Basel November Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) PROGRAMM.

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1 33. Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) PROGRAMM Basel November Chirurgische Arbeitsgemeinschaft Endokrinologie der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)

2 Copyright 204 CIONM in der Schilddrüsenchirurgie Die Saxophonelektrode für das kontinuierliche Neuromonitoring AVALANCHE SI vagus nerve stimulation VNS optimized 33. Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) WISSENSCHAFTLICHE LEITUNG Prof. Dr. med. Daniel Oertli Universitätsspital Basel Chirurgische Abteilung Viszeralchirurgie Spitalstr Basel E: doertli@uhbs.ch Dr. med. Christof Kull Kantonsspital Baselland Standort Liestal Klinik für Viszeral-, Allgemein-, Thorax- und Gefäßchirurgie Rheinstr Liestal E: christof.kull@ksbl.ch Dr. med. Thomas Clerici Kantonsspital St. Gallen Klinik für Chirurgie Chirurgische Abteilung Rorschacher Str St. Gallen E: thomas.clerici@kssg.ch TAGUNGSORT Universitätsspital Basel Zentrum für Lehre und Forschung (ZLF) Hebelstr Basel FÖRDERER Die wissenschaftliche Leitung dankt der Theodor Nägeli-Stiftung für die finanzielle Unterstützung der CAEK-Tagung 204 in Basel. ÖFFNUNGSZEITEN TAGUNGSBÜRO Das Tagungsbüro befindet im Foyer des ZLF (Zentrum für Lehre und Forschung) der Universität Basel, siehe Plan auf Seite 63. Donnerstag, 20. November Uhr Das intelligente Soundmodul für die Erkennung von Signalveränderungen KONGRESSORGANISATION Porstmann Kongresse GmbH Alte Jakobstr Berlin T: +49 (0) F: +49 (0) E: caek204@porstmann-kongresse.de Freitag, 2. November Uhr Samstag, 22. November Uhr Telefon vor Ort: Die Wireless-Display- Anbindung für noch mehr Flexibilität im OP TRÄGERSCHAFT SAVC GmbH Servicegesellschaft für Allgemein- und Viszeralchirurgie Haus der Bundespressekonferenz Schiffbauerdamm Berlin

3 PROGRAMMÜBERSICHT UND INHALTSVERZEICHNIS GRUSSWORT DONNERSTAG, 20. NOVEMBER Uhr Vorstandssitzung der CAEK im Restaurant Schlüsselzunft (Vorgesetztenstube) Uhr Get Together im Restaurant Schlüsselzunft (Zunftsaal) FREITAG, 2. NOVEMBER Uhr Eröffnung der 33. Arbeitstagung der CAEK Uhr Pitfalls and missed cases Uhr Hepatische Metastasen neuroendokriner Tumore Uhr Besuch der Posterausstellung Uhr Theodor-Kocher-Vorlesung Uhr Der kleine neuroendokrine Tumor des Pankreas (pnet) Uhr Neuroendokrine Tumore: Freie Vorträge Uhr Gesellschaftsabend (Besuch des Museums Tinguely, Schiffsfahrt 7 auf dem Rhein, musikalische Unterhaltung durch Trionettli ) SAMSTAG, 22. NOVEMBER Uhr Mitgliederversammlung der CAEK Uhr Vorstellung des 9. Postgradualen Kurses der CAEK in Halle/Saale 8 und Vorstellung der 34. Arbeitstagung der CAEK in Mainz Uhr Ökonomie, Qualität und Effizienz in der Schilddrüsenchirurgie: 8 Freie Vorträge Uhr Tumorboard für Patienten mit PDTC / UTC Uhr Vorstellung Eurocrine Uhr Freie Vorträge Uhr Verabschiedung inklusive Verleihung des Vortrags- und Posterpreises Uhr Abschlussimbiss 9 Poster Abendveranstaltungen 4 Vorstand der CAEK 5 Referenten und Moderatoren 8 Abstracts 23 Autorenindex 53 Technische Hinweise 57 Sponsoren und Aussteller 58 Plan der Industrieausstellung 60 Tagungs- und Anreiseinformationen 6 Ankündigung CAEK Liebe CAEK-Mitglieder, liebe Kolleginnen und Kollegen, wir freuen uns sehr, Sie zur nächsten Arbeitstagung der CAEK im November 204 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! 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 2 3

4 BESUCHEN SIE UNSEREN STAND! WISSENSCHAFTLICHES PROGRAMM FREITAG, Intraoperatives Vagus-Monitoring mit APS-Elektrode und Video- Präsentation der OP-Technik. Neuromonitoring NIM FR.0 Eröffnung 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) FR.02 Pitfalls and missed cases Moderation: Bareck E. (Wiener Neustadt), Köberle-Wührer R. (Liestal) FR.02.0 Pitfalls and missed cases in der radiologischen Diagnostik Fretz C. (St. Gallen) FR Pitfalls and missed cases in der nuklearmedizinischen Diagnostik Wild D. (Basel) FR Mediastinal parathyroid adenoma in primary hyperparathyroidism: What determines positive MIBI-scintigraphy? Lorenz K., Clerici T., Bailer S., Sekulla C., Nguyen- Thanh P., Dralle H. (Halle/Saale, St. Gallen) FR 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) FR 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) 0.00 Kaffeepause in der Industrieausstellung Eine Auflistung der Indikationen, Kontraindikationeione onen, Vorsichtsmassnahmen und Warnhinweise finden Sie in der Bedienungsanleitung UC DE 204 Medtronic, Inc. All Rights Reserved. Printed in Euro ope FR.03 Hepatische Metastasen neuroendokriner Tumore Moderation: Frilling A. (London), Steinmüller T. (Berlin) 0.5 FR03.0 Prätherapeutisches Assessment Frilling A. (London) 0.35 FR Möglichkeiten chirurgischer Resektionen Breitenstein S. (Winterthur) 0.55 FR Indikationen zur Peptid-Rezeptoren vermittelten Radionukleidtherapie Wild D. (Basel).5 FR Wann kommen Bio- und Chemotherapie zum Einsatz? Winterhalder R. (Luzern) 4 5

5 WISSENSCHAFTLICHES PROGRAMM FREITAG, WISSENSCHAFTLICHES PROGRAMM FREITAG, FR Macht die Resektion des Primärtumors bei nicht resektablen Lebermetastasen Sinn? Musholt T. J. (Mainz) Mittagspause in der Industrieausstellung Besuch der Posterausstellung Siehe Seite FR.04 Theodor-Kocher-Vorlesung Laudatio: Christ E., Perren A. (Bern) Prof. Dr. Jean-Claude Reubi (Bern) Somatostatin und GLP- Rezeptor-Targeting in NET: Beispiele erfolgreicher translationeller Forschung FR.05 Der kleine neuroendokrine Tumor des Pankreas (pnet) Moderation: Bartsch D. K. (Marburg), Scheuba C. (Wien) 4.00 FR.05.0 Management of small, incidentally discovered non-functioning pnet Falconi M. (Ancona) 4.20 FR Management of small, non-functioning MEN-associated pnet Triponez F. (Genf) 4.40 FR Chirurgische Therapie des sporadischen und MEN- assoziierten Zollinger-Ellison-Syndroms Bartsch D. K. (Marburg) 5.00 FR One for all? die GLP-Szintigraphie zur Lokalisation von Insulinomen Christ E. (Bern) 5.20 FR Chirurgische Therapie der hyperinsulinämen Hypoglykämien Goretzki P. E. (Neuss) FR.06 Neuroendokrine Tumore Freie Vorträge Moderation: Fendrich V. (Marburg), Riss P. (Wien) 6.00 FR.06.0 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) 6.0 FR 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) 6.20 FR Outcome of enucleations for pancreatic neuroendocrine neoplasms Strobel O., Schimmack S., Cherrez A., Hinz U., Fischer L., Hackert T., Büchler M. W. (Heidelberg) 6.30 FR Bronchopulmonary neuroendocrine tumors in multiple endocrine neopasia type Albers M. B., López-López C., Waldmann J., Fendrich V., Slater E. P., Apitzsch J. C., Bartsch D. K. (Marburg) 6.40 FR 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) Gesellschaftsabend Besuch des Museums Tinguely, Schiffsfahrt auf dem Rhein, musikalische Unterhaltung durch Trionettli, siehe Seite Kaffeepause in der Industrieausstellung 6 7

