close

Anmelden

Neues Passwort anfordern?

Anmeldung mit OpenID

Herren

EinbettenHerunterladen
33. Arbeitstagung der
Chirurgischen Arbeitsgemeinschaft
Endokrinologie (CAEK)
PROGRAMM
Basel | 20. – 22. November 2014
www.caek2014.ch
Chirurgische Arbeitsgemeinschaft
Endokrinologie der Deutschen
Gesellschaft für Allgemein- und
Viszeralchirurgie (DGAV)
Copyright © 2014
CIONM in der Schilddrüsenchirurgie
AVALANCHE® SI
vagus
VNS
nerve
stimulation
optimized
Die Saxophonelektrode®
für das kontinuierliche
Neuromonitoring
Das intelligente Soundmodul für die Erkennung
von Signalveränderungen
33. Arbeitstagung der
Chirurgischen Arbeitsgemeinschaft
Endokrinologie (CAEK)
WISSENSCHAFTLICHE LEITUNG
TAGUNGSORT
Prof. Dr. med. Daniel Oertli
Universitätsspital Basel
Chirurgische Abteilung
Viszeralchirurgie
Spitalstr. 21 | 4031 Basel
E: doertli@uhbs.ch
Universitätsspital Basel
Zentrum für Lehre und Forschung (ZLF)
Hebelstr. 20 | 4031 Basel
www.unispital-basel.ch
Dr. med. Christof Kull
Kantonsspital Baselland – Standort Liestal
Klinik für Viszeral-, Allgemein-, Thorax- und
Gefäßchirurgie
Rheinstr. 26 | 4410 Liestal
E: christof.kull@ksbl.ch
FÖRDERER
Die wissenschaftliche Leitung dankt der
Theodor Nägeli-Stiftung für die finanzielle
Unterstützung der CAEK-Tagung 2014 in Basel.
ÖFFNUNGSZEITEN TAGUNGSBÜRO
Dr. med. Thomas Clerici
Kantonsspital St. Gallen
Klinik für Chirurgie
Chirurgische Abteilung
Rorschacher Str. 95 | 9007 St. Gallen
E: thomas.clerici@kssg.ch
Das Tagungsbüro befindet im Foyer des
ZLF (Zentrum für Lehre und Forschung) der
Universität Basel, siehe Plan auf Seite 63.
KONGRESSORGANISATION
Freitag, 21. November 2014
07.00 – 17.00 Uhr
Porstmann Kongresse GmbH
Alte Jakobstr. 76 | 10179 Berlin
T: +49 (0) 30 28449919
F: +49 (0) 30 28449911
E: caek2014@porstmann-kongresse.de
www.porstmann-kongresse.de
Donnerstag, 20. November 2014
13.00 – 18.30 Uhr
Samstag, 22. November 2014
07.30 – 13.30 Uhr
Telefon vor Ort: +49 172 1690 112
TRÄGERSCHAFT
Die Wireless-DisplayAnbindung für noch
mehr Flexibilität im OP
SAVC GmbH
Servicegesellschaft für
Allgemein- und Viszeralchirurgie
Haus der Bundespressekonferenz
Schiffbauerdamm 40 | 10117 Berlin
www.dgav.de/savc
www.medical-langer.de
1
PROGRAMMÜBERSICHT UND INHALTSVERZEICHNIS
GRUSSWORT
DONNERSTAG, 20. NOVEMBER 2014
18.30 – 19.30 Uhr
Vorstandssitzung der CAEK im Restaurant Schlüsselzunft
(Vorgesetztenstube)
19.00 – 22.00 Uhr
Get Together im Restaurant Schlüsselzunft (Zunftsaal)
Liebe CAEK-Mitglieder,
liebe Kolleginnen und Kollegen,
wir freuen uns sehr, Sie zur nächsten Arbeitstagung der CAEK im November 2014 nach Basel einzuladen: Seien Sie ganz herzlich willkommen! Nicht nur interessante wissenschaftliche Themen
locken nach Basel; auch die Kulturstadt Basel hält einige Überraschungen für Sie bereit!
FREITAG, 21. NOVEMBER 2014
08.15 – 08.45 Uhr
Eröffnung der 33. Arbeitstagung der CAEK
5
08.45 – 10.00 Uhr
Pitfalls and missed cases
5
10.15 – 12.00 Uhr
Hepatische Metastasen neuroendokriner Tumore
5
12.10 – 12.50 Uhr
Besuch der Posterausstellung
6
13.00 – 13.45 Uhr
Theodor-Kocher-Vorlesung
6
14.00 – 15.45 Uhr
Der kleine neuroendokrine Tumor des Pankreas (pNET)
6
16.00 – 17.00 Uhr
Neuroendokrine Tumore: Freie Vorträge
7
17.30 – 22.30 Uhr
Gesellschaftsabend (Besuch des Museums Tinguely, Schiffsfahrt
auf dem Rhein, musikalische Unterhaltung durch „Trionettli“)
7
SAMSTAG, 22. NOVEMBER 2014
08.00 – 09.00 Uhr
Mitgliederversammlung der CAEK
8
09.00 – 09.10 Uhr
Vorstellung des 9. Postgradualen Kurses der CAEK in Halle/Saale
und Vorstellung der 34. Arbeitstagung der CAEK in Mainz
8
09.10 – 10.10 Uhr
Ökonomie, Qualität und Effizienz in der Schilddrüsenchirurgie:
Freie Vorträge
8
10.10 – 11.30 Uhr
Tumorboard für Patienten mit PDTC / UTC
9
11.45 – 12.15 Uhr
Vorstellung „Eurocrine“
9
12.15 – 13.00 Uhr
Freie Vorträge
9
13.00 – 13.15 Uhr
Verabschiedung inklusive Verleihung des Vortrags- und Posterpreises
9
13.15 Uhr
Abschlussimbiss
Poster
2
9
11
Abendveranstaltungen
14
Vorstand der CAEK
15
Referenten und Moderatoren
18
Abstracts
23
Autorenindex
53
Technische Hinweise
57
Sponsoren und Aussteller
58
Plan der Industrieausstellung
60
Tagungs- und Anreiseinformationen
61
Ankündigung CAEK 2015
67
Im Wissen darum, dass die Nuklearmedizinische Klinik in Basel eines der weltweit führenden
Zentren in der Bildgebung und Behandlung neuroendokriner Tumore ist, hatten wir die Therapie gastro-entero-pankreatischer neuroendokriner Tumore zu einem Schwerpunktthema der
Tagung gemacht. Am ersten Kongresstag sind zwei Hauptsitzungen mit eingeladenen Referenten folgenden Themen gewidmet: Eine Sitzung hat den „kleinen“ pankreatischen neuroendokrinen Tumor zum Thema; eine weitere Sitzung beschäftigt sich mit der Diagnostik und Therapie hepatischer Metastasen neuroendokriner Tumore.
Als endokrine Chirurgen wurden wir wohl schon alle einmal durch die präoperative Bildgebung
intraoperativ „in die Irre“ geführt – in der Sitzung Pitfalls and missed cases werden uns Nuklearmediziner und Radiologen ihre Sichtweise zu diesen Situationen aufzeigen.
Am zweiten Tag der Tagung ist ein interdisziplinäres Tumorboard für schlecht differenzierte
Schilddrüsenmalignome mit Experten verschiedener Fachrichtungen geplant, bei welchem
CAEK-Mitglieder eigene klinische Fälle zur gemeinsamen Besprechung der Vorgehensweise vorstellen werden. Einen weiteren thematischen Focus setzen wir mit einer Sitzung zum Thema der
Ökonomie, Qualität und Effizienz in der Schilddrüsenchirurgie.
Ergänzt werden die Themensitzungen mit freien Vorträgen. Zahlreiche, qualitativ hochstehende
Abstract-Eingaben wurden uns zugestellt und von einer Jury selektioniert. Diese werden relevant
zur wissenschaftlichen Attraktivität der Tagung beitragen.
Kulturell halten wir Ihnen einige Basler Highlights bereit: Einen gemeinsamer Besuch im Tinguely-Museum, eine Schiffsfahrt auf dem Rhein mit Abendessen und Unterhaltung und nicht
zuletzt am Donnerstagabend als Eröffnung ein gemütliches Get Together im ältesten Zunfthaus
Basels, der „Schlüsselzunft“. Natürlich wird auch ein Streiflicht von der berühmten Basler Fasnacht
nicht fehlen!
Es würde uns sehr freuen, wenn Sie zwei Tage in Basel Freundschaft, Wissenschaft und Basler
Kultur mit uns teilen würden!
Ein herzliches „willkomm“ und „grüetzi mitenand“ vom Organisationsteam!
Ihre
Daniel Oertli
Christof Kull
Thomas Clerici
3
BESUCHEN SIE
UNSEREN STAND!
WISSENSCHAFTLICHES PROGRAMM
Intraoperatives Vagus-Monitoring
mit APS-Elektrode und VideoPräsentation der OP-Technik.
08.15 – 08.45 FR.01 Eröffnung
Neuromonitoring NIM 3.0
08.45 – 10.00 FR.02 Pitfalls and missed cases
Grußwort der Organisatoren und des Präsidenten der
Arbeitsgruppe Endokrine Chirurgie der SGVC
Grußwort des Vorsitzenden der CAEK
Musikalische Einlage „Drummeler und Pfiifer“
„Basel für Non-Baseler“
Oertli D. (Basel)
Moderation:
Bareck E. (Wiener Neustadt), Köberle-Wührer R. (Liestal)
08.45
FR.02.01
Pitfalls and missed cases in der radiologischen Diagnostik
Fretz C. (St. Gallen)
09.00
FR.02.02
Pitfalls and missed cases in der nuklearmedizinischen Diagnostik
Wild D. (Basel)
09.20
FR.02.03
Mediastinal parathyroid adenoma in primary hyperparathyroidism:
What determines positive MIBI-scintigraphy?
Lorenz K., Clerici T., Bailer S., Sekulla C., NguyenThanh P., Dralle H. (Halle/Saale, St. Gallen)
09.30
FR.02.04
Parathyroid gland identification during thyroidectomy: Noticed and
missed by the endocrine surgeon – data for Court-appointed experts
Bures C., Zielinski V., Preldzic L., Kober F., Klug E., Hermann M. (Wien)
09.40
FR.02.05
Our experience comparing MRI, EUS and CT
in the diagnosis of insulinoma
Akca A., Melin A., Starke A. A. R., Lammers B. J., Goretzki P. E. (Neuss)
4
UC201501637DE ©2014 Medtronic, Inc. All Rights Reserved. Printed in Europe.
10.00
Eine Auflistung der Indikationen, Kontraindikationen, Vorsichtsmassnahmen und Warnhinweise
finden Sie in der Bedienungsanleitung
FREITAG, 21.11.2014
Kaffeepause in der Industrieausstellung
10.15 – 12.00 FR.03 Hepatische Metastasen neuroendokriner Tumore
Moderation:
Frilling A. (London), Steinmüller T. (Berlin)
10.15
FR03.01
Prätherapeutisches Assessment
Frilling A. (London)
10.35
FR.03.02
Möglichkeiten chirurgischer Resektionen
Breitenstein S. (Winterthur)
10.55
FR.03.03
Indikationen zur Peptid-Rezeptoren vermittelten Radionukleidtherapie
Wild D. (Basel)
11.15
FR.03.04
Wann kommen Bio- und Chemotherapie zum Einsatz?
Winterhalder R. (Luzern)
5
WISSENSCHAFTLICHES PROGRAMM
11.35
FR.03.05
FREITAG, 21.11.2014
Macht die Resektion des Primärtumors bei nicht
resektablen Lebermetastasen Sinn?
Musholt T. J. (Mainz)
12.00 – 13.00
Mittagspause in der Industrieausstellung
12.10 – 12.50
Besuch der Posterausstellung
WISSENSCHAFTLICHES PROGRAMM
16.00 – 17.00 FR.06 Neuroendokrine Tumore – Freie Vorträge
Moderation:
Fendrich V. (Marburg), Riss P. (Wien)
16.00
FR.06.01
Long-term survival is not impaired after the complete
resection of neuroendocrine tumors of the appendix
Steffen T., Ebinger S., Warschkow R., Lüthi C.,
Schmied B. M., Clerici T. (St. Gallen)
16.10
FR.06.02
Minichromosome maintenance expression in slow growing
gastroenteropancreatic neuroendocrine neoplasms
Schimmack S., Lawrence B., Kenney B., Schmitz-Winnenthal H.,
Strobel O., Modlin I. M., Kidd M. (Heidelberg, New Haven)
16.20
FR.06.03
Outcome of enucleations for pancreatic neuroendocrine neoplasms
Strobel O., Schimmack S., Cherrez A., Hinz U., Fischer L.,
Hackert T., Büchler M. W. (Heidelberg)
16.30
FR.06.04
Bronchopulmonary neuroendocrine tumors in
multiple endocrine neopasia type 1
Albers M. B., López-López C., Waldmann J., Fendrich V.,
Slater E. P., Apitzsch J. C., Bartsch D. K. (Marburg)
16.40
FR.06.05
Lymph node ratio has a significant influence on survival
in neuroendocrine neoplasia of the ileum
Heverhagen A., Schuchmann M., Wiese D., Waldmann J.,
Bartsch D. K., Fendrich V. (Marburg)
Siehe Seite 11
13.00 – 13.45 FR.04 Theodor-Kocher-Vorlesung
Laudatio:
Christ E., Perren A. (Bern)
Prof. Dr. Jean-Claude Reubi (Bern)
“Somatostatin und GLP-1 Rezeptor-Targeting in NET:
Beispiele erfolgreicher translationeller Forschung“
14.00 – 15.45 FR.05 Der kleine neuroendokrine Tumor des Pankreas (pNET)
Moderation:
Bartsch D. K. (Marburg), Scheuba C. (Wien)
14.00
FR.05.01
Management of small, incidentally discovered non-functioning pNET
Falconi M. (Ancona)
14.20
FR.05.02
Management of small, non-functioning MEN1-associated pNET
Triponez F. (Genf)
14.40
FR.05.03
Chirurgische Therapie des sporadischen und MEN1assoziierten Zollinger-Ellison-Syndroms
Bartsch D. K. (Marburg)
15.00
FR.05.04
„One for all?“ – die GLP1-Szintigraphie zur
Lokalisation von Insulinomen
Christ E. (Bern)
15.20
FR.05.05
Chirurgische Therapie der hyperinsulinämen Hypoglykämien
Goretzki P. E. (Neuss)
15.45
6
FREITAG, 21.11.2014
17.30 – 22.30
Gesellschaftsabend
Besuch des Museums Tinguely, Schiffsfahrt auf dem Rhein,
musikalische Unterhaltung durch „Trionettli“,
siehe Seite 14
Kaffeepause in der Industrieausstellung
7
WISSENSCHAFTLICHES
WISSENSCHAFTLICHESPROGRAMM
PROGRAMM
SAMSTAG,
FREITAG, 22.11.2014
21.11.2014
WISSENSCHAFTLICHES
WISSENSCHAFTLICHESPROGRAMM
PROGRAMM
08.00 – 09.00 SA.01 Mitgliederversammlung der CAEK
11.30
Kaffeepause in der Industrieausstellung
09.00 – 09.10
11.45 – 12.15 SA.04
Vorstellung „Eurocrine“
Vorstellung künftiger CAEK-Kurse und Tagungen
9. Postgradualer Kurs der CAEK in Halle/Saale 2015
34. Arbeitstagung der CAEK in Mainz 2015
09.10 – 10.10 SA.02
Ökonomie, Qualität und Effizienz in der
Schilddrüsenchirurgie – Freie Vorträge
Moderation:
Kern B. (Basel), Vorländer C. (Frankfurt/Main)
09.10
Efficacy of a single preoperative dexamethasone dose to
prevent nausea and vomiting after thyroidectomy (tPONV):
a randomized, double-blind, placebo-controlled clinical trial
Tarantino I., Warschkow R., Beutner U., Kolb W., Lüthi A.,
Lüthi C., Schmied B. M., Clerici T. (St. Gallen)
09.20
SA.02.01
SA.02.02
Influence of intraoperatve neuromonitoring (IONM) in
postoperative nausea and vomiting (PONV) in thyroid
surgery. Analysis of a standardized drug regime
Vorländer C., Kazmierczak R., Yadev P., Lienenlüke R. H. (Frankfurt/Main)
Musholt T. (Mainz)
12.15 – 13.00 SA.05
Freie Vorträge
Moderation:
Weber T. (Mainz), Hermanns M. (Berlin)
12.15
SA.05.01
Impact of EMG tracing of postoperative vocal cord
function in CNM guided thyroidectomy
Schneider R., Sekulla C., Lorenz K., Nguyen-Thanh P.,
Machens A., Dralle H. (Halle/Saale)
12.25
SA.05.02
Changes of laryngeal mobility and symptoms
following thyroid surgery – 6 months follow-up
Gohrbandt A. E., Aschoff A., Lang H., Musholt T. J. (Mainz)
12.35
SA.05.03
The normocalcemic primary Hyperparathyroidism –
the early phase of a symptomatic pHPT?
Zahn A., Schmitz E., Kußmann J. (Hamburg)
12.45
SA.05.04
Calcitonin stimulation testing and the risk of pancreatitis
Lorenz K., Abuazab M., Sekulla C., Dralle H. (Halle/Saale)
09.30
SA.02.03
Is postoperative laryngoscopy mandatory after
thyroid surgery in times of IONM?
Estourgie S., Schwarz K., Goretzki P. E. (Neuss)
09.40
SA.02.04
Thyroiditis and surgery: multivariate analysis of risk
profile and incidence of postoperative complications:
A prospective multicenter study of Europe
Thomusch O., Sekulla C., Dralle H., Lorenz K.,
PETS Study Team (Freiburg, Halle/Saale)
13.00 -13.15
Objective and subjective scar aesthetics after
MIVAT vs. conventional thyroidectomy
Sahm M., Pross M., Lippert H. (Berlin, Magdeburg)
13.15
10.10 – 11.30 SA.03
Tumorboard für Patienten mit PDTC / UTC
Moderation:
Lorenz K. (Halle/Saale), Kußmann J. (Hamburg)
Das Schweizer Organisationskomitee bedankt sich
herzlich für die Bewertung der Vorträge bei
09.50
SA.02.05
Pathologie: Schmid K. W. (Essen)
Endokrinologie-Onkologie: Führer-Sakel D. (Essen)
Radioonkologie: Vordermark D. (Halle/Saale)
SAMSTAG,
FREITAG, 22.11.2014
21.11.2014
Verabschiedung
Inklusive Preisverleihung
Abschiedsimbiss
Prof. Dr. Cornelia Dotzenrath (Wuppertal)
Prof. Dr. Christoph Nies (Osnabrück)
Prof. Dr. Rupert Prommegger (Innsbruck)
Dr. Jochen Schabram (Lich)
Fallvorstellungen
Scheuba C. (Wien), Kußmann J. (Hamburg), Lorenz K.
(Halle/Saale), Hermann M. (Wien), Simon D. (Duisburg),
Vorländer C. (Frankfurt), Weber T. (Mainz)
8
9
POSTER
Die Posterautoren werden gebeten, am Freitag, den 21. November 2014, in der Zeit von 12.10
bis 12.50 Uhr am Poster anwesend zu sein, um interessierten Teilnehmern Fragen zum Poster zu
beantworten. Weitere Informationen zu den Postern siehe Seite 57.
NEW HARMONIC
FOCUS®+ Shears
with Adaptive Tissue Technology
Johnson & Johnson AG
ETHICON
Gubelstrasse 34
6300 Zug
Tel: +41 (0) 58 / 231 23 33
Fax: +41 (0)58 / 231 35 24
PI
Schilddrüse
P 01
Discordance in histopathologic findings of papillary microcarcinoma in thyroid
specimens – Interobserver variations of two institutes of pathology
Bures C., Zielinski V., Klatte T., Neuhold N., Schultheis A.,
Kober F., Neumann S., Hermann M. (Wien)
P 02
“Indeterminated” (follicular) thyroid nodules: Is a simplified
cytological classification of value to plan lymph node surgery
Strobl S., Riss P., Selberherr A., Bichler C., Scheuba C., Niederle B. (Wien)
P 03
Does the date of postoperative ENT-check influence the rate of
early postoperative recurrent laryngeal nerve paralysis?
Lienenlüke R. H., Altindag H., Kufleitner H., Vorländer C. (Frankfurt/Main)
P 04
First experiences with robotic-assisted hemithyroidectomy via axillary single incision
Eckhardt S., Maurer E., Fendrich V., Bartsch D. K. (Marburg)
P 05
Predicting the risk for postoperative hypoparathyroidism
after thyroid surgery: results of a prospective study
Manzini G., Malhofer F., Weber T. (Ulm, Mainz)
P 06
Does normotension at the end of thyroidectomy
prevent postoperative haemorrhage?
Bock S., Kolb W., Clerici T. (St. Gallen)
P 07
Thyroid nodules: Guideline compliance in preoperative diagnostics in Germany
Reinisch A., Malkomes P., Habbe N., Bechstein W.-O., Holzer K. (Frankfurt/Main)
P 08
Cryopreservation of parathyroids in sHPT under GCP-like conditions:
Will the demanding procedure be justified in the future?
