Zentralblatt fur Chirurgie最新文献

Background: In Germany, nosocomial infections and postoperative wound infections are a significant burden for the healthcare system and the patients affected. A postoperative wound infection is often accompanied by a massive deterioration in the quality of the treatment success of surgical measures in terms of patient stress, the functional results and the cost-effectiveness of a treatment for the service provider. The aim of this article is to present the current hygiene requirements for the perioperative setting in a comprehensible manner and to explain them to everyone involved in the surgical procedure.

Method: First of all, the importance of hygienic measures is explained, as well as a brief overview of the development up to modern hygiene concepts of today. Then the current recommendations of the KRINKO (Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute): "Prevention of postoperative wound infections, recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute" are presented.

Conclusion: Hygienic work is a basic prerequisite for work in the surgical area, because convincing treatment results with good functional results cannot be achieved in many areas (e.g. modern endoprosthetics) without sufficient hygiene. The modern requirements for hygienic work are complex and affect all areas of the hospital. The best possible degree of process quality can only be guaranteed if all pillars of modern hygiene concepts are observed.

Today, endoscopy plays a decisive role not only in the detection of colorectal adenomas and carcinomas, but also in the treatment of precancerous lesions, in particular flat adenomas and early carcinomas. In recent years, endoscopic submucosal dissection (ESD) has become increasingly important alongside classic polypectomy and mucosal resection after saline injection using a snare (EMR). Using ESD the lesion is marked, injected submucosally using viscous substances and the mucosa incised and tunneled with a transparent cap and a fine diathermy knife. Particularly in the case of widespread and high-risk lesions ESD enables a quasi-surgical "en bloc" resection almost regardless of size, with a histological R0 resection rate of far over 90% in specialized centers. ESD enables an excellent histopathological evaluation and has a low recurrence risk of 1-3%. Endoscopic full-thickness resection using a dedicated device (FTRD system) represents another addition to the armamentarium. It can be used for circumscribed submucosal, suspicious or scarred changes up to 2 cm in the middle and upper rectum. Endoscopic intermuscular dissection (EID) enables histopathological analysis of the complete submucosa beyond the mucosa and upper submucosal layer by including the circular inner muscle layer within the resection specimen. It reduces basal R1 situations and offers a new perspective for T1 carcinomas through curative, organ-preserving endoscopic therapy, especially in the case of deep submucosal infiltration alone, without other risk factors for metastases. Indications, the procedure itself and significance of the various techniques for premalignant and early malignant lesions in the rectum are presented.

The review titled "Staging and Diagnostics of Rectal Cancer" aims to provide insight to imaging techniques in patients with rectal cancer.Rectal cancer is among the most common malignancies, with one of the highest mortality rates worldwide. Timely diagnosis and therapy of this cancer therefore has important socio-economic implications.Radiological imaging plays a major role in the planning of subsequent therapy. Modern tomographic imaging is used not only for initial diagnosis, but also for staging.The individual role of different imaging techniques in diagnosis of rectal cancer will be explained in detail, and their function in general. Furthermore, we will present relevant radiological research related.The increasing role of MRI-based local staging will be presented in detail in this review. Defined diagnostic criteria, based on common recommendations, will be explained. We will show how MRI-based local staging can support the initial diagnosis and follow-up examinations in collaboration with other medical specialties in therapeutic planning. In particular, we describe how MRI is capable of substantially influencing the determination of surgical procedures in rectal cancer.

Approximately 15% of patients with colorectal cancer show high microsatellite instability (MSI-high) in their tumour tissue. For one third of these patients, there is a hereditary cause for this finding - that leads to the diagnosis of Lynch Syndrome. In combination with clinical findings such as the Amsterdam or the revised Bethesda criteria, MSI-high status has been used as a tool in identifying patients at risk. Today, MSI-status has gained much more importance, due to its impact on treatment decisions. Patients with UICC II cancers should not receive adjuvant treatment. For patients with distant metastases and MSI-high status, immune checkpoint inhibitors can be given as first line therapy - with tremendous success. Novel data show a deep response for immune checkpoint antibodies in patients with locally advanced colon as well as rectal cancer in a neoadjuvant setting. Especially for patients with MSI-high rectal cancer, there might be a novel therapeutic regimen utilising immune checkpoint inhibitors without neoadjuvant radio-chemotherapy and even without surgery. This could lead to a relevant reduction in morbidity in this patient cohort. In conclusion, universal MSI-testing is essential for identifying patients at risk for Lynch syndrome and for optimal decision making in treatment planning.