[Effect of surgical trauma on NK cell activity in esophageal carcinoma after transmediastinal dissection vs. transthoracic en bloc resection]

In order to assess the impact of surgical trauma involved in the therapy of esophageal carcinoma on the cellular immune system, a perspective study was performed involving perioperative hematological parameters. The activity of natural killer cells and the serum concentrations of interleukin-2, interleukin-6 and TNF-alpha were measured in 12 cases of transmediastinal dissection and 10 cases of transthoracic en bloc esophageal resection and compared to values of a control group of thoracic and abdominal surgical patients with non-malignant maladies. Natural killer cells assume a central role in the non-specific immunological response in tumor patients. Their main function is the destruction of tumor cells via cytotoxic activities amplified by the release of interleukin-2 and TNF-alpha. Natural killer cell activity was measured prior to surgery and on postoperative days 4 and 10 using a standardized europium chloride release assay, utilizing K562 target cells. Lymphokines interleukin-2, interleukin-6, and TNF-alpha were also measured on postoperative days 1 and 7 using standardized ELISA assays. The activity of natural killer cells in our patient group sank significantly (P < 0.05) on postoperative day 4 and likewise in the control group and both study groups, activity sank to the original values. In the control group, natural killer cell activity averaged 45% of preoperative values, in comparison with an average of 63% following transmediastinal esophageal carcinoma resection (one cavity procedure), and transthoracic en bloc resection (two cavity procedure). On postoperative day 10, all groups displayed a significant reacceleration of natural killer cell activity (P < 0.05). Whereas transthoracic en bloc resection patients only reached 61% of preoperative values, transmediastinal dissection patients assumed 75%, and 77% was achieved by control group members. Transthoracic en bloc resection of the esophagus led to a more extreme reduction in cytotoxic cellular activity owing to the greater surgical trauma. Suppression of the immunological tumor resistance, especially in the vulnerable perisurgical phase, can have an indirect negative effect on the manifestation risk of hematogenic metastases owing to intraoperative tumor cell dissemination resulting from tumor manipulation and may thus be prognostically relevant.

Value of bronchoscopic pneumonia diagnosis: prospective study

In a prospective clinical study we examined whether bronchoscopically controlled suctioning is preferable to the blind suctioning of mucus aspirates for bacterial identification of intensive care unit patients with pneumonia. Forty patients with clinical and radiologic signs of pneumonia underwent both bronchoscopically controlled and blind endotracheal lavage. Bronchoscopically controlled suctioning did not demonstrate greater sensitivity for identifying organisms than the results obtained from blind suctioning (58 organism were bronchoscopically identified, compared to 57 organisms identified by blind suctioning; p = 0.32, NS). Arterial and mixed venous partial oxygen pressure and shunt also showed no significant differences 15 minutes before and after examination, nor did the blood pressure or pulse. The use of four of the bronchoscopes resulted in preinterventional contamination with Pseudomonas. Bronchoscopically controlled lavage shows no advantages over blind endotracheal lavage for diagnosing pneumonia. Blind suctioning with single-use sterile catheters can be done more quickly and inexpensively with fewer personnel and a lower complication rate.

Quality of life after surgical therapy of bronchogenic carcinoma

Quality of life (QL) after the "curative" resection of non-small cell bronchogenic carcinoma was assessed by patients using the EORTC QL questionnaire (QLQ) and by a psychologist using the Spitzer Index. Quality of life was assessed in 52 patients on one occasion 12 months postoperatively and in 20 patients regularly starting with a preoperative assessment. Self- and external evaluation showed a significant correlation (r = 0.41), but QL was assessed as being higher by the external observer. After surgery it was mainly affected by restrictions related to physical activities, job and household tasks, and disease symptoms, whereas limitations in emotional, social, and financial domains were found less frequently and less severely. Of the different medical (surgical procedures, tumor recurrence) and social factors (sex, marital and employment status), only tumor recurrence was determined to have a significant and negative influence on postoperative QL (P < 0.02). When compared to the preoperative assessment, QL had deteriorated on discharge from hospital but was restored within 3-6 months postoperatively in disease-free patients.

Anastomotic tissue oxygen tension during esophagectomy in patients with esophageal carcinoma

Submucosal tissue oxygen tension (PtO2) was measured in 20 patients with cervical esophagogastrostomy after resection of esophageal carcinoma, using a Clark-type oxygen electrode. The mean gastric baseline PtO2 was 54.6 +/- 10.7 mm Hg. Following ligature of the vasa brevia and the left gastroepiploic artery PtO2 decreased to 45.8 +/- 9.9 mm Hg, ligature of the left gastric artery caused a decrease to 34.2 +/- 9.7 mm Hg and resection of the lesser curvature and pulling up of gastric tube led to 25.5 +/- 9.0 mm Hg. Clinical value and practicability of intraoperative PtO2 measurements could be proven.