Dralle S., Uckermark A., Linnebacher M., Klar E. (Rostock)
P 09
Postoperative hypoparathyroidism after thyroid surgery in the elderly
Sehnke N., Schwarz K., Lammers B. J., Goretzki P. E. (Neuss)
P 10
Management of papillary carcinoma of thyroglossal duct carcinoma according
to the CAEK guidelines on surgical treatment of malignant thyroid diseases
Bittscheidt H., Richter G., Müller J. A., Lück R. (Hameln, Hannover)
P 11
Thyroid micro-carcinoma with lymphnode metastasis
Bradatsch A., Wolf G. (Graz)
©2014 Ethicon
Für aktuelle und vollständige Anleitungen
beachten Sie bitte immer die der Verpackung
beiliegende Gebrauchsanweisung.
11
POSTER
POSTER
P II
Nebenschilddrüsen
P 22
P 12
Sleeping disturbances in patients with primary
hyperparathyreoidism – a prospective, case-control study
Schuster F., Rasche R. V., Neukirch A. K., Meyer A., Papadakis M., Dotzenrath C. (Wuppertal)
Coincidence of two mutations in a patient presenting with multiple
endocrine neoplasia type 1 – is the clinical course more aggressive?
Melin M., Akca A., Wirowski D., Schwarz K., Starke A. A. R., Goretzki P. E. (Neuss)
P 23
Roboter-assisted surgical management of neuroendocrine tumors of the pancreas
Fendrich V., Maurer E., Bartsch D. K. (Marburg)
P 13
Comparative diagnostic value of ultrasound, ultrasound-guided
fine needle aspiration and sestamibi scintigraphy for the correct
preoperative localisation of parathyroid adenomas
Bilz S., Rogowski-Lehmann N., Krull I., Oettli R., Brändle M., Kolb W., Clerici T. (St. Gallen)
P IV
Basic Science / Case Reports
P 24
Effect of combined antiangiogenic therapy at different points
of tumorangiogenesis in RIP1-TAg5-transgenic mice
Strothmann H., Schimmack S., Schölch S., Scherer U., Schmidt T.,
Büchler M. W., Schmitz-Winnenthal H. (Heidelberg)
P 25
Hashimoto Thyroiditis is dominated by infiltrating Th1/Th17 cells
Gasser M., Almanzar G., Schreiner J., Höfner K., Wild V., Rosenwald A.,
Germer C.-T., Waaga-Gasser A. M., Prelog M. (Würzburg)
P 26
Two cases of renal neuroendocrine tumor – case report and review of the literature
Melin A., Otto C., Akca A., Starke A. A. R., Goretzki P. E. (Neuss)
P 27
Interdisciplinary treatment of a high malignant gastric neuroendocrine carcinoma
(NEC) with hepatic metastasis in multiple endocrine neoplasia type I syndrome:
a case report.
Watzka F., Schad A., Fottner C., Miederer M., Weber M., Lang H., Musholt T. J. (Mainz)
P 28
A rare cause of a solitary thyreoid nodule
Trum S., Krenz D. (München)
P 14
Functional evaluation of parathyroid grafts after total
parathyroidectomy for secondary hyperparathyroidism with
autotransplantation into the tibialis anterior muscle
Anamaterou C., Schimmack S., Lang M., Rudofsky G., Strobel O.,
Nawroth P., Büchler M. W., Schmitz-Winnenthal H. (Heidelberg)
P 15
Failed parathyroid operation: high serum calcium levels do not exclude FHH
Meyer A., Meurer N., Papadakis M., Meyer I., Weyerbrock N.,
Tosch M., Dotzenrath C. (Wuppertal)
P 16
Can pre-operative vitatmin D treatment prevent postoperative
hypocalcemia in primary hyperparathyroidism?
Ebner H., Herrle F., Nowak K., Nittka S., Wasser K., Lammert A. (Mannheim)
P 17
P 18
Insufficient decrease of intraoperative parathyroid hormone after
parathyroidectomy: is extended cervical exploration necessary?
Müller A.-K., Lindner K., Lenschow C., Senninger N., ColomboBenkmann M. (Münster, Neuruppin)
Intraoperative bilateral jugular venous sampling and rapid parathyroid hormone
testing in patients undergoing parathyroidectomy for primary hyperparathyroidism
Pluto N.-N., Bechstein W.-O., Holzer K. (Düsseldorf, Frankfurt/Main)
Das Schweizer Organisationskomitee bedankt sich
herzlich für die Bewertung der Poster bei
P III
NET/Nebennieren
P 19
Experience in 129 patients with pancreatic neuroendocrine neoplasia
(pNEN): large procedure variety with low morbidity
Akca A., Goretzki P. E., Melin A., Starke A. A. R. (Neuss)
P 20
Long-term results after surgery for pheochromocytoma
Waldmann J., Nuttebaum A.-L., Fendrich V., Ramaswamy A., Bartsch D. K. (Marburg)
P 21
The outcome of patients with neuroendocrine neoplasias
of the lung – experience with 17 patients
Meyer C., Kirschbaum A., Bartsch D. K., Fendrich V. (Marburg)
12
Prof. Dr. Ayman Agha (München)
Prof. Dr. Kenko Cupisti (Euskirchen)
Dr. Katharina Schwarz (Neuss)
13
ABENDVERANSTALTUNGEN
VORSTAND DER CAEK
GET TOGETHER IM RESTAURANT SCHLÜSSELZUNFT
Das Get Together findet am 20. November 2014
in der Zeit von 19.00 bis 22.00 Uhr im Restaurant
Schlüsselzunft, dem ältesten Zunfthaus von Basel,
statt. Das denkmalgeschützte Restaurant mit einer
besonderen Historie liegt im Herzen der Stadt,
nicht weit vom Marktplatz entfernt. Genießen Sie
bei netten Gesprächen mit Kollegen einen entspannten Abend mit herzhaften, kulinarischen Spezialitäten aus der Region.
Adresse: Freie Str. 25 | 4001 Basel (siehe Plan auf Seite 64)
Um vorherige Anmeldung wird gebeten, die Teilnehmerzahl ist begrenzt.
GESELLSCHAFTSABEND – SCHIFFSFAHRT AUF DEM RHEIN INKLUSIVE BESUCH DES
MUSEUMS TINGUELY
Für den diesjährigen Gesellschaftsabend der CAEK
haben die Schweizer Organisatoren etwas Besonderes arrangiert.
Um 17.30 Uhr beginnt eine kurze Fahrt mit dem
Schiff „Christoph Merian“ direkt zum Museum Tinguely. Nach der Ankunft und einer kurzen allgemeinen Einleitung werden die Gäste im Museum
gruppenweise mit den besonderen Schätzen des
Jean Tinguely vertraut gemacht. Nach ca. 90 Minuten erwartet das Schiff alle Gäste zu einer beeindruckenden Fahrt auf dem Rhein. Freuen Sie sich auf
einen besonderen Abend mit regionalen Spezialitäten und einem guten Tropfen Wein – musikalisch
untermalt vom Trionettli.
Die Schiffsfahrt endet um 22.30 Uhr an der Anlegestelle „Basel-Schifflände“.
Der Gesellschaftsabend wird mit 70,00 € pro Person berechnet.
Treffpunkt um 17.15 Uhr: Anlegestelle „Basel-Schifflände“ (siehe Plan Seite 64)
Um vorherige Anmeldung wird gebeten, die Teilnehmerzahl ist begrenzt.
14
VORSITZENDER
Prof. Dr. Thomas J. Musholt
Johannes-Gutenberg-Universität Mainz
Klinik für Allgemein- und Abdominalchirurgie
Endokrine Chirurgie
Langenbeckstr. 1 | 55101 Mainz
STELLVERTRETENDER VORSITZENDER
Prof. Dr. Thomas Steinmüller
DRK-Kliniken Berlin Westend
Chirurgische Klinik
Zentrum für Allgemein- und Viszeralchirurgie
Zentrum für Endokrine Chirurgie
Spandauer Damm 130 | 14050 Berlin
SCHRIFTFÜHRER
Prof. Dr. Christian Scheuba
Medizinische Universität Wien
Universitätsklinik für Chirurgie
Klinische Abteilung für Allgemeinchirurgie
Währinger Gürtel 18-20 | 1090 Wien
BEIRAT
Dr. Jochen Schabram
Asklepios Klinik Lich
Klinik für Endokrine Chirurgie
Goethestr. 4 | 35423 Lich
Prof. Dr. Christoph Nies
Niels-Stensen-Kliniken
Marienhospital Osnabrück GmbH
Klinik für Allgemein- und Viszeralchirurgie
Bischofsstr. 1 | 49074 Osnabrück
Die CAEK-Vorstandssitzung findet am 20.11.2014 in der Zeit von 18.30 bis 19.30 Uhr im
Restaurant Schlüsselzunft (Vorgesetztenstube) statt.
15
Speziell zur Behandlung von Akromegalie
und Neuroendokrinen Tumoren entwickelt:
Die besondere Galenik von Somatuline Autogel®
START RIGHT
& STAY RIGHT
Somatuline Autogel®
• wirkt schnell und dauerhaft 1, 2, 3
• ist sicher in der Anwendung und
gut verträglich 1, 2, 3
• als Fertigspritze sofort anwendbar
• zur Selbstinjektion und
Intervallverlängerung zugelassen4
Fertigspritze mit automatischem
Nadelsicherungssystem
Somatuline Autogel® Injektionslösung in einer Fertigspritze; Wirkstoff: Lanreotid als Acetat. Indikationen: Akromegalie: keine Normalisierung der
Wachstumshormonsekretion nach chirurgischer Behandlung und/oder Radiotherapie. Neuroendokrine (insbesondere karzinoide) Tumoren: Behandlung von Symptomen.
Dosierung/Anwendung: Tief subkutane Injektion ins Gesäss (durch Fachpersonal oder unterwiesene Person) oder in den Oberschenkel (bei Selbstinjektion). Bei
Erstbehandlung mit einem Somatostatin-Analogon initial 60 mg alle 28 Tage. Danach Anpassung der Dosis je nach Ansprechen. Maximaldosis 120 mg alle 28
Tage. Bei guter Einstellung auf SSA Behandlung mit 120 mg alle 42 oder 56 Tage möglich. Einzelheiten s. AIPS Plattform Swissmedic (www.swissmedicinfo.ch).
Kontraindikation: Überempfindlichkeit auf Somatostatin oder ähnliche Peptide oder einen der Hilfsstoffe. Vorsichtsmassnahmen: Verringerung der Motilität der
Gallenblase und Bildung von Gallensteinen möglich: Untersuchung von Gallenblase und Pankreas zu Behandlungsbeginn und danach in 6-monatigen Intervallen.
Hypoglykämie oder Hyperglykämie: Kontrolle des Blutzuckerspiegels zu Behandlungsbeginn und bei Dosisänderung. Anpassung der Diabetes-Behandlung
bei Diabetikern. Absinken der Herzfrequenz und bei Patienten mit Herzerkrankungen Sinusbradykardie möglich. Vorsicht bei Patienten mit Bradykardie zu
Behandlungsbeginn. Bei Patienten mit neuroendokrinen Tumoren Ausschluss eines obstruktiven Intestinal-Tumors vor Behandlungsbeginn. Anwendung in
Schwangerschaft und Stillzeit nur bei eindeutiger Erfordernis. Einzelheiten s. AIPS Plattform Swissmedic (www.swissmedicinfo.ch). Interaktionen: Ciclosporin,
Bromocriptin, CYP3A4-Substrate (Chinidin, Terfenadin). Einzelheiten s. AIPS Plattform Swissmedic (www.swissmedicinfo.ch). Unerwünschte Wirkungen: Hauptsächlich
im Magen-Darmbereich, gewöhnlich mild oder mässig und vorübergehend. Sehr häufig: Diarrhö, weiche Stühle, Schmerzen im Bauchraum, Cholelithiasis. Häufig:
Schwindel, Kopfschmerzen, Sinusbradykardie, Nausea, Erbrechen, Verstopfung, Flatulenz, biliäre Dilatation, Alopezie, Hypotrichose, veränderte Laborwerte,
Müdigkeit und Reaktionen an der Injektionsstelle. Hypoglykämie trat häufig, Hyperglykämie gelegentlich auf. Weitere Nebenwirkungen s. AIPS Plattform Swissmedic
(www.swissmedicinfo.ch). Packungen: Erhältlich als gebrauchsfertige Einmalinjektion in den Stärken 60 mg, 90 mg und 120 mg: Packung mit einer vorgefüllten Fertigspritze.
Sonstige Hinweise: Sofort nach dem Öffnen als Einmaldosis verwenden. Aufbewahrung bei 2-8°C in der Originalverpackung. Verkaufskategorie: A, kassenzulässig.
Weitere Informationen entnehmen Sie bitte der AIPS Plattform Swissmedic (www.swissmedicinfo.ch). Zulassungsinhaberin: Future Health Pharma GmbH,
Guyer-Zeller-Strasse 10, 8620 Wetzikon ZH. Herstellerin: Ipsen Pharma Biotech SAS, F-83870 Signes. Stand der Information: Juli 2010. Zul.-Nr.: 56148.
Referenzen
1 Melmed S et al. Rapid and sustained reduction of serum growth hormone and insulin like growth factor-1 in patients with acromegaly receiving lanreotide
Autogel therapy: a randomized, placebo controlled, multicenter study with a 52 week open extension. Pituitary 2010;13(1):18-28.
2 Ruszniewski P et al. Rapid and sustained relief from the symptoms of carcinoid syndrome: results from an open 6-month study
of the 28-day prolonged-release formulation of lanreotide. Neuroendocrinology 2004;80(4):244-51.
3 Caron P et al. Effectiveness and tolerability of 3-year lanreotide Autogel treatment in patients with acromegaly. Clin Endocrinol
(Oxf). 2006;64(2):209-14.
4 Fachinformation: AIPS Plattform Swissmedic (www.swissmedicinfo.ch), Somatuline Autogel® 60 mg / 90 mg / 120 mg, Stand Juli 2010.
16
DIE BISHERIGEN ARBEITSTAGUNGEN DER ACE & CAEK
JAHR/ORT
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Marburg
Göttingen
Mainz
Bern/CH
Hamburg
Wien/A
Düsseldorf
Hannover
München
Marburg
Innsbruck/A
Tübingen
Frankfurt
Bremen
Feldkirch/A
Halle
Hamburg
Berlin
Düsseldorf
Bern/CH
Potsdam
Frankfurt
Wien/A
2005
2006
2007
2008
2009
2010
2011
2012
2013
Hamburg
Duisburg
Mainz
Rostock
Lodz/PL
Osnabrück
Innsbruck/A
Regensburg
Wuppertal
TAGUNGSPRÄSIDENT
Prof. Dr. Hans-Dietrich Röher
Prof. Dr. Horst Dieter Becker
Prof. Dr. Fritz Kümmerle
Prof. Dr. Rudolf Berchtold
Prof. Dr. Volker Bay
Prof. Dr. Bruno Niederle
Prof. Dr. Hans-Dietrich Röher
Prof. Dr. Henning Dralle
Prof. Dr. Jörg Rüdiger Siewert
Prof. Dr. Matthias Rothmund
Prof. Dr. Ernst Bodner
Prof. Dr. Horst Dieter Becker
Prof. Dr. Albrecht Enke
Prof. Dr. Istvan Klempa
Prof. Dr. Gerhard Zimmermann
Prof. Dr. Henning Dralle
Prof. Dr. Andrea Frilling
Prof. Dr. Thomas Steinmüller
Prof. Dr. Hans-Dietrich Röher
Prof. Dr. Markus Büchler
Prof. Dr. Hubertus J. C. Wenisch
Prof. Dr. Robert A. Wahl
Prof. Dr. Bruno Niederle, Prof. Dr. Michael Hermann
Prof. Dr. Rudolf Roka
Prof. Dr. Jochen Kußmann
Prof. Dr. Dietmar Simon
Prof. Dr. Thomas J. Musholt
Prof. Dr. Ernst Klar
Prof. Dr. Henning Dralle, Prof. Dr. Krzysztof Kuzdak
Prof. Dr. Christoph Nies
Prof. Dr. Rupert Prommegger
Prof. Dr. Ayman Agha
Prof. Dr. Cornelia Dotzenrath
17
REFERENTEN UND MODERATOREN
REFERENTEN UND MODERATOREN
Akca, Aycan, Dr., Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 41464 Neuss/D,
E-Mail: aakca@lukasneuss.de
Estourgie, Susanne, Dr., Lukaskrankenhaus Neuss, Klinik fur Allgemein-, Viszeral-, Torax- und
Gefäßchirurgie, Preußenstr. 84, 41464 Neuss/D, E-Mail: sestourgie@yahoo.com
Albers, Max Benjamin, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort
Marburg, Klinik für Viszeral-, Thorax- und, Gefäßchirurgie, Baldingerstr., 35043 Marburg/D,
E-Mail: albersm@med.uni-marburg.de
Falconi, Massimo, Prof. Dr., Università Politecnica delle Marche A.O.U. Ospedali Riuniti, U.O.C.
