Abstracts - Chirurgie Kongress

Abklärung zugeführt. Peri- und postoperativ wurde die Behandlung nach einem an unserer Klinik fest
etablierten Management vorgenommen. Weiterhin erfolgte bei allen Patienten zu definierten Zeitpunkten
eine ambulante Kontrolluntersuchung, in deren Rahmen Daten zum Lokalbefund, zur Lebensqualität
und Schmerzintensität anhand eines speziellen Fragebogens erhoben wurden.
Results: Eine Konvertierung zu einem konventionellen Operationsverfahren war in keinem Fall erforderlich.
Bei insgesamt fünf Patienten (8%) kam es zu postoperativen Komplikationen in Form einer
Bar-Dislokation bzw. Dislokation der Stabilisatorplatte, Infekt oder Hämatothorax. Bei zwei Patienten
(3%) musste eine Korrektur bei Dislokation vorgenommen werden. In einem weiteren Fall erfolgte eine
vorzeitige Stabentfernung auf Wunsch des Patienten. 75% der Patienten beschreiben ihre Lebensqualität
postoperativ als deutlich verbessert. Mehr als 80% der Patienten sind mit dem kosmetischen
Resultat sehr zufrieden. Auch nach Entfernung des Metallstabes, nach in der Regel drei Jahren, bei
inzwischen mehr als 50% der operierten Patienten kam es zu keinem Rezidiv der Trichterbrust im Kurz
– und Langzeitverlauf.
Conclusion: Die Operation nach Nuss kann auch bei Erwachsenen mit guten Langzeitergebnissen und
bei geringer Komplikationsrate durchgeführt werden. Sie führt zu einer deutlichen Verbesserung der
Lebensqualität und ist daher gerade bei psychischen Belastungssituationen zu erwägen.
12.2
Promising outcome with neoadjuvant chemo- and radiotherapy in patients with operable stage III
B non-small cell lung cancer. A prospective multicenter trial by the Swiss Group for Clinical Cancer
Research (SAKK 16/01)
H. B. Ris (Lausanne)
Objective: Outcome of patients with locally advanced NSCLC is poor due to both local and distant
tumor recurrence. Advances in surgery allow considering resection in selected patients with advanced
tumor stages, in particular after prior neoadjuvant therapy.
Methods: This multicenter phase II trial aimed at evaluating a tri-modality concept of neoadjuvant chemotherapy
(3 cycles of cisplatin/docetaxel), followed by accelerated concomitant boost radiotherapy
(44 Gy/22fractions) and definitive surgery. Fit patients up to age 75 years with technically operable,
stage IIIB NSCLC were eligible.
Results: Forty-six patients were enrolled, median age was 60 years (range 28-70), N3-disease was
present in 28%, T4 stage in 78% of patients. The response rate after chemotherapy was 48% (exact
95% c.i. 33-63%), after additional RT 59% (43-73%). Thirty-five patients (76%) underwent surgery,
pneumonectomy was required in 17 patients. A complete (R0) resection was achieved in 27 pts (78%
of operated patients, 59% of all patients). Perioperative complications occurred in 14 patients, including
2 patients dying from ARDS and a cerebro-vascular event, respectively. Seven patients required
a second surgical intervention. The event-free survival at 1 year was 54%. After a median follow-up of
almost 5 years, the median overall survival is 29 months with corresponding 1-, and 3-year survival
rates of 67% and 47%.
Conclusion: This combined modality treatment strategy including neoadjuvant chemo- and radiotherapy
followed by surgery is feasible. Toxicity is considerable but manageable. Overall survival compares
favorably to the best reports of combined modality treatment of less advanced stage IIIA disease.
12.3
Identification of CD9+ MSC-like cells in human lung parenchyma capable of differentiating into
airway epithelial cells
G. Karoubi, L. Cortes-Dericks, I. Breyer, R. A. Schmid, A. E. Dutly (Bern)
Objective: The lack of effective therapies for end-stage lung disease validates the need for stem cell
based-therapeutic approaches as alternative treatment options. Recent studies have demonstrated
the presence of multipotent “mesenchymal stem cells” (MSCs) in the adult lung. The majority of these,
however, are limited to animal models, and to date there has been no report of an analogous cell
population in adult human lung parenchyma.
