ObjectiveTo answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications, the authors evaluated complications relating to 1440 cholecystectomies performed by the same surgeons in a retrospective study. Summary Background DataA definite pronouncement on whether LC truly is superior to OC is not possible because prospective trials are burdened with problems of recruitment. MethodsAfter the introduction of LC at the authors' institution in April 1991 and until October 1993, 94.6% (700/740) of all patients admitted for operation because of symptomatic gallstone disease could be treated laparoscopically. The clinical records of the last 700 patients who underwent OC before the introduction of LC were re-evaluated with regard to both overall complications and the grade of complication (severity grade 1-4). A comparison of the incidence of complications relating to the two surgical methods, age, sex, common bile duct stones, acute cholecystitis, concomitant illness, Apache score, and length of operation was calculated by multivariate analysis using the logistic regression model. ResultsThe total rate of complications in the OC group was 7.7%, with five postoperative deaths, compared with 1.9% and one postoperative death in the LC group. Multivariate analysis for OC revealed that both old age (p = 0.014) and the existence of common bile duct stones (p = 0.02) had independent prognostic influences in increasing the overall complication rate, whereas only old age (p = 0.019) influenced the overall complication rate after LC. Multivariate analysis of all cholecystectomies (n = 1440) showed that the overall complication rate was influenced independently by OC as a detrimental factor. ConclusionsAs this analysis emphasizes, LC can be performed safely with an overall complication rate that is distinctly lower than that of OC. For elective surgery, LC is undoubtedly superior to OC and can probably be seen as a new "gold standard" for cholecystectomies.

Tumour-associated macrophages (TAM) are involved in tumour angiogenesis and anti-tumour immune response. In colorectal cancer (CRC), an association of high microvascular density (MVD) and unfavourable prognosis has been reported by some investigators. However, heterogeneous patient groups were studied. We, therefore, analysed the correlation between TAM and MVD and the prognostic relevance of MVD, TAM and T lymphocyte infiltration for long-term survival in a homogeneous group of 70 patients with moderately differentiated cancers of the International Union Against Cancer (UICC) stages II and III, who did not receive chemotherapy. MVD was evaluated using immunohistochemistry with antibodies against CD34 and von Willebrand factor (vWF). TAM and T lymphocytes were visualised with antibodies against CD68 and CD3, respectively. Statistical analysis did not reveal a significant correlation between TAM and T lymphocyte numbers and MVD. Multivariate analysis of immunohistochemical data from all CRC patients and the subgroup of patients with UICC stage-II CRC identified TAM- and vWF-positive microvessel numbers as prognostically relevant markers. Low numbers of TAM- and high numbers of vWF-positive microvessels were associated with an unfavourable prognosis. In conclusion, TAM- and vWF-positive microvessel numbers may serve as independent prognostic markers for patients with UICC stage-II and -III CRC and may help to identify patients with an unfavourable prognosis.

The patient accrual of our trial is satisfactory, neoadjuvant radiochemotherapy is well tolerated and bears no higher risk for postoperative morbidity.

Adjuvant intraperitoneal therapy of gastric cancer by mitomycin bound to activated carbon particles is associated with an increased rate of postoperative complications. However, no benefit for prognosis following radical resection of locally advanced tumors was observed in this multicenter phase III trial.

Background. The prognosis for surgically treated gastric cancer remains poor in most Western countries compared with reports from Japanese investigators during the past 3 decades. Methods. A radical surgical procedure principally to extended lymphadenectomy as defined by the Japanese Research Society for Gastric Cancer was performed prospectively from January 1984 to June 30, 1994 for 512 patients with gastric cancer, 345 of whom were treated with potentially curative surgery. Clinical, histopathologic, and surgical factors were examined for their influence on long term survival by univariate and multivariate analyses. Results. Five‐ and 10‐year survival rates for all patients were 40.5% and 34.3%, respectively, and for patients who underwent tumor resection were 45.7% and 38.6%, respectively. For patients who underwent curative surgery, 5‐ and 10‐year adjusted survival rates were 57.7% and 44.3%, respectively, with a median survival of 96 months. Postoperative hospital mortality was 6.8%: 4.9% for R‐0 resected patients, 9% for R‐1 and R‐2 resected patients, and 13.4% for those with palliative procedures. Multivariate analysis using the Cox model identified age older than 65 years, prior total gastrectomy, an increasing number of positive lymph nodes, a high pathologic N classification, male sex, a high pT classification, and low preoperative hemoglobin level as detrimental factors with an independent influence on survival. Conclusion. Radical lymphadenectomy in this 10‐year Austrian study yielded survival rates similar to those in Japanese investigations without sacrificing low postoperative mortality. In particular, the relatively high overall survival rates seemed to reaffirm the value of radical lymph node dissection with wide resection margins.