Chirurgia Pancreatica, Via Conca 71, 60126 Ancona/I, E-Mail: m.falconi@univpm.it
Anamaterou, Chrysanthi, Universitätsklinikum Heidelberg, Klinik für Endokrinologie,
Stoff wechsel und, Klinische Chemie, Im Neuenheimer Feld 410, 69120 Heidelberg/D
Bareck, Evelyne, Dr., Allg. öffentl. Krankenhaus Wiener Neustadt, Abteilung für
Allgemeinchirurgie und Gefäßchirurgie, Corvinusring 3 - 5, 2700 Wiener Neustadt/A,
E-Mail: Evelyne.Bareck@wienerneustadt.lknoe.at
Bartsch, Detlef K., Prof. Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg,
Klinik für Allgemein-, Viszeral-, Thorax- u. Gefäßchirurgie, Baldingerstr., 35043 Marburg/D,
E-Mail: bartsch@med.uni-marburg.de
Bilz, Stefan, Dr., Kantonsspital St. Gallen, Klinik für Endokrinologie/Diabetologie/Osteologie,
Rorschacher Str. 95, 9007 St. Gallen/CH, E-Mail: stefan.bilz@kssg.ch
Bittscheidt, Hans, Dr., Sana Klinikum Hameln-Pyrmont, Allgemein- und Viszeralchirurgie,
Saint-Maur-Platz 1, 31785 Hameln/D, E-Mail: bittscheidt@gmail.com
Bock, Susanne, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Rorschacher Str. 95,
9007 St. Gallen/CH, E-Mail: Susanne.Bock@gmail.com
Bradatsch, Andrea, Dr., Medizinische Universität Graz, Abteilung für Endokrine
Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Auenbruggerplatz 29, 8036 Graz/A,
E-Mail: andrea.bradatsch@medunigraz.at
Breitenstein, Stefan, PD Dr., Kantonsspital Winterthur, Viszeral- und Thoraxchirurgie,
Brauerstr. 15, 8401 Winterthur/CH, E-Mail: Stefan.Breitenstein@ksw.ch
Bures, Claudia, Dr., Krankenanstalt Rudolfstiftung, 2. Chirurgische Abteilung, Juchgasse 25,
1030 Wien/A, E-Mail: claudia.bures@wienkav.at
Christ, Emanuel, Prof. Dr., Universiätsspital Bern, Klinik für Endokrinologie, Diabetologie und
klinische Ernährung, Freiburgstr. 4, 3010 Bern/CH, E-Mail: emanuel.christ@insel.ch
Clerici, Thomas, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung,
Rorschacher Str. 95, 9007 St. Gallen/CH, E-Mail: thomas.clerici@kssg.ch
Dralle, Steven, Dr., Universität Rostock, Chirurgische Universitätsklinik, Abteilung für
Allgemeine, Thorax-, Gefäß- und Transplantationschirurgie, Schillingallee 35, 18057 Rostock/D,
E-Mail: dralle@me.com
Ebner, Hannah, Universitätsmedizin Mannheim, V. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3,
68167 Mannheim/D
Eckhardt, Sabine, Dr., VTG-Chirurgie Uniklinikum Marburg, Baldingerstr., 35043 Marburg/D,
E-Mail: seckhard@med.uni-marburg.de
18
Fendrich, Volker, Prof. Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort
Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., 35039 Marburg/D,
E-Mail: fendrich@med.uni-marburg.de
Fretz, Christian, Dr., Kantonsspital St. Gallen, Klinik für Radiologie und Nuklearmedizin,
Rorschacher Str. 95, 9007 St. Gallen/CH, E-Mail: christian.fretz@kssg.ch
Frilling, Andrea, Prof. Dr., Imperial College London, Hammersmith Campus, Division of Surgery,
Department of Surgery and Cancer, Du Cane Road, London/GB, E-Mail: a.frilling@imperial.ac.uk
Führer-Sakel, Dagmar, Prof. Dr. Dr., Universitätsklinikum Essen, Klinik für Endokrinologie und
Stoff wechselerkrankungen, Hufelandstr. 55, 45122 Essen/D, E-Mail: dagmar.fuehrer@uk-essen.de
Gasser, Martin, Prof. Dr., Universitätsklinikum Würzburg, Zentrum Operative Medizin,
Chirurgische Klinik I, Oberdürrbacher Str. 6, 97080 Würzburg/D, E-Mail: gasser_m@ukw.de
Gohrbandt, Antje Evelyn, Dr., Universitätsmedizin Mainz, Allgemein-, Viszeral- und
Transplantationschirurgie, Sektion Endokrine Chirurgie, Langenbeckstr. 1, 55131 Mainz/D,
E-Mail: antje.gohrbandt@unimedizin-mainz.de
Goretzki, Peter E., Prof. Dr., Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Klinik
für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Preußenstr. 84, 41456 Neuss/D,
E-Mail: pgoretzki@lukasneuss.de
Hermann, Michael, Prof. Dr., Krankenanstalt Rudolfstiftung, II. Chirurgische Abteilung,
Juchgasse 25, 1030 Wien/A, E-Mail: michael.hermann@wienkav.at
Hermanns, Mechthild, Dr., DRK Kliniken Berlin-Westend, Chirurgische Abteilung, Klinik
für Allgemein-, Viszeral- und Endokrine Chirurgie, Spandauer Damm 130, 14050 Berlin/D,
E-Mail: m.hermanns@drk-kliniken-berlin.de
Heverhagen, Anna, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort
Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., 35033 Marburg/D,
E-Mail: Anna.Heverhagen@med.uni-marburg.de
Kern, Beatrice, Dr., St. Claraspital, Chirurgische Klinik, Allgemeinchirurgische Abteilung,
Kleinriehenstr. 30, 4058 Basel/CH, E-Mail: beatrice.kern@claraspital.ch
Köberle-Wührer, Roswitha, Dr., Kantonsspital Baselland, Standort Liestal, Chirurgische
Abteilung, Klinik für Viszeral-, Allgemein-, Thorax- und Gefäßchirurgie, Rheinstr. 26, 4410 Liestal/
CH, E-Mail: roswitha.koeberle-wuehrer@ksbl.ch
Kull, Christof, Dr., Kantonsspital Baselland, Standort Liestal, Chirurgische Abteilung,
Klinik für Viszeral-, Allgemein-, Thorax- und Gefäßchirurgie, Rheinstr. 26, 4410 Liestal/CH,
E-Mail: Christof.Kull@ksbl.ch
19
REFERENTEN UND MODERATOREN
REFERENTEN UND MODERATOREN
Kußmann, Jochen, Prof. Dr., Schön Kliniken, Klinikum Eilbek, Klinik für Endokrine Chirurgie,
Dehnhaide 120, 22081 Hamburg/D, E-Mail: jkussmann@schoen-kliniken.de
Sahm, Maik, PD Dr., DRK Kliniken Berlin Köpenick, Klinik für Chirurgie, Salvador-Allende-Str. 2-8,
12559 Berlin/D, E-Mail: priv.doz.dr.m.sahm@versanet.de
Lienenlüke, Robert H., Dr., Bürgerhospital Frankfurt am Main e.V., Klinik für Endokrine Chirurgie,
Nibelungenallee 37-41, 60318 Frankfurt/Main/D, E-Mail: robert@lienenlueke.de
Scheuba, Christian, Prof. Dr., Medizinische Universität Wien, Universitätsklinik
für Chirurgie, Chirurgische Endokrinologie, Währinger Gürtel 18-20, 1090 Wien/A,
E-Mail: christian.scheuba@meduniwien.ac.at
Lorenz, Kerstin, Prof. Dr., Martin-Luther Universität Halle-Wittenberg, Universitätsklinikum Halle,
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Ernst-Grube-Str. 40, 06120 Halle/Saale/D,
E-Mail: kerstin.lorenz@uk-halle.de
Manzini, Giulia, Dr., Universitätsklinikum Ulm, Klinik für Allgemein- und Viszeralchirurgie,
Albert-Einstein-Allee 23, 89081 Ulm/D, E-Mail: giulia.manzini@uniklinik-ulm.de
Melin, Anastasia, Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 41464 Neuss/D,
E-Mail: anastasia.sotke@gmx.de
Melin, Magnus, Lukaskrankenhaus GmbH, Chirurgische Klinik I, Klinik für Allgemein-, Viszeral-,
Gefäß- und Thoraxchirurgie, Preußenstr. 84, 41464 Neuss/D, E-Mail: mmelin@lukasneuss.de
Meyer, Anke, HELIOS Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstr. 40,
42283 Wuppertal/D, E-Mail: anke.meyer@helios-kliniken.de
Meyer, Christian, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort
Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., 35043 Marburg/D,
E-Mail: meyerch@med.uni-marburg.de
Müller, Ann-Kathrin, Dr., Universitätsklinikum Münster, Klinik für Allgemein- und
Viszeralchirurgie, Waldeyerstr. 1, 48149 Münster/D, E-Mail: Ann-Kathrin.Mueller@ukmuenster.de
Musholt, Thomas J., Prof. Dr., Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und
Transplantationschirurgie, Sektion Endokrine Chirurgie, Langenbeckstr. 1, 55101 Mainz/D,
E-Mail: Musholt@uni-mainz.de
Oertli, Daniel, Prof. Dr., Universitätsspital Basel, Chirurgische Abteilung, Viszeralchirurgie,
Spitalstr. 21, 4031 Basel/CH, E-Mail: doertli@uhbs.ch
Perren, Aurel, Prof. Dr., Universität Bern, Institut für Pathologie, Murtenstr. 31, 3010 Bern/CH,
E-Mail: aurel.perren@pathology.unibe.ch
Pluto, Naja-Norina, Dr., Florence-Nightingale-Krankenhaus, Klinik für Plastische und Ästhetische
Chirurgie, Kreuzbergstr. 79, 40489 Düsseldorf/D, E-Mail: naja.pluto@gmail.com
Reinisch, Alexander, Dr., Universitätsklinikum Frankfurt, Klinik für Allgemeinund Viszeralchirurgie, Theodor-Stern-Kai 7, 60590 Frankfurt/Main/D,
E-Mail: alexander.reinisch@kgu.de
Reubi, Jean-Claude, Prof. Dr., Universität Bern, Institut für Pathologie, Murtenstr. 31,
3010 Bern/CH, E-Mail: jean.reubi@pathology.unibe.ch
Riss, Philipp, Dr., Medizinische Universität Wien, Universitätsklinik für Chirurgie, Chirurgische
Endokrinologie, Währinger Gürtel 18-20, 1090 Wien/A, E-Mail: philipp.riss@meduniwien.ac.at
20
Schimmack, Simon, Dr., Universitätsklinikum Heidelberg, Klinik für Allgemein-,
Viszeral- und Transplantationschirurgie, Im Neuenheimer Feld 110, 69120 Heidelberg/D,
E-Mail: simon.schimmack@med.uni-heidelberg.de
Schmid, Kurt Werner, Prof. Dr., Universitätsklinikum Essen, Institut für Pathologie
und Neuropathologie, Abteilung für Pathologie, Hufelandstr. 55, 45122 Essen/D,
E-Mail: kw.schmid@uk-essen.de
Schneider, Rick, Dr., Universitätsklinikum Halle, Universitätsklinik und Poliklinik für
Allgemein-, Viszeral- und Gefäßchirurgie, Ernst-Grube-Str. 40, 06120 Halle/Saale/D,
E-Mail: rick.schneider@uk-halle.de
Schuster, Frauke, HELIOS Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstr. 40,
42283 Wuppertal/D, E-Mail: fschuster@yahoo.de
Sehnke, Nina, Dr., Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 41464 Neuss/D,
E-Mail: ninasehnke@gmail.com
Simon, Dietmar, Prof. Dr., Ev. Bethesda Krankenhaus zu Duisburg, Klinik für Allgemein- und
Viszeralchirurgie, Heerstr. 219, 47053 Duisburg/D, E-Mail: dsimon@online.de
Steffen, Thomas, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung,
Rorschacher Str. 95, 9007 St. Gallen/CH, E-Mail: thomas.steffen@kssg.ch
Steinmüller, Thomas, Prof. Dr., DRK Kliniken Berlin-Westend, Chirurgische Klinik, Klinik
für Allgemein-, Viszeral- und Endokrine Chirurgie, Spandauer Damm 130, 14050 Berlin/D,
E-Mail: t.steinmueller@drk-kliniken-berlin.de
Strobel, Oliver, PD Dr., Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeralund Transplantationschirurgie, Im Neuenheimer Feld 110, 69120 Heidelberg/D,
E-Mail: oliver.strobel@med.uni-heidelberg.de
Strobl, Stephanie, Dr., Medizinische Universität Wien, Universitätklinik für Chirurgie,
Chirurgische Endokrinologie, Klinische Abteilung für Allgemeinchirurgie, Währinger Gürtel
18-20, 1090 Wien/A, E-Mail: stephanie.strobl@meduniwien.ac.at
Strothmann, Hendrik, Chirurgische Universitätsklinik Heidelberg, Klinik für Allgemein-,
Viszeral- und Transplantationschirurgie, Im Neuenheimer Feld 110, 69120 Heidelberg/D,
E-Mail: hendrik.strothmann@med.uni-heidelberg.de
Tarantino, Ignazio, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung,
Rorschacher Str. 95, 9007 St. Gallen/CH, E-Mail: ignazio.tarantino@kssg.ch
21
REFERENTEN UND MODERATOREN
Thomusch, Oliver, Prof. Dr., Universitätsklinikum Freiburg, Abteilung für
Allgemein- und Viszeralchirurgie, Hugstetter Str. 55, 79106 Freiburg/D,
E-Mail: oliver.thomusch@uniklinik-freiburg.de
Triponez, Frédéric, Prof. Dr., Hôpitaux Universitaires de Genève, Service de Chirurgie
thoracique et endocrinienne, Rue Gabrielle-Perret-Gentil 4, 1205 Genève/CH,
E-Mail: frederic.triponez@hcuge.ch
Trum, Stephanie, Dr., Klinikum Dritter Orden München-Nymphenburg, Abteilung für
Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Menzinger Str. 44, 80638 München/D,
E-Mail: steffi.trum@hotmail.de
Vordermark, Dirk, Prof. Dr., Universitätsklinikum Halle, Klinik und Poliklinik für Strahlentherapie,
Dryanderstr. 4, 06110 Halle/Saale/D, E-Mail: dirk.vordermark@uk-halle.de
Vorländer, Christian, Dr., Bürgerhospital Frankfurt am Main, Klinik für Endokrine Chirurgie,
Nibelungenallee 37-41, 60318 Frankfurt/Main/D, E-Mail: c.vorlaender@buergerhospital-ffm.de
Waldmann, Jens, PD Dr., Universitätsklinikum Gießen und Marburg, Standort Marburg,
Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., 35043 Marburg/D,
E-Mail: jwaldman@med.uni-marburg.de
Watzka, Felix, Dr., Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und
Transplantationschirurgie, Langenbeckstr. 1, 55131 Mainz/D, E-Mail: felix.w1@gmx.de
Weber, Theresia, Prof. Dr., Katholisches Klinikum Mainz, Klinik für Endokrine Chirurgie, An der
Goldgrube 11, 55131 Mainz/D, E-Mail: t-weber@kkmainz.de
Wild, Damian, Prof. Dr., Universitätsspital Basel, Klinik für Radiologie und Nuklearmedizin,
Petersgraben 4, 4031 Basel/CH, E-Mail: wildd@uhbs.ch
ABSTRACTS
FR.02.03 Mediastinal parathyroid adenoma in primary hyperparathyroidism:
What determines positive MIBI-scintigraphy?
Kerstin Lorenz1, Thomas Clerici2, Sebastian Bailer1, Carsten Sekulla1, Phuong Nguyen
Thanh1, Henning Dralle1
1
Department for General-, Visceral-, and Vascular Surgery, University of Halle-Wittenberg, Halle an der
Saale, Germany; 2Department for Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
Background: MIBI-scintigraphy can localize parathyroid adenomas (PA) in primary hyperparathyroidism (pHPT) and stratify surgical approach, especially relevant for mediastinal localization,
possibly requiring open or endoscopic mediastinal approach. Incidence of MBI-negative mediastinal PA and determinants for positive MIBI findings are indistinct.
Methods: Dual center retrospective analysis of mediastinal PA in pHPT preoperatively investigated
with MIBI-scintigraphy. Biochemical and clinical data of MIBI-negative and MIBI-positive PA were
compared.
Results: In center A 8/1075 (0.7 %), center B 5/547 (0.9 %) pHPT patients had mediastinal PA localization. 6 were MIBI-positive, 6 negative. There were no significant differences between MIBI positive
and negative regarding preoperative calcium, PTH levels and PA weight (median Ca 2.9 mmol/l;
PTH 456.6 pg/ml in MIBI-positive vs.3.1 mmol/l; 310.6 pg/ml in MIBI-negative; median specimen
weight MIBI-positive was 5351 mg vs. negative 17705 mg). Successful parathyroidectomy resulted
in postoperative median calcium/PTH levels of 1.86 mmol/l and 49.8 pg/ml.
Conclusion: Comparison of biochemical and clinical criteria of mediastinal PA in pHPT in two
centers did not reveal reliable determinants to prognosticate MIBI-performance. In order to assess true incidence of MIBI-negative mediastinal PA and to preclude bias due to underpowered
data, multicentric study of this clinically important phenomenon is desired.
Winterhalder, Ralph, Dr., Kantonsspital Luzern, Medizinische Onkologie, Spitalstr., 6000 Luzern/
CH, E-Mail: ralph.winterhalder@luks.ch
kerstin.lorenz@uk-halle.de
Zahn, Alexandra, Dr., Schön Kliniken, Klinikum Eilbek, Endokrine Chirurgie, Dehnhaide 120,
22081 Hamburg/D, E-Mail: azahn@schoen-kliniken.de
FR.02.04 Parathyroid gland identification during thyroidectomy:
Noticed and missed by the endocrine surgeon – data for Courtappointed experts
Claudia Bures, V. Zielinski, L. Preldzic, Friedrich Kober, E. Klug, Michael Hermann
2nd Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria
Background: Legal aspects of thyroidectomy focus on recurrent nerve injury, postoperative bleeding and hypoparathyroidism. Court-appointed experts often claim that the identification of 4 parathyroid glands during thyroid surgery has to be mandatory. The aim of this study was to evaluate
how many parathyroid glands (PG) are identified by an experienced thyroid surgeon.
Methods: More than 300 thyroidectomies were analyzed according to a prospective protocol. The
number of intraoperatively identified, accidentally removed parathyroid glands and the clinical
outcome were evaluated.
22
23
ABSTRACTS
Results: Median dissected number of parathyoid glands (PGs) was 2.3. Four, three, two, one and
zero PGs were found in 12 %, 31 %, 35 %, 16 % and 6 % of patients, respectively. In the histopathologic examination, a single accidentally removed PG was found in 9 %, two PGs in 1 %. The incidence of latent permanent and manifest permanent hypoparathyroidism was 2,8 % and 0,3 %
(1/357)
Conclusion: An experienced surgeon does not identify all parathyroid glands in the majority of
cases, however, the specimen itself should be examined thoroughly by the surgeon after removal.
A low number of identified PGs does not necessarily impact the outcome. The visualization of all 4
PGs cannot be demanded by court appointed experts.
claudia.bures@wienkav.at
FR.02.05 Our experience comparing MRI, EUS and CT in the diagnosis
of insulinoma
Aycan Akca, Anastasia Melin, Achim A. R. Starke, Bernhard J. Lammers, Peter E. Goretzki
Department of Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss, Germany
Background: Different imagings are used to localize insulinoma. Endoscopic ultrasonography
(EUS) is accepted as the best diagnostic tool to detect insulinoma, but holds a strong interobserver variability.
Methods: We analyzed all patients with insulinoma, who underwent EUS, computed tomography
(CT), and magnetic resonance imaging (MRI) between 2001 and 2014 retrospectively.
Results: 69 of our 232 patients with neuroendocrine tumors suffered from insulinoma, including
10 cases of malignancy. EUS, CT and MRI were positive in 30 patients (43.5 %), 29 (42 %), 26 (37.7 %)
patients, respectively. In 20 (30 %), 14 (20.3 %) and 6 (8.7 %) patients EUS, CT and MRI were negative. In 14 patients (46.7 %) MRI and EUS were positive. MRI localized the tumor in 10 (33.3 %)
patients with negative EUS. Whereas EUS detected the tumor in 4 (13.3 %) patients with negative
MRI. 20 patients in our collective underwent all three examinations. MRI was positive in 14 patients, whilst EUS or CT was positive in 10.
Conclusion: Our data shows, that MRI has the best diagnostic performance in detection and localization of insulinoma. EUS has interobserver variability and the exact localization in the pancreas
is not always possible.
aakca@lukasneuss.de
ABSTRACTS
FR.06.01 Long-term survival is not impaired after the complete resection of
neuroendocrine tumors of the appendix
Thomas Steffen1*, Sabrina M. Ebinger1*, René Warschkow1,2, Cornelia Lüthi1, Bruno
M. Schmied1, Thomas Clerici1
1
Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; 2Institute of Medical Biometry
and Informatics, University of Heidelberg, Heidelberg, Germany
*Both authors contributed equally
Background: aNET are a common entity in routine medical care, with a rate per appendectomy
as high as 0.3 to 0.9 %. Considering the relatively young age at diagnosis for these patients, exact
information about the long-term prognosis of aNET is required.
Methods: Between 1990 and 2003, the ten-year survival rates of 79 patients was analyzed using
risk-adjusted Cox proportional hazard regression models adjusted for population-based baseline
mortality. Additionally, prognostic factors for the oncologic outcomes were assessed.
Results: The median follow-up of all patients was 12.1 years and 13.7 years for those alive. All patients underwent curative R0 resections. No distant metastases were diagnosed. A total of 31
(39.2 %), 29 (36.7 %), 18 (22.8 %), and 1 (1.3 %) patients had stage I, IIA, IIB and IIIB aNET, respectively,
according to the latest classification by the European Neuroendocrine Tumor Society (ENETS). The
ten-year overall and relative survival rates were 83.6 % (95 %CI: 75.5 %-92.6 %) and 96.7 % (95 %CI
87.5 %- 107 %), respectively. Second primary malignancies (hazard ratio of death = 7.0, 95 %CI: 1.630.6) were identified as a significant prognosticator for long-term survival.
Conclusion: Long-term survival is not significantly depreciated after the curative resection of appendiceal NET.
sabrina.ebinger@gmx.ch
FR.06.02 Minichromosome maintenance expression in slow growing
gastroenteropancreatic neuroendocrine neoplasms
Simon Schimmack1,2, Ben Lawrence1, Barton Kenney3, Hubertus Schmitz-Winnenthal2,
Oliver Strobel2, Irvin M. Modlin1, Mark Kidd1
1
Gastrointestinal Pathobiology Research Group, Department of Gastrointestinal Surgery, Yale
University School of Medicine, CT, USA; 2University Hospital of General-, Visceral- and TransplantationSurgery of Heidelberg, Heidelberg, Germany; 3Department of Pathology, Division of Gastrointestinal
and Hepatic Pathology, Yale University School of Medicine, New Haven, CT, USA.
Background: Small intestinal neuroendocrine neoplasms (SI-NENs) often are characterized by
a low Ki67 index. We hypothesized that expression of Minichromosome Maintenance proteins
(MCMs), which are essential replication licensing markers, may provide information to augment
standard Ki-67 expression in these tumors.
Methods: We conducted immunohistochemical staining (IHC), western blot analysis, quantitative
PCR and copy number variations of MCM2, MCM3 and Ki-67 in small intestinal NENs (n=22). MCM
24
25
ABSTRACTS
ABSTRACTS
and Ki67 expression was compared by Kaplan-Meier survival analysis (tissue microarray, independent set [n=55]). We used 43 pancreatic NENs and 14 normal tissues as control groups.
FR.06.04 Bronchopulmonary neuroendocrine tumors in multiple endocrine
neopasia type 1
Results: In SI- NENs, MCM2 and MCM3 were detected in significantly (10x, p<0.01) more cells than
Ki67; expression trended toward higher levels than in normal small intestine (p=0.06). MCM2
mRNA correlated with Ki-67 IHC (p<0.05). MCM3 expression in proliferating cells significantly
predicted survival (p<0.002). Combinations of Ki67 and MCM2/3 in algorithms differentiated low
proliferative lesions (overall survival 12 years) and high proliferating tumors (OS: 6.1 years).
Max B. Albers1, Caroline Lopez-Lopez1, Jens Waldmann1, Volker Fendrich1, Emily P. Slater1,
Jonas C. Apitzsch2, Detlef K. Bartsch1
1
Klinik für Viszeral-, Thorax- und Gefäßchirurgie, 2Klinik für diagnostische und interventionelle
Radiologie, Universitätsklinikum Gießen und Marburg, Standort Marburg
Conclusion: MCMs are expressed in a higher proportion of NEN cells than Ki67 in slow growing
lesions and correlates with survival. Assessment can be used to augment Ki-67 to improve prognostic classification in low-grade lesions.
simon.schimmack@med.uni-heidelberg.de
FR.06.03 Outcome of enucleations for pancreatic neuroendocrine neoplasms
Oliver Strobel, Simon Schimmack, Annia Cherrez, Ulf Hinz, Lars Fischer, Thilo Hackert,
Markus W. Büchler
Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
Background: Pancreatic enucleations are increasingly performed for pancreatic neuroendocrine
neoplasms (pNENs) but little is known about perioperative and long term results.
Methods: From a prospective database including 303 patients undergoing pancreatic resection
for pNENs between 10/2001 and 2/2013, patients with enucleations were identified and perioperative morbitiy as well as follow-up results were assessed.
Results: Enucleations were performed in 60 (19.8 %) patients with pNENs. 34 (57 %) pNENs were
located in the pancreatic head/uncinate process and 26 (43 %) in the body/tail. The median tumor
size was 1.3 cm (IQR: 0.9-1.7). There were 47 (78 %) G1 and 13 (22 %) G2 tumors. The median duration of the operation was 137 min (IQR: 101-172) and the median postoperative stay was 8 days
(IQR: 7-10). Morbidity was 35 %. 18 patients (30 %) developed postoperative pancreatic fistula
(POPF). 10 patients developed grade A POPF (ISGPF-definition). Only 8 (13 %) patients developed
clinically relevant POPF (n=3 grade B, n=5 grade C). Mortality was 0 %. After a median follow-up
time of 26 months (IQR: 7-46) all patients were still alive resulting in an actuarial 5 year survival
rate of 100 %.
Conclusion: In context of the high morbidity of formal pancreatic resections, enucleation for G1/
G2 pNENs is a safe procedure with favorable outcome.
oliver.strobel@med.uni-heidelberg.de
Background: This study aimed to determine the prevalence, potential precursor lesions, course of
disease and prognosis of BNENs in MEN1.
Methods: A prospectively collected database of MEN1 patients was retrospectively analysed for
BNENs.
Results: Five of 75 MEN1 patients developed histologically confirmed BNENs. 2 patients had multiple lung lesions. All patients underwent surgery (4 anatomic resections, one wedge resection).
Histopathology revealed carcinoids G1 sized 7 to 32mm. Lymph node metastases were found in
3 patients. 4 patients had tumorlets as well as diffuse pulmonary neuroendocrine cell hyperplasia.
CT scans revealed bronchopulmonary lesions >3mm in 16 of 53 patients. After a median of 48
months follow-up, these were stable in 12 patients (75 %) and slightly progressive in 4 patients
(25 %). Hypergastrinemia was the only feature more common in patients with pulmonary nodules
and BNENs compared to patients without pulmonary nodules (p=0,072). One patient deceased of
BNEN during long-term follow-up.
Conclusion: BNENs in MEN1 might be more common than previously reported and pulmonary
neuroendocrine cell hyperplasia is a potential precursor. The natural course seems rather benign,
but lesions >2cm tend to metastasize. These data should be considered for screening, therapy
and follow-up strategies.
albersm@med.uni-marburg.de
FR.06.05 Lymph node ratio has a significant influence on survival in
neuroendocrine neoplasia of the ileum
Anna E. Heverhagen, M. Schuchmann, Dominik Wiese, Jens Waldmann, Detlef K. Bartsch,
Volker Fendrich
Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
Background: The aim of this study was to evaluate the role of resected lymph node metastases
ratio in patients who underwent surgery due to a neuroendocrine neoplasia of the ileum between 1999 and 2014 in our institution.
Methods: 120 patients that underwent surgery for ileal NEN between 1999 and 2014 at our institution were retrospectively evaluated regarding their survival and their lymph node ratio at time
of surgery.
Results: In 106 patients lymph nodes were resected as a part of the main oncological resection
of the primary. After a median follow-up of 48 months (range 1-157) 63 patients are still alive
26
27
ABSTRACTS
whereas 43 patients died. Patients still alive had a mean lymph node ratio of 0.158, whereas patients who died had a lymph node ratio of 0.488 (p=0.000).
Conclusion: Survival is statistically significantly higher in patients with lower lymph node ratio. An
early and aggressive surgical approach could redcue the amount of lymph node metastases and
consecutively could approve survival.
Anna.Heverhagen@med.uni-marburg.de
SA.02.01 Efficacy of a single preoperative dexamethasone dose to prevent
nausea and vomiting after thyroidectomy (tPONV): a randomized,
double-blind, placebo-controlled clinical trial
Ignazio Tarantino1, Rene Warschkow1, Ulrich Beutner1, Walter Kolb1, Andreas Lüthi2,
Cornelia Lüthi1, Bruno M. Schmied1, Thomas Clerici1
1
Klinik für Chirurgie, 2Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, Kantonsspital
St. Gallen, St. Gallen, Switzerland
ABSTRACTS
SA.02.02 Influence of intraoperatve neuromonitoring (IONM) in postoperative
nausea and vomiting (PONV) in thyroid surgery – Analysis of a
standardized drug regime
Christian Vorländer1, Romuald Kazmierczak2, P. Yadev1, Robert H. Lienenlüke1
1
Klinik für Endokrine Chirurgie, Bürgerhospital Frankfurt am Main; 2Klinik für Anästhesiologie,
Bürgerhospital Frankfurt am Main
Background: IONM is established in thyroid/parathyroid surgery nowadays to reduce the rate of
recurrent laryngeal nerve palsy. PONV as a side effect of this procedure is known. Postoperative
bleeding is a complication which might be influenced by PONV. A standardized PONV-prophylaxis might lower the rate of these complications
Methods: In 2010 151 female patients were observed using IONM without standardized prophylaxis for PONV but using the total intravenous technique (TIVA) as anaesthesia (Group A). 2014
a total of 200 patients were observed using TIVA and PONV prophylaxis [Granisetron and dexamethason] (Group B). The rate of early (up to 2hrs), midtime (2-6hrs) and late (6-24hrs) nausea and
vomiting was recorded prospectively in both groups using the Apfel score.
Background: PONV is an unsettling problem that commonly occurs in patients after thyroidectomy. Various preventive measures have been studied, such as a single administration of steroids.
However, many of these studies have been criticized for their biases (e.g., use of opioids, gender
selection) or were retracted. Therefore, we performed a randomized-controlled trial to investigate the effect of dexamethasone on PONV after thyroidectomy while carefully controlling for
known biases.
Results: Analysis showed an early rate of 53 % in Group A (Apfel 2-4) vs. 5 % in Group B (p<0,001).
For midtime and late PONV-rate the results were 35 % and 8 % in Group A and 30 % and 15 % in
Group B respectively (n.s.). No postoperative bleeding was observed in both cohorts.
Methods: This single-institution, randomized, double-blind, placebo-controlled, superiority study
was performed between Jan, 2011 and May, 2013. Patients undergoing thyroidectomy for benign
disease were randomly allocated to receive a single dose of dexamethasone (8 mg) or placebo
before surgery. The primary endpoint was the incidence of PONV.
c.vorlaender@buergerhospital-ffm.de
Results: The total incidence of PONV was 65 of 152 patients (43 %, 95 % CI:35 %-51 %). In the ITT
analysis, PONV occurred in 22 of 76 patients (29 %, 95 % CI:20 %-40 %) in the treatment arm and in
43 of 76 patients (57 %, 95 % CI:45 %-67 %) in the control arm (p=0.001; OR=0.31, 95 % CI: 0.16-0.61).
The number needed to treat was four. No severe dexamethasone-related adverse events were
observed during the study.
Conclusion: A single preoperative dexamethasone administration is an effective, safe, and economical measure to reduce PONV incidence after thyroidectomy.
ignazio.tarantino@kssg.ch
Conclusion: IONM is connected with a higher rate of postoperative nausea and vomiting. A standardized prophylaxis can lower the PONV rate in the most vulnerable period early postoperatively.
This regime makes thyroid surgery more safely.
SA.02.03 Is postoperative laryngoscopy mandatory after thyroid surgery in
times of IONM?
Susanne H. Estourgie, Katharina Schwarz, Peter E. Goretzki
Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Lukaskrankenhaus Neuss
Aim: what is the role of laryngoscopy after thyroid-surgery regarding long-term laryngeal nerve
paralysis (LNP) in times of intraoperative-neuromonitoring (IONM).
Methods: 684 patients (1038 nerves-at-risk) were studied retrospectively. Vocal-cord-function was
assessed by laryngoscopy pre and post-operatively. Permanent LNP was defined as impairment
of active vocal-cord-mobility exceeding one year post-surgery.
Results: 59 patients had postoperative (unilateral) VCD. There was one false positive result. 18/59
patients had no IONM-loss (false negative). Permanent VCD occurred in nine patients (incidence
0,87 %). Sensitivity, specificity and predictive values of IONM for predicting permanent VCD were:
100 %, 96 %, 25 %, 100 % and for ENT-findings: 100 %, 94 %, 18 %, 100 %. In case of a normal IONM,
no permanent VCD were seen. Only one patient had VCD up to five months and had clinical symptoms of hoarseness. The other 14 patients recovered within three months.
28
29
ABSTRACTS
Conclusion: This study confirms that IONM alone can predict permanent VCD with high sensitivity. Preoperative laryngoscopy and IONM remain standard for (para-)thyroid surgery. In case of
IONM loss, two-stage-thyroidectomy and postoperative laryngo(strobo)scopy is recommended.
Patients with normal IONM but laryngeal symptoms should also be examined by the ORL-specialist. Patients with normal IONM and no laryngeal symptoms exceeding the common laryngeal
discomfort after intubation do not require postoperative laryngoscopy.
ABSTRACTS
SA.02.05 Objective and subjective scar aesthetics after MIVAT vs. conventional
thyroidectomy
Maik Sahm1,2, Matthias Pross1, Hans Lippert2
DRK Klinken Berlin-Köpenick, Department of Surgery; 2Institute for Quality Control in Operative
Medicine, University Magdeburg
1
sestourgie@yahoo.com
Background: The scar analysis needs a long-term follow-up period because the scar remodeling
is most active during the first six months after operation. Data of examinations of the long-term
results after MIVAT and conventional thyroidectomy (CT) are rare.
SA.02.04 Thyroiditis and surgery: multivariate analysis of risk profile and
incidence of postoperative complications: A prospective multicenter
study of Europe
Methods: Between 2004 and 2011, 143 patients underwent MIVAT. In 2011, 134 patients underwent
CT. We performed a cohort study with a follow-up examination and included 117 vs. 102 patients
(MIVAT vs. CT) with a follow-up period of 23.1 vs. 23.6 months. We used the valid Patient and Observer Scar Assessment Scale (PSAS/OSAS).
Oliver Thomusch1, Carsten Sekulla2, Henning Dralle2, Kerstin Lorenz2, and the PETS
Study Team
1
Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg; 2Klinik für Allgemein-,
Viszeral- und Gefäßchirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg
Background: Risk profiles and incidence of complications have not systematically been investigated for surgery of thyroiditis. This study was performed to clarify the topic and to receive evidence based data regarding surgery for thyroiditis.
Methods: An European Prospective Evaluation Multicenter Study was conducted between July
2010 to July 2012. Overall, 22011 patients with surgery for thyroid diseases were evaluated. 2487
patients received surgery thyroiditis [Graves disease (n=1141) and thyroiditis de Quervain and
Hashimoto (n=1347)]. A logistic regression analysis was performed for recurrent laryngeal nerve
palsy and hypoparathyroidism.
Results: General complications did not differ significantly. The incidence of temporary and permanent RLN palsy ranged for both groups between 3.44 %-3.86 % and 0.50 %-0.86 % and were not
statistically significant. Logistic regression analysis revealed larger extent of resection and no intraoperative RLN identification as risk factors for transient and permanent RLN palsy. Onset of thyroiditis, extended thyroid resections, number of identified parathyroid glands, and no performed
autotransplantion evolved as independent risk factors for the onset of transient and permanent
hypoparathyroidism.
Conclusion: The presented data demonstrated that surgery for thyroiditis is save and not generally
accompanied with an increased risk of postoperative complications. To save parathyroid glands
seems to be mandatory in surgery for thyroiditis.
oliver.thomusch@uniklinik-freiburg.de
30
Results: The measurable scar length was 19.7 vs. 39.7 mm (MIVAT vs. CT) (p<0.001). The score of
PSAS was 10.4 vs. 9.9 (p=0.666), and the score of OSAS was 8.5 vs. 9.9 (p=0.010).
Conclusion: In terms of long-term cosmetic results, MIVAT shows compared with CT no significant
difference in PSAS but a significant difference in OSAS. This is the first long-term examination of
this question.
priv.doz.dr.m.sahm@versanet.de
SA.05.01 Impact of EMG tracing of postoperative vocal cord function in CNM
guided thyroidectomy
Rick Schneider, Carsten Sekulla, Kerstin Lorenz, Phuong Nguyen Thanh, Andreas Machens,
Henning Dralle
Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg,
Halle (Saale), Germany
Background: This prospective study was undertaken to evaluate the impact of intraoperative EMG
signal tracing in continuous neuromonitoring (CNM) on postoperative vocal cord palsy (VCP).
Methods: 962 nerves at risk (NAR) were continuously stimulated. Changes of EMG signal parameters amplitude (AMP) and latency (LAT) were analysed within defined subgroups: (1) uneventfull
EMG tracing; (2) severe combined event (SCE); (3) SCE and loss of signal (LOS); (4) LOS without SCE.
Results: LOS was registered in 36 NAR (3.7 %), 21 LOS in (3) and 15 LOS in (4). Early postoperative
VCP was seen in (1) 3, (2) 0, (3) 7, and (4) 14 NAR. There was no permanent VCP. Subgroup analysis
showed significant shorter mean CNM session time in (1) 40.7 ± 24.1 min, compared to (2) 58.1 ±
42.8 min (3) 68.1 ± 37.1 min and (4) 55.8 ± 31.6, respectively. Relative numbers of AMP < 50 % of
baseline and AMP < 100 µV were significantly higher in (3) 2.43, 0.47 and (4) 2.75, 1.02, compared
to (1) 0.25, 0.04 and (2) 0.95, 0.01, respectively. In contrast, relative number of LAT > 110 % of baseline was comparable in all groups.
31
ABSTRACTS
Conclusion: Severe changes of AMP or LAT from baseline frequently occur in CNM. To prevent
false positive results, EMG artefacts have to be excluded by real-time correlation of EMG tracing
with surgical manoeuver. However, AMP < 50 % from baseline or AMP < 100 µV are significantly
indicative for impending nerve injury with subsequent VCP.
rick.schneider@uk-halle.de
SA.05.02 Changes of laryngeal mobility and symptoms following thyroid
surgery – 6 months follow-up
Antje E. Gohrbandt, Anna Aschoff, Hauke Lang, Thomas J. Musholt
Department of Endocrine Surgery, University Hospital Mainz, Germany
Background: Swallowing disorders are frequent complains after thyroidectomy even in absence
recurrent laryngeal nerve pareses. The aim of this study was to assess the laryngeal movement
following thyroidectomy in relation to dysphagia.
Methods: 53 patients (mean age 52.4±12.5 yrs; 36 female) with benign pathologies and intact
recurrent nerve function were prospectively evaluated. Laryngeal movement was analyzed by
ultrasound preoperatively and 1,3, and 6 months postoperatively. Additionally, a dysphagia and
voice-specific quality of life questionnaire was evaluated.
Results: Mean laryngeal movement differed between genders preoperatively and postoperatively
resulting in a recovery predominantly in women (differences preoperatively to 1, 3, and 6 months
postoperatively in females 6.0, 3.7, and 1.5mm, in males 13.8, 11.7, and 10.3mm). Hoarseness (9 females), impaired swallowing (1 female, 2 males) and cervical discomfort (7 females, 3 males) was
mainly reported by women 1 month postoperatively. After 6 months, these complaints resolved
(cervical discomfort 1 female). Quality of life was only affected in 1 female 1 month after surgery.
Conclusion: Laryngeal movement was postoperatively significantly impaired and only females
revealed a recovery nearly to baseline after 6 months. Though showing only a small grade of
recovery of laryngeal movement, clinical symptoms are rare in male patients.
antje.gohrbandt@unimedizin-mainz.de
SA.05.03 The normocalcemic primary Hyperparathyroidism – the early phase of
a symptomatic pHPT?
Alexandra Zahn, E. Schmitz, Jochen Kußmann
Schön Klinik Hamburg Eilbek, Abteilung für endokrine Chirurgie, Hamburg
Background: Routine measurement of PTH has lead to an increased identification of patients with
normocalcemic pHPT. Is there an indication for parathyroidectomy?
Methods: In this retrospective review of our parathyroid database (2007 - 2012) parathyroidectomy was performed in 660 patients with pHPT. In 58 patients a normocalcemic pHPT (serum calcium 2,14 – 2,58 mmol/l, PTH > 65 pg/ml) was diagnosed (group I). 58 patients with hypercalcemic
32
ABSTRACTS
pHPT were enrolled for comparison (group II). An incidentaloma (normocalcemic) was found in
26 patients initially referred for thyroid operation (group III). Secondary causes for hyperparathyroidism were excluded.
Results: The median preoperative serum calcium levels (group I: 2,5 mmol/l, group II: 2,9 mmol/l,
group III: 2,4 mmol/l) and the median gland weights (group I: 470 mg, group II: 900 mg, group III:
170 mg) were different. Patients presented kidney stones in group I in 33 %, group II in 31 % and
in group III in 4 %. The symptoms “mood swings” (group I: 43 %, group II: 55 %) and “bone pain”
(group I: 53 %, group II: 55 %) were indicated quite similar. Adenomas were found in group I in
73 %, group II in 84 % and in group III in 35 %. The presence of multigland disease tended to be
higher in group I: 17 % versus group II: 9 %. Single gland disease occurred in group I in 83 %, group
II in 91 % and in group III in 100 %.
Conclusion: In our review patients with normocalcemic pHPT presented the same signs and symptoms as the symptomatic pHPT patients. Parathyroidectomy should be considered. Particularly
when thyroid operation is planned it might prevent a potential reoperation.
azahn@schoen-kliniken.de
SA.05.04 Calcitonin stimulation testing and the risk of pancreatitis
Kerstin Lorenz, Mohammed Abuazab, Carsten Sekulla, Henning Dralle
Department of General-, Visceral, and Vascular Surgery, University of Halle-Wittenberg,
Halle an der Saale, Germany
Background: Calcitonin stimulation testing serves preoperative discrimination of c-cell hyperplasia from MTC and directing extension of surgery. Adverse reactions involve flush, sweating, tachycardia, nausea; however, severe side effects are rarely reported. Pancreatitis following calcitonin
stimulation testing may evolve undiagnosed. Rationale of calcitonin stimulation testing needs to
be rigorously verified for this potentially severe complication.
Methods: Patients undergoing pre- and intraoperative calcitonin stimulation testing using pentagastrin or calcium were retrospectively investigated for development of associated pancreatitis.
Results: Of 198 patients with calcitonin stimulation test, 6 (3 %) (female 3, male 3; mean age
43,5 years) developed pancreatitis thereafter. Mean preoperative basal calcitonin was 5001 pg/
ml, maximum stimulation level was mean 107683 pg/ml. Mean postoperative levels for amylase
and lipase was 15,4 and 8,9 µmol/, respectively. Sonography and CT revealed edematous pancreatitis in 4, necrotizing pancreatitis in 2. All patients were managed conservatively, however hospital
stay was prolonged (mean 9,3 days).
Conclusion: Calcitonin stimulation testing is unpleasant for the patient, intricate for the investigator and may induce pancreatitis. No cut-off or predisposing criteria for development of pancreatitis were identified. In absence of reliable cut-offs for preoperative calcitonin, risk of pancreatitis calls for rigorous indication for calcitonin stimulation testing in considerably elevated basal
calcitonin.
kerstin.lorenz@uk-halle.de
33
ABSTRACTS
P 01
Discordance in histopathologic findings of papillary microcarcinoma
in thyroid specimens – Interobserver variations of two institutes of
pathology
Claudia Bures1, V. Zielinski1, Tobias Klatte2, Nikolaus Neuhold3, Andrea Schultheis3,
Friedrich Kober1, S. Neumann3, Michael Hermann1
1
2nd Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria; 2Department of
Urology, Medical University of Vienna, Vienna, Austria; 3Department of Pathology and Bacteriology,
Krankenanstalt Rudolfstiftung, Vienna, Austria
Background: According to the literature the incidence of thyroid microcarcinomas has increased
in the last decades. The detection rate is, however, significantly determined by the accuracy of the
histological examination.
Methods: Up to 2012 our department was situated in a clinic specialized in thyroid surgery and
pathology. In 2013 the surgical department but not the institute of pathology was moved and integrated into a maximum care hospital. In this study we compared the detection rate of papillary
microcarcinomas in the two different institutes of pathology in a time frame of 6 months during
two consecutive years (2012 and 2013).
Results: In 2012, 597 thyroid surgeries were performed of which 60 (i.e. 10 %) showed a microcarcinoma. In 2013, 509 thyroid surgeries were performed and 29 (i.e. 5.7 %) microcarcinomas were
identified. The difference is highly significant (p<0,008). An analysis of tumorsize, number of microcarcinomas, lymph node metastases, etc. will be presented.
Conclusion: Pathologic identification of microcarcinoma is highly observer dependent. The pathologist and the standardization of specimen work-up are of paramount importance for the accurate diagnosis of papillary microcarcinoma, which has a significant clinical impact.
claudia.bures@wienkav.at
P 02
“Indeterminated” (follicular) thyroid nodules: Is a simplified
cytological classification of value to plan lymph node surgery
Stephanie Strobl, Philipp Riss, Andreas Selberherr, Christoph Bichler, Christian Scheuba,
Bruno Niederle
Section Endocrine Surgery, Division General Surgery, Department of Surgery, Medical University,
Vienna Stephanie.strobl@meduniwien.ac.at
Background: According to the guidelines of “Austrian Society of Cytology (ÖGZ)” and simplifying
the Bethesda System for Reporting Thyroid Cytopathology cytodiagnosis was divided into four
categories: nondiagnostic (0), benign (A), follicular neoplasia (B) [with sub-classifications (B1): suspicious/indeterminate or follicular neoplasm and (B2): follicular neoplasm suspicious for papillary
thyroid cancer] or malignant (C). B1 and B2 tumours were of interest analyzing the prediction of
malignancy and the incidence of lymph node metastasis.