Methods: Here we demonstrate the identification of a population of CD9+ MSC-like human parenchyma
cells (pHLPs) derived from intra-operative normal lung parenchyma biopsies.
Results: Surface and intracellular immunophenotyping revealed a similar expression pattern of surface
antigens characteristic with MSCs including CD73, CD166, CD105, CD90 and STRO-1. In addition, flow
cytometry analysis illustrates that cultures do not contain alveolar type I epithelial cells or Clara cells
and are devoid of the following hematopoietic markers: CD34, CD45 and CXCR4. Our CD9+ MSC-like
pHLPs have the ability to differentiate along the adipogenic and osteogenic mesenchymal pathways
when cultured in the respective differentiation conditions. More importantly, when placed in small airway
growth media, pHLP cell cultures show the expression of aquaporin 5 and Clara cell secretory protein
identified with alveolar type I epithelial cells and Clara cells respectively. Further characterization of
cultures, depicted the presence of a side population phenotype, which could potentially be identified as
the source of the MSC-like population.
Conclusion: To the best of our knowledge, this is the first report to illustrate endogenous human lung
parenchyma MSC-like cells capable of differentiating into cell types of the lung. Further investigation
of these resident cells may elucidate a therapeutic cell population capable of lung repair and/or regeneration.
12.4
Assessment of cardiac function by intraoperative transesophageal echocardiography before and
after surgical repair of pectus excavatum
T. Krueger, P. G. Chassot, M. Christodoulou, C. Cheng, H. B. Ris, L. Magnusson (Lausanne)
Objective: Assessment of en-diastolic right ventricular (RV) dimensions and left ventricular (LV) ejection
fraction by use of intraoperative transesophageal echocardiography before and after surgical cor-
rection of pectus excavatum in adults.
Methods: Seventeen patients undegoing surgical correction of pectus excavatum according to the
technique of Ravitch-Shamberger were prospectively assessed between 1999 and 2004. Intraoperative
transesophageal echocardiography was performed under general anesthesia before and after
surgery in order to assess end-diastolic RV dimensions and LV ejection fraction. The end-diastolic RV
diameter and area were measured in 4-chamber and RV inflow-outflow view and the RV volume was
calculated from these data. The LV was assessed by transgastric short axis view and its ejection fraction
was calculated by use of the Teichholz formula.
Results: The end-diastolic right ventricular diameter, area and volume all significantly increased after
surgery (2.4 + 0.8 cm vs 3.0 + 0.9 cm, p=0.00001; 12.5 + 5.2 cm 2 vs 18.4 + 7.5 cm 2 , p=0.0000003;
21.7 + 11.7 ml vs 40.8+ 23 ml, p=0.00003; mean values + SD). The LV ejection fraction also significantly
increased after surgery (58.4 + 14.6% vs 66.2 + 6.2%, p=0.00001; mean values + SD).
Conclusion: Surgical correction of pectus excavatum according to Ravitch-Shamberger results in a
significant increase in end-diastolic RV dimensions and a significantly increased LV ejection fraction.
Figure 1: Transesophageal 4-chamber view of the right ventricle (RV) before a), and after b), surgical
correction (LV : left ventricle)
12.5
Carcinomes bronchiques post transplantation d‘organes solides
P. Morand 1 , R. Fakin 1 , G. Carboni 1 , P. Soccal 2 , M. Pascual 3 , R. A. Schmid 1 ( 1 Bern, 2 Genève, 3 Lausanne)
Objective: Bien que l‘incidence des tumeurs suivant une transplantation d‘organes soit augmentée,
aucune étude n‘est actuellement disponible en Suisse sur le diagnostic des carcinomes bronchiques
post transplantation rénale, hépatique, cardiaque ou pancréatique.
Methods: Il s‘agit d‘une étude rétrospective sur huit années allant de 1998 à 2006 incluant trois centres
universitaires suisse de transplantation. Les données concernant le moment de survenue du carcinome
bronchique, les facteurs de risque, les circonstances du diagnostic, le traitement appliqué ainsi
que le suivi ont été collectées.