Isolated hyperthermic perfusion with mitoxantrone of melphalan in malignant melanoma of the limb

BACKGROUND

Melphalan administered by isolated hyperthermic perfusion of the affected limb is an accepted treatment for malignant melanoma of the extremities. In contrast, pharmacologic and phase I studies suggest that, because of its high uptake, mitoxantrone may give even better local control, but data on survival, onset of metastases, and local and systemic toxicities have not yet been reported.

METHODS

A matched-pairs comparison was performed to examine differences in the tolerability and effectiveness of isolated hyperthermic extremity perfusion with mitoxantrone (n = 44) and melphalan (n = 44) in high risk and locoregionally (P < 0.41) metastatic malignant melanoma. Criteria evaluated were local and systemic complications, and recurrence-free and overall survival.

RESULTS

Local complications, such as delayed wound healing, were more frequent in the mitoxantrone (27.9%) than in the melphalan group (9.8%) (P < 0.05). Systemic toxicity, in particular bone marrow toxicity, was also more severe with mitoxantrone (78.6% versus 15.4%, P < 0.001). Hepatotoxic effects were more frequent among patients in the melphalan group who were older and has lower tissue perfusion temperatures (P < 0.05). There was no difference between the two groups in overall or recurrence-free survival (P < 0.41).

CONCLUSIONS

Local and systemic toxicity seem to be higher with mitoxantrone. Survival rates were similar with both drugs. The data obtained suggest a randomized phase II study with an appropriate number of patients.

Immunostimulation by propionibacteria--effects on immune status and antineoplastic treatment

Experimental studies were performed to investigate further the effects of immunotherapy with Propionibacterium avidum KP-40 on thymocyte proliferation, maturation and emigration in BALB/c-mice. Thymus weight and thymocyte counts, especially cells presenting the immature or cytotoxic/suppressor phenotype were significantly increased. Due to enhanced emigration, peripheral blood lymphocyte and monocyte counts as well as expression of activation markers were significantly upregulated. The antimetastatic effect of Propionibacterium avidum KP-40 was demonstrated in BALB/c-mice, where RAW 117-H10 lymphosarcoma liver colonization was significantly reduced after immunostimulation. Clinical investigations proved that surgical treatment of colorectal carcinoma induced an evident decrease of peripheral blood lymphocytes as compared with preoperative counts. However, single preoperative Propionibacterium avidum KP-40 administration induced a considerable increase of peripheral white blood cell counts, especially lymphocytes. Clinical effects of preoperative immunostimulation by Propionibacterium granulosum KP-45 were investigated in a prospective randomized trial in colorectal carcinoma patients. Positive effects on survival time, local tumor recurrence and distant metastasis could be demonstrated in stages I and II, whereas no advantage of immunotherapy was found in advanced stages III and IV. A recent prospective randomized clinical trial was initiated on the quality of life of colorectal carcinoma patients. Three months after surgical treatment negative effects could not be determined after immunotherapy. Quality of life even proved to be better in patients with abdominoperineal resection as compared to non Propionibacterium avidum KP-40 treated control patients.

[Ileocecal tuberculosis as rare differential diagnosis of lower abdominal tumor]

Tuberculosis is extremely rare in Germany today. Diagnosis of extrapulmonary tuberculosis has proved to be particularly difficult and a correct diagnosis can take months. The danger of fatality is high. In the case of a 29 year old male paraplegic patient suffering from enteral tuberculosis, diagnosis was possible only after several weeks of onward observation, extreme physical degeneration and finally, a laparotomy.

Middle and lower third rectum carcinoma: sphincter saving or abdominoperineal resection?

Sphincter saving resections (SSR) are performed with increasing frequency in carcinoma of the lower and middle third of the rectum. In this retrospective study local and distant recurrence and survival were compared to abdominoperineal resection (APR). In 71 women and 71 men (mean age: 64 years) with a primary adenocarcinoma between 5 and 10 cm from the anal verge 89 SSR, and 53 APR, were performed (Dukes stages--SSR--A 19%; B 30.3%; C 50.7% vs APR--A 15%; B 45.3%; C 39.6%). Patients have been followed up for a minimum of 24 months (mean time 62 months). There were no differences in intraluminal diameters of the tumours in each operative procedure. The distal tumour-free distance was more than 6 cm in 52% after APR (SSR: 10%) and less than 3 cm in 43% after SSR. Survival was not different between procedures in Dukes stages A and B. A survival advantage for patients with Dukes C carcinoma after APR did not reach statistical significance. No differences in distant spread were found for SSR (Dukes stage A 0%; B 7%; C 18%) and APR (Dukes stage A 0%; B 8%; C 14%) for local recurrence in Dukes stages A and B after SSR (A and B 0%) and APR (A 0%; B 8%) whereas a significant increase in local recurrence rate was seen in Dukes stage C after SSR (24% vs, APR 5%). Although a further resection could be performed in almost all of these patients a negative effect of local recurrence on survival occurred (25.4 months with and 80 months without local recurrence). While SSR seems to be favourable in Dukes stages A and B, APR should be considered in carcinoma of the lower and middle third of the rectum with lymphatic spread. Effective preoperative staging determines selection of the appropriate operation.

Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study

Postoperative radiation therapy following curative resection of squamous cell carcinoma of the esophagus was investigated in a prospective randomized study. A group of 33 patients received postoperative radiation therapy and were compared to a control group of 35 patients treated by surgery alone. No statistically significant differences were noted between the two treatment groups concerning overall and disease-free survival rates. Postoperative irradiation significantly increased the incidence of fibrotic strictures of the esophagogastric or esophagocolonic anastomoses and caused a delayed recovery of patients quality of life. Based on these results, we believe that postoperative radiation therapy alone cannot be advocated as a adjuvant therapy following curative resection of squamous cell carcinoma of the esophagus.

[Should a pyloroplasty be carried out in stomach transposition after subtotal esophagectomy with esophago-gastric anastomosis at the neck? A prospective randomized study]

The effects of pyloroplasty following subtotal oesophagectomy and gastric substitution with cervical oesophago-gastric anastomosis were studied in a prospective randomized trial. 52 patients received extramucosal pyloroplasty and were compared to a control group of 55 patients, in whom no drainage procedure was performed. 6 patients died postoperatively. One of these patients died following the insufficiency of pyloroplasty. The other causes of death were not related to the performance or non-performance of pyloroplasty. Regarding to patients subjective self-assessment of abdominal discomfort and radiologic emptying of the gastric tube no statistical significant differences between both groups were noted 2 weeks and 6 months postoperatively. Two patients with pyloroplasty, but no patient of the control group, suffered 12 months postoperatively from severe vomiting due to fibrotic stricture of the pylorus. The results of this study suggest, that usually no pyloroplasty should be performed following subtotal oesophagectomy and interposition of a gastric tube with oesophagogastric anastomosis in the neck.

Diagnosis, treatment and prognosis of the leiomyosarcoma of the inferior vena cava. Three cases and summary of published reports

OBJECTIVE

To describe our experience with three cases of leiomyosarcoma of the inferior vena cava, and summarise current methods of diagnosis and treatment.

DESIGN

Descriptive study.

SETTING

University hospital, Germany.

SUBJECTS

3 Patients with histologically confirmed leiomyosarcoma of the inferior vena cava.

INTERVENTIONS

Resection, with or without vascular reconstruction.

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

Case 1 was diagnosed on magnetic resonance imaging, the tumour was resected, and the vena cava replaced with a polytetrafluoroethylene (PTFE) graft. She made an uncomplicated recovery and was well and free of symptoms 10 months later. Case 2 was diagnosed at operation (the differential diagnosis on computed tomography was a retroperitoneal tumour), the tumour was resected, and the defect oversewn. She made an uneventful recovery and was well and free of symptoms 14 months later. Case 3 was diagnosed at operation (a diagnosis of pancreatic cancer had been made preoperatively), the tumour was resected, and the defect oversewn. She was well and free of symptoms 10 months after operation.

CONCLUSIONS

Magnetic resonance imaging is superior to computed tomography in the diagnosis of leiomyosarcoma of the inferior vena cava. The treatment of choice is resection; small defects can be closed by suture or PTFE patch, and large defects by PTFE prostheses. Reported resectability is 40% to 60%, but the prognosis is poor; the local recurrence rate is about 36%, most patients are dead within 2.5 years, and the 5-year survival is 30%. Chemotherapy and radiotherapy will give some degree of palliation, but do not affect the outcome.

[The value of systematized follow-up studies after resection of a stomach carcinoma]

A retrospective study of the possible value of standardized follow-up examinations was undertaken in a group of 251 patients (163 men, 88 women; mean age at diagnosis 58 [33-78] years) who had undergone putatively curative gastric resection for adenocarcinoma between 1.1. 1978 and 31. 12. 1987 and had survived at least 3 months after the operation. 113 patients (45%) regularly had follow-up examinations according to a standardized diagnostic protocol, 67 (27%) only irregularly, while 71 (28%) had none. Follow-up examination revealed tumour recurrence in 53 patients (30%), which in 18 (34%) was still asymptomatic. In one of these patients resection of the recurrence was again undertaken with curative intent, a palliative operation was performed in five, chemotherapy in seven, three received radiotherapy and 37 were treated purely symptomatically. The results do not indicate that the survival rate was improved by the standardized follow-up protocol and it is concluded that symptom-oriented and individualized follow-up examination without standardized protocol is sufficient in this type of case, except for scientific purposes.

