Peter Tschann

Background/Objectives: Opinions concerning the role of obesity and changes in muscle mass in individuals with malignancies vary. It is believed that decreased fat tissue leads to a higher complication rate, while decreased muscle mass results in a poorer oncologic outcome. This study aimed to evaluate the impact of fat distribution and skeletal muscle mass on postoperative morbidity and long-term oncological outcomes in patients with non-metastatic colon cancer. Methods: Between 2012 and 2018, a total of 129 patients with stage I-III colon cancer were evaluated. Abdominal CT scans were used to assess muscle mass and fat tissue (subcutaneous and visceral). Differences in postoperative morbidity and long-term oncologic outcome were analyzed and compared. Results: No significant differences occurred concerning complication rate or anastomotic leakage. Individuals with altered body composition parameters had a shorter length of hospital stay (p = 0.046) and an increased duration of surgery (p = 0.029). In patients with an ASA III score, altered fat tissue distribution was associated with improvements in both overall and disease-free survival (p = 0.031 and p = 0.027, respectively) but also resulted in longer hospital stay. Conclusions: Changes in body composition parameters lead to alterations in economic factors as well as changes in oncologic survival, especially in patients with higher ASA scores. No differences in morbidity were observed.

Background: The treatment of locally advanced rectal cancer (LARC) has steadily progressed over the past four decades, with recent focus shifting towards total neoadjuvant therapy (TNT). This survey aims to elucidate the perceived surgical challenges faced by Austrian colorectal surgeons performing total mesorectal excision (TME), focusing on the increased complexity and surgical difficulty introduced by intensified treatment regimens. Methods: A comprehensive survey was conducted among Austrian colorectal surgeons to explore various aspects of managing and performing TME following TNT. The survey included questions on the general management of LARC within their institutions and utilized a five-point Likert scale to assess the respondents’ perceptions and experiences regarding surgical precision and post-operative morbidity associated with TNT. Results: A total of 31 surgeons (54% response rate) completed the survey. Regarding multidisciplinary therapy preferences, 56% of respondents preferred conventional neoadjuvant therapy regimens, with 32% favoring chemoradiotherapy and 24% opting for short-course radiotherapy, while 31% chose TNT. The majority of respondents (65%) reported quality differences in tissue dissection during TME following TNT, with 57% experiencing difficulties in identifying tissue planes and 47% noting increased tissue fragility. Increased bleeding was reported by 32% of respondents. In cases of regrowth after a watch-and-wait approach, 64% observed quality changes in tissue dissection, and 47% noted tissue fragility. Conclusions: The survey results indicate that TNT impairs surgical precision due to changes in tissue quality and challenges in identifying surgical planes. Given the critical importance of surgical precision in achieving low local recurrence rates in mid-to-low LARC, these challenges could significantly impact patient outcomes. Further prospective studies are required to elucidate the extent of these effects.

Background/Objectives: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). Methods: A prospective analysis was performed on consecutive patients undergoing MIS for ABO at a single center in 2021 and 2022. Prior to the study onset, a structured treatment pathway was defined to apply MIS in all patients. The rate of success in the MIS and patient-, surgeon- and outcome-specific parameters with a focus on complication and conversion rates were analyzed. Results: Compared to a historical control group, the conversion rate from MIS to open surgery (OS) nearly doubled from 20.4% to 36.4% (p = 0.14). The complication rate in converted patients was 43.8% vs. 7.15% in non-converted patients (p < 0.05). Conclusions: A structured clinical pathway, including technical standardization and preoperative decisional processes, can be used to implement MIS as a primary surgical treatment in ABO. This is accompanied by high conversion rates and a significant increase in postoperative complications in patients undergoing conversion. Individual decision-making concerning the surgical approach remains paramount to prevent complications and high conversion rates.