34
ABSTRACTS
Methods: Within 5 years 278 (27.6 %) fine needle aspirations were performed in 1008 patients.
98 (35.2 %) were classified ÖGZ B. [B1: 75 (76.5 %) B2: 23 (23.5 %)]. In all patients with B tumours
total thyroidectomy and initial (first step) unilateral central neck dissection was performed.
Results: The overall malignancy was 25 (25.5 %) of 98 B tumors. Definitive histology revealed cancer in 14 (18.7 %) B1 and in 11 (47.8 %) B2 nodules. 9 (12.0 %) B1 tumours were classified papillary
thyroid cancer (PTC [9/14: 64.3 % of malignant B1]; one patient pN1) and 5 (6.7 %; [5/14: 35.7 % of
malignant B1]) follicular thyroid cancer (FTC). All 11 malignant B2 tumours [11/23: 47.8 %] were
classified PTC, 5 (45.5 %) patients with pN1.
Conclusion: In the absence of a clear cytological diagnosis, the simplified cytopathological ÖGZ
classification is helpful planning surgery in the “indeterminated” (follicular) thyroid nodule. ÖGZ
B1 does not exclude PTC. In thyroid nodules classified B2 PTC was documented in 43 %. “First step
central (level 6) neck dissection” may be considered in B2 tumours because in 45.5 % lymph node
metastasis were demonstrated.
stephanie.strobl@meduniwien.ac.at
P 03
Does the date of postoperative ENT-check influence the rate of early
postoperative recurrent laryngeal nerve paralysis?
Robert H. Lienenlüke, Halil Altindag, Heidrun Kufleitner, Christian Vorländer
Klinik für Endokrine Chirurgie, Bürgerhospital Frankfurt am Main
Background: Postoperative paralysis of recurrent laryngeal nerve (rlnp) is one of the major complications in thyroid- and parathyroid surgery. A control of vocal cord mobility should be conducted
after each thyroid or parathyroid operation. But does the date of the examination influence the
rate of rlnp?
Methods: Between Sept 2012 and March 2014 1960 patients underwent surgery of the thyroid or
parathyroid glands in our hospital. From Sept 2012 up to August 2013 (group A, n=1224) patients
were sent to the ENT-examination one day after surgery. From Sept 2013 up to March 2014 (group
B, n=736) ENT-examination was performed five to eight days after surgery. Data was recorded
prospectively using a Microsoft Access database and analyzed retrospectively.
Results: 19 out of 1224 patients in group A showed a decrease or loss of vocal cord movement
(0,9 % related to 1943 nerves at risk, while 15 out of 736 patients (1,3 % related to 1148 nerves at
risk) showed the same result in group B.
Conclusion: Since there was no significant difference between both groups patients can be send
to postoperative ENT-check on the first day after surgery to facilitate the postoperative management and enable early discharge.
robert@lienenlueke.de
35
ABSTRACTS
P 04
First experiences with robotic-assisted hemithyroidectomy via axillary
single incision
Sabine Eckhardt, Elisabeth Maurer, Volker Fendrich, Detlef K. Bartsch
Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Standort Marburg, Universitätsklinikum Gießen und
Marburg GmbH
Background: We report our first experiences with robotic-assisted hemithyroidectomy (RAHT). Acceptance of this new technique, operating time, hospital stay and patients´satisfaction including
the cosmetic result were recorded.
Results: RAHT was offered to 58 patients. Twenty (34 %) patients decided for RAHT. The median
operation time was 160min (range106min to 300min). The learning curve was impressive, since
operating time could be reduced to 120 minutes in the last 5 operations. Two patients (10 %) had a
T1 thyroid cancer (1 PTC, 1 MFTC). There occurred no surgical site infection, no permanent dysaesthesia of the breast/thoracic skin, no postoperative hemorrhage and no postoperative hypoparathyreoidism. 2 of the first 5 patients had a transient upper plexus palsy that lasted 5 and 28 days
until complete restitution. Therefore positioning of the arm was changed to a horizontal position.
Two patients (10 %) had a transient recurrent laryngeal nerve palsy (RLNP), most likely due to heat
irritation. Median postoperative stay was 3 (range 2-5) days. All 20 patients were highly satisfied
with the cosmetic result.
Conclusion: Robotic-assisted thyroid surgery is yet not well accepted by eligible patients. There is
a significant learning curve. Special attention is required to avoid plexus palsy by optimal patient
positioning and transient RLNP due to the use of vessel sealing instruments. Cosmetic outcome is
valued very well and patients’ satisfaction is high.
seckhard@med.uni-marburg.de
P 05
Predicting the risk for postoperative hypoparathyroidism after thyroid
surgery: results of a prospective study
Giulia Manzini1, Florian Malhofer1, Theresia Weber2
1
Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm; 2Abteilung für endokrine
Chirurgie, Katholisches Klinikum Mainz
Background: Postoperative hypoparathyroidism is a common complication after total thyroidectomy. The aim of our study was to identify specific risk factors for transient and permanent
hypoparathyroidism.
Methods: Prospective study on 361 patients undergoing near-total (Dunhill) or total thyroidectomy (TT) with or without lymph node dissection (ND). Serum calcium and parathyroid hormone
(PTH) levels were measured on the first postoperative day and during a mean follow-up of 4.8
months. A multivariate logistic regression analysis was used to identify risk factors for transient
and permanent hypoparathyroidism.
36
ABSTRACTS
Results: Surgery was performed for 224 patients with multinodular goiter, 40 with Graves disease
and 97 thyroid carcinomas. In 124 patients (34 %) a transient hypoparathyroidism (PTH ≤ 10 pg/
ml) was treated with calcium and vitamin D regardless of symptoms. The rate of permanent hypoparathyroidism was 3.6 % and correlated with the extent of surgery (1.4 % Dunhill operation,
7.9 % TT plus ND). On univariate analysis extent of surgery, autotransplantation, postoperative
PTH and histopathology were the strongest predictors of hypoparathyroidism. Vitamin D deficiency (≤ 10 ng/ml) showed only a trend towards a higher risk for transient (p = 0.0514) but failed
to predict permanent hypoparathyroidism.
Conclusion: Postoperative PTH accurately identifies patients at risk for hypoparathyroidism. High
preoperative Vitamin D levels could no prevent permanent hypoparathyroidism.
t-weber@kkmainz.de
P 06
Does normotension at the end of thyroidectomy prevent postoperative
haemorrhage?
Susanne Bock, Walter Kolb, Thomas Clerici
Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen, Switzerland
Background: Postoperative haemorrhage is reported in around 1-2 % after thyroid surgery. The
known risk factors can hardly be influenced. We hypothesize that postoperative haemorrhage
might partly be due to an inadequate surgical haemostasis as a result of hypotonic blood pressure
intraoperatively, preventing a proper identification of potential sources of haemorrhage.
Methods: Having set up this hypothesis in 2010, we started to ask our anaesthetists to provide normotension during haemostasis in the final phase of surgery. We present a retrospective analysis
covering the last 10 years, focussing on the rate of postoperative bleeding before and after the
introduction of normotension, as well as pre- and intraoperative blood pressure values.
Results: 1870 patients underwent thyroid surgery from 2003 to 2013; 1204 before the introduction
of normotension and 666 afterwards. The rate of postoperative haemorrhage decreased from
1.7 % to 0.5 % (p=0.017). The median difference in blood pressure between the preoperative value
and the value during haemostasis decreased by 20mmHg (systolic) and 10mmHg (diastolic), respectively (p<0.002).
Conclusion: Normotension during final haemostasis seems to be a valuable method to minimize
postoperative haemorrhage and is easy to implement. We therefore highly recommend this as a
standard of care in thyroid surgery.
Susanne.Bock@gmail.com
37
ABSTRACTS
P 07
Thyroid nodules: Guideline compliance in preoperative diagnostics in
Germany
Alexander Reinisch, Patrizia Malkomes, Nils Habbe, Wolf-Otto Bechstein, Katharina Holzer
Department of General and Visceral Surgery, Goethe-University Hospital and Clinics, Frankfurt am Main,
Germany
Background: Since 2006 several guidelines regarding the preoperative diagnostics in surgery for
thyroid nodules were published. Aim of this study was to determine guideline compliance depending on the institution initiating these diagnostics.
Methods: Preoperative diagnostic measures of patients who underwent thyroid surgery for
nodular goiter between 2006 and 2013 were recorded and analyzed based on their assignation
through the university medical centre (UMC), a specialized endocrinologist (ENP) or a general
practitioner (GP). Postoperative malignancy rates were analyzed.
Results: Of 677 Patients enrolled, 62 % were assigned by UMC, 18.5 % by ENP and 19.5 % by GP. Ultrasonography was preformed between 97.6 % in UMC and 90.9 % in GP (p < 0.0001). The rates of
fine-needle aspiration cytology bestrode between 47.6 % in UMC and 23.2 % in ENP (p < 0.0001).
Rates for analysis of thyroid-stimulating hormone and thyronine were above 93 % in all groups
(n.s.) whereas rates for calcitonin were found between 75 % in GP and 66.4 % in ENP (n.s.). Malginancy rates were 11.82 % for differentiated thyroid cancer and 1.03 % for medullary thyroid cancer.
Conclusion: Evidence-based guidelines may optimize the therapeutic outcome and allow target-oriented and economic diagnostics. Efforts should be undertaken to reduce deficits in guideline adherence and hereby reduce variations in care.
alexander.reinisch@kgu.de
P 08
Cryopreservation of parathyroids in sHPT under GCP-like conditions:
Will the demanding procedure be justified in the future?
Steven Dralle, Anneliese Uckermark, Michael Linnebacher, Ernst Klar
Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock
Background: In 2008 the German Department of Health (BMG) has finally finished a long discussion by defining that cryopreservation of parathyroid glands (PG) and subsequent retransplantation is not subject to the German pharmaceutical law (AMG). Nevertheless the procedure has to
be performed under GCP-like conditions. It is the aim of this study to give an update of a standard
operating procedure for PG cryopreservation that complies with GCP and shows the clinical impact of cryopreservation in the long run in our department.
Methods: Since 2003 we have been processing and cryopreserving 103 samples of surgically removed PGs. Currently we are performing a long-term follow-up of all patients suffering from sHPT
who have been treated surgically and whose PG have been cryopreserved. Parameters: patient’s
sex and age by the time of operation, diagnosis that lead to chronic end-stage renal failure, status post renal transplantation, follow-up in months, number of removed PG, no/immediate/sub-
38
ABSTRACTS
sequent retransplantation of PG, intraoperative PTH-monitoring and other laboratory findings
(PTH, CA2+, PO4, AP, Crea) in the follow-up.
Results: So far 72 of 103 patients have been analyzed (39 men, 33 women). The average age by the
time of operation was 52.6 (23 - 80) years. The average time between first dialysis and parathyroidectomy is 81.5 (5 - 273) months. The long-term follow-up is 83.4 (6 - 133) months. 16 patients
were operated after renal transplantation and on average 3.6 PG were removed. 7 patients were
operated due to a recurrence of sHPT. 24 patients did not undergo a retransplantation of PG at all
and 37 patients were retransplantated immediately. 7 patients underwent a subsequent retransplantation of PG, whereby the average time between removal and subsequent retransplantation
of PG varied from 4 days to 20 months.
Conclusion: Together, subsequent retransplantation of PG was performed rarely (7 of 72 patients).
More than 50 % of all patients (37 of 72) underwent an immediate retransplantation. PG of every
patient was cryopreserved. Is it still worthwhile to keep the strategy of cryopreservation despite
a low retransplantation rate?
dralle@me.com
P 09
Postoperative hypoparathyroidism after thyroid surgery in the elderly
Nina Sehnke, Katharina Schwarz, Bernhard J. Lammers, Peter E. Goretzki
Chirurgische Klinik I, Lukaskrankenhaus Neuss
Background: Postoperative hypoparathyreoidism is the most frequently complication of thyreoid surgery. Most of the literature deals with postoperative hypoparathyreoidism in younger patients, but there is little information about this complication in the elderly.
Methods: We analyzed 4467 patients retrospectively, who underwent thyroid surgery between
2007 – 08/2012.
Results: 196 patients were older than 75 years and 24 of those patients suffered a complication like
postoperative hypoparathyrodism (PTH <15pg/ml). The transient rate of postoperative hypoparathyreoidism was 12 % (24/196) and 3 % (24/705) of all patients with reduced parathyroid function.
Everyone was substituted with calcium and rocaltrol. Only 20 % were symptomatic, but 32 % in
the comparison group under 74 years. Retention time (7 days) was longer than in the comparison
group (<75 years; 4 days). Two patients were re-admitted because of hypercalcaemia.
Conclusion: The elderly were rarely symptomatic, but the retention time was longer than in the
comparison group under 74 years. Calcium substitution must be more strictly controlled in the
elderly, because of the risk of hypercalcaemia (renal failure).
nsehnke@lukasneuss.de
39
ABSTRACTS
P 10
Management of papillary carcinoma of thyroglossal duct carcinoma
according to the CAEK guidelines on surgical treatment of malignant
thyroid diseases.
Hans Bittscheidt1, Georg Richter2, Jörg Müller3, Rainer Lück1
1
Abteilung für Viszeralchirurgie, Sanaklinikum Hameln-Pyrmont; 2Abteilung für Pathologie,
Sanaklinikum Hameln-Pyrmont; 3Abteilung für Nuklearmedizin, Medizinische Hochschule Hannover
ABSTRACTS
Conclusion: A small cohort of patients with micro-PTC presents primarily with lymph node enlargement and are diagnosed as by lymph node biopsy. They represent a sub-group of micro-carcinoma, which is normally considered to be a negligeable disease. After surgical treatment, they
seem to have the same favorable prognosis as micro-PTC without metastasis. It seems that the
primary tumour size is the most important prognostic factor, despite the presence of lymph node
metastasis.
andrea.bradatsch@medunigraz.at
Background: Thyroglossal duct cysts are aberations in thyroid development. A malignant transformation is rare and present in only 1 %.
Methods: We describe two patients (female 42 and 59 years) with a PTC of a thyroglossal duct cyst.
The first patient underwent local excision of a PTC (pT1a) next to hyoidal bone in 2008. No further action was taken until 2013. At this time a suspect solitary nodule in the thyroid and cervical
lymphadenopathy was found. We performed thyroidectomy with selective neck dissection. Histology confirmed pT1a pN0 PTC. Radioiodine therapy was done. The second patient underwent
resection of a thyroglossal duct cyst, histology showed a PTC (pT1b). Due to the tumor size further
suspect nodules of the thyroid gland and local lymphadenopathy thyroid resection and selective neck dissection were performed. Histology showed no futher tumor manifestation or lymph
node metastasis. Radioiodine therapy was done.
Conclusion: Due to the small number of cases of malignancies in thyroglossal duct cysts strict recommendations of treatment are missing. A malignant thyroid carcinoma of the thyroglossal duct
can be judged as primary thyroidal and therefore be treated according to the CAEK guidelines.
bittscheidt@gmail.com
P 11
Thyroid micro-carcinoma with lymphnode metastasis
Andrea Bradatsch, Gerhard Wolf
Department für Endokrine Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für
Chirurgie, Medizinische Universität Graz
P 12
Sleeping disturbances in patients with primary
hyperparathyreoidism – a prospective, case-control study
Frauke Schuster1, Renan Viola Rasche1, Ana Karena Neukirch1, Anke Meyer1,
Marios Papadakis1, Kurt Rasche2, Cornelia Dotzenrath1
1
Helios Klinikum Wuppertal, Abteilung für Endokrine Chirurgie; 2Helios Klinikum Wuppertal, Abteilung
für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin
Background: Studies about cognitive changes in patients with primary hyperparathyreoidism
showed a decreased concentration level . The aim of this study was to find out if there is a relationship between primary hyperparathyreoidism and sleeping disturbances.
Methods: In a prospective, case-control study with matching pairs, sleeping quality was examind
in 30 patients with primary hyperparathyreoidism and 30 patients with non-toxic nodular goiter.
Our testing battery consisted of four different tests: the Landauer Inventar, the Epsworth sleepiness scale, the berlin questionnaire and the PSQI.
Results: Early results show that patients with primary hyperparathyreoidism have a lower sleeping
quality and have more sleeping disturbences as for example insomnia, nightmares, restless legs
and body rocking compared a match control group.
fschuster@yahoo.de
Background: Papillary micro-carcinoma are considered to be „benign diseases“. However, lymph
node metastasis can still be found in a small cohort of patients. In some cases lymph node enlargement is the first sign of disease. Prognosis seems, however, to be favorable, and identical to
non-metastatic micro-PTC.
P 13
Methods: We analyzed the data of all patients who were diagnosed with micro-PTC (<1cm)
through cervical lymph node enlargement and biopsy. The smallest focus measured 0,2 mm, 60 %
presented with 3 to 6 mm, 15 % were multifocal. In one case with lymph node involvement, no
thyroid tumour could be identified.
Stefan Bilz1, Natalie Rogowski-Lehmann1, Ina Krull1, René Oettli2, Michael Brändle1,
Walter Kolb3, Thomas Clerici3
1
Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen,
Switzerland; 2Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Switzerland;
3
Department of Surgery, Kantonsspital St. Gallen, Switzerland
Results: In contrast to treatment of micro-PTC, where non-radical surgical treatment is advocated,
all cases presenting with lymph node metastases were treated by thyroidectomy, completing
lympadenectomy and radio-Iodine ablation. In this group no recurrent or metatstatic disease was
observed.
40
Comparative diagnostic value of ultrasound, ultrasound-guided
fine needle aspiration and sestamibi scintigraphy for the correct
preoperative localisation of parathyroid adenomas
Background: Open minimally invasive parathyroidectomy (OMIP) has become the standard surgical therapy for patients with primary hyperparathyroidism (pHPT) and requires exact preoperative
localisation procedures. This study prospectively assessed the sensitivity and positive predictive
value (PPV) of ultrasound (US), ultrasound-guided fine needle aspiration with PTH measurement
41
ABSTRACTS
in the needle washout (US-FNA) and sestamibi scintigraphy (SS) for the localisation of parathyroid
adenomas in patients with pHPT.
Methods: 40 consecutive patients with pHPT were included. US and US-FNA were performed by
2 endocrinologists using high-resolution ultrasound and a free hand technique. Double isotope
scanning with 99mTc pertechnetate and 99mTc sestamibi was used during the scintigraphic studies. A localisation procedure was considered correct if surgical removal of a parathyroid gland at
this localisation resulted in biochemical cure of the pHPT at 6 weeks and/or 6 months postoperatively. All surgeries were performed by 2 experienced endocrine surgeons using intraoperative
PTH monitoring.
Results: The sensitivities for correctly identifying the localisation of a hyperfunctioning adenoma
were 69 % (SS), 97 % (US), 69 % (US-FNA), 100 % (combination of SS or US) and 85 % (combination
of SS or US-FNA).The respective PPVs were 96 % (SS), 92 % (US), 100 % (US-FNA), 93 % (combination
of SS or US) and 100 % (combination of SS or US-FNA). Surgical cure was achieved by a minimally
invasive approach in 35 patients. A bilateral neck exploration was performed in 3 cases and one
adenoma was located ectopically in the anterior mediastinum and correctly localised by SS. USFNA confirmed an adenoma in 42 % of the scintigraphically negative lesions. Hemorrhagic and/
or fibrotic changes following US-FNA were detectable intraoperatively in 33 % and complicated
surgery in 3 cases.
Conclusion: US, US-FNA and SS correctly localise parathyroid adenomas and allow OMIP in the vast
majority of patients with pHPT. Due to its high sensitivity US is superior to SS and recommended
as first-line investigation. Both SS and US-FNA may be reserved for sonographically equivocal
cases. US-FNA, although highly predictive, is complicated by a high rate of hemorrhagic and/or
fibrotic changes in the biopsied adenoma and should be used cautiously.
stefan.bilz@kssg.ch
P 14
Functional evaluation of parathyroid grafts after total
parathyroidectomy for secondary hyperparathyroidism with
autotransplantation into the tibialis anterior muscle
Chrysanthi Anamaterou1, Simon Schimmack2, Matthias Lang1, G. Rudofsky1, Oliver Strobel2,
Peter Nawroth1, Markus W. Büchler2, Hubertus Schmitz-Winnenthal2
1
Department of Medicine I and Clinical Chemestry, 2Department of General, Visceral and Transplantation Surgery University Hospital of Heidelberg, Germany
Background: At our institution total parathyroidectomy with heterotopic autotransplantation into
the tibialis anterior muscle is the preferred procedure for renal HPT. The aim of this study was to
assess the long-term function of autotransplanted parathyroid tissue.
Methods: We reviewed the medical records of a consecutive series of 42 patients who underwent
total parathyroidectomy with autotransplantation into the tibialis anterior muscle. In these patients we examined the function of the autograft using a modified Casanova test of the leg bearing the parathyroid tissue.