6 WISSENSCHAFTLICHES PROGRAMM SAMSTAG, FREITAG, WISSENSCHAFTLICHES PROGRAMM SAMSTAG, FREITAG, SA.0 Mitgliederversammlung der CAEK.30 Kaffeepause in der Industrieausstellung Vorstellung künftiger CAEK-Kurse und Tagungen 9. Postgradualer Kurs der CAEK in Halle/Saale Arbeitstagung der CAEK in Mainz SA.02 Ökonomie, Qualität und Effizienz in der Schilddrüsenchirurgie Freie Vorträge Moderation: Kern B. (Basel), Vorländer C. (Frankfurt/Main) 09.0 SA.02.0 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) SA 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) SA Is postoperative laryngoscopy mandatory after thyroid surgery in times of IONM? Estourgie S., Schwarz K., Goretzki P. E. (Neuss) SA 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) SA Objective and subjective scar aesthetics after MIVAT vs. conventional thyroidectomy Sahm M., Pross M., Lippert H. (Berlin, Magdeburg) SA.03 Tumorboard für Patienten mit PDTC / UTC Moderation: Lorenz K. (Halle/Saale), Kußmann J. (Hamburg) Pathologie: Schmid K. W. (Essen) Endokrinologie-Onkologie: Führer-Sakel D. (Essen) Radioonkologie: Vordermark D. (Halle/Saale) Fallvorstellungen Scheuba C. (Wien), Kußmann J. (Hamburg), Lorenz K. (Halle/Saale), Hermann M. (Wien), Simon D. (Duisburg), Vorländer C. (Frankfurt), Weber T. (Mainz) SA.04 Vorstellung Eurocrine Musholt T. (Mainz) SA.05 Freie Vorträge Moderation: Weber T. (Mainz), Hermanns M. (Berlin) 2.5 SA.05.0 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) 2.25 SA Changes of laryngeal mobility and symptoms following thyroid surgery 6 months follow-up Gohrbandt A. E., Aschoff A., Lang H., Musholt T. J. (Mainz) 2.35 SA The normocalcemic primary Hyperparathyroidism the early phase of a symptomatic phpt? Zahn A., Schmitz E., Kußmann J. (Hamburg) 2.45 SA Calcitonin stimulation testing and the risk of pancreatitis Lorenz K., Abuazab M., Sekulla C., Dralle H. (Halle/Saale) Verabschiedung Inklusive Preisverleihung 3.5 Abschiedsimbiss Das Schweizer Organisationskomitee bedankt sich herzlich für die Bewertung der Vorträge bei Prof. Dr. Cornelia Dotzenrath (Wuppertal) Prof. Dr. Christoph Nies (Osnabrück) Prof. Dr. Rupert Prommegger (Innsbruck) Dr. Jochen Schabram (Lich) 8 9

7 POSTER NEW HARMONIC FOCUS + Shears with Adaptive Tissue Technology Johnson & Johnson AG ETHICON Gubelstrasse Zug Tel: +4 (0) 58 / Fax: +4 (0)58 / Ethicon Für aktuelle und vollständige Anleitungen beachten Sie bitte immer die der Verpackung beiliegende Gebrauchsanweisung. Die Posterautoren werden gebeten, am Freitag, den 2. November 204, in der Zeit von 2.0 bis 2.50 Uhr am Poster anwesend zu sein, um interessierten Teilnehmern Fragen zum Poster zu beantworten. Weitere Informationen zu den Postern siehe Seite 57. P I P 0 P 02 P 03 P 04 P 05 P 06 P 07 P 08 P 09 P 0 P Schilddrüse 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) 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) 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) First experiences with robotic-assisted hemithyroidectomy via axillary single incision Eckhardt S., Maurer E., Fendrich V., Bartsch D. K. (Marburg) Predicting the risk for postoperative hypoparathyroidism after thyroid surgery: results of a prospective study Manzini G., Malhofer F., Weber T. (Ulm, Mainz) Does normotension at the end of thyroidectomy prevent postoperative haemorrhage? Bock S., Kolb W., Clerici T. (St. Gallen) Thyroid nodules: Guideline compliance in preoperative diagnostics in Germany Reinisch A., Malkomes P., Habbe N., Bechstein W.-O., Holzer K. (Frankfurt/Main) 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) Postoperative hypoparathyroidism after thyroid surgery in the elderly Sehnke N., Schwarz K., Lammers B. J., Goretzki P. E. (Neuss) 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) Thyroid micro-carcinoma with lymphnode metastasis Bradatsch A., Wolf G. (Graz)

8 POSTER POSTER P II P 2 P 3 P 4 P 5 P 6 P 7 P 8 P III P 9 P 20 P 2 Nebenschilddrüsen 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) 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) 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) 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) 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) Insufficient decrease of intraoperative parathyroid hormone after parathyroidectomy: is extended cervical exploration necessary? Müller A.-K., Lindner K., Lenschow C., Senninger N., Colombo- Benkmann 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) NET/Nebennieren Experience in 29 patients with pancreatic neuroendocrine neoplasia (pnen): large procedure variety with low morbidity Akca A., Goretzki P. E., Melin A., Starke A. A. R. (Neuss) Long-term results after surgery for pheochromocytoma Waldmann J., Nuttebaum A.-L., Fendrich V., Ramaswamy A., Bartsch D. K. (Marburg) The outcome of patients with neuroendocrine neoplasias of the lung experience with 7 patients Meyer C., Kirschbaum A., Bartsch D. K., Fendrich V. (Marburg) P 22 P 23 P IV P 24 P 25 P 26 P 27 P 28 Coincidence of two mutations in a patient presenting with multiple endocrine neoplasia type is the clinical course more aggressive? Melin M., Akca A., Wirowski D., Schwarz K., Starke A. A. R., Goretzki P. E. (Neuss) Roboter-assisted surgical management of neuroendocrine tumors of the pancreas Fendrich V., Maurer E., Bartsch D. K. (Marburg) Basic Science / Case Reports Effect of combined antiangiogenic therapy at different points of tumorangiogenesis in RIP-TAg5-transgenic mice Strothmann H., Schimmack S., Schölch S., Scherer U., Schmidt T., Büchler M. W., Schmitz-Winnenthal H. (Heidelberg) Hashimoto Thyroiditis is dominated by infiltrating Th/Th7 cells Gasser M., Almanzar G., Schreiner J., Höfner K., Wild V., Rosenwald A., Germer C.-T., Waaga-Gasser A. M., Prelog M. (Würzburg) 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) 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) A rare cause of a solitary thyreoid nodule Trum S., Krenz D. (München) Das Schweizer Organisationskomitee bedankt sich herzlich für die Bewertung der Poster bei Prof. Dr. Ayman Agha (München) Prof. Dr. Kenko Cupisti (Euskirchen) Dr. Katharina Schwarz (Neuss) 2 3

9 ABENDVERANSTALTUNGEN VORSTAND DER CAEK GET TOGETHER IM RESTAURANT SCHLÜSSELZUNFT Adresse: Freie Str Basel (siehe Plan auf Seite 64) Das Get Together findet am 20. November 204 in der Zeit von 9.00 bis 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. Um vorherige Anmeldung wird gebeten, die Teilnehmerzahl ist begrenzt. VORSITZENDER Prof. Dr. Thomas J. Musholt Johannes-Gutenberg-Universität Mainz Klinik für Allgemein- und Abdominalchirurgie Endokrine Chirurgie Langenbeckstr. 550 Mainz STELLVERTRETENDER VORSITZENDER Prof. Dr. Thomas Steinmüller DRK-Kliniken Berlin Westend Chirurgische Klinik Zentrum für Allgemein- und Viszeralchirurgie Zentrum für Endokrine Chirurgie Spandauer Damm Berlin GESELLSCHAFTSABEND SCHIFFSFAHRT AUF DEM RHEIN INKLUSIVE BESUCH DES MUSEUMS TINGUELY Für den diesjährigen Gesellschaftsabend der CAEK haben die Schweizer Organisatoren etwas Besonderes arrangiert. Um 7.30 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 Uhr an der Anlegestelle Basel-Schifflände. Der Gesellschaftsabend wird mit 70,00 pro Person berechnet. Treffpunkt um 7.5 Uhr: Anlegestelle Basel-Schifflände (siehe Plan Seite 64) Um vorherige Anmeldung wird gebeten, die Teilnehmerzahl ist begrenzt. SCHRIFTFÜHRER Prof. Dr. Christian Scheuba Medizinische Universität Wien Universitätsklinik für Chirurgie Klinische Abteilung für Allgemeinchirurgie Währinger Gürtel Wien BEIRAT Dr. Jochen Schabram Asklepios Klinik Lich Klinik für Endokrine Chirurgie Goethestr Lich Prof. Dr. Christoph Nies Niels-Stensen-Kliniken Marienhospital Osnabrück GmbH Klinik für Allgemein- und Viszeralchirurgie Bischofsstr Osnabrück Die CAEK-Vorstandssitzung findet am in der Zeit von 8.30 bis 9.30 Uhr im Restaurant Schlüsselzunft (Vorgesetztenstube) statt. 4 5