Results: Parmi une cohorte de 1695 patients transplantés, totalisant 192 coeurs, 518 foies, 873 reins
et 112 pancréas, 14 patients ont présenté un carcinome bronchique. De ces 14 patients, 6 ont subit
une transplantation rénale, 1 une transplantation cardiaque, 4 une transplantation hépatique, 1 une
double transplantation foie-rein et 1 une double transplantation coeur-rein. Ces 14 patients transplantés
ont tous présenté une anamnèse positive de fumeur.
Conclusion: L‘incidence du carcinome bronchique est nettement plus élevé dans la population de
transplantés fumeurs que dans la population de fumeurs non-transplantés. Une imagerie thoracique
de routine et des biopsies diagnostics devant chaque lésion suspecte devraient permettre de détecter
les cas de carcinome bronchique à un stade précoce et ainsi améliorer la survie de ces patients.
12.6
Size-reduced lung transplantation: Correlation of donor predicted postoperative FEV1 with recipient
best FEV1
I. Inci, P. Kestenholz, D. Schneiter, S. Hillinger, I. Opitz, S. Irani, A. Boehler, W. Weder (Zürich)
Objective: Size-reduced lung transplantation allows the use of oversized grafts for small recipient. There
is a lack of data which correlates the donor predicted postoperative FEV1 (ppoFEV1) with recipient
best FEV1.
Methods: Lung transplant recipients (n=65) who underwent size-reduced lung transplantation
between 1992 and 2007 were analyzed retrospectively. Donor FEV1 (Donor FEV1 (male)= 4.3 x Height
– 0.029 x Age; Donor FEV1 (female) 3.95 x Height – 0.025 x Age) was calculated and corrected
for postoperative predicted FEV1 with respect to size reduction. We estimated ppoFEV1 by using the
following equation: ppoFEV1= preoperative FEV1 x (1-S x 0.0526), where S= number of resected segments.
This value was correlated with the recipient measured best FEV1 (Pearson correlation test).
Results: Size-reduced lung transplantation was performed in 65 patients. This accounted 27.6% of all
transplantations performed at our center (65/235). Size reduction was done by lobar transplantation
(n=20) and anatomic or non-anatomic resection (n=45). There was a statistically highly significant
correlation between donor ppoFEV1 and recipient best FEV1 (p=0.01, Pearson correlation coefficient=0.705)
(Figure 1).
Conclusion: Size-reduced lung transplantation (lobar or segmental resection) is a safe method to overcome
the size discrepancies in lung transplantation. Predicted postoperative FEV1 calculated from
donor correlates well with the recipient best FEV1.
12.7
Photodynamic pre-treatment as a mean to enhance drug uptake of liposomal doxorubicin during
isolated lung perfusion in a rat sarcoma model
C. Cheng, E. Debefve, A. Haouala, J. P. Ballini, T. Krueger, J. Y. Perentes, S. Andrejevic-blant,
L. A. Decosterd, G. Wagnieres, H. B. Ris (Lausanne)
Objective: Isolated lung perfusion (ILP) combined with liposomal doxorubicin (LiporubicinTM) with
and without pre-treatment by VisudyneÒ-mediated photodynamic therapy (PDT) was compared with
respect to drug uptake and distribution in rat lungs bearing a sarcoma tumor.
Methods: A single sarcomatous tumor was generated in the left lung of 28 Fisher rats, followed 10
days later by left-sided ILP with liposomal doxorubicin at dose of 400 mg (n=12) and 3200 mg (n=16),
with (n=14) or without (n=14) PDT pre-treatment of the sarcoma bearing lung (0.125 mg/kg VisudyneÒ,
10J/cm 2 , 35 mW/cm 2 ). In each perfused lung, the drug concentration and distribution were
assessed in the tumor and lung by HPLC and fluorescence microscopy, respectively.
Results: At a drug dose of 400 mg Liporubicn, there was no significant difference for ILP+PDT and ILP
alone in tumor (5.24 ± 1.18 vs 4.57 ± 0.05) and normal lung (8.42 ± 0.13 vs10.38 ± 4.49) drug uptake
swiss knife 2009; special edition 19