ABSTRACTS
Results: The ischemic blockade led to a marked reduction in the plasma concentration of intact
PTH (≥ 50 % of the baseline value) in nineteen patients indicating well-functioning autografts
(45 %). In eleven patients, ischemia of the graft site did not cause any change in the concentration
of PTH indicating functioning residual parathyroid tissue in the neck (26 %). During the median
follow-up time of 8.2 years, two patients developed graft-dependent recurrent hyperparathyroidism (5 %) without therapeutic consequence and three patients suffered from persistent symptomatic hypoparathyroidism (7 %).
Conclusion: Our results indicate that total parathyroidectomy with autotransplantation into the
tibialis anterior muscle was successful in 88 % and provides therefore an alternative surgical treatment of secondary hyperparathyroidism.
simon.schimmack@med.uni-heidelberg.de
P 15
Failed parathyroid operation: high serum calcium levels do not exclude FHH
Anke Meyer1, Natalie Meurer1, Marios Papadakis1, Imke Meyer, Norbert Weyerbrock1,
Marco Tosch2, Cornelia Dotzenrath1
1
Klinik für Endokrine Chirurgie, Helios Klinikum Wuppertal; 2Klinik für Nuklearmedizin, Helios Klinikum
Wuppertal
Methods: A 61-year-old male was admitted for surgery of primary hyperparathyroidism (pHPT).
His intact PTH level was 108 pg/ml (normal range:12-65pg/ml) and serum calcium level was 3.2
mmol/l (2.1-2.6). Urine calcium was 4.3 (normal range 2.5-8.0) and a ratio of calcium creatinine
clearance was >0.01. He had a history of stroke with complete recovery, but no further pHPT associated symptoms. US of the neck was negative and 99 Tc MIBI scintigraphy was slightly positive
on the left side.
Results: Intraoperatively, only the right superior parathyroid gland which was slightly enlarged,
was removed. Histology confirmed the diagnosis of an adenoma. All other parathyroid glands
were not enlarged. Transcervical thymectomy was performed. 10 minutes after removal of the
adenoma intraoperative PTH was 35.4pg/ml. Serum calcium level was 2.64mmol/l at the first
postoperative day but was 2.94 mmol/l after one week with a PTH level 89.2 pg/ml indicating
persistent pHPT. 99 Tc MIBI scintigraphy was redone and was negative. MRI did no show an adenoma. Genetic testing for MEN-I- mutation and for calcium-sensing receptor (CaSR)-mutation was
performed. Surprisingly, a missens-mutation of the CaSR was detected which was not described
yet (c.1651A>G for p.Arg551Gly (Exon 6). Therefore we recalculated the ratio of calcium creatinine
clearance which was 0,0093, indicated a former miscalculation.
Conclusion: Familial hypocalciuric hypercalcemia (FHH) is a rare disease with usually mildly elevated serum calcium levels. In our case, a new mutation associated with very high calcium level
was detected. Therefore we conclude:
FHH should be considered in all patients with elevated calcium levels
FHH should be considered in all patients with persisting pHPT
FHH can also be associated with calcium levels >3.1 mmol/l.
anke.meyer@helios-kliniken.de
42
43
ABSTRACTS
P 16
Can pre-operative vitatmin D treatment prevent postoperative
hypocalcemia in primary hyperparathyroidism?
ABSTRACTS
exploration. The objective of the study was to evaluate whether continuation of exploration
shows an improved outcome compared to re-measurement.
Hannah Ebner1, Florian Herrle2, Kai Nowak2, Stefanie Nittka3, Klaus Wasser4,
Alexander Lammert1
1
Fifth Medical Clinic (Department of Nephrology, Endocrinology), University Medical Centre Mannheim,
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2Department of Surgery,
University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim,
Germany; 3Institute for Clinical Chemistry, University Medical Centre Mannheim, Medical Faculty
Mannheim, Heidelberg University, Mannheim, Germany; 4Institute of Clinical Radiology and Nuclear
Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University,
Mannheim, Germany
Methods: We conducted a retrospective study on 122 patients (m:w=36:86) operated on for pHPT
between 2007 and 02/2014. Blood samples were collected before surgery, at gland excision and
10 minutes after PTx.
Background: Postoperative hypocalcemia in primary hyperparathyroidism (pHPT) is a common
problem. This may cause severe clinical symptoms and increase hospital stay. We analysed if preoperative vitamin D substitution mitigates postoperative hypocalcemia.
Conclusion: In case of insufficient PTH-decrease, we recommend re-measurement before initiating an extended exploration if localization diagnostic was unambiguous. In case of discordant
localization diagnostic or thyroid nodules, we consider cervical exploration for detection of a possible second adenoma useful.
Methods: We retrospectively analysed all patients which were referred and diagnosed via our endocrinology outpatient department. Surgery was performed by endocrine surgeons.
Results: We retrieved 70 cases of pHPT. 31 were operated (19 without, 12 patients with preoperative Vitamin D substitution). Anthropometrical and biochemical data were comparable between
groups. Vitamin D substitution was started at mean 107.8 days prior to operation with a mean
daily dosage of 2178 units per day. On day one postoperatively more patients presented without
hypocalcemic symptoms in the vitamin D treated group (33.3 % vs. 50 %, p=0.20). In patients without preoperative vitamin D therapy postoperative calcium dropped to a lower nadir (mean 2.17
mmol/l vs 2.31 mmol/l, p=0.06) even though PTH levels were comparable in both groups (19.7
ng/ml vs. 15.4 ng/l, p=0.47). Furthermore, need for treatment with oral calcium supplementation
was reduced in patients receiving preoperative vitamin D substitution (41.6 % vs. 66.6 %, p=0.27).
Conclusion: Pre-operative Vitamin D substitution proved save in our population and may reduce
symptomatic as well as biochemical hypocalcemia.
florian.herrle@umm.de
P 17
Insufficient decrease of intraoperative parathyroid hormone after
parathyroidectomy: is extended cervical exploration necessary?
Ann-Kathrin Müller1, Kirsten Lindner1, Christina Lenschow1, Norbert Senninger1,
Mario Colombo-Benkmann2
1
Klinik für Allgemein-und Viszeralchirurgie, Universitätsklinikum Münster, Germany; 2Klinik für
Allgemein-und Viszeralchirurgie, Ruppiner Kliniken GmbH, Neuruppin, Germany
Background: In focused parathyroidectomy (PTx), intraoperative parathyroid hormone monitoring (ioPTH) is helpful to confirm surgical success. In case of insufficient decrease, defined by <50 %
from baseline level, literature recommends re-measurement of ioPTH for avoiding unnecessary
Results: 12 patients (9,8 %) with parathyroid hyperplasia showed an insufficient decrease [range
2-48 %]. Subsequently, 7 patients were explored leading to the diagnosis of a second adenoma in
all cases. Preoperatively, 2 patients were diagnosed a singular adenoma, in 3 patients diagnosis
was inconclusive and 2 patients had thyroid nodules. In 5 cases, surgery was not continued because of sufficient PTH-decrease after re-measurement (n=4) and loss of signal of intraoperative
neuromonitoring. Preoperative localization was unambiguous in 4 patients.
Ann-Kathrin.Mueller@ukmuenster.de
P 18
Intraoperative bilateral jugular venous sampling and rapid parathyroid
hormone testing in patients undergoing parathyroidectomy for
primary hyperparathyroidism
Naja-Norina Pluto1, Wolf-Otto Bechstein2, Katharina Holzer2
1
Klinik für Plastische und Ästhetische Chirurgie, Florence-Nightingale-Krankenhaus, Düsseldorf; 2Klinik
für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt
Background: A successful focused parathyroidectomy is based on an accurate preoperative localization technique. In some cases, preoperative imaging is negative. Some surgeons think that
bilateral internal jugular venous sampling (BIJV) is a helpful tool to localize the side of the parathyroid adenoma.
Methods: 50 patients with primary hyperparathyroidism had bilateral internal jugular venous
sampling during surgery. Lateralizing PTH levels were determined by comparing the left with the
right sample. A difference of 5 % or more was defined as lateralisation.
Results: Of the 50 patients, 41 demonstrated a single adenoma, three had double adenomas and
six patients had four-gland hyperplasia. Sensitivity of BIJV in all 50 patients was 84,4 %, positive
predictive value was 65,1 %. Localization was correctly predicted in 28 of 50 patients. False-positive results were observed in 15 patients. 20 patients had a negative preoperative imaging (ultrasound and/or Tc-99m sestamibi scan). Of these, BIJV successfully localized the adenoma in 12
cases (60 %) so that a focused approach could be still possible.
Conclusion: BIJV is helpful in detecting parathyroid adenoma especially in the event of negative
localization studies.
pluto@kaiserswerther-diakonie.de
44
45
ABSTRACTS
P 19
Experience in 129 patients with pancreatic neuroendocrine neoplasia
(pNEN): large procedure variety with low morbidity
Aycan Akca, Peter E. Goretzki, Anastasia Melin, Achim A. R. Starke
Department of Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss, Germany
Background: Resection is indicated in most patients with pNEN. Treatment varies from conservative procedure to pancreatectomie.
Methods: We analyzed all patients with neuroendocrine tumors treated between 2001 and 2014
retrospectively.
Results: Of 232 patients with NEN 129 (55.6 %) demonstrated with pNEN. 69 (53.5 %) patients suffered from insulinoma, followed by functional pNEN n=26 (20.2 %), non-functional pNEN n=19
(14.7 %) and NIPHS n=15 (11.6 %). 3 of 129 (2.3 %) patients without symptoms of pNEN and NIPHS
refused surgical treatment. 2 patients (1.6 %) with not resectable non-functional pNEN were operated on gastroenterostomy. Pancreatic mid-resection was performed in n=5, subtotal pancreatectomy in n=3, pancreatectomy in n=5, modified Whipple’s procedure in n=23, enucleation
in n=42 and distal pancreatectomy in n=45, with one case of unknown procedure. 64 patients
(49.6 %) had no postoperative complications. The most common complications were pancreatic
fistulas n=8 (6.2 %), postoperative bleeding n=7 (5.4 %), and diabetes mellitus n=7 (5.4 %). The
median hospital stay was 15.9 days (range 4-60).
Conclusion: Our data demonstrates that resection even in patients with advanced disease can
lead to an improvement of symptoms, associated with less morbidity. However not all patients
(with mild symptoms) require surgical treatment.
aakca@lukasneuss.de
P 20
Long-term results after surgery for pheochromocytoma
Jens Waldmann1, Anna-Lena Nuttebaum1, Volker Fendrich1, Annette Ramaswamy2,
Detlef K. Bartsch1
1
Department of Visceral-, Thoracic- and Vascular Surgery, 2Department of Pathology, University
Hospital Giessen and Marburg, Marburg, Germany
Background: Risk for recurrency and metastases in patients with pheochromocytoma is unreliable
to predict after surgery.
Methods: A consecutive patient cohort after surgery for pheochromocytoma/paraganglioma
from 1988-2014 was retrospectively analyzed. Clinical presentation, surgery, hormone levels,
tumor size, diagnostic imaging, recurrency, capsular disrupture, metastases and death were analysed. Risk factors for recurrency were analysed by univariate analysis.
ABSTRACTS
revealed lymphnode metastases. After a median follow-up of 110 months only 1 of 79 benign
and 3 of six malignant pheochromocytomas reccured. At final follow-up 73 patients were disease-free, 3 were alive with disease, 2 succumbed to disease and 7 for other reasons. KaplanMeyer estimates for 5/10-years survival after surgery were 95/90 % with an estimated median
overall-survival of 234 months. Malignant disease, SDHB mutation and vascular invasion were
predictors for recurrency at univariate analysis while all other evaluated parameters including
capsular disrupture failed.
Conclusion: Recurrency in benign pheochromocytomas seems to be overestimated in historic cohorts while it occurs frequently in patients with malignant pheochromocytomas.
jwaldman@med.uni-marburg.de
P 21
The outcome of patients with neuroendocrine neoplasias of the lung –
experience with 17 patients
Christian Meyer, Andreas Kirschbaum, Detlef K. Bartsch, Volker Fendrich
Department of Surgery, Universitätsklinik Gießen und Marburg, Standort Marburg, Germany
Background: To evaluate the outcome of patients with neuroendocrine neoplasias of the lung in
a tertiary referral centre.
Methods: All patients that underwent surgery for neuroendocrine neoplasias of the lung between
2000 and January 2014 at our institution were retrospectively evaluated. The diagnosis of neuroendocrine neoplasias of the lung was based on clinical symptoms, CT-Scan, bronchoscopy, histopathology and by Octreotid-Scan.
Results: 17 patients, 10 with a typical- and 7 with a atypical neuroendocrine neoplasias of the lung
patients were identified. 18 operations in 17 patients were performed, atypical resection of the
tumor and lobectomy both with radical lymphnode dissection were the main type of operations.
Preoperative imaging modalities showed no evidence of suspicious lymph node metastases.
Overall 374 lymph nodes were resected. Only one patient with a atypical mulifocal tumor had
lymph node metastases (6/18) all other patients with a neuroendocrine tumor of the lung had no
lymph node metastases during time point of operation. After a median follow up of 31 months
(range 1-142), all 17 patients are alive and without any signs of tumor recurrence.
Conclusion: The management of neuroendocrine neoplasias of the lung is still limited by missing randomised trials. We suggest that lymph node metastases are a rare event in patients with
sporadic neuroendocrine tumor of the lung. The influence of systemic lymph node dissection on
overall survival remains questionable.
meyerch@med.uni-marburg.de
Results: A total of 85 consecutive patients were included in the present study.Forty open and 53
laparoscopic adrenalectomies, including 8 bilateral and 4 subtotal procedures were performed.
No in-hospital mortality occured. Six patients (7 %) presented with malignant pheochromocytoma. Fifteen RET and 1 SDHB mutation were identified in 45 patients. Five of 18 patients (28 %)
46
47
ABSTRACTS
P 22
Coincidence of two mutations in a patient presenting with multiple
endocrine neoplasia type 1 – is the clinical course more aggressive?
ABSTRACTS
P 24
Effect of combined antiangiogenic therapy at different points of
tumorangiogenesis in RIP1-TAg5-transgenic mice
Magnus Melin, Aycan Akca, Denis Wirowski, Katharina Schwarz, Achim A. R. Starke,
Peter E. Goretzki
Department for General and Endocrine Surgery, Lukaskrankenhaus Neuss, Germany
Hendrik Strothmann, Simon Schimmack, S. Schoelch, U. Scherer, Thomas Schmidt,
Markus W. Buechler, F. Hubertus Schmitz-Winnenthal
Department of Surgery, University of Heidelberg, Germany
Background: Patients with multiple endocrine neoplasia type 1 (MEN1) are known to develop primary hyperthyroidism in 90-95 %, pancreatic tumors in 40-50 % and pituitary tumors in 10-60 %.
Bronchial or thymic carcinoids are rare with a prevalence of 10 %. Primary hyperparathyroidism is
the most common first symptom.
Background: Hypervascularisation as a common feature of pancreatic neuroendocrine neoplasms
(pNEN) has promoted antiangiogenic therapy to the centre of attention in the treatment of this
entity. This study aims to assess the effect of combination of different antiangiogenic agents on
early and late tumor formation of pNEN in RIP1-TAg5-transgenic mice.
Methods: We performed a retrospective analysis of the clinical course of a MEN1 family presenting
with two different mutations, including the coincidence of both in the index patient.
Methods: RIP1-TAg5-transgenic mice developing beta cell neoplasms at defined points in time
were treated with four antiangiogenically acting substances – VXM01 (oral DNA-vaccine encoding VEGFR-2), sunitinib (multi-targeted tyrosinekinase inhibitor), everolimus (mTOR-Inhibitor),
and DC101 (monoclonal antibody against murine VEGFR-2/flk-1 receptor) - solely and in combination at defined stages of tumorangiogenesis. IHC-staining for CD31 and survival analyses were
performed to determine the effects of preemptive, interventional, and regressive therapies.
Results: The index patient was a young female presenting with multifocal pancreatic gastrinoma
and hepatic metastasis at the age of 21. The following molecular genetic diagnostics showed two
mutations, the paternal on exon 3 and the maternal on intron 1 of the MEN1 gene. The paternal
mutation has been associated with disease, whilst the maternal mutation has not. The index patient further developed primary hyperparathyroidism, a bronchial carcinoid and multiple pulmonary, hepatic and lymphatic metastases. The father developed primary hyperparathyroidism and
a bronchial carcinoid, however, at a later age. The mother and the second daughter, who only
showed the maternal mutation, were disease free.
Conclusion: The question remains, whether the sequence variation IVS1-2A>G could aggravate
the clinical symptoms of the MEN1 mutation on exon 3.
mmelin@lukasneuss.de
P 23
Roboter-assisted surgical management of neuroendocrine tumors
of the pancreas
Volker Fendrich, Elisabeth Maurer, Detlef K. Bartsch
Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg
Background: To evaluate the first experiences using the DaVinci robotic system for resection of
neuroendocrine tumors of the pancreas.
Methods: All patients which underwent surgery for neuroendocrine tumors of the pancreas between February and June 2014 by using the roboter-assisted DaVinci device were evaluated.
Results: In the time period mnetioned above, five patients were evaluated. Three patients underwent dital pancreatic resection and in two ppatients the tumor was enucleated. there was no
conversion. The mean operation time was 175 min (120-195). One patient devloped a pancreatic
fistula type B after enucleation.
Conclusion: Using the DaVinci robotic system for resection of neuroendocrine tumors of the pancreas is feasible. If there is an advantage for the patients has to be evaluated in clinical trials.
fendrich@med.uni-marburg.de
48
Results: Everolimus and VXM01/everolimus treatment led to a significant 1.8-fold (1.6-fold) increase
of CD31-positive vessels (p<0.01) in the preemptive group, co-administration of sunitinib negated
this effect. Combined VXM01/DC101 treatment resulted in significantly reduced CD31-positive
vessels (48 % of control, p<0,05) in the regressive group. Kaplan-Meier-analyses showed a significantly longer survival of mice under VXM01/DC101, everolimus, sunitinib/everolimus, VXM01/
everolimus treatment (p<0.05).
Conclusion: Our study confirms the potential of antiangiogenic therapy in the treatment of pNEN
and supports the combined use of different agents to increase treatment efficiency.
hendrik.strothmann@med.uni-heidelberg.de
P 25
Hashimoto Thyroiditis is dominated by infiltrating Th1/Th17 cells
Martin Gasser1, Giovanni Almanzar2, Jochen Schreiner2, Kerstin Höfner‘‘, Vanessa Wild3,
Andreas Rosenwald3, Christoph-Thomas Germer1, Ana Maria Waaga-Gasser1, Martina Prelog2
1
Department of General, Vascular, and Pediatric Surgery, University of Würzburg, Würzburg, Germany;
2
Laboratory of Pediatric Rheumatology, Special Immunology and Osteology, Department of Pediatrics,
University of Würzburg; 3Institute of Pathology, University of Würzburg
Background: The role of infiltrating T-cells in the pathogenesis of Hashimoto’s thyroiditis HT is still
under debate. Here we characterized the phenotype and function of isolated T-cells (Th1/Th17
versus Tregs) from the thyroid gland.
Methods: Thyroid tissue and peripheral blood mononuclear cells (PBMCs) were obtained from
HT patients who underwent thyroidectomy. After in-vitro expansion cytokine production profiles of isolated infiltrating T-cells and PBMCs were assessed by flow cytometry. Cell surface
markers, chemokine-ligand 20 (CCL20) and Treg transcription factor FoxP3 were analyzed by
immunohistochemistry.
49
ABSTRACTS
Results: Infiltrating cells were mostly CD4+ T-cells with a predominant memory-effector phenotype
CD4+CD45RO+CD27+. Infiltrating CD4+ T-cells upregulated the expression of chemokine-receptors CCR5 (5.5 %), CCR6 (9.6 %) and CXCR3 (9.3 %), producing high amounts of IFNgamma (41.3 %)
and IL-17 (4.0 %) compared to circulating CD4+ T-cells. High numbers of CD4+CD25+CD127FoxP3+ (Tregs) were found in infiltrating cells (2.9 %) compared to peripheral blood. Immunohistological analysis of the thyroid gland demonstrated the abundance of CD4+CD45RO+CD27+
T-cells, the expression of CCL20 and expression of FoxP3.
Conclusion: Our findings suggest that infiltrating T-cells, possibly driven by chemokine-receptors, belong to the Th1/Th17 effector T-cell phenotype producing high amounts of IFNgamma and IL-17. The
presence of Tregs within inflammatory tissue indicate a role of these cells in modulating inflammation.
gasser_m@ukw.de
P 26
Two cases of renal neuroendocrine tumor –
case report and review of the literature
Anastasia Melin1, C. Otto2, Aycan Akca1, Achim A. R. Starke1, Peter E. Goretzki1
1
Department of Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss, Germany; 2Department of
Urology, Gemeinschaftsklinikum Koblenz-Mayen
Background: 0.3 % of all renal tumors are neuroendocrine and 1 % of NET are localized in the
urogenital tract, where neuroendocrine cells do not exist. The origin of these tumors remains
unclear. In 18-26 % there is an association with a horseshoe kidney. 27 % of the patients remain
symptomless.
Methods: We analyzed the patient data retrospectively and compared with the literature on renal
NET.