10 Speziell zur Behandlung von Akromegalie und Neuroendokrinen Tumoren entwickelt: Die besondere Galenik von Somatuline Autogel START RIGHT & STAY RIGHT Somatuline Autogel, 2, 3 wirkt schnell und dauerhaft ist sicher in der Anwendung und, 2, 3 gut verträglich als Fertigspritze sofort anwendbar zur Selbstinjektion und Intervallverlängerung zugelassen 4 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 20 mg alle 28 Tage. Bei guter Einstellung auf SSA Behandlung mit 20 mg alle 42 oder 56 Tage möglich. Einzelheiten s. AIPS Plattform Swissmedic ( 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 ( Interaktionen: Ciclosporin, Bromocriptin, CYP3A4-Substrate (Chinidin, Terfenadin). Einzelheiten s. AIPS Plattform Swissmedic ( 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 ( Packungen: Erhältlich als gebrauchsfertige Einmalinjektion in den Stärken 60 mg, 90 mg und 20 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 ( Zulassungsinhaberin: Future Health Pharma GmbH, Guyer-Zeller-Strasse 0, 8620 Wetzikon ZH. Herstellerin: Ipsen Pharma Biotech SAS, F Signes. Stand der Information: Juli 200. Zul.-Nr.: Referenzen Melmed S et al. Rapid and sustained reduction of serum growth hormone and insulin like growth factor- in patients with acromegaly receiving lanreotide Autogel therapy: a randomized, placebo controlled, multicenter study with a 52 week open extension. Pituitary 200;3(): 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): Caron P et al. Effectiveness and tolerability of 3-year lanreotide Autogel treatment in patients with acromegaly. Clin Endocrinol (Oxf). 2006;64(2): Fachinformation: AIPS Plattform Swissmedic ( Somatuline Autogel 60 mg / 90 mg / 20 mg, Stand Juli 200. DIE BISHERIGEN ARBEITSTAGUNGEN DER ACE & CAEK JAHR/ORT TAGUNGSPRÄSIDENT 982 Marburg Prof. Dr. Hans-Dietrich Röher 983 Göttingen Prof. Dr. Horst Dieter Becker 984 Mainz Prof. Dr. Fritz Kümmerle 985 Bern/CH Prof. Dr. Rudolf Berchtold 986 Hamburg Prof. Dr. Volker Bay 987 Wien/A Prof. Dr. Bruno Niederle 988 Düsseldorf Prof. Dr. Hans-Dietrich Röher 989 Hannover Prof. Dr. Henning Dralle 990 München Prof. Dr. Jörg Rüdiger Siewert 99 Marburg Prof. Dr. Matthias Rothmund 992 Innsbruck/A Prof. Dr. Ernst Bodner 993 Tübingen Prof. Dr. Horst Dieter Becker 994 Frankfurt Prof. Dr. Albrecht Enke 995 Bremen Prof. Dr. Istvan Klempa 996 Feldkirch/A Prof. Dr. Gerhard Zimmermann 997 Halle Prof. Dr. Henning Dralle 998 Hamburg Prof. Dr. Andrea Frilling 999 Berlin Prof. Dr. Thomas Steinmüller 2000 Düsseldorf Prof. Dr. Hans-Dietrich Röher 200 Bern/CH Prof. Dr. Markus Büchler 2002 Potsdam Prof. Dr. Hubertus J. C. Wenisch 2003 Frankfurt Prof. Dr. Robert A. Wahl 2004 Wien/A Prof. Dr. Bruno Niederle, Prof. Dr. Michael Hermann Prof. Dr. Rudolf Roka 2005 Hamburg Prof. Dr. Jochen Kußmann 2006 Duisburg Prof. Dr. Dietmar Simon 2007 Mainz Prof. Dr. Thomas J. Musholt 2008 Rostock Prof. Dr. Ernst Klar 2009 Lodz/PL Prof. Dr. Henning Dralle, Prof. Dr. Krzysztof Kuzdak 200 Osnabrück Prof. Dr. Christoph Nies 20 Innsbruck/A Prof. Dr. Rupert Prommegger 202 Regensburg Prof. Dr. Ayman Agha 203 Wuppertal Prof. Dr. Cornelia Dotzenrath 6 7

11 REFERENTEN UND MODERATOREN REFERENTEN UND MODERATOREN Akca, Aycan, Dr., Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 4464 Neuss/D, Albers, Max Benjamin, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik für Viszeral-, Thorax- und, Gefäßchirurgie, Baldingerstr., Marburg/D, Anamaterou, Chrysanthi, Universitätsklinikum Heidelberg, Klinik für Endokrinologie, Stoffwechsel und, Klinische Chemie, Im Neuenheimer Feld 40, 6920 Heidelberg/D Bareck, Evelyne, Dr., Allg. öffentl. Krankenhaus Wiener Neustadt, Abteilung für Allgemeinchirurgie und Gefäßchirurgie, Corvinusring 3-5, 2700 Wiener Neustadt/A, Bartsch, Detlef K., Prof. Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik für Allgemein-, Viszeral-, Thorax- u. Gefäßchirurgie, Baldingerstr., Marburg/D, Bilz, Stefan, Dr., Kantonsspital St. Gallen, Klinik für Endokrinologie/Diabetologie/Osteologie, Rorschacher Str. 95, 9007 St. Gallen/CH, Bittscheidt, Hans, Dr., Sana Klinikum Hameln-Pyrmont, Allgemein- und Viszeralchirurgie, Saint-Maur-Platz, 3785 Hameln/D, Bock, Susanne, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Rorschacher Str. 95, 9007 St. Gallen/CH, Bradatsch, Andrea, Dr., Medizinische Universität Graz, Abteilung für Endokrine Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Auenbruggerplatz 29, 8036 Graz/A, Breitenstein, Stefan, PD Dr., Kantonsspital Winterthur, Viszeral- und Thoraxchirurgie, Brauerstr. 5, 840 Winterthur/CH, Bures, Claudia, Dr., Krankenanstalt Rudolfstiftung, 2. Chirurgische Abteilung, Juchgasse 25, 030 Wien/A, Christ, Emanuel, Prof. Dr., Universiätsspital Bern, Klinik für Endokrinologie, Diabetologie und klinische Ernährung, Freiburgstr. 4, 300 Bern/CH, Clerici, Thomas, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung, Rorschacher Str. 95, 9007 St. Gallen/CH, Dralle, Steven, Dr., Universität Rostock, Chirurgische Universitätsklinik, Abteilung für Allgemeine, Thorax-, Gefäß- und Transplantationschirurgie, Schillingallee 35, 8057 Rostock/D, Ebner, Hannah, Universitätsmedizin Mannheim, V. Medizinische Klinik, Theodor-Kutzer-Ufer -3, 6867 Mannheim/D Eckhardt, Sabine, Dr., VTG-Chirurgie Uniklinikum Marburg, Baldingerstr., Marburg/D, Estourgie, Susanne, Dr., Lukaskrankenhaus Neuss, Klinik fur Allgemein-, Viszeral-, Torax- und Gefäßchirurgie, Preußenstr. 84, 4464 Neuss/D, Falconi, Massimo, Prof. Dr., Università Politecnica delle Marche A.O.U. Ospedali Riuniti, U.O.C. Chirurgia Pancreatica, Via Conca 7, 6026 Ancona/I, Fendrich, Volker, Prof. Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., Marburg/D, Fretz, Christian, Dr., Kantonsspital St. Gallen, Klinik für Radiologie und Nuklearmedizin, Rorschacher Str. 95, 9007 St. Gallen/CH, Frilling, Andrea, Prof. Dr., Imperial College London, Hammersmith Campus, Division of Surgery, Department of Surgery and Cancer, Du Cane Road, London/GB, Führer-Sakel, Dagmar, Prof. Dr. Dr., Universitätsklinikum Essen, Klinik für Endokrinologie und Stoffwechselerkrankungen, Hufelandstr. 55, 4522 Essen/D, Gasser, Martin, Prof. Dr., Universitätsklinikum Würzburg, Zentrum Operative Medizin, Chirurgische Klinik I, Oberdürrbacher Str. 6, Würzburg/D, Gohrbandt, Antje Evelyn, Dr., Universitätsmedizin Mainz, Allgemein-, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Langenbeckstr., 553 Mainz/D, Goretzki, Peter E., Prof. Dr., Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Preußenstr. 84, 4456 Neuss/D, Hermann, Michael, Prof. Dr., Krankenanstalt Rudolfstiftung, II. Chirurgische Abteilung, Juchgasse 25, 030 Wien/A, Hermanns, Mechthild, Dr., DRK Kliniken Berlin-Westend, Chirurgische Abteilung, Klinik für Allgemein-, Viszeral- und Endokrine Chirurgie, Spandauer Damm 30, 4050 Berlin/D, Heverhagen, Anna, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., Marburg/D, Kern, Beatrice, Dr., St. Claraspital, Chirurgische Klinik, Allgemeinchirurgische Abteilung, Kleinriehenstr. 30, 4058 Basel/CH, Köberle-Wührer, Roswitha, Dr., Kantonsspital Baselland, Standort Liestal, Chirurgische Abteilung, Klinik für Viszeral-, Allgemein-, Thorax- und Gefäßchirurgie, Rheinstr. 26, 440 Liestal/ CH, Kull, Christof, Dr., Kantonsspital Baselland, Standort Liestal, Chirurgische Abteilung, Klinik für Viszeral-, Allgemein-, Thorax- und Gefäßchirurgie, Rheinstr. 26, 440 Liestal/CH, 8 9

