Male breast cancer: Austrian experience.

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5-year recurrence-free survival for the entire group was 55%, and the estimated 5-year overall survival was 62%. Although stage-adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence-free survival p = 0.00001; overall survival p = 0.03) and axillary lymph node status (recurrence-free survival p = 0.0001; overall survival p = 0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence-free survival p = 0.001; overall survival p = 0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.

[Mediastinal lymphadenectomy. Anatomical basis and its surgical relevance in central bronchus carcinoma]. / Die mediastinale Lymphadenektomie. Anatomische Grundlagen und ihre chirurgische Relevanz beim zentralen Bronchuskarzinom.

102 patients with potentially curable bronchial carcinoma were subjected to pneumonectomy and mediastinal lymph node dissection regardless of gross appearance of the mediastinum at the time of surgery. 83 of these patients were analysed retrospectively. In 34 patients (41%) enlarged mediastinal lymph nodes were found; in 19 of these (56%) malignant invasion was verified histologically, whereas in 15 of these 34 patients (44%) the enlarged lymph nodes revealed only inflammatory changes. On the other hand, in 49 patients (59%) the mediastinum was grossly inconspicuous, yet in 2 of these patients (4.1%) microscopic invasion by carcinoma was found. This confirms that the assessment of the mediastinum by gross appearance is unreliable. As a consequence, mediastinal lymph node dissection should be performed routinely in all patients in order to detect occult metastases since only patients who had a complete resection have a change of cure. This approach is justified as in our experience mediastinal lymph node dissection does not impose an additional operative risk and long-term survival or even cure may be achieved in individual patients. Estimated 5-year survival in our patients with histologically proven mediastinal lymph node metastases was 22%; 3 of 21 patients with N 2 carcinoma are alive 8, 10 and 13 years p.o., without evidence of recurrence. The operative strategy and technical aspects based on anatomical knowledge of pathways of lymphatic spread of carcinoma of the lung are presented.

[Temporary and permanent recurrent laryngeal nerve paralysis following thyroid surgery. Modifying factors: the educational status of the surgeon]. / Die passagere und permanente Rekurrenzparese nach Schilddrüsen-operationen. Beeinflussende Faktoren: der Ausbildungsstand des Chirurgen.

17 of 525 patients (3.2%) showed an laryngoscopically established palsy of the recurrent laryngeal nerve after surgery for struma. The analysis of these operations, performed by five surgeons during or within three years after the period of surgical training, revealed that the operations performed under assistance of the senior surgeons were high grade selected (p = 0.026). Thus 14.8% of the operations performed because of simple goiter but only 4.8% of the operations performed because of thyroid cancer/recurrent goiter/extensive nodular goiter were assisted in this way. On the other hand it was necessary to call for help of a senior surgeon because of intraoperative difficulties in only 1.26% of the cases operated on for simple goiter, but in 19.6% of the more complex forms of goiter (p less than 0.001). The risk of recurrent laryngeal nerve palsy was nearly 10 times higher in the complex forms of goiter than in the simple forms (p less than 0.001). More extensive surgical training in the forms of complex goiters should be able to improve the results.

[Long-term laryngoscopic follow-up in vocal cord paralysis following struma surgery]. / Die langfristige laryngoskopische Nachkontrolle bei Einschränkung der Stimmbandmotilität nach Strumaoperation.

Of 525 patients 17 (3.2%) showed a laryngoscopically established palsy of the recurrent laryngeal nerve after surgery due to goiter. A laryngoscopic follow-up of all these patients, performed at least one year after the operation, revealed that 76.5% of the recurrent nerve palsies were temporary and 23.5% were permanent. Danger of permanent palsy increased in the sequence--uncomplicated nodular goiter--struma maligna--recurrent goiter. The outcome of long-term follow-up showed a palsy rate of 0.8%, which was much lower than the corresponding rate reported by short-term control (p = 0.005). Therefore laryngoscopic long-term follow-up in cases of postoperative abnormal laryngoscopic function should be a standard part of follow-up in thyroid gland surgery.