Results: Our first case was a 20-year-old male patient with a horseshoe kidney and a renal NET of
the left kidney, which was operated in June 2012. A year after first diagnosis, the patient came
to us with a metastasis in the renal pedicle, showing up in a DOTATOC-PET-CT. We resected a
lymph node metastasis, showing infiltration of a NET with a proliferation of 5 %. The second case
was a 57-year-old male patient, diagnosed with a renal tumor coincidentally. He was operated
in June 2013. The tumor showed syntaptophysin positivity. Follow-up examinations showed no
recurrence.
Conclusion: 45.6 % of renal neuroendocrine tumors have already metastasized at initial diagnosis.
It is important to include this rare tumor into the differential diagnosis of renal tumors. Due to its
rareness, a standardized therapy does not yet exist.
anastasia.sotke@gmx.de
50
ABSTRACTS
P 27
Interdisciplinary treatment of a high malignant gastric neuroendocrine
carcinoma (NEC) with hepatic metastasis in multiple endocrine
neoplasia type I syndrome: a case report.
Felix M. Watzka, Arno Schad, Christian Fottner, Matthias Miederer, Matthias M. Weber,
Hauke Lang, Thomas J. Musholt
Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz,
Mainz, Germany
Background: In this case report we present a patient with a gastric neuroendocrine carcinoma
in association with multiple endocrine neoplasia type I (MEN I) and discuss the interdisciplinary
treatment concept in this individual case.
Methods: We report the clinical and laboratory data, including histopathologic and immunocytochemical findings, for our current patient and also review the literature on gastric neuroendocrine
neoplasia and MEN I syndromes.
Results: In focus was a 53-year-old female patient with family history of multiple endocrine neoplasia type I. The patient had a gastric NEC grade 3 (Ki-67 index > 70 %), located in the antrum,
with hepatic metastasis. A pancreatic NEN with a diameter of 1.5cm existed additionally. In an interdisciplinary concept after two cycles of neoadjuvant chemotherapy (carboplatin / etoposid) a
gastrectomy with systematic lymphadenectomy and resection of the liver metastases was carried
out. The final TNM clasification: T3, N0 (0/23), M1 (hep), R0. Postoperatively an adjuvant chemotherapie was suggested.
Conclusion: Curative surgery for patients with MEN1 associated malignant NEC should only be
performed in an interdisciplinary context. Even in patients with advanced disease surgery can be
part of the therapy because of effective neoadjuvant chemotherapy concepts and the improved
surgical outcome.
felix.watzka@unimedizin-mainz.de
P 28
A rare cause of a solitary thyreoid nodule
Stephanie Trum, Detlef Krenz
Abteilung für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum Dritter Orden MünchenNymphenburg
Introduction: 3-15 % of all solitary thyreoid nodules are malignant. Papillary thyroid carcinoma
(PTC) is the most common type of thyroid cancer. Sometimes, however, rare types of malignancies can be found.
Case report: We report the case of a 29-year-old female patient that presented with an enlarged
neck mass of the the left lobe of the thyroid gland. Neck ultrasound showed a singular hypoechoic nodule in the left lobe of the thyroid gland. The right lobe didn´t show any abnormality.
Additionally conspicuous lymph nodes were found on the left side of the neck. Due to the suspicious ultrasound we performed a hemithyroidectomy. Postoperatively, histology showed pri-
51
ABSTRACTS
mary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma), on
the background of autoimmune Hashimoto‘s thyroiditis. In order to complete the staging of the
desease the patient underwent further evaluation with panendoscopy, PET- CT and bone marrow
biopsy, which were all negative. The potential benefits of being further treated by radiotherapy
and/or chemotherapy were discussed with our oncologists and the final decision was a radiotherapy with 30Gy. One year after the radiotherapy she is well, with no evidence of local or systematic
disease, adequately replaced with L-thyroxine.
Discussion: MALT lymphomas, which account for 25 % of primary lymphomas, arise mainly in the
stomach (60–70 %). Primary thyroid lymphoma however, is a really rare malignancy, representing 2-8 % of all thyroid malignancies and 1-2 % of all extranodal lymphomas. The existing data
support that autoimmune thyroiditis seems to be a risk factor for the development of thyroid
MALT lymphoma due to an acquired pathological transformation of the intrathyroidal lymphoid
tissue. In the absence of randomized clinical trials to compare different treatment options (thyroidectomy, radiotherapy, chemotherapy) in patients with thyroid MALT lymphoma, there are no
widely accepted guidelines. Surgery and radiotherapy as well as a combination of both is being
discussed. In conclusion, our case of a concurrence of primary thyroid MALT lymphoma and autoimmune thyroiditis, is trying to emphasize the need of a careful evaluation of any palpable
thyroid mass. Moreover, this case in addition to the existing published cases, illustrates that the
nature of follow-up care and long-term results of treatment of patients with primary thyroid MALT
lymphomas are not fully established yet.
steffi.trum@hotmail.de
AUTORENINDEX
Abuazab M.
Akca A.
Albers M. B.
Almanzar G.
Altindag H.
Anamaterou C.
Apitzsch J. C.
Aschoff A.
Bailer S.
Bareck E.
Bartsch D. K.
Bechstein W.-O.
Beutner U.
Bichler C.
Bilz S.
Bittscheidt H.
Bock S.
Bradatsch A.
Brändle M.
Breitenstein S.
Büchler M. W.
Bures C.
SA.05.04
FR.02.05, P 19, P 22,
P 26
FR.06.04
P 25
P 03
P 14
FR.06.04
SA.05.02
FR.02.03
FR.02
FR.05, FR.05.03,
FR.06.04, FR.06.05,
P 04, P 20, P 21, P 23
P 07, P 18
SA.02.01
P 02
P 13
P 10
P 06
P 11
P 13
FR.03.02
FR.06.03, P 14, P 24
FR.02.04, P 01
Cherrez A.
Christ E.
Clerici T.
FR.06.03
FR.04, FR.05.04
FR.02.03, FR.06.01,
SA.02.01, P 06, P 13
Colombo-Benkmann M. P 17
Dotzenrath C.
Dralle H.
52
Dralle S.
P 12, P 15
FR.02.03, SA.02.04,
SA.05.01, SA.05.04
P 08
Ebinger S.
Ebner H.
Eckhardt S.
Estourgie S.
FR.06.01
P 16
P 04
SA.02.03
Falconi M.
FR.05.01
Fendrich V.
Fischer L.
Fottner C.
Fretz C.
Frilling A.
Führer-Sakel D.
FR.06, FR.06.04,
FR.06.05, P 04, P 20,
P 21, P 23
FR.06.03
P 27
FR.02.01
FR.03, FR.03.01
SA.03.02
Gasser M.
Germer C.-T.
Gohrbandt A. E.
Goretzki P. E.
P 25
P 25
SA.05.02
FR.02.05, FR.05.05,
SA.02.03, P 09, P 19,
P 22, P 26
Habbe N.
Hackert T.
Hermann M.
P 07
FR.06.03
FR.02.04, SA.03.08,
P 01
SA.05
P 16
FR.06.05
FR.06.03
P 25
P 07, P 18
Hermanns M.
Herrle F.
Heverhagen A.
Hinz U.
Höfner K.
Holzer K.
Kazmierczak R.
Kenney B.
Kern B.
Kidd M.
Kirschbaum A.
Klar E.
Klatte T.
Klug E.
Kober F.
Köberle-Wührer R.
Kolb W.
Krenz D.
Krull I.
Kufleitner H.
Kußmann J.
SA.02.02
FR.06.02
SA.02
FR.06.02
P 21
P 08
P 01
FR.02.04
FR.02.04, P 01
FR.02
SA.02.01, P 06, P 13
P 28
P 13
P 03
SA:03, SA.03.05,
SA.05.03
Lammers B. J.
FR.02.05, P 09
53
AUTORENINDEX
Lammert A.
Lang H.
Lang M.
Lawrence B.
Lenschow C.
Lienenlüke R. H.
Lindner K.
Linnebacher M.
Lippert H.
López-López C.
Lorenz K.
Lück R.
Lüthi A.
Lüthi C.
AUTORENINDEX
P 16
SA.05.02, P 27
P 14
FR.06.02
P 17
SA.02.02, P 03
P 17
P 08
SA.02.05
FR.06.04
FR.02.03, SA.02.04,
SA.03, SA.03.06,
SA.05.01, SA.05.04
P 10
SA.02.01
FR.06.01, SA.02.01
Machens A.
Malhofer F.
Malkomes P.
Manzini G.
Maurer E.
Melin A.
Melin M.
Meurer N.
Meyer A.
Meyer C.
Meyer I.
Miederer M.
Modlin I. M.
Müller A.-K.
Müller J. A.
Musholt T. J.
SA.05.01
P 05
P 07
P 05
P 04, P 23
FR.02.05, P 19, P 26
P 22
P 15
P 12, P 15
P 21
P 15
P 27
FR.06.02
P 17
P 10
FR.03.05, SA.04.01,
SA.05.02, P 27
Nawroth P.
Neuhold N.
Neukirch A. K.
Neumann S.
Nguyen-Thanh P.
Niederle B.
Nittka S.
Nowak K.
Nuttebaum A.-L.
P 14
P 01
P 12
P 01
FR.02.03, SA.05.01
P 02
P 16
P 16
P 20
54
Oettli R.
Otto C.
P 13
P 26
Slater E. P.
Starke A. A. R.
Papadakis M.
Perren A.
PETS Study Team
Pluto N.-N.
Preldzic L.
Prelog M.
Pross M.
P 12, P 15
FR.04
SA.02.04
P 18
FR.02.04
P 25
SA.02.05
Steffen T.
Steinmüller T.
Strobel O.
Ramaswamy A.
Rasche R. V.
Reinisch A.
Reubi J.-C.
Richter G.
Riss P.
Rogowski-Lehmann N.
Rosenwald A.
Rudofsky G.
P 20
P 12
P 07
FR.04.02
P 10
FR.06, P 02
P 13
P 25
P 14
Sahm M.
Schad A.
Scherer U.
Scheuba C.
Schimmack S.
SA.02.05
P 27
P 24
FR.05, SA.03.04, P 02
FR.06.02, FR.06.03,
P 14, P 24
Schmid K. W.
SA.03.01
Schmidt T.
P 24
Schmied B. M.
FR.06.01, SA.02.01
Schmitz E.
SA.05.03
Schmitz-Winnenthal H. FR.06.02, P 14, P 24
Schneider R.
SA.05.01
Schölch S.
P 24
Schreiner J.
P 25
Schuchmann M.
FR.06.05
Schultheis A.
P 01
Schuster F.
P 12
Schwarz K.
SA.02.03, P 09, P 22
Sehnke N.
P 09
Sekulla C.
FR.02.03, SA.02.04,
SA.05.01, SA.05.04
Selberherr A.
P 02
Senninger N.
P 17
Simon D.
SA.03.07
Strobl S.
Strothmann H.
FR.06.04
FR.02.05, P 19, P 22,
P 26
FR.06.01
FR.03
FR.06.02, FR.06.03,
P 14
P 02
P 24
Tarantino I.
Thomusch O.
Tosch M.
Triponez F.
Trum S.
SA.02.01
SA.02.04
P 15
FR.05.02
P 28
Uckermark A.
P 08
Vordermark D.
Vorländer C.
SA.03.03
SA.02, SA.02.02,
SA.03.10, P 03
Waaga-Gasser A. M.
Waldmann J.
Warschkow R.
Wasser K.
Watzka F.
Weber T.
Weyerbrock N.
Wiese D.
Wild D.
Wild V.
Winterhalder R.
Wirowski D.
Wolf G.
P 25
FR.06.04, FR.06.05,
P 20
FR.06.01, SA.02.01
P 16
P 27
SA.03.09, SA.05, P 05
P 15
FR.06.05
FR.02.02, FR.03.03
P 25
FR.03.04
P 22
P 11
Yadev P.
SA.02.02
Zahn A.
Zielinski V.
SA.05.03
FR.02.04, P 01
55
Ersparen Sie Ihren Patienten
Hypothyreose zu googeln.
TECHNISCHE HINWEISE
REDEZEITEN
Thyrogen® vermeidet die Begleiterscheinungen der Hypothyreose.
Um einen reibungslosen Ablauf des gesamten Programms zu gewährleisten, sind alle Vortragenden aufgefordert, sich an die vorgegebenen Zeiten zu halten. Die jeweiligen Vorsitzenden der
Sitzungen sind angehalten, bei Überziehungen Vorträge abzubrechen. Jede Sitzung beinhaltet
ein Zeitfenster für Diskussionen, deren zeitliche Zuordnung den jeweiligen Vorsitzenden obliegt.
RICHTLINIEN FÜR POSTER
■ Die maximale Postergröße beträgt DIN A0 (H x B) 118,90 cm x 84,10 cm. Befestigungsmaterial
wird am Tagungsbüro zur Verfügung gestellt.
■ Die Poster sind während der gesamten Arbeitstagung zur Besichtigung ausgestellt. Alle
Poster müssen bis zum Freitag, den 21. November 2014, um 09.00 Uhr angebracht sein und
bleiben bis zum Ende der Tagung hängen.
■ Die Posterautoren werden gebeten, am Freitag, den 21. November 2014, in der Zeit von 12.10
bis 12.50 Uhr am Poster anwesend zu sein, um interessierten Teilnehmern Fragen zum Beitrag
zu beantworten.
Poster, die bis Samstag, den 22. November 2014, 14.00 Uhr, nicht abgenommen wurden, werden
entsorgt. Sollte ein rechtzeitiges Anbringen des Posters nicht möglich sein, so sollte der verantwortliche Autor des Posters eine Kollegin/einen Kollegen seiner Klinik bitten, das Poster anzubringen. In Ausnahmefällen kann das Poster vorab und nach Rücksprache an das Kongressbüro
gesendet werden. Das beste Poster und der beste Vortrag werden am Samstag, den 22. November
2014, im Anschluss an die Sitzung SA.05 um 13.00 Uhr prämiert. Wir bitten deshalb um Anwesenheit der Posterautoren / des Vortragenden oder eines Vertreters der jeweiligen Arbeitsgruppe.
• schnell
• zuverlässig
• kontrolliert
Ihr Kontakt:
sanofi-aventis (schweiz) ag
Genzyme a Sanofi Company
Gulmmatt, CH-6340 Baar
Tel. +41 (0) 41 727 80 20
Fax +41 (0) 41 727 80 29
www.genzyme.ch
PROJEKTIONSTECHNIK
Die Beiträge sollten als PowerPoint Präsentation vorliegen und müssen rechtzeitig (spätestens 30
min. vor Sitzungsbeginn) an der Medienannahme im Foyer abgegeben werden (vorzugsweise auf
einem USB-Stick). Vortragende in einer morgendlichen Session bitten wir dringlich, die Vorträge
spätestens am Vorabend der Sitzung abzugeben. Um einen reibungslosen Veranstaltungsablauf
zu gewährleisten, bitten wir Sie, sämtliche Beiträge ausschließlich als Datei im Microsoft PowerPoint-Format ab Version 8 (.pptx und .ppt) einzureichen. Ebenso bitten wir Mac-User ihre Präsentation in einem windowskompatiblen Format abzuspeichern. Sie haben auch die Möglichkeit,
die Daten Ihrer Präsentation unter Angabe der Vortragnummer vorab per E-Mail (max. 15 MB) an
caek2014@porstmann-kongresse.de zu senden.
CH: 036758/08-2014
Thyrogen® Wirkstoff: Thyrotopin alfa. Zusammensetzung: 1,1 mg Thyrotropin alfa und Hilfsstoffe als Pulver pro Durchstechflasche zur Bereitung eines Konzentrats und Herstellung
einer Injektionslösung. Nach dem Auflösen enthält jede Durchstechflasche 0,9 mg Thyrotropin alfa in 1,0 ml. Indikation: Thyrogen ist für die Anwendung bei Serum-Thyreoglobulintests (Tg) mit oder ohne Radiojod-Ganzkörperszintigraphie bestimmt, die durchgeführt werden, um Schilddrüsenreste und gut differenziertes Schilddrüsenkarzinom bei solchen Patienten festzustellen, die nach einer Thyreoidektomie mittels Schilddrüsenhormon-Suppressionstherapie (THST) behandelt werden. Patienten mit niedrigem Gefährdungsgrad bei gut
differenziertem Schilddrüsenkarzinom, bei denen während einer THST keine Tg-Konzentrationen und kein rhTSH-stimulierter Anstieg der Tg-Konzentrationen im Serum nachweisbar
sind, können im Anschluss durch Bestimmung der rhTSH-stimulierten Tg-Spiegel überwacht werden. Thyrogen (Thyrotropin alfa) ist zur prätherapeutischen Stimulierung in Kombination mit 30 mCi (1,1 GBq) bis 100 mCi (3,7 GBq) Radiojod zur Ablation von restlichem Schilddrüsengewebe bei Patienten bestimmt, die wegen eines gut differenzierten Schilddrüsenkarzinoms einer fast totalen oder totalen Thyreoidektomie unterzogen wurden und bei denen keine Hinweise auf Fernmetastasen des Schilddrüsenkarzinoms vorliegen. Dosierung:
Zwei Dosen 0,9 mg Thyrotropin alfa in 24-stündigen Abständen bei ausschliesslich intramuskulärer Verabreichung. Kontraindikation: Überempfindlichkeit gegenüber dem Wirkstoff
oder einem der Hilfsstoffe gemäss Zusammensetzung, Schwangerschaft. Warnhinweise und Vorsichtsmassnahmen: Darf nicht i. v. verabreicht werden. Nur in Ausnahmefällen
an Kinder verabreichen, da keine Daten vorliegen. Falsch-negative Ergebnisse sind möglich, bei dringendem Verdacht auf Metastasierung weitere Untersuchungen in Betracht ziehen.
Bei Anwesenheit von Tg-Autoantikörpern (18-40% der Patienten) kann es zu falsch-negativen Tg-Serum-Messwerten führen, daher sowohl TgAb und Tg bestimmen. Bei Risikofaktoren
für Herzerkrankung Nutzen-Risiko-Verhältnis sorgfältig abwägen, ebenso bei Patienten mit erheblichem Schilddrüsenrestgewebe in situ. Nur begrenzte Erfahrungen mit niedrigen
Radiojod-Aktivitäten (1 GBq), Wirksamkeit nicht belegt. Bei dialyseabhängigen Patienten ist die Elimination von Thyrogen verlangsamt (verstärktes Auftreten von Kopfschmerzen und
Übelkeit). Bei stark eingeschränkter Nierenfunktion Aktivität von Radiojod sorgfältig festlegen. Erhöhung der TSH-Spiegel nach Verabreichung kann zu lokaler Tumorexpansion führen,
bei Patienten mit Situs der Metastasen in lebenswichtigen Strukturen Vorbehandlung mit Kortikosteroiden erwägen. Schwangerschaft und Stillzeit: Reproduktionstoxikologische
Untersuchungen mit Thyrogen am Tier wurden nicht durchgeführt. Es ist nicht bekannt, ob Thyrogen bei Verabreichung an Schwangere den Fötus schädigen oder die Fortpflanzungsfähigkeit beeinflussen kann. Thyrogen in Kombination mit der diagnostischen Radiojod-Ganzkörperszintigraphie ist in der Schwangerschaft kontraindiziert, da der Fötus durch die Folgebehandlung einer hohen Dosis radioaktiven Materials ausgesetzt wird. Die Patientinnen dürfen nicht stillen. Unerwünschte Wirkungen: Sehr häufig: Übelkeit; häufig: Schwindel,
Kopfschmerzen, Parästhesie, Erbrechen, Durchfall, Müdigkeit, Asthenie; gelegentlich: Hitzegefühl, Urtikaria, Exanthem, grippeähnliche Erkrankung, Pyrexie, Rigor, Rückenschmerzen;
unbekannt (auf Grundlage der vorhandenen Daten nicht abschätzbar): Neoplasma, Schwellung, Metastasenschmerzen, Tremor, Schlaganfall, Herzklopfen, Hitzewallungen, Dyspnoe,
Pruritus, Hyperhidrosis, Arthralgie, Myalgie, Beschwerden, Schmerzen, Juckreiz, Exanthem und Urtikaria an der i. m. Einstichstelle, TSH verringert. Interaktionen: Wechselwirkungen
zwischen Thyrotropin alfa und anderen Arzneimitteln wurden nicht untersucht. In klinischen Studien wurden bei gleichzeitiger Verabreichung keine Wechselwirkungen zwischen
Thyrotropin alfa und den Schilddrüsenhormonen Trijodthyronin (T3) und Thyroxin (T4) festgestellt. Packungen: 2 Durchstechflaschen pro Karton. Verkaufskategorie: A*. Zul-Inh.:
sanofi-aventis (schweiz) ag, 1214 Vernier/GE. Stand der Information: November 2013. Weitere Informationen entnehmen Sie bitte der Fachinformation unter www.swissmedicinfo.
ch. 035367-04/2014
Sämtliche Daten werden nach der Tagung unwiderruflich gelöscht.
PUBLIKATION
Die Abstracts der diesjährigen Arbeitstagung der CAEK werden in „Langenbeck‘s Archives of
Surgery“, Springer-Verlag Heidelberg, Band 399, Heft 8, veröffentlicht. Dieses Heft erscheint im
Dezember (15.12.2014) und wird allen DGAV-Mitgliedern per Post zugesandt.