12 REFERENTEN UND MODERATOREN REFERENTEN UND MODERATOREN Kußmann, Jochen, Prof. Dr., Schön Kliniken, Klinikum Eilbek, Klinik für Endokrine Chirurgie, Dehnhaide 20, 2208 Hamburg/D, Lienenlüke, Robert H., Dr., Bürgerhospital Frankfurt am Main e.v., Klinik für Endokrine Chirurgie, Nibelungenallee 37-4, 6038 Frankfurt/Main/D, Lorenz, Kerstin, Prof. Dr., Martin-Luther Universität Halle-Wittenberg, Universitätsklinikum Halle, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Ernst-Grube-Str. 40, 0620 Halle/Saale/D, Manzini, Giulia, Dr., Universitätsklinikum Ulm, Klinik für Allgemein- und Viszeralchirurgie, Albert-Einstein-Allee 23, 8908 Ulm/D, Melin, Anastasia, Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 4464 Neuss/D, Melin, Magnus, Lukaskrankenhaus GmbH, Chirurgische Klinik I, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Preußenstr. 84, 4464 Neuss/D, Meyer, Anke, HELIOS Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstr. 40, Wuppertal/D, Meyer, Christian, Dr., Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., Marburg/D, Müller, Ann-Kathrin, Dr., Universitätsklinikum Münster, Klinik für Allgemein- und Viszeralchirurgie, Waldeyerstr., 4849 Münster/D, Musholt, Thomas J., Prof. Dr., Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Langenbeckstr., 550 Mainz/D, Oertli, Daniel, Prof. Dr., Universitätsspital Basel, Chirurgische Abteilung, Viszeralchirurgie, Spitalstr. 2, 403 Basel/CH, Perren, Aurel, Prof. Dr., Universität Bern, Institut für Pathologie, Murtenstr. 3, 300 Bern/CH, Pluto, Naja-Norina, Dr., Florence-Nightingale-Krankenhaus, Klinik für Plastische und Ästhetische Chirurgie, Kreuzbergstr. 79, Düsseldorf/D, Reinisch, Alexander, Dr., Universitätsklinikum Frankfurt, Klinik für Allgemeinund Viszeralchirurgie, Theodor-Stern-Kai 7, Frankfurt/Main/D, Reubi, Jean-Claude, Prof. Dr., Universität Bern, Institut für Pathologie, Murtenstr. 3, 300 Bern/CH, Riss, Philipp, Dr., Medizinische Universität Wien, Universitätsklinik für Chirurgie, Chirurgische Endokrinologie, Währinger Gürtel 8-20, 090 Wien/A, Sahm, Maik, PD Dr., DRK Kliniken Berlin Köpenick, Klinik für Chirurgie, Salvador-Allende-Str. 2-8, 2559 Berlin/D, Scheuba, Christian, Prof. Dr., Medizinische Universität Wien, Universitätsklinik für Chirurgie, Chirurgische Endokrinologie, Währinger Gürtel 8-20, 090 Wien/A, Schimmack, Simon, Dr., Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Im Neuenheimer Feld 0, 6920 Heidelberg/D, Schmid, Kurt Werner, Prof. Dr., Universitätsklinikum Essen, Institut für Pathologie und Neuropathologie, Abteilung für Pathologie, Hufelandstr. 55, 4522 Essen/D, Schneider, Rick, Dr., Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Ernst-Grube-Str. 40, 0620 Halle/Saale/D, Schuster, Frauke, HELIOS Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstr. 40, Wuppertal/D, Sehnke, Nina, Dr., Lukaskrankenhaus Neuss, Chirurgische Klinik I, Preußenstr. 84, 4464 Neuss/D, Simon, Dietmar, Prof. Dr., Ev. Bethesda Krankenhaus zu Duisburg, Klinik für Allgemein- und Viszeralchirurgie, Heerstr. 29, Duisburg/D, Steffen, Thomas, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung, Rorschacher Str. 95, 9007 St. Gallen/CH, Steinmüller, Thomas, Prof. Dr., DRK Kliniken Berlin-Westend, Chirurgische Klinik, Klinik für Allgemein-, Viszeral- und Endokrine Chirurgie, Spandauer Damm 30, 4050 Berlin/D, Strobel, Oliver, PD Dr., Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeralund Transplantationschirurgie, Im Neuenheimer Feld 0, 6920 Heidelberg/D, Strobl, Stephanie, Dr., Medizinische Universität Wien, Universitätklinik für Chirurgie, Chirurgische Endokrinologie, Klinische Abteilung für Allgemeinchirurgie, Währinger Gürtel 8-20, 090 Wien/A, Strothmann, Hendrik, Chirurgische Universitätsklinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Im Neuenheimer Feld 0, 6920 Heidelberg/D, Tarantino, Ignazio, Dr., Kantonsspital St. Gallen, Klinik für Chirurgie, Chirurgische Abteilung, Rorschacher Str. 95, 9007 St. Gallen/CH,

13 REFERENTEN UND MODERATOREN ABSTRACTS Thomusch, Oliver, Prof. Dr., Universitätsklinikum Freiburg, Abteilung für Allgemein- und Viszeralchirurgie, Hugstetter Str. 55, 7906 Freiburg/D, Triponez, Frédéric, Prof. Dr., Hôpitaux Universitaires de Genève, Service de Chirurgie thoracique et endocrinienne, Rue Gabrielle-Perret-Gentil 4, 205 Genève/CH, Trum, Stephanie, Dr., Klinikum Dritter Orden München-Nymphenburg, Abteilung für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Menzinger Str. 44, München/D, Vordermark, Dirk, Prof. Dr., Universitätsklinikum Halle, Klinik und Poliklinik für Strahlentherapie, Dryanderstr. 4, 060 Halle/Saale/D, Vorländer, Christian, Dr., Bürgerhospital Frankfurt am Main, Klinik für Endokrine Chirurgie, Nibelungenallee 37-4, 6038 Frankfurt/Main/D, Waldmann, Jens, PD Dr., Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Baldingerstr., Marburg/D, Watzka, Felix, Dr., Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Langenbeckstr., 553 Mainz/D, Weber, Theresia, Prof. Dr., Katholisches Klinikum Mainz, Klinik für Endokrine Chirurgie, An der Goldgrube, 553 Mainz/D, Wild, Damian, Prof. Dr., Universitätsspital Basel, Klinik für Radiologie und Nuklearmedizin, Petersgraben 4, 403 Basel/CH, Winterhalder, Ralph, Dr., Kantonsspital Luzern, Medizinische Onkologie, Spitalstr., 6000 Luzern/ CH, Zahn, Alexandra, Dr., Schön Kliniken, Klinikum Eilbek, Endokrine Chirurgie, Dehnhaide 20, 2208 Hamburg/D, FR Mediastinal parathyroid adenoma in primary hyperparathyroidism: What determines positive MIBI-scintigraphy? Kerstin Lorenz, Thomas Clerici 2, Sebastian Bailer, Carsten Sekulla, Phuong Nguyen Thanh, Henning Dralle Department for General-, Visceral-, and Vascular Surgery, University of Halle-Wittenberg, Halle an der Saale, Germany; 2 Department 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 8/075 (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 pg/ml in MIBI-positive vs.3. mmol/l; 30.6 pg/ml in MIBI-negative; median specimen weight MIBI-positive was 535 mg vs. negative 7705 mg). Successful parathyroidectomy resulted in postoperative median calcium/pth levels of.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. kerstin.lorenz@uk-halle.de FR 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

14 ABSTRACTS ABSTRACTS Results: Median dissected number of parathyoid glands (PGs) was 2.3. Four, three, two, one and zero PGs were found in 2 %, 3 %, 35 %, 6 % and 6 % of patients, respectively. In the histopathologic examination, a single accidentally removed PG was found in 9 %, two PGs in %. The incidence of latent permanent and manifest permanent hypoparathyroidism was 2,8 % and 0,3 % (/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 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 200 and 204 retrospectively. Results: 69 of our 232 patients with neuroendocrine tumors suffered from insulinoma, including 0 cases of malignancy. EUS, CT and MRI were positive in 30 patients (43.5 %), 29 (42 %), 26 (37.7 %) patients, respectively. In 20 (30 %), 4 (20.3 %) and 6 (8.7 %) patients EUS, CT and MRI were negative. In 4 patients (46.7 %) MRI and EUS were positive. MRI localized the tumor in 0 (33.3 %) patients with negative EUS. Whereas EUS detected the tumor in 4 (3.3 %) patients with negative MRI. 20 patients in our collective underwent all three examinations. MRI was positive in 4 patients, whilst EUS or CT was positive in 0. 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 FR.06.0 Long-term survival is not impaired after the complete resection of neuroendocrine tumors of the appendix Thomas Steffen *, Sabrina M. Ebinger *, René Warschkow, 2, Cornelia Lüthi, Bruno M. Schmied, Thomas Clerici Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; 2 Institute 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 990 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 2. years and 3.7 years for those alive. All patients underwent curative R0 resections. No distant metastases were diagnosed. A total of 3 (39.2 %), 29 (36.7 %), 8 (22.8 %), and (.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 %- 07 %), respectively. Second primary malignancies (hazard ratio of death = 7.0, 95 %CI: ) 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 Minichromosome maintenance expression in slow growing gastroenteropancreatic neuroendocrine neoplasms Simon Schimmack, 2, Ben Lawrence, Barton Kenney 3, Hubertus Schmitz-Winnenthal 2, Oliver Strobel 2, Irvin M. Modlin, Mark Kidd Gastrointestinal Pathobiology Research Group, Department of Gastrointestinal Surgery, Yale University School of Medicine, CT, USA; 2 University Hospital of General-, Visceral- and Transplantation- Surgery of Heidelberg, Heidelberg, Germany; 3 Department 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

15 ABSTRACTS ABSTRACTS and Ki67 expression was compared by Kaplan-Meier survival analysis (tissue microarray, independent set [n=55]). We used 43 pancreatic NENs and 4 normal tissues as control groups. Results: In SI- NENs, MCM2 and MCM3 were detected in significantly (0x, p<0.0) 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 2 years) and high proliferating tumors (OS: 6. years). 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 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 0/200 and 2/203, patients with enucleations were identified and perioperative morbitiy as well as follow-up results were assessed. Results: Enucleations were performed in 60 (9.8 %) 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.3 cm (IQR: ). There were 47 (78 %) G and 3 (22 %) G2 tumors. The median duration of the operation was 37 min (IQR: 0-72) and the median postoperative stay was 8 days (IQR: 7-0). Morbidity was 35 %. 8 patients (30 %) developed postoperative pancreatic fistula (POPF). 0 patients developed grade A POPF (ISGPF-definition). Only 8 (3 %) 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 00 %. Conclusion: In context of the high morbidity of formal pancreatic resections, enucleation for G/ G2 pnens is a safe procedure with favorable outcome. oliver.strobel@med.uni-heidelberg.de FR Bronchopulmonary neuroendocrine tumors in multiple endocrine neopasia type Max B. Albers, Caroline Lopez-Lopez, Jens Waldmann, Volker Fendrich, Emily P. Slater, Jonas C. Apitzsch 2, Detlef K. Bartsch Klinik für Viszeral-, Thorax- und Gefäßchirurgie, 2 Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Gießen und Marburg, Standort Marburg Background: This study aimed to determine the prevalence, potential precursor lesions, course of disease and prognosis of BNENs in MEN. Methods: A prospectively collected database of MEN patients was retrospectively analysed for BNENs. Results: Five of 75 MEN patients developed histologically confirmed BNENs. 2 patients had multiple lung lesions. All patients underwent surgery (4 anatomic resections, one wedge resection). Histopathology revealed carcinoids G 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 6 of 53 patients. After a median of 48 months follow-up, these were stable in 2 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 MEN 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 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 999 and 204 in our institution. Methods: 20 patients that underwent surgery for ileal NEN between 999 and 204 at our institution were retrospectively evaluated regarding their survival and their lymph node ratio at time of surgery. Results: In 06 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 -57) 63 patients are still alive 26 27