Purpose This study aimed to compare the outcomes of robotic-assisted rectal resection with conventional laparoscopic and open approaches, focusing on complication rates, conversion rates, length of hospital stay, and oncologic outcomes. Methods A retrospective single-center cohort study included 106 patients with non-metastatic rectal cancer (UICC stages I-III) who underwent rectal resection from January 2013 to December 2023. Patients were assigned to open surgery (n = 23), conventional laparoscopic surgery (n = 55), or robotic-assisted surgery (n = 28). Results Robotic surgery demonstrated significantly lower conversion rates compared to minimal-invasive surgeries (p = 0.047) and shorter hospital stays (11.5 ± 8 days) compared to open (17.91 ± 12 days) and laparoscopic (17.2 ± 14 days) surgeries (p = 0.001). The quality of the specimen was significantly better (Score 1) in robotic (85.71%) and open (89.09%) cases compared to laparoscopic approaches (47.83%) (p < 0.001). Laparoscopic surgery was identified as a risk factor for worse specimen quality (p < 0.001). Older patients (> 63 years) had a higher risk for conversion in univariate analysis (p = 0.049). Morbidity was comparable between the groups (p = 0.131), and the anastomotic leakage rate did not differ significantly (laparoscopic: 18.18%, open: 13.04%, robotic: 17.86%). Kaplan–Meier survival curves showed no significant differences in overall survival probabilities among the groups. Conclusion Robotic-assisted rectal resection provides significant advantages in terms of lower conversion rates, better specimen quality, and shorter hospital stays while maintaining comparable complication rates and oncologic outcomes to conventional laparoscopic and open approaches. These findings support robotic surgery as a standard treatment option for rectal cancer.

Background: Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic leakage rate, and long-term oncological outcomes. Methods: Patients undergoing elective rectal cancer resection from 2008 to 2017 in an Austrian institution were retrospectively reviewed regardless of the surgical approach. CT scans were analysed for pelvic measurements and volumes. The primary outcomes of interest were the correlation between pelvic dimensions and the TME quality and anastomotic leakage. Subanalysis was done by surgical approach (open, laparoscopic, transanal TME). Secondary outcomes were overall and disease-free survivals. Results: Among 154 eligible patients, 112 were included. The angle between pubic symphysis and promontory significantly correlated with worse TME grades (TME grade 1: mean(s.d.) 102.7(5.7)°; TME grade 2: 92.0(4.4)°; TME grade 3: 91.4(3.6)°; P < 0.001). A significantly lower distance between tumour and circumferential resection margin (CRM) was observed in grade 3 resections, whereas no difference appeared in grade 1 and grade 2 resection (TME grade 1: mean(s.d.) 11.92(9.4) mm; TME grade 2: 10.8(8.1) mm; TME grade 3: 3.1(4.1) mm; P = 0.003). The anastomotic leakage rate was significantly higher in case of a lower CRM (patients with anastomotic leakage: mean(s.d.) 6.8(5.8) mm versus others: 12.6(9.8) mm, P = 0.027), but not associated with pelvimetry measurements. The transanal TME (TaTME) subgroup displayed a wider angle between the pubic symphysis and promontory, younger age and improved TME quality compared to others (respectively, mean TME grades in TaTME versus open versus laparoscopic: 1.0 ± 0.0, 1.5 ± 0.7 and 1.3 ± 0.5, P = 0.013). Finally, oncological survival was not impacted by pelvic measurements or worse TME quality. Conclusion: The angle between the pubic symphysis and promontory and the distance between tumour and CRM were associated with worse TME grades. The anastomotic leakage was associated with a lower CRM but not with pelvimetric measures.

(1) Background: Peritoneal metastasized colorectal cancer is associated with a worse prognosis. The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients, but standardization is lacking so far. We present the first tool enabling standardized peritoneal surface area (PSA) quantification in patients undergoing CRS and HIPEC: The SAlzburg PEritoneal SUrface CAlculator (SAPESUCA). (2) Methods: SAPESUCA was programmed using the R-Shiny framework. The application was validated in 23 consecutive colon cancer patients who received 27 closed oxaliplatin-based HIPECs between 2016 and 2020. The programming algorithm incorporates the patient’s body surface area and its correlated peritoneal surface area (PSA) based on the 13 Peritoneal Cancer Index (PCI) regions. (3) Results: Patients’ median age was 56 years. Median PCI was 9. SAPESUCA revealed a mean PSA of 18,613 cm² ± 1951 of all patients before compared to 13,681 cm² ± 2866 after CRS. The Central PCI region revealed the highest mean peritonectomy extent (1517 cm² ± 737). The peritonectomy extent correlated significantly with PCI score and postoperative morbidity. The simulated mean oxaliplatin dose differed significantly before and after CRS (558 mg/m² ± 58.4 vs. 409 mg/m² ± 86.1; p < 0.0001). (4) Conclusion: SAPESUCA is the first free web-based app for standardized determination of the resected and remaining PSA after CRS. The tool enables chemotherapeutic dose adjustment to the remaining PSA.