[Experiences with intraoperative radiotherapy in inoperable pancreatic carcinoma]. / Erfahrungen mit der intraoperativen Radiotherapie beim inoperablen Pankreaskarzinom.

From January 1983 to April 1985 six patients suffering from unresectable pancreatic cancer underwent intraoperative irradiation therapy (IORT) followed by external radiotherapy. All tumors showed T4-stages except one tumor staged as T2N2. From the onset of symptoms to IORT the median time of hospitalization was 26.5 days. After surgery, treatment (external irradiation included) required a median hospitalization period of 43.5 days. Follow up, complications and the terminal hospital stay of the patients who died lead to another median hospitalization period of 30 days. Altogether hospitalization required an average of 90 days which represented 38.5% of the mean life-expectancy of 234 (SE = 57.4) days. 47.3% of the survival time did not show discomfort, in 31.6% there were reversible and in 21.1% irreversible complaints. Therefore, patients suffering from unresectable pancreatic cancer had to pay a heavy price for prolonging life expectancy by IORT and following percutaneous irradiation.

[Value of preoperative study methods in midrectal cancer. Microscopy versus macroscopy]. / Der Aussagewert präoperativer Untersuchungsmethoden beim Midrectum-Karzinom. Mikroskopie versus Makroskopie.

A retrospective analysis was made of data pre-operatively obtained from 110 patients who had undergone curative, palliative or exploratory surgery for midrectal carcinoma, between 1972 and 1983. Macroscopic tumour findings obtained from rectoscopy, in that context, were found to provide a clue to loco-regional spread (p = between 0.0001 and 0.0162). On the other hand, no information as to loco-regional spread proved to be recordable by histological typing of mid-rectum carcinomas, but for tubulo-papillary carcinoma (p = 0.0153). Grading could provide a clue as to possible lymph node involvement (p = 0.0205). A clearly differentiated prognosis could be usually made by macroscopic tumour appearance (p = 0.0001 to 0.0657). Histological typing was of no value for prognostication (p larger than 0.337), while the value of grading proved to be extremely low (p = 0.1819). Incidence of locally delimited recurrences could not be safely forecast at all, neither by macroscopic assessment (p larger than 0.119) nor by microscopy (p larger than 0.161). The information obtainable from macroscopic findings on both present phase and prognosis was generally greater than that recorded from histological processing of biopsy material (p = 0.0470) and should, therefore, by no means be neglected in pre-operative reconnaissance.

[Space-occupying rectal cancer. Concept of the operation and early results in 15 patients]. / Das organüberschreitende Rectumcarcinom. Operationskonzept und Frühergebnisse bei 15 Patienten.

In 1982 and 1983, 15 patients (14 women, 1 man) suffering from large tumors of the rectum and of the rectosigmoidal junction totally filling the small pelvis, underwent operation. Depending on the extent of the tumor, 8 patients underwent a hysterectomy (53.3%), 7 a resection of the small intestine (46.6%), five a resection of part of the bladder (33.3%), three a resection of the vagina (20%), two an extirpation of the bladder (13.3%), and one each a nephrectomy, a resection of the ureter, a resection of the pelvic vein, and a resection of the abdominal wall. In two cases an ileal conduit was applied, in three an ureter splint. Hospital lethality rate was 20% (3 patients) with an average hospital stay of 53 days. After an average observation period of 18.3 months, 8 patients were still alive. The probability of surviving 12 months was 63%. - The surgical concept applied is presented.

[Prognostically unfavorable factors in esophagus cancer. II. Value of diagnostic significance]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. II. Der Wert diagnostischer Aussagen.

The analysis of data of 121 patients with esophageal carcinoma treated at the Department of Surgery, Landeskrankenhaus Klagenfurt, between 1969 and 1982 revealed that neither histological type nor tumor grading had any significant influence on survival time (p = greater than 0,158). However, tumor localization and length influenced the chance of survival; the more proximal the tumor the poorer the chance to survive more than one year (p = 0,0008); patients with tumors less than 6 cm in length had a better chance of survival (p = 0,031). Cures were achieved only after resection for stage I. Resections for stage II and III did not show any difference in prognosis (p = 0,879). Although no cures could be achieved by surgery, the 1-year survival chance was increased threefold (p = 0,041). In the absence of contraindications, resection should be carried out even when mediastinal lymphnodes are involved by tumor.

[Prognostically unfavorable factors in esophagus cancer. III. Operative therapy of esophagus cancer--effect of preoperative measures on prognosis in curative resection]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. III. Operative Therapie des Oesophaguscarcinoms--Einfluss präoperativer Massnahmen auf die Prognose bei kurativer Resektion.

Between 1969 and 1982, 121 patients were treated for esophageal carcinoma at the Department of Surgery, Landeskrankenhaus Klagenfurt. 38 patients (31.4%) had palliative surgery, 23 patients underwent a curative resection. Hospital mortality after resection was 39%, overall adjusted survival rate at 7 years was 11.2%. An analysis of data shows that a higher resection rate (p = 0.0045) will not improve long-term results. A preoperative parenteral nutrition seems to decrease postoperative mortality (p = 0.069). Preoperative radiotherapy does not improve long-term results (p = 0.788).

[Carotid artery surgery with local anesthesia. Experiences with a series of 181 operations]. / Karotischirurgie in Lokalanästhesie. Erfahrungen mit einer Serie von 181 Operationen.

Between 1982 and 1984, 181 operations of the carotid artery were performed--180 of these in primary awake patients--36 in stage I (19.9%), 72 in stage II (39.8%), 72 in stage IV (39.8%) and only one in stage III (0.6%). 144 patients (79.6%) tolerated clamping of the carotid artery very well. In 37 patients (20.4%) clamping was not tolerated (two patients, in whom the control of cerebral function was not possible, were submitted to the latter group). In three of 181 patients clamping-intolerance started at the end of operation, more than 30 minutes after clamping. Clamping intolerance in these cases was found to be confined to pulmonary and cardiac factors, no shunt was used, but operation was brought to an end as quickly as possible. Complications were present in 15 patients (8.3%), three of them resulting in death (hospital mortality rate 1.7%), 2 of them in permanent loss of function (morbidity rate 1.1%). Only in 2 patients (asystolism with consecutive successful reanimation in one case, and thoracotomy due to enlargement of surgical procedure in the other case) a primary general anaesthesia would have facilitated surgery. Surgery of the carotid artery under local anaesthesia is considered to be a guarantee for a secure intraoperative surveillance followed by a low postoperative complication rate. In a few cases more difficult surgical procedures have to be accepted in account of that.

[Operative therapy of esophageal cancer. Palliative surgical methods and results]. / Operative Therapie des Osophaguskarzinoms. Palliative Operationsmethoden und ihr Ergebnis.

Between 1969 and 1982, 38 out of 121 patients with oesophageal carcinoma underwent palliative surgery. Operatively in 22 patients a Celestin- or Häring-tube was inserted, gastrostomy was performed 10 times, palliative resection two times. Four times the obstruction was bypassed. 17 patient achieved additional radiation therapy. An analysis of data showed, that all operative palliative procedures had nearly the same bad prognosis (p greater than 0.265). A longer survival could be achieved by additional radiation therapy (p = 0.044). Postoperative mortality rate was higher in patients with additional diseases (p = 0.018). Lethal aspiration-pneumonitis was a common (30%) and typical (p = 0.031) complication, when gastrostomy was performed. Because oft the high mortality rate of the first and because of the missing crude palliation of the second operation, palliative resection and gastrostomy were considered to be not indicated in most cases.

[Prognosticly unfavorable factors in esophageal carcinoma. I. The importance of anamnestic data]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. I. Die Bedeutung anamnestischer Angaben.

The analysis of data of 121 patients with esophageal carcinoma treated at the Department of Surgery, Landeskrankenhaus Klagenfurt, between 1969 and 1982 revealed that neither sex nor age, environment, delay of treatment or additional disease had any significant influence on survival time. Weight loss, however, significantly shortened survival time (p = 0.0002). In addition, weight loss suggests an advanced tumor stage (p = 0.0279). After curative resection, rate of survival was significantly lower in patients with weight loss (p = 0.042). In the presence of weight loss and additional risk factors resection is probably not indicated.