16 ABSTRACTS ABSTRACTS whereas 43 patients died. Patients still alive had a mean lymph node ratio of 0.58, whereas patients who died had a lymph node ratio of (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.02.0 Efficacy of a single preoperative dexamethasone dose to prevent nausea and vomiting after thyroidectomy (tponv): a randomized, double-blind, placebo-controlled clinical trial Ignazio Tarantino, Rene Warschkow, Ulrich Beutner, Walter Kolb, Andreas Lüthi 2, Cornelia Lüthi, Bruno M. Schmied, Thomas Clerici Klinik für Chirurgie, 2 Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, Kantonsspital St. Gallen, St. Gallen, Switzerland 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. Methods: This single-institution, randomized, double-blind, placebo-controlled, superiority study was performed between Jan, 20 and May, 203. 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. Results: The total incidence of PONV was 65 of 52 patients (43 %, 95 % CI:35 %-5 %). 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=0.00; OR=0.3, 95 % CI: ). 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 SA Influence of intraoperatve neuromonitoring (IONM) in postoperative nausea and vomiting (PONV) in thyroid surgery Analysis of a standardized drug regime Christian Vorländer, Romuald Kazmierczak 2, P. Yadev, Robert H. Lienenlüke Klinik für Endokrine Chirurgie, Bürgerhospital Frankfurt am Main; 2 Klinik 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 female patients were observed using IONM without standardized prophylaxis for PONV but using the total intravenous technique (TIVA) as anaesthesia (Group A). 204 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. Results: Analysis showed an early rate of 53 % in Group A (Apfel 2-4) vs. 5 % in Group B (p<0,00). For midtime and late PONV-rate the results were 35 % and 8 % in Group A and 30 % and 5 % in Group B respectively (n.s.). No postoperative bleeding was observed in both cohorts. 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. c.vorlaender@buergerhospital-ffm.de SA 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 (038 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. 8/59 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: 00 %, 96 %, 25 %, 00 % and for ENT-findings: 00 %, 94 %, 8 %, 00 %. 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 4 patients recovered within three months

17 ABSTRACTS 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. SA Thyroiditis and surgery: multivariate analysis of risk profile and incidence of postoperative complications: A prospective multicenter study of Europe Oliver Thomusch, Carsten Sekulla 2, Henning Dralle 2, Kerstin Lorenz 2, and the PETS Study Team Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg; 2 Klinik 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 200 to July 202. Overall, 220 patients with surgery for thyroid diseases were evaluated patients received surgery thyroiditis [Graves disease (n=4) and thyroiditis de Quervain and Hashimoto (n=347)]. 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 SA Objective and subjective scar aesthetics after MIVAT vs. conventional thyroidectomy Maik Sahm, 2, Matthias Pross, Hans Lippert 2 DRK Klinken Berlin-Köpenick, Department of Surgery; 2 Institute for Quality Control in Operative Medicine, University Magdeburg 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. Methods: Between 2004 and 20, 43 patients underwent MIVAT. In 20, 34 patients underwent CT. We performed a cohort study with a follow-up examination and included 7 vs. 02 patients (MIVAT vs. CT) with a follow-up period of 23. vs months. We used the valid Patient and Observer Scar Assessment Scale (PSAS/OSAS). Results: The measurable scar length was 9.7 vs mm (MIVAT vs. CT) (p<0.00). The score of PSAS was 0.4 vs. 9.9 (p=0.666), and the score of OSAS was 8.5 vs. 9.9 (p=0.00). 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.05.0 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: () 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 %), 2 LOS in (3) and 5 LOS in (4). Early postoperative VCP was seen in () 3, (2) 0, (3) 7, and (4) 4 NAR. There was no permanent VCP. Subgroup analysis showed significant shorter mean CNM session time in () 40.7 ± 24. min, compared to (2) 58. ± 42.8 min (3) 68. ± 37. min and (4) 55.8 ± 3.6, respectively. Relative numbers of AMP < 50 % of baseline and AMP < 00 µv were significantly higher in (3) 2.43, 0.47 and (4) 2.75,.02, compared to () 0.25, 0.04 and (2) 0.95, 0.0, respectively. In contrast, relative number of LAT > 0 % of baseline was comparable in all groups. 30 3

18 ABSTRACTS 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 < 00 µv are significantly indicative for impending nerve injury with subsequent VCP. rick.schneider@uk-halle.de SA 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±2.5 yrs; 36 female) with benign pathologies and intact recurrent nerve function were prospectively evaluated. Laryngeal movement was analyzed by ultrasound preoperatively and,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, 3, and 6 months postoperatively in females 6.0, 3.7, and.5mm, in males 3.8,.7, and 0.3mm). Hoarseness (9 females), impaired swallowing ( female, 2 males) and cervical discomfort (7 females, 3 males) was mainly reported by women month postoperatively. After 6 months, these complaints resolved (cervical discomfort female). Quality of life was only affected in female 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 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 ( ) parathyroidectomy was performed in 660 patients with phpt. In 58 patients a normocalcemic phpt (serum calcium 2,4 2,58 mmol/l, PTH > 65 pg/ml) was diagnosed (group I). 58 patients with hypercalcemic 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: 70 mg) were different. Patients presented kidney stones in group I in 33 %, group II in 3 % 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: 7 % versus group II: 9 %. Single gland disease occurred in group I in 83 %, group II in 9 % and in group III in 00 %. 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 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 98 patients with calcitonin stimulation test, 6 (3 %) (female 3, male 3; mean age 43,5 years) developed pancreatitis thereafter. Mean preoperative basal calcitonin was 500 pg/ ml, maximum stimulation level was mean pg/ml. Mean postoperative levels for amylase and lipase was 5,4 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 32 33

19 ABSTRACTS ABSTRACTS P 0 Discordance in histopathologic findings of papillary microcarcinoma in thyroid specimens Interobserver variations of two institutes of pathology Claudia Bures, V. Zielinski, Tobias Klatte 2, Nikolaus Neuhold 3, Andrea Schultheis 3, Friedrich Kober, S. Neumann 3, Michael Hermann 2nd Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria; 2 Department of Urology, Medical University of Vienna, Vienna, Austria; 3 Department 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 202 our department was situated in a clinic specialized in thyroid surgery and pathology. In 203 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 (202 and 203). Results: In 202, 597 thyroid surgeries were performed of which 60 (i.e. 0 %) showed a microcarcinoma. In 203, 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 (B): suspicious/indeterminate or follicular neoplasm and (B2): follicular neoplasm suspicious for papillary thyroid cancer] or malignant (C). B and B2 tumours were of interest analyzing the prediction of malignancy and the incidence of lymph node metastasis. Methods: Within 5 years 278 (27.6 %) fine needle aspirations were performed in 008 patients. 98 (35.2 %) were classified ÖGZ B. [B: 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 4 (8.7 %) B and in (47.8 %) B2 nodules. 9 (2.0 %) B tumours were classified papillary thyroid cancer (PTC [9/4: 64.3 % of malignant B]; one patient pn) and 5 (6.7 %; [5/4: 35.7 % of malignant B]) follicular thyroid cancer (FTC). All malignant B2 tumours [/23: 47.8 %] were classified PTC, 5 (45.5 %) patients with pn. 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 B 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 202 and March patients underwent surgery of the thyroid or parathyroid glands in our hospital. From Sept 202 up to August 203 (group A, n=224) patients were sent to the ENT-examination one day after surgery. From Sept 203 up to March 204 (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: 9 out of 224 patients in group A showed a decrease or loss of vocal cord movement (0,9 % related to 943 nerves at risk, while 5 out of 736 patients (,3 % related to 48 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 34 35

20 ABSTRACTS 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 60min (range06min to 300min). The learning curve was impressive, since operating time could be reduced to 20 minutes in the last 5 operations. Two patients (0 %) had a T thyroid cancer ( PTC, 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 (0 %) 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 Manzini, Florian Malhofer, Theresia Weber 2 Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm; 2 Abteilung 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 36 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. Results: Surgery was performed for 224 patients with multinodular goiter, 40 with Graves disease and 97 thyroid carcinomas. In 24 patients (34 %) a transient hypoparathyroidism (PTH 0 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 (.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 ( 0 ng/ml) showed only a trend towards a higher risk for transient (p = 0.054) 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 -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 200, 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 0 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: 870 patients underwent thyroid surgery from 2003 to 203; 204 before the introduction of normotension and 666 afterwards. The rate of postoperative haemorrhage decreased from.7 % to 0.5 % (p=0.07). The median difference in blood pressure between the preoperative value and the value during haemostasis decreased by 20mmHg (systolic) and 0mmHg (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 36 37

21 ABSTRACTS 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 203 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, 8.5 % by ENP and 9.5 % by GP. Ultrasonography was preformed between 97.6 % in UMC and 90.9 % in GP (p < 0.000). The rates of fine-needle aspiration cytology bestrode between 47.6 % in UMC and 23.2 % in ENP (p < 0.000). 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.82 % for differentiated thyroid cancer and.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 03 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/subsequent retransplantation of PG, intraoperative PTH-monitoring and other laboratory findings (PTH, CA2+, PO4, AP, Crea) in the follow-up. Results: So far 72 of 03 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 8.5 (5-273) months. The long-term follow-up is 83.4 (6-33) months. 6 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 /202. Results: 96 patients were older than 75 years and 24 of those patients suffered a complication like postoperative hypoparathyrodism (PTH <5pg/ml). The transient rate of postoperative hypoparathyreoidism was 2 % (24/96) 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 38 39