Background: Malnutrition and skeletal muscle waste (sarcopenia) are known as predictive factors for a poor postoperative outcome. Paradoxically, obesity seems to be associated with a survival advantage in wasting diseases such as cancer. Thus, the interpretation of body composition indices and their impact on rectal cancer therapy has become more and more complex. The aim of this study was to evaluate body composition indices in locally advanced rectal cancer patients prior to therapy and their impact on short- and long-term outcomes. Methods: Between 2008 and 2018, 96 patients were included in this study. Pre-therapeutic CT scans were used to evaluate visceral and subcutaneous fat mass, as well as muscle mass. Body composition indices were compared to body mass index, morbidity, anastomotic leakage rate, local recurrency rate, and oncological long-term outcomes. Results: Increased visceral fat (p < 0.01), subcutaneous fat (p < 0.01), and total fat mass (p = 0.001) were associated with overweight. Skeletal muscle waste (sarcopenia) (p = 0.045), age (p = 0.004), comorbidities (p < 0.01), and sarcopenic obesity (p = 0.02) were significantly associated with increased overall morbidity. The anastomotic leakage rate was significantly influenced when comorbidities were present (p = 0.006). Patients with sarcopenic obesity showed significantly worse disease-free (p = 0.04) and overall survival (p = 0.0019). The local recurrency rate was not influenced by body composition indices. Conclusion: Muscle waste, older age, and comorbidities were demonstrated as strong risk factors for increased overall morbidity. Sarcopenic obesity was associated with worse DFS and OS. This study underlines the role of nutrition and appropriate physical activity prior to therapy.

Article: Strategies to decrease morbidity in surgical management of esophageal cancer: a single center experience - Minerva Surgery 2022 Jun 16 - Minerva Medica - Journals

Purpose In oncology settings, music, especially music therapy (MT), is frequently used to improve patients’ quality of life, pain situation, anxiety, depression, fatigue, and comfort. However, to date, there are no prospectively collected data correlating regular standardized MT sessions during radiotherapy (RT) to physical parameters such as heart rate, blood pressure, respiratory rate, and oxygen saturation and corresponding quality of life measures using quantitative descriptive scales in oncological patients. Thus, the aim of this study was to investigate the effect of MT on the condition of radiooncology patients using these parameters. Materials and methods During this study, patients participated weekly MT sessions guided by a board-certified music therapist. Data such as pain, physical comfort, and respiratory comfort based on the visual analogue scale (VAS) were collected before and after MT sessions. Furthermore, vital signs including heart rate, blood pressure, respiratory rate, and oxygen saturation as well as RT side effects were recorded. Results A total of 57 patients (age 61 ± 11 years) were enrolled in the study. Median VAS score was significantly different before and after MT for pain: VAS 1 (interquartile range [IQR]: 0–3) vs. VAS 0 (IQR: 0–2; p < 0.001); physical comfort: VAS 7 (IQR: 6–7) vs. VAS 8 (IQR: 7–9; p < 0.001); and respiratory comfort only in the patients with pre-existing symptoms (VAS < 10 before therapy): VAS 8 (IQR: 6–8) vs. VAS 9 (IQR: 8–10; p = 0.002). Furthermore, vital signs were significantly reduced from pre-session to post-session (p > 0.001): heart rate 81 ± 14 min⁻¹ to 76 ± 13 min⁻¹ and respiratory rate from 12 ± 5 min⁻¹ to 10 ± 4 min⁻¹. RT-related side effects did not interfere with participation in MT sessions. Conclusion In our study cohort of radiooncology patients, weekly MT sessions improved defined physical parameters as well as pain, physical comfort, and respiratory comfort. Establishing MT in the routine clinical setting should be more readily considered to further improve patient outcomes.