Zulassungs- sanofi-aventis (schweiz) ag
inhaberin:
3, Route de Monfleury, CH-1214 Vernier
57
SPONSOREN UND AUSSTELLER
SPONSOREN UND AUSSTELLER
INDUSTRIEAUSSTELLUNG
Silber Sponsoren
Der Veranstalter, die Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK), dankt allen Sponsoren und Ausstellern für die großzügige Unterstützung bei der Durchführung der 33. Arbeitstagung 2014 in Basel.
Ipsen Pharma GmbH
Ettlingen, D
Alle Tagungsteilnehmer sind herzlich eingeladen, die Industrieausstellung zu besuchen, auf der
die neuesten Produkte und Entwicklungen aus der Medizin- und Pharmaindustrie präsentiert
werden. Kaffee und Imbiss werden nur im Bereich der Ausstellung angeboten. Die Industrieausstellung ist am Freitag von 08.15 bis 17.00 Uhr und am Samstag von 08.30 bis 13.30 Uhr geöffnet.
Medtronic (Schweiz) AG
Münchenbuchsee, CH
Sponsoren
Premium Sponsor
Covidien Switzerland Ltd.
Wollerau, CH
Covidien Deutschland GmbH
Neustadt/Donau, D
Covidien Austria GmbH
Brunn im Gebirge, A
Gold Sponsoren
Dr. Langer Medical GmbH
Waldkirch, D
Novartis Pharma Schweiz AG
Rotkreuz, CH
CONDOR® GmbH
Salzkotten, D
DCI GmbH
Kiel, D
ERBE Swiss AG
Winterthur, CH
Future Diagnostics B.V.
Wijchen, NL
inomed Medizintechnik GmbH
Emmendingen, D
Karl Storz GmbH & Co. KG
Tuttlingen, D
Takeda Pharma AG
Pfäffikon, CH
Silber Sponsoren
ETHICON
Zug, CH
Bundesverband Schilddrüsenkrebs
Ohne Schilddrüse leben e.V.
Berlin, D
Stand bei Drucklegung (Oktober 2014)
Genzyme a Sanofi Company
Baar, CH
58
59
PLAN DER INDUSTRIEAUSSTELLUNG
TAGUNGSINFORMATIONEN
UNKOSTENBEITRAG
Zentrum für Lehre und Forschung (ZLF)
Foyer 1. Etage
Gesamte Tagung
Tageskarte
Gesellschaftsabend
Get Together*
Studenten/Pflegepersonal**
Medienannahme
Vortragssaal
Kleiner Hörsaal
Treppe
Lift
* zusätzliche Karte | ** Nachweis erforderlich
Lift
Postergruppe I & II
Lift
Ipsen
Abfall
Covidien
2.00
Takeda Karl Storz
Novartis
Eingang
Dr. Langer
Ethicon
Erbe
Eingang
Pausenversorgung
3.30
Medtronic
Genyzme
Schilddrüse e.V.
Inomed Condor
DCI
Future
Diagnostics
ZLF
Pausenversorgung
pp
e
III
&
Registrierung
Po
st
er
gr
u
Personal
IV
Eingang
Pause
160,00 €
95,00 €
70,00 €
40,00 €
kostenfreie Tageskarte
Der Unkostenbeitrag für die gesamte Tagung beinhaltet:
■
■
■
■
■
Kongressunterlagen
Besuch der Industrieausstellung
Kaffeepausen
Mittagsbuffet
Get Together (1 Person)
ANMELDUNG
Bitte melden Sie sich online unter www.caek2014.ch an. Ihre Anmeldung wird schriftlich bestätigt. Überweisungen des Unkostenbeitrages erfolgen auf das in der Anmeldebestätigung angegebene Konto (Verwendungszeck: CAEK 2014 und Name des Teilnehmers).
STORNIERUNG
Stornierungen werden ausschließlich in schriftlicher Form akzeptiert. Eine Erstattung ist leider
nicht möglich.
ZERTIFIZIERUNG
Die 33. Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) wurde von
der Schweizerischen Gesellschaft für Chirurgie (SGC) mit insgesamt 13 CME-Credits zertifiziert.
Die Teilnahmebescheinigungen mit den CME-Punkten werden am Ende der Veranstaltung ausgegeben.
60
61
TAGUNGSINFORMATIONEN
LAGEPLAN UNIVERSITÄTSSPITAL BASEL
ZIMMERRESERVIERUNG
Augenklinik,
Mittlere Strasse 91
In den nachfolgenden Hotels sind über Porstmann Kongresse GmbH Zimmerkontingente
gebucht. Bitte beachten Sie, dass die Schweizer Hotels zusätzlich eine Gasttaxe/Kurtaxe von 3,50
CHF pro Person/Tag erheben!
Klinge
Hotel Dreiländerbrücke ****
Hauptstr. 436 | 79576 Weil am Rhein (D)
EZ 79,00 €, DZ 99,00 €, inklusive Frühstück
Entfernung zum Tagungsort: ca. 10 min mit dem Auto
Carathotel Basel ***
Alte Str. 58 | 79576 Weil am Rhein (D)
EZ 125 €, DZ 145 €, inklusive Frühstück
Entfernung zum Tagungsort: ca. 15 min mit dem Auto
Weitere interessante Informationen über Basel können Sie der folgenden Internetseite
entnehmen: www.basel.ch
62
Bus 30, 33
Kinderspital UKBB
Bus 30
Kinderspital UKBB
r.
N
Hotel D ****
Blumenrain 19 | 4051 Basel
EZ 236 CHF, DZ 236 CHF, Frühstück 22 CHF pro Person/Tag
Entfernung zum Tagungsort: 5 min zu Fuß
Inklusive Baseler Mobility Ticket
Hotel Basel ****
Münzgasse 12 | 4001 Basel
Superior: EZ 260 CHF, DZ 300 CHF, inklusive Frühstück (DO-FR)
Superior: EZ 210 CHF, DZ 250 CHF, inklusive Frühstück (FR-SA)
Business: EZ 230 CHF (DO-FR) / EZ 185 CHF (FR-SA) inklusive Frühstück / keine DZ
Entfernung zum Tagungsort: 10 min zu Fuß
Inklusive Baseler Mobility Ticket
lbergst
Bus 30, 33
Bernoullianum
Sch
anz
ens
02/13/UF
r.
lst
be
He
Pe
t
Sp
er
sg
ra
b
en
Pre
Bus 31, 33, 34, 36, 38
Universitätsspital
er
dig
ita
lst
ra s
Bus 34
Universitätsspital
Bus 31, 33, 36, 38, 603, 604
Kinderspital UKBB
Tram 11
Universitätsspital
sse
H
se
e
ch
kir
t ra
Bus 36, 38, 603, 604
Kinderspital UKBB
Bus 33, 36, 38
Universitätsspital
A Klinikum 2, Behandlungsbau
Petersgraben 4
Cafeteria, Coiffeure, Kiosk
I
Bettenhaus 3
Postomat
K
Hebelstrasse 34+36
Bancomat Basler Kantonalbank
B
Klinikum 2, Bettenhaus, Petersgraben 4
L
Holsteinerhof, Hebelstrasse 32
C
Operationstrakt Ost
M Institut für Pathologie, Schönbeinstrasse 40
Informationsporten
Spitalstrasse 21
Petersgraben 4
D Klinikum 1, Behandlungsbau, Spitalstrasse 21
E
Klinikum 1 Ost, Bettenhaus
Spitalstrasse 21 Cafeteria, Kiosk
F
Klinikum 1 West, Bettenhaus
Spitalstrasse 21
G Frauenklinik, Operationstrakt West
Spitalstrasse 21
N
N
Zentrum für Lehre und Forschung (ZLF),
Hebelstrasse 20
O Personalrestaurant, Cafeteria
P Markgräflerhof
Q Hebelstrasse 2
City Parking
Einfahrt Schanzenstrasse oder
Einfahrt Klingelbergstrasse
Haltestellen
Basler Verkehrsbetriebe
Augenklinik
Mittlere Strasse 91
R Klingelbergstrasse 23
H Rossettibau, Spitalstrasse 26
63
9. Postgradualer Kurs der CAEK
ABSTRACTSBASEL
ORTSPLAN
Komplikationen in der endokrinen Chirurgie
Weil am Rhein
1
2
3
Grenzacherstrasse
Altstadt Grossbasel
R h ein
sse
Spiegelgasse
sgas
hif
flä
nd
e
3
se
ukt
tt
Mi
as
g
en
Eis
THEMEN
ch
As
ue
nn
el
.
Str
ntu
5
sse
ga
4
nz
Mü
7
Altstadt Grossbasel
ie
Fre
Na
1 Universitätsspital Basel
Zentrum für Lehre und Forschung (ZLF)
Hebelstr. 20 | 4031 Basel
2 Hotel D
Blumenrain 19 | 4051 Basel
3 Basel Schifflände
Schifflände Ecke Mittlere Brücke
4 Hotel Basel
Münzgasse 12 | 4001 Basel
64
Chirurgische Arbeitsgemeinschaft
Endokrinologie (CAEK) der Deutschen
Gesellschaft für Allgemein- und
Viszeralchirurgie (DGAV)
ke
üc
r
eB
ler
en
g
Pete
r
ben
sgra
Pete
r
Sc
ein
d
-Via
ag
wa
Heu
en
Rh
in
ra
en
2
m
1
ra
b
Halle/Saale, 26.-28. Februar 2015
Blu
We
tt
ste
inb
rüc
ke
5
4
6
5 Restaurant Schlüsselzunft
Freie Strasse 25 | 4001 Basel
6 Museum Tinguely
Paul Sacher-Anlage 2 | 4002 Basel
7 Basel SBB (Hauptbahnhof)
Centralbahnstrasse 20 | 4051 Basel
•
•
•
•
Desaster in der endokrinen Chirurgie
Komplikationen und Outcome-Volume Effekte
Medizinrechtliche Bedeutung der Komplikationen
Komplikationen der Schilddrüsenchirurgie
(Recurrensparese, Hypoparathyreoidismus,
Nachblutung, Wundinfektion, Narbe)
• Komplikationen der Lymphknotendissektion
• Komplikationen der MEN-Chirurgie des Pankreas, der
Nebennieren und Nebenschilddrüsen
www.caek-kurs2015.de
65
VERANTWORTLICH FÜR DEN REDAKTIONELLEN INHALT
Prof. Dr. Daniel Oertli, Universitätsspital Basel
Dr. Christof Kull, Kantonsspital Baselland, Standort Liestal
Dr. Thomas Clerici, Kantonsspital St. Gallen
VERANTWORTLICH FÜR WEBDESIGN, GRAFIKDESIGN,
KOORDINATION, ANZEIGEN, DRUCKHERSTELLUNG
Porstmann Kongresse GmbH (PCO)
Alte Jakobstr. 76 | 10179 Berlin
T: +49 (0)30 284499-0
F: +49 (0)30 284499-11
E: caek2014@porstmann-kongresse.de
34. Arbeitstagung
der Chirurgischen Arbeitsgemeinschaft
Endokrinologie
und
45. Jahrestagung
der Sektion Schilddrüse der Deutschen
Gesellschaft für Endokrinologie
Mainz | 19.-21. November 2015
© Tupungato - Fotolia.com
IMPRESSUM
FOTONACHWEIS
Titelseite: Basel Tourismus
Seite 14: Restaurant Schlüsselzunft
Seite 14: Basler Personenschifffahrt AG
Für Programmänderungen, Verschiebungen oder für Ausfälle von Veranstaltungen wird keine
Gewähr übernommen. Stand bei Drucklegung: Oktober 2014
HAFTUNG
Der Veranstalter der Tagung kann keine Haftung für Personenschäden oder Verluste oder Schäden an Eigentumsgegenständen von Tagungsteilnehmern übernehmen, die während der Tagung
oder durch die Tagung eintreten.
Wissenschaftliche Leitung
Prof. Dr. Theresia Weber
Katholisches Klinikum Mainz
Zentrum für Viszeral-, Endokrine und Gefäßchirurgie
An der Goldgrube 11 | 55131 Mainz
E: endokrine-chirurgie@kkmainz.de
Prof. Dr. Matthias M. Weber
Universitätsmedizin Mainz
1. Medizinische Klinik und Poliklinik
Endokrinologie und Stoffwechselerkrankungen
Langenbeckstr. 1 | 55131 Mainz
E: mmweber@uni-mainz.de
Tagungsort
Hilton Hotel Mainz
Rheinstr. 68 | 55116 Mainz
Chirurgische Arbeitsgemeinschaft
Endokrinologie der Deutschen
Gesellschaft für Allgemein- und
Viszeralchirurgie (DGAV)
www.caek2015.de
66
Themenschwerpunkte
• Qualitätssicherung und Mindestmengen
• Diagnostik und Resektionsausmaß der
Knotenstruma
• Differenziertes Schilddrüsenkarzinom
• Neue Therapieansätze beim undifferenzierten
Schilddrüsenkarzinom
• Rezidiv des medullären Schilddrüsenkarzinoms
• Primärer Hyperparathyreoidismus
• Schilddrüsen- und Nebenschilddrüsenerkrankungen bei Kindern und Jugendlichen
Organisation (PCO)
Porstmann Kongresse GmbH
Alte Jakobstr. 76 | 10179 Berlin
T: +49 (0) 30 284499 19
F: +49 (0) 30 284499 11
E: caek2015@porstmann-kongresse.de
Deutschen Gesellschaft
für Endokrinologie
Deutsche Gesellschaft für
Allgemein- und Viszeralchirurgie
NOTIZEN
AFINITOR® – strong in three indications
Oral mTOR-inhibitor with anti-tumour efficacy in mRCC, pNET and aBC 1-3
1,4-9
Abbreviations:
aBC: advanced breast cancer. In postmenopausal women with HR+/HER2-negative advanced breast cancer in combination with exemestane; mRCC: metastatic renal cell carcinoma. International
Guidelines (ESMO1, NCCN2, EAU3 & EORTC4) consistently recommend AFINITOR® after failure of tyrosine-kinase inhibitors (TKI). Swissmedic indication: after sunitinib or sorafenib; pNET: pancreatic
neuroendocrine tumour
1. Motzer RJ et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 2008;372:449-456. 2. Yao JC et al. Everolimus for
Advanced Pancreatic Neuroendocrine Tumors. New Engl J Med 2011;364:514-523. 3. Baselga J et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J
Med. 2012;366:520-529. 4. Escudier B et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 23 (Supplement 7): vii65-vii71, 2012.
5. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer. V.2.2012. 6. Ljungberg B et al. EAU guidelines on renal cell carcinoma: the 2010 update.
Eur Urol 2010;58:398-406. 7. de Reijke TM et al. EORTC-GU group expert opinion on metastatic renal cell cancer. European Journal of Cancer 2009;45: 765-773. 8. Motzer RJ et al. Phase 3 trial of
everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 2010;116:4256-4265. 9. Afinitor prescribing information, www.swissmedicinfo.ch. 10. Pavel M
et al. ENETS Consensus Guidelines for the Management of Patients with Liver and Other Distant Metastases from Neuroendocrine Neoplasms of Foregut, Midgut, Hindgut, and Unknown Primary.
Neuroendocrinology 2012;95:157-176. 11. Yardley DA et al. Everolimus Plus Exemestane in Postmenopausal Patients with HR(+) Breast Cancer: BOLERO-2 Final Progression-Free Survival Analysis. Adv
Ther 2013;30(10):870-884. 12. Gnant M. The Role of Mammalian Target of Rapamycin (mTOR) Inhibition in the Treatment of Advanced Breast Cancer. Curr Oncol Rep 2013;15:14-23.
Afinitor® (Everolimus) C: Tablets containing 2.5 mg, 5 mg or 10 mg everolimus. I: In combination with exemestane for the treatment of postmenopausal women with advanced, hormone-receptor
positive, HER 2-negative breast cancer following failure of treatment with letrozole or anastrozole. Treatment of patients with - advanced, progressive, well or moderately differentiated neuroendocrine
tumours of pancreatic origin. - advanced renal cell carcinoma following failure of treatment with sunitinib or sorafenib. * D: 10 mg as a single daily dose, at the same time every day, administered
orally, with or without food. Adverse effects (grade 1-4) may require temporary dose reduction and/or interruption of treatment (see www.swissmedicinfo.ch). Not recommended for paediatric cancer
patients. For patients with mild hepatic impairment (Child-Pugh A), the recommended daily dose is 7.5 mg, for patients with moderate hepatic impairment (Child-Pugh B), the recommended daily dose
is 2.5 mg; everolimus is not recommended for patients with severe hepatic impairment (Child-Pugh C) - if the desired benefit outweighs the risk, a dose of 2.5 mg daily must not be exceeded. A dose
adjustment should be made if a patient’s hepatic (Child-Pugh) status changes during treatment. Reduce the dose by around 50% if patients require co-administration of a moderate CYP3A4 or PgP
inhibitor. For dose reductions below the lowest available dosage strength, alternate-day dosing should be considered. Concomitant administration of a strong CYP3A4 inducer: dose increase up to
20 mg. For further information, see www.swissmedicinfo.ch. CI: Hypersensitivity to the active ingredient, to other rapamycin derivatives or to any of the excipients. PC: Non-infectious pneumonitis:
Cases have been documented, some of them serious and a few even fatal. Diagnosis should be considered for patients presenting with non-specific respiratory signs and symptoms and in whom infectious, neoplastic and other non-medicinal causes have been ruled out. In certain cases, adjusting the dosage and/or interrupting or discontinuing therapy may be required; in this context, the use of
corticosteroids may be indicated. Infections: Local and systemic infections have been documented. Be vigilant for signs and symptoms of infection and, if they are detected, begin suitable treatment
immediately, and consider interruption/discontinuation of therapy. Any prior infections should have completely resolved before treatment initiation. Hypersensitivity reactions: Cases have been observed.
Renal failure (incl. acute): Cases have been observed, some with a fatal outcome. Oral ulceration: Cases have been observed; topical treatment is recommended, though oral rinses/mouthwashes
containing alcohol, peroxide, iodine or thyme should be avoided. Laboratory tests and monitoring: Liver function test, fasting glucose test, lipid test and differential blood count prior to the start of
treatment and then at regular intervals are recommended. Interactions: see below. Impaired liver function: Exposure to everolimus is increased with mild (Child-Pugh A), moderate (Child-Pugh B), and
severe (Child-Pugh C) hepatic impairment. Everolimus is not recommended in patients with severe hepatic impairment (Child-Pugh C) who have neuroendocrine tumours of pancreatic origin or advanced
renal cell carcinoma. Immunizations: Avoid the use of live vaccines. For further information, see www.swissmedicinfo.ch. IA: Avoid concomitant administration with strong CYP3A4 or PgP inhibitors.
Caution with moderate CYP3A4 or PgP inhibitors (dose reduction, monitoring of adverse effects). Avoid concomitant administration with strong CYP3A4 or PgP inducers (if necessary: dose adjustment).
Caution in concomitant use of everolimus with orally administered CYP3A4 substrates with a narrow therapeutic index: it is necessary to monitor for the adverse effects of the CYP3A4 substrate.
Caution is required when everolimus is co-administered with midazolam (increased exposure to midazolam). Avoid consumption of grapefruit / grapefruit juice, as well as other foods known to influence
CYP P450 and PgP activity. AE: Very common: infections, reduced lymphocyte count, reduced haemoglobin, reduced platelet count, reduced neutrophil count, elevated glucose, elevated cholesterol,
elevated triglycerides, reduced phosphate, reduced potassium, decreased appetite, dysgeusia, headache, pneumonitis, dyspnoea, epistaxis, cough, stomatitis, diarrhoea, vomiting, nausea, elevated
ALT or AST, rash, dry skin, pruritus, nail changes, elevated creatinine levels, mucosal inflammation, peripheral oedema, asthenia, fatigue, pyrexia, weight loss. Common: dehydration, diabetes mellitus,
insomnia, conjunctivitis, eyelid oedema, hypertension, haemorrhage, pulmonary embolism, haemoptysis, dry mouth, oral pain, abdominal pain, dysphagia, dyspepsia, elevated bilirubin levels, hand-foot
syndrome, erythema, exfoliation, acneiform dermatitis, onychoclasis, acne, arthralgia, proteinuria, renal failure (including acute renal failure), chest pain. Uncommon: pure red cell aplasia, new onset
of diabetes mellitus, heart failure, acute respiratory distress syndrome, angioedema, delayed wound healing, deep vein thrombosis. Other: Hepatitis B reactivation, amenorrhoea. Rare: see
www.swissmedicinfo.ch P: Afinitor tablets containing 2.5 mg, 5 mg or 10 mg everolimus: 30 tablets. Sales category: A. * Reimbursed by insurance. For further information, see www.swissmedicinfo.ch.
Novartis Pharma Schweiz Inc., Risch; Address: Suurstoffi 14, 6343 Rotkreuz Tel. 041/763 71 11, www.novartis.ch
68
244630 12/2013
First choice in 2nd-line mRCC
10
Recommended choice in advanced pNET
11,12
Breakthrough in HR + advanced breast cancer
LigaSure Precise™. Get Cooler.
Consistent seals at lower temperatures
COVIDIEN, COVIDIEN with logo, Covidien logo and ™ marked brands are U.S. and/or internationally registered trademarks of Covidien AG
© 2009 Covidien. All rigths reserved. - V-VS-P-LPIce/GB
Document
Kategorie
Kunst und Fotos
Seitenansichten
189
Dateigröße
4 654 KB
Tags
1/--Seiten
melden