22 ABSTRACTS ABSTRACTS P 0 Management of papillary carcinoma of thyroglossal duct carcinoma according to the CAEK guidelines on surgical treatment of malignant thyroid diseases. Hans Bittscheidt, Georg Richter 2, Jörg Müller 3, Rainer Lück Abteilung für Viszeralchirurgie, Sanaklinikum Hameln-Pyrmont; 2 Abteilung für Pathologie, Sanaklinikum Hameln-Pyrmont; 3 Abteilung für Nuklearmedizin, Medizinische Hochschule Hannover Background: Thyroglossal duct cysts are aberations in thyroid development. A malignant transformation is rare and present in only %. 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 (pta) next to hyoidal bone in No further action was taken until 203. At this time a suspect solitary nodule in the thyroid and cervical lymphadenopathy was found. We performed thyroidectomy with selective neck dissection. Histology confirmed pta pn0 PTC. Radioiodine therapy was done. The second patient underwent resection of a thyroglossal duct cyst, histology showed a PTC (ptb). 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 Thyroid micro-carcinoma with lymphnode metastasis Andrea Bradatsch, Gerhard Wolf Department für Endokrine Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz 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. Methods: We analyzed the data of all patients who were diagnosed with micro-ptc (<cm) through cervical lymph node enlargement and biopsy. The smallest focus measured 0,2 mm, 60 % presented with 3 to 6 mm, 5 % were multifocal. In one case with lymph node involvement, no thyroid tumour could be identified. 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. 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 P 2 Sleeping disturbances in patients with primary hyperparathyreoidism a prospective, case-control study Frauke Schuster, Renan Viola Rasche, Ana Karena Neukirch, Anke Meyer, Marios Papadakis, Kurt Rasche 2, Cornelia Dotzenrath Helios Klinikum Wuppertal, Abteilung für Endokrine Chirurgie; 2 Helios 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 P 3 Comparative diagnostic value of ultrasound, ultrasound-guided fine needle aspiration and sestamibi scintigraphy for the correct preoperative localisation of parathyroid adenomas Stefan Bilz, Natalie Rogowski-Lehmann, Ina Krull, René Oettli 2, Michael Brändle, Walter Kolb 3, Thomas Clerici 3 Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen, Switzerland; 2 Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Switzerland; 3 Department of Surgery, Kantonsspital St. Gallen, Switzerland 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 40 4

23 ABSTRACTS 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), 00 % (combination of SS or US) and 85 % (combination of SS or US-FNA).The respective PPVs were 96 % (SS), 92 % (US), 00 % (US-FNA), 93 % (combination of SS or US) and 00 % (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. US- FNA 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 4 Functional evaluation of parathyroid grafts after total parathyroidectomy for secondary hyperparathyroidism with autotransplantation into the tibialis anterior muscle Chrysanthi Anamaterou, Simon Schimmack 2, Matthias Lang, G. Rudofsky, Oliver Strobel 2, Peter Nawroth, Markus W. Büchler 2, Hubertus Schmitz-Winnenthal 2 Department of Medicine I and Clinical Chemestry, 2 Department 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. 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 5 Failed parathyroid operation: high serum calcium levels do not exclude FHH Anke Meyer, Natalie Meurer, Marios Papadakis, Imke Meyer, Norbert Weyerbrock, Marco Tosch 2, Cornelia Dotzenrath Klinik für Endokrine Chirurgie, Helios Klinikum Wuppertal; 2 Klinik für Nuklearmedizin, Helios Klinikum Wuppertal Methods: A 6-year-old male was admitted for surgery of primary hyperparathyroidism (phpt). His intact PTH level was 08 pg/ml (normal range:2-65pg/ml) and serum calcium level was 3.2 mmol/l (2.-2.6). Urine calcium was 4.3 (normal range ) and a ratio of calcium creatinine clearance was >0.0. 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. 0 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.65a>g for p.arg55gly (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. mmol/l. anke.meyer@helios-kliniken.de 42 43

24 ABSTRACTS ABSTRACTS P 6 Can pre-operative vitatmin D treatment prevent postoperative hypocalcemia in primary hyperparathyroidism? Hannah Ebner, Florian Herrle 2, Kai Nowak 2, Stefanie Nittka 3, Klaus Wasser 4, Alexander Lammert Fifth Medical Clinic (Department of Nephrology, Endocrinology), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2 Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 3 Institute for Clinical Chemistry, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 4 Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany 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. 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. 3 were operated (9 without, 2 patients with preoperative Vitamin D substitution). Anthropometrical and biochemical data were comparable between groups. Vitamin D substitution was started at mean 07.8 days prior to operation with a mean daily dosage of 278 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 2.7 mmol/l vs 2.3 mmol/l, p=0.06) even though PTH levels were comparable in both groups (9.7 ng/ml vs. 5.4 ng/l, p=0.47). Furthermore, need for treatment with oral calcium supplementation was reduced in patients receiving preoperative vitamin D substitution (4.6 % vs %, 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 7 Insufficient decrease of intraoperative parathyroid hormone after parathyroidectomy: is extended cervical exploration necessary? Ann-Kathrin Müller, Kirsten Lindner, Christina Lenschow, Norbert Senninger, Mario Colombo-Benkmann 2 Klinik für Allgemein-und Viszeralchirurgie, Universitätsklinikum Münster, Germany; 2 Klinik 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 exploration. The objective of the study was to evaluate whether continuation of exploration shows an improved outcome compared to re-measurement. Methods: We conducted a retrospective study on 22 patients (m:w=36:86) operated on for phpt between 2007 and 02/204. Blood samples were collected before surgery, at gland excision and 0 minutes after PTx. Results: 2 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. 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. Ann-Kathrin.Mueller@ukmuenster.de P 8 Intraoperative bilateral jugular venous sampling and rapid parathyroid hormone testing in patients undergoing parathyroidectomy for primary hyperparathyroidism Naja-Norina Pluto, Wolf-Otto Bechstein 2, Katharina Holzer 2 Klinik für Plastische und Ästhetische Chirurgie, Florence-Nightingale-Krankenhaus, Düsseldorf; 2 Klinik 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, 4 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, %. Localization was correctly predicted in 28 of 50 patients. False-positive results were observed in 5 patients. 20 patients had a negative preoperative imaging (ultrasound and/or Tc-99m sestamibi scan). Of these, BIJV successfully localized the adenoma in 2 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

25 ABSTRACTS ABSTRACTS P 9 Experience in 29 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 200 and 204 retrospectively. Results: Of 232 patients with NEN 29 (55.6 %) demonstrated with pnen. 69 (53.5 %) patients suffered from insulinoma, followed by functional pnen n=26 (20.2 %), non-functional pnen n=9 (4.7 %) and NIPHS n=5 (.6 %). 3 of 29 (2.3 %) patients without symptoms of pnen and NIPHS refused surgical treatment. 2 patients (.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 5.9 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 Waldmann, Anna-Lena Nuttebaum, Volker Fendrich, Annette Ramaswamy 2, Detlef K. Bartsch Department of Visceral-, Thoracic- and Vascular Surgery, 2 Department 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 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. 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 SDHB mutation were identified in 45 patients. Five of 8 patients (28 %) revealed lymphnode metastases. After a median follow-up of 0 months only 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. Kaplan- Meyer estimates for 5/0-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 2 The outcome of patients with neuroendocrine neoplasias of the lung experience with 7 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 204 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: 7 patients, 0 with a typical- and 7 with a atypical neuroendocrine neoplasias of the lung patients were identified. 8 operations in 7 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 (6/8) 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 3 months (range -42), all 7 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 46 47

26 ABSTRACTS ABSTRACTS P 22 Coincidence of two mutations in a patient presenting with multiple endocrine neoplasia type is the clinical course more aggressive? P 24 Effect of combined antiangiogenic therapy at different points of tumorangiogenesis in RIP-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 Background: Patients with multiple endocrine neoplasia type (MEN) are known to develop primary hyperthyroidism in %, pancreatic tumors in % and pituitary tumors in 0-60 %. Bronchial or thymic carcinoids are rare with a prevalence of 0 %. Primary hyperparathyroidism is the most common first symptom. Methods: We performed a retrospective analysis of the clinical course of a MEN family presenting with two different mutations, including the coincidence of both in the index patient. Results: The index patient was a young female presenting with multifocal pancreatic gastrinoma and hepatic metastasis at the age of 2. The following molecular genetic diagnostics showed two mutations, the paternal on exon 3 and the maternal on intron of the MEN 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 IVS-2A>G could aggravate the clinical symptoms of the MEN 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 204 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 75 min (20-95). 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 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: 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 RIP-TAg5-transgenic mice. Methods: RIP-TAg5-transgenic mice developing beta cell neoplasms at defined points in time were treated with four antiangiogenically acting substances VXM0 (oral DNA-vaccine encoding VEGFR-2), sunitinib (multi-targeted tyrosinekinase inhibitor), everolimus (mtor-inhibitor), and DC0 (monoclonal antibody against murine VEGFR-2/flk- receptor) - solely and in combination at defined stages of tumorangiogenesis. IHC-staining for CD3 and survival analyses were performed to determine the effects of preemptive, interventional, and regressive therapies. Results: Everolimus and VXM0/everolimus treatment led to a significant.8-fold (.6-fold) increase of CD3-positive vessels (p<0.0) in the preemptive group, co-administration of sunitinib negated this effect. Combined VXM0/DC0 treatment resulted in significantly reduced CD3-positive vessels (48 % of control, p<0,05) in the regressive group. Kaplan-Meier-analyses showed a significantly longer survival of mice under VXM0/DC0, everolimus, sunitinib/everolimus, VXM0/ 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 Th/Th7 cells Martin Gasser, Giovanni Almanzar 2, Jochen Schreiner 2, Kerstin Höfner, Vanessa Wild 3, Andreas Rosenwald 3, Christoph-Thomas Germer, Ana Maria Waaga-Gasser, Martina Prelog 2 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; 3 Institute 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 (Th/Th7 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