Importance of lectins for the prevention of bacterial infections and cancer metastases

Adhesion of bacteria and of metastasizing tumour cells have much in common, especially the participation of lectins in this process. In the future it might be possible to inhibit the metastatic process and bacterial adhesion by blocking with lectins specific for appropriate (oligo) saccharides or glycoconjugates. Initial clinical trials are very promising.

In vitro and in vivo viability assessment of unpurified pancreatic islet tissue

The viability of porcine collagenase-prepared islet preparations (n = 16) was classified by 31P-NMR spectroscopy, staining by neutral red and trypan blue, and in vitro insulin secretion following glucose challenge. Vital islets exhibited a phosphate diester/phosphate monoester (PDE/PME) ratio of 0.5-0.9, a staining score of 18-30 and an insulin secretion responding well to glucose challenge. Damaged islets performed at a PDE/PME of 0.2-0.49 and a staining score of 9-17 and necrotic islets had 0.0-0.49 and a staining score of 9-17 and necrotic islets had 0.0-0.19 and 0-8, respectively. The islets of the latter two groups did not adequately respond to glucose. The in vivo function following autotransplantation of these islets into the spleen was investigated in five recipients of more than 3000/kg vital islets of which 4 expressed daily normoglycemia (< 200 mg%), normalized intravenous glucose tolerance (K = -2.21), and a prolonged survival (mean +/- SD) of 167 +/- 12 days compared to five recipients of > 3000/kg damaged islets (K = -0.814) (P = 0.0017) and a survival of 86 +/- 21 days (P = 0.0096). It is suggested that 31P-NMR spectroscopy is a valuable and practical method to predict islet graft viability prior to transplantation in order to assure good graft function in the recipient.

[The effectiveness of standardized follow-up studies after resection of non-small cell bronchial carcinoma]

The outcomes of 190 patients in whom a non-small-cell bronchogenic carcinoma had been resected with curative intent in the Department of Surgery, University of Cologne, between 1. 1. 1977 and 31. 12. 1987 were analysed retrospectively. Sixty-seven (35%) of these patients underwent regular, 64 (34%) irregular, and 59 (31%) no standardized follow-up programmes. During follow-up procedures tumour recurrences were detected in 33 patients (25%). Thirteen (39%) of these recurrences were completely asymptomatic at the time of diagnosis. Three recurrences (9%) were resected with curative intent, but the patients died between 14 and 17 months later due to recurrent disease. Seven recurrences (21%) were treated by radiotherapy, three (9%) by chemotherapy, and 20 patients (61%) received no oncologic therapy. The survival rates after diagnosis of recurrence were not affected by the type of treatment or by the presence of clinical symptoms. There is no evidence that long-term results following resection of non-small-cell bronchogenic carcinoma can be improved by regular and standardized follow-up programmes. The observed incidence of postoperative pulmonary disorders and the patients' self-assessment underline the necessity for postoperative care after resection of bronchogenic carcinoma. Apart from clinical studies, follow-up should primarily focus on individual symptoms and should no longer include standardized investigations in asymptomatic patients except occasional X-ray checks of the thorax.

[Preliminary experiences with thoracoscopic operations]

During the period March 3, 1992 to September 30, 1993 36 video-assisted thoracoscopic operations were performed at the Surgical Department of the University of Cologne. In 12 cases wedge resection of peripheral pulmonary nodules were carried out. Two of the patients underwent video-assisted thoracoscopic lobectomy of the left lower lobe due to peripheral primary bronchogenic carcinoma. In 6 cases biopsy of the lung or pleura was undertaken. Further indications were partial pleurectomy and resection of blebs (n = 12). Pleural effusion was drained under thoracoscopic vision twice. No intraoperative complications occurred. Two patients proceeded to thoracotomy after persistence of pneumothorax following thoracoscopic pleurectomy. The postoperative course of the remaining patients was uneventful and was especially characterized by the reduction in pain and disability. In accordance to the experience of other authors we believe that thoracoscopic surgery is a method with a promising future. Further investigations have to evaluate indications, different techniques, and long term results.

Randomised trial of monoclonal antibody for adjuvant therapy of resected Dukes' C colorectal carcinoma. German Cancer Aid 17-1A Study Group

Over the past decade various clinical trials have used monoclonal antibodies as therapeutic agents against solid tumours. No consistent pattern of response or improved survival has yet emerged although antigenic heterogeneity and insufficient accessibility of cells in advanced tumours have been offered as explanations for these failures. We designed a study in which a monoclonal antibody was used to target minimal residual disease in an early stage of tumour cell dissemination in patients with colorectal cancer. Only patients in Dukes' stage C who had undergone curative surgery and were free of manifest residual tumour were admitted. 189 patients with colorