvement programs have already been established, such as the implementation of the surgical safety checklist used in the time-out procedure, effectively reducing perioperative mortality. 12,13 In addition, different clinical audits have been developed in the pursuit of quality improvement.…”

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confidence: 99%

Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery

et al. 2019

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IMPORTANCE Despite ongoing advances in the field of colorectal surgery, the quality of surgical treatment is still variable. As an intrinsic part of surgical quality, the technical information regarding the surgical procedure is reflected only by the narrative operative report (NR), which has been found to be subjective and regularly omits important information. OBJECTIVE To investigate systematic video recording (SVR) as a potential improvement in quality and safety with regard to important information in colorectal cancer surgery. DESIGN, SETTING, AND PARTICIPANTS The Imaging for Quality Control Trial was a prospective, observational cohort study conducted between January 12, 2016, and October 30, 2017, at 3 centers in the Netherlands. The study group consisted of 113 patients 18 years or older undergoing elective laparoscopic surgery for colorectal cancer. These patients were case matched and compared with cases from a historical cohort that received only an NR. INTERVENTIONS Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips. MAIN OUTCOMES AND MEASURES The SVRs and NRs were analyzed for adequacy with respect to the availability of important information regarding the predefined key steps. Adequacy of the reported information was defined as the proportion of key steps with available and sufficient information in the report. Adequacy of the SVR and NR was compared between the study and control groups, with the SVR alone and as an adjunct to the NR in the study group vs NR alone in the control group. RESULTS Of the 113 study patients, 69 women (61.1%) were included; mean (SD) age was 66.3 (9.8) years. In the control group, a mean (SD) of 52.5% (18.3%) of 631 steps were adequately described in the NR. In the study group, the adequacy of both the SVR (78.5% [16.5%], P < .001) and a combination of the SVR with NR (85.1% [14.6%], P < .001) was significantly superior to NR alone. The only significant difference between the study and historical control groups regarding postoperative and pathologic outcomes was a shorter postoperative mean (SD) length of stay in favor of the study group (8.0 [7.7] vs 8.6 [6.8] days; P = .03). CONCLUSIONS AND RELEVANCE Use of SVR in laparoscopic colorectal cancer surgery as an adjunct to the NR might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intraoperative information and contributing to quality control and objectivity.

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“…Patients who underwent curative resection had a significantly better prognosis. [12,13] Hermanek et al [12] demonstrated that patients who underwent resection for cure (R0) had significantly higher survival rates than those with R1 and R2 resections. The quality of surgery depended on the residual tumor status (categorized by the R classification), the size of the surgical margin, and the ELN number.…”

Section: Discussionmentioning

confidence: 99%

The impact of a multispecialty operative team on colorectal cancer surgery: A retrospective study from a would-be medical center in Taiwan

Chen

Chuang

et al. 2022

Medicine

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Some studies showed that when distant metastasis or locally advanced tumors were observed, the participation of 2 or more operating surgeons (combined surgery) in the operation could improve the prognosis of patients. The multispecialty operative team would perform combined surgery in colon cancer patients with some complications since 2015.The goal of this study is to confirm performing combined surgery would improve the outcomes of colon cancer patients.A retrospective observational study was conducted, which involved all colon cancer patients between November 2015 and December 2019 at one would-be medical center. Patients were divided into 3 cohorts: those with complicated cases and had combined surgery (C_2S), those with complicated cases and had surgery performed by a single surgeon (C_1S), and those with uncomplicated cases and had surgery performed by a single surgeon (NC_1S). Overall survival and disease-free survival were compared among the 3 groups.A total of 296 colon cancer patients during the study period. Among them, 35 were C_2S, 87 were C_1S, and 174 were NC_1S. Patients in the NC_1S group had significantly higher 12-, 24-, and 36-month OS rates compared to those in the C_1S group (P < .01). In contrast, there was no significant difference in overall survival among patients in the NC_1S and C_2S group (P =.15).The quality of surgery must be impact the prognosis, especially in the individual who was complicated case, the survival in patients who had surgery performed by multispecialty operative team would be improved.Abbreviations: C_1S = patients with complicated cases and had surgery performed by a single surgeon, C_2S = patients with complicated cases and had combined surgery, CRC = colorectal cancer, CI = confidence interval, CT = computed tomography, DFS = disease-free survival, ELN = examined lymph node, HR = hazard ratio, LOS = length of stay, mCRC = metastatic colorectal cancer, NC_1S = patients with uncomplicated cases and had surgery performed by a single surgeon, OS = overall survival, R0 = resection for cure, SD = standard deviation, TCRD = Taiwan Cancer Registry Database.

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The German Experience

Cited by 65 publications

References 2 publications

One Step Nucleic Acid Amplification (OSNA) - a new method for lymph node staging in colorectal carcinomas

One Step Nucleic Acid Amplification (OSNA) - a new method for lymph node staging in colorectal carcinomas

Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery

The impact of a multispecialty operative team on colorectal cancer surgery: A retrospective study from a would-be medical center in Taiwan

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