27 ABSTRACTS 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 (4.3 %) and IL-7 (4.0 %) compared to circulating CD4+ T-cells. High numbers of CD4+CD25+CD27- FoxP3+ (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 Th/Th7 effector T-cell phenotype producing high amounts of IFNgamma and IL-7. 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 Melin, C. Otto 2, Aycan Akca, Achim A. R. Starke, Peter E. Goretzki Department of Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss, Germany; 2 Department of Urology, Gemeinschaftsklinikum Koblenz-Mayen Background: 0.3 % of all renal tumors are neuroendocrine and % of NET are localized in the urogenital tract, where neuroendocrine cells do not exist. The origin of these tumors remains unclear. In 8-26 % 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 202. 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 203. 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 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.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), M (hep), R0. Postoperatively an adjuvant chemotherapie was suggested. Conclusion: Curative surgery for patients with MEN 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 München- Nymphenburg Introduction: 3-5 % 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- 50 5

28 ABSTRACTS AUTORENINDEX 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 -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 Abuazab M. SA Akca A. FR.02.05, P 9, P 22, P 26 Albers M. B. FR Almanzar G. P 25 Altindag H. P 03 Anamaterou C. P 4 Apitzsch J. C. FR Aschoff A. SA Bailer S. FR Bareck E. FR.02 Bartsch D. K. FR.05, FR.05.03, FR.06.04, FR.06.05, P 04, P 20, P 2, P 23 Bechstein W.-O. P 07, P 8 Beutner U. SA.02.0 Bichler C. P 02 Bilz S. P 3 Bittscheidt H. P 0 Bock S. P 06 Bradatsch A. P Brändle M. P 3 Breitenstein S. FR Büchler M. W. FR.06.03, P 4, P 24 Bures C. FR.02.04, P 0 Cherrez A. FR Christ E. FR.04, FR Clerici T. FR.02.03, FR.06.0, SA.02.0, P 06, P 3 Colombo-Benkmann M. P 7 Dotzenrath C. P 2, P 5 Dralle H. FR.02.03, SA.02.04, SA.05.0, SA Dralle S. P 08 Ebinger S. FR.06.0 Ebner H. P 6 Eckhardt S. P 04 Estourgie S. SA Falconi M. FR.05.0 Fendrich V. FR.06, FR.06.04, FR.06.05, P 04, P 20, P 2, P 23 Fischer L. FR Fottner C. P 27 Fretz C. FR.02.0 Frilling A. FR.03, FR.03.0 Führer-Sakel D. SA Gasser M. P 25 Germer C.-T. P 25 Gohrbandt A. E. SA Goretzki P. E. FR.02.05, FR.05.05, SA.02.03, P 09, P 9, P 22, P 26 Habbe N. P 07 Hackert T. FR Hermann M. FR.02.04, SA.03.08, P 0 Hermanns M. SA.05 Herrle F. P 6 Heverhagen A. FR Hinz U. FR Höfner K. P 25 Holzer K. P 07, P 8 Kazmierczak R. SA Kenney B. FR Kern B. SA.02 Kidd M. FR Kirschbaum A. P 2 Klar E. P 08 Klatte T. P 0 Klug E. FR Kober F. FR.02.04, P 0 Köberle-Wührer R. FR.02 Kolb W. SA.02.0, P 06, P 3 Krenz D. P 28 Krull I. P 3 Kufleitner H. P 03 Kußmann J. SA:03, SA.03.05, SA Lammers B. J. FR.02.05, P

29 AUTORENINDEX AUTORENINDEX Lammert A. P 6 Lang H. SA.05.02, P 27 Lang M. P 4 Lawrence B. FR Lenschow C. P 7 Lienenlüke R. H. SA.02.02, P 03 Lindner K. P 7 Linnebacher M. P 08 Lippert H. SA López-López C. Lorenz K. FR FR.02.03, SA.02.04, SA.03, SA.03.06, SA.05.0, SA Lück R. P 0 Lüthi A. SA.02.0 Lüthi C. FR.06.0, SA.02.0 Machens A. SA.05.0 Malhofer F. P 05 Malkomes P. P 07 Manzini G. P 05 Maurer E. P 04, P 23 Melin A. FR.02.05, P 9, P 26 Melin M. P 22 Meurer N. P 5 Meyer A. P 2, P 5 Meyer C. P 2 Meyer I. P 5 Miederer M. P 27 Modlin I. M. FR Müller A.-K. P 7 Müller J. A. P 0 Musholt T. J. FR.03.05, SA.04.0, SA.05.02, P 27 Nawroth P. P 4 Neuhold N. P 0 Neukirch A. K. P 2 Neumann S. P 0 Nguyen-Thanh P. FR.02.03, SA.05.0 Niederle B. P 02 Nittka S. P 6 Nowak K. P 6 Nuttebaum A.-L. P 20 Oettli R. P 3 Otto C. P 26 Papadakis M. P 2, P 5 Perren A. FR.04 PETS Study Team SA Pluto N.-N. P 8 Preldzic L. FR Prelog M. P 25 Pross M. SA Ramaswamy A. P 20 Rasche R. V. P 2 Reinisch A. P 07 Reubi J.-C. FR Richter G. P 0 Riss P. FR.06, P 02 Rogowski-Lehmann N. P 3 Rosenwald A. P 25 Rudofsky G. P 4 Sahm M. SA Schad A. P 27 Scherer U. P 24 Scheuba C. FR.05, SA.03.04, P 02 Schimmack S. FR.06.02, FR.06.03, P 4, P 24 Schmid K. W. SA.03.0 Schmidt T. P 24 Schmied B. M. FR.06.0, SA.02.0 Schmitz E. SA Schmitz-Winnenthal H. FR.06.02, P 4, P 24 Schneider R. SA.05.0 Schölch S. P 24 Schreiner J. P 25 Schuchmann M. FR Schultheis A. P 0 Schuster F. P 2 Schwarz K. SA.02.03, P 09, P 22 Sehnke N. P 09 Sekulla C. FR.02.03, SA.02.04, SA.05.0, SA Selberherr A. P 02 Senninger N. P 7 Simon D. SA Slater E. P. FR Starke A. A. R. FR.02.05, P 9, P 22, P 26 Steffen T. FR.06.0 Steinmüller T. FR.03 Strobel O. FR.06.02, FR.06.03, P 4 Strobl S. P 02 Strothmann H. P 24 Tarantino I. SA.02.0 Thomusch O. SA Tosch M. P 5 Triponez F. FR Trum S. P 28 Uckermark A. P 08 Vordermark D. Vorländer C. SA SA.02, SA.02.02, SA.03.0, P 03 Waaga-Gasser A. M. P 25 Waldmann J. FR.06.04, FR.06.05, P 20 Warschkow R. FR.06.0, SA.02.0 Wasser K. P 6 Watzka F. P 27 Weber T. SA.03.09, SA.05, P 05 Weyerbrock N. P 5 Wiese D. FR Wild D. FR.02.02, FR Wild V. P 25 Winterhalder R. FR Wirowski D. P 22 Wolf G. P Yadev P. SA Zahn A. SA Zielinski V. FR.02.04, P

30 schnell zuverlässig kontrolliert Ersparen Sie Ihren Patienten Hypothyreose zu googeln. Thyrogen vermeidet die Begleiterscheinungen der Hypothyreose. TECHNISCHE HINWEISE REDEZEITEN 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) 8,90 cm x 84,0 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 2. November 204, um Uhr angebracht sein und bleiben bis zum Ende der Tagung hängen. Die Posterautoren werden gebeten, am Freitag, den 2. November 204, in der Zeit von 2.0 bis 2.50 Uhr am Poster anwesend zu sein, um interessierten Teilnehmern Fragen zum Beitrag zu beantworten. Poster, die bis Samstag, den 22. November 204, 4.00 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 204, im Anschluss an die Sitzung SA.05 um 3.00 Uhr prämiert. Wir bitten deshalb um Anwesenheit der Posterautoren / des Vortragenden oder eines Vertreters der jeweiligen Arbeitsgruppe. Thyrogen Wirkstoff: Thyrotopin alfa. Zusammensetzung:, mg Thyrotropin alfa und Hilfsstoffe als Pulver pro Durchstechfl asche zur Bereitung eines Konzentrats und Herstellung einer Injektionslösung. Nach dem Aufl ösen enthält jede Durchstechfl asche 0,9 mg Thyrotropin alfa in,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 (, GBq) bis 00 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: Überempfi ndlichkeit 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 (8-40% 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 ( 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 Fortpfl anzungsfähigkeit 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 häufi g: Übelkeit; häufi g: 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 Durchstechfl aschen pro Karton. Verkaufskategorie: A*. Zul-Inh.: sanofi-aventis (schweiz) ag, 24 Vernier/GE. Stand der Information: November 203. Weitere Informationen entnehmen Sie bitte der Fachinformation unter ch /204 Ihr Kontakt: sanofi-aventis (schweiz) ag Genzyme a Sanofi Company Gulmmatt, CH-6340 Baar Zulassungs- sanofi-aventis (schweiz) ag inhaberin: 3, Route de Monfleury, CH-24 Vernier Tel. +4 (0) Fax +4 (0) 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 Power- Point-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 (max. 5 MB) an caek204@porstmann-kongresse.de zu senden. 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 ( ) und wird allen DGAV-Mitgliedern per Post zugesandt. 57

