TY  - JOUR
A1  - Lichthardt, Sven
A1  - Wagner, Johanna
A1  - Löb, Stefan
A1  - Matthes, Niels
A1  - Kastner, Caroline
A1  - Anger, Friedrich
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry
JF  - BMC Cancer
N2  - Background 
Preoperative chemoradiotherapy is the recommended standard of care for patients with local advanced rectal cancer. However, it remains unclear, whether a prolonged time interval to surgery results in an increased perioperative morbidity, reduced TME quality or better pathological response. Aim of this study was to determine the time interval for best pathological response and perioperative outcome compared to current recommended interval of 6 to 8 weeks. 

Methods 
This is a retrospective analysis of the German StuDoQ|Rectalcarcinoma registry. Patients were grouped for the time intervals of "less than 6 weeks", "6 to 8 weeks", "8 to 10 weeks" and "more than 10 weeks". Primary endpoint was pathological response, secondary endpoint TME quality and complications according to Clavien-Dindo classification. 

Results 
Due to our inclusion criteria (preoperative chemoradiation, surgery in curative intention, M0), 1.809 of 9.560 patients were suitable for analysis. We observed a trend for increased rates of pathological complete response (pCR: ypT0ypN0) and pathological good response (pGR: ypT0-1ypN0) for groups with a prolonged time interval which was not significant. Ultimately, it led to a steady state of pCR (16.5%) and pGR (22.6%) in "8 to 10" and "more than 10" weeks. We were not able to observe any differences between the subgroups in perioperative morbidity, proportion of rectal extirpation (for cancer of the lower third) or difference in TME quality. 

Conclusion 
A prolonged time interval between neoadjuvant chemoradiation can be performed, as the rate of pCR seems to be increased without influencing perioperative morbidity.
KW  - Rectal cancer
KW  - Surgery
KW  - Radiochemotherapy
KW  - Time interval
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229334
VL  - 20
IS  - 1
ER  - 
TY  - JOUR
A1  - Matthes, Niels
A1  - Diers, Johannes
A1  - Schlegel, Nicolas
A1  - Hankir, Mohammed
A1  - Haubitz, Imme
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Validation of MTL30 as a quality indicator for colorectal surgery
JF  - PLoS One
N2  - Background 
Valid indicators are required to measure surgical quality. These ideally should be sensitive and selective while being easy to understand and adjust. We propose here the MTL30 quality indicator which takes into account 30-day mortality, transfer within 30 days, and a length of stay of 30 days as composite markers of an uneventful operative/postoperative course. 

Methods 
Patients documented in the StuDoQ|Colon and StuDoQ|Rectal carcinoma register of the German Society for General and Visceral Surgery (DGAV) were analyzed with regard to the effects of patient and tumor-related risk factors as well as postoperative complications on the MTL30. 

Results 
In univariate analysis, the MTL30 correlated significantly with patient and tumor-related risk factors such as ASA score (p<0.001), age (p<0.001), or UICC stage (p<0.001). There was a high sensitivity for the postoperative occurrence of complications such as re-operations (p<0.001) or subsequent bleeding (p<0.001), as well as a significant correlation with the CDC classification (p<0.001). In multivariate analysis, patient-related risk factors and postoperative complications significantly increased the odds ratio for a positive MTL30. A negative MTL30 showed a high specify for an uneventful operative and postoperative course. 

Conclusion 
The MTL30 is a valid indicator of colorectal surgical quality.
KW  - surgical care
KW  - discharge definition
KW  - definition
KW  - mortality
KW  - pancreatectomy
KW  - complications
KW  - superior
KW  - capture
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230530
VL  - 15
IS  - 8
ER  -