31 SPONSOREN UND AUSSTELLER SPONSOREN UND AUSSTELLER INDUSTRIEAUSSTELLUNG Der Veranstalter, die Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK), dankt allen Sponsoren und Ausstellern für die großzügige Unterstützung bei der Durchführung der 33. Arbeitstagung 204 in Basel. 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 08.5 bis 7.00 Uhr und am Samstag von bis 3.30 Uhr geöffnet. 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 Silber Sponsoren ETHICON Zug, CH Genzyme a Sanofi Company Baar, CH Silber Sponsoren Ipsen Pharma GmbH Ettlingen, D Medtronic (Schweiz) AG Münchenbuchsee, CH Sponsoren 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 Bundesverband Schilddrüsenkrebs Ohne Schilddrüse leben e.v. Berlin, D Stand bei Drucklegung (Oktober 204) 58 59

32 PLAN DER INDUSTRIEAUSSTELLUNG TAGUNGSINFORMATIONEN Zentrum für Lehre und Forschung (ZLF) Foyer. Etage Vortragssaal Kleiner Hörsaal Medienannahme UNKOSTENBEITRAG Gesamte Tagung 60,00 Tageskarte 95,00 Gesellschaftsabend 70,00 Get Together* 40,00 Studenten/Pflegepersonal** kostenfreie Tageskarte Ipsen Medtronic Genyzme Abfall 3.30 Lift Covidien Treppe Takeda Lift Lift Karl Storz 2.00 Postergruppe I & II * zusätzliche Karte ** Nachweis erforderlich Der Unkostenbeitrag für die gesamte Tagung beinhaltet: Kongressunterlagen Besuch der Industrieausstellung Kaffeepausen Mittagsbuffet Get Together ( Person) Novartis Dr. Langer Eingang Ethicon Erbe Inomed Condor DCI Pausenversorgung Schilddrüse e.v. Future Diagnostics Eingang ANMELDUNG Bitte melden Sie sich online unter an. Ihre Anmeldung wird schriftlich bestätigt. Überweisungen des Unkostenbeitrages erfolgen auf das in der Anmeldebestätigung angegebene Konto (Verwendungszeck: CAEK 204 und Name des Teilnehmers). Eingang Pause Personal ZLF Registrierung Pausenversorgung Postergruppe II I & IV 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 3 CME-Credits zertifiziert. Die Teilnahmebescheinigungen mit den CME-Punkten werden am Ende der Veranstaltung ausgegeben. 60 6

33 TAGUNGSINFORMATIONEN LAGEPLAN UNIVERSITÄTSSPITAL BASEL ZIMMERRESERVIERUNG 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! Augenklinik, Mittlere Strasse 9 Klingelbergstr. Bus 30, 33 Bernoullianum Bus 30 Kinderspital UKBB Bus 30, 33 Kinderspital UKBB Hotel D **** Blumenrain 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 Basel Superior: EZ 260 CHF, DZ 300 CHF, inklusive Frühstück (DO-FR) Superior: EZ 20 CHF, DZ 250 CHF, inklusive Frühstück (FR-SA) Business: EZ 230 CHF (DO-FR) / EZ 85 CHF (FR-SA) inklusive Frühstück / keine DZ Entfernung zum Tagungsort: 0 min zu Fuß Inklusive Baseler Mobility Ticket Hotel Dreiländerbrücke **** Hauptstr Weil am Rhein (D) EZ 79,00, DZ 99,00, inklusive Frühstück Entfernung zum Tagungsort: ca. 0 min mit dem Auto Carathotel Basel *** Alte Str Weil am Rhein (D) EZ 25, DZ 45, inklusive Frühstück Entfernung zum Tagungsort: ca. 5 min mit dem Auto Weitere interessante Informationen über Basel können Sie der folgenden Internetseite entnehmen: Hebelstr. Petersgraben Bus 3, 33, 34, 36, 38 Universitätsspital Bus 34 Universitätsspital A Klinikum 2, Behandlungsbau Petersgraben 4 Cafeteria, Coiffeure, Kiosk B Klinikum 2, Bettenhaus, Petersgraben 4 C Operationstrakt Ost D Klinikum, Behandlungsbau, Spitalstrasse 2 E Klinikum Ost, Bettenhaus Spitalstrasse 2 Cafeteria, Kiosk F Klinikum West, Bettenhaus Spitalstrasse 2 G Frauenklinik, Operationstrakt West Spitalstrasse 2 H Rossettibau, Spitalstrasse 26 N Predigerkirche I Bettenhaus 3 K Hebelstrasse L Holsteinerhof, Hebelstrasse 32 M Institut für Pathologie, Schönbeinstrasse 40 N Zentrum für Lehre und Forschung (ZLF), Hebelstrasse 20 O Personalrestaurant, Cafeteria P Markgräflerhof Q Hebelstrasse 2 R Klingelbergstrasse 23 N Tram Universitätsspital Spitalstrasse H 02/3/UF Bus 3, 33, 36, 38, 603, 604 Kinderspital UKBB Bus 33, 36, 38 Universitätsspital Schanzenstrasse Postomat Bus 36, 38, 603, 604 Kinderspital UKBB Bancomat Basler Kantonalbank Informationsporten Spitalstrasse 2 Petersgraben 4 City Parking Einfahrt Schanzenstrasse oder Einfahrt Klingelbergstrasse Haltestellen Basler Verkehrsbetriebe Augenklinik Mittlere Strasse

34 ABSTRACTS ORTSPLAN BASEL 9. Postgradualer Kurs der CAEK Komplikationen in der endokrinen Chirurgie Weil am Rhein 2 3 Altstadt Grossbasel Grenzacherstrasse 6 4 Heuwaag-Viadukt 7 5 Nauentunnel Aschengraben Wettsteinbrücke Universitätsspital Basel Zentrum für Lehre und Forschung (ZLF) Hebelstr Basel 2 Hotel D Blumenrain Basel 3 Basel Schifflände Schifflände Ecke Mittlere Brücke 4 Hotel Basel Münzgasse Basel Rhein Petersgraben 2 Blumenrain Petersgassse Spiegelgasse Münzgasse Schifflände Rhein 3 Eisengasse Altstadt Grossbasel 4 Freie Str. 5 Restaurant Schlüsselzunft Freie Strasse Basel 6 Museum Tinguely Paul Sacher-Anlage Basel 7 Basel SBB (Hauptbahnhof) Centralbahnstrasse Basel Mittlere Brücke 5 Halle/Saale, Februar 205 THEMEN Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) 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

35 IMPRESSUM 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 Berlin T: +49 (0) F: +49 (0) E: FOTONACHWEIS Titelseite: Basel Tourismus Seite 4: Restaurant Schlüsselzunft Seite 4: Basler Personenschifffahrt AG 34. Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie und 45. Jahrestagung der Sektion Schilddrüse der Deutschen Gesellschaft für Endokrinologie Mainz November 205 Tupungato - Fotolia.com Für Programmänderungen, Verschiebungen oder für Ausfälle von Veranstaltungen wird keine Gewähr übernommen. Stand bei Drucklegung: Oktober 204 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 553 Mainz E: endokrine-chirurgie@kkmainz.de Prof. Dr. Matthias M. Weber Universitätsmedizin Mainz. Medizinische Klinik und Poliklinik Endokrinologie und Stoffwechselerkrankungen Langenbeckstr. 553 Mainz E: mmweber@uni-mainz.de Tagungsort Hilton Hotel Mainz Rheinstr Mainz 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 Berlin T: +49 (0) F: +49 (0) E: caek205@porstmann-kongresse.de Chirurgische Arbeitsgemeinschaft Endokrinologie der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) Deutschen Gesellschaft für Endokrinologie Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie 66

36 NOTIZEN AFINITOR strong in three indications Oral mtor-inhibitor with anti-tumour efficacy in mrcc, pnet and abc -3 First choice in 2 nd -line mrcc,4-9 Recommended choice in advanced pnet 0 Breakthrough in HR + advanced breast cancer,2 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 (ESMO, NCCN 2, EAU 3 & EORTC 4 ) consistently recommend AFINITOR after failure of tyrosine-kinase inhibitors (TKI). Swissmedic indication: after sunitinib or sorafenib; pnet: pancreatic neuroendocrine tumour. Motzer RJ et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 2008;372: Yao JC et al. Everolimus for Advanced Pancreatic Neuroendocrine Tumors. New Engl J Med 20;364: Baselga J et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med. 202;366: Escudier B et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 23 (Supplement 7): vii65-vii7, National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer. V Ljungberg B et al. EAU guidelines on renal cell carcinoma: the 200 update. Eur Urol 200;58: de Reijke TM et al. EORTC-GU group expert opinion on metastatic renal cell cancer. European Journal of Cancer 2009;45: Motzer RJ et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 200;6: Afinitor prescribing information, 0. 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 202;95: Yardley DA et al. Everolimus Plus Exemestane in Postmenopausal Patients with HR(+) Breast Cancer: BOLERO-2 Final Progression-Free Survival Analysis. Adv Ther 203;30(0): Gnant M. The Role of Mammalian Target of Rapamycin (mtor) Inhibition in the Treatment of Advanced Breast Cancer. Curr Oncol Rep 203;5:4-23. Afinitor (Everolimus) C: Tablets containing 2.5 mg, 5 mg or 0 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: 0 mg as a single daily dose, at the same time every day, administered orally, with or without food. Adverse effects (grade -4) may require temporary dose reduction and/or interruption of treatment (see 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 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 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 P: Afinitor tablets containing 2.5 mg, 5 mg or 0 mg everolimus: 30 tablets. Sales category: A. * Reimbursed by insurance. For further information, see Novartis Pharma Schweiz Inc., Risch; Address: Suurstoffi 4, 6343 Rotkreuz Tel. 04/763 7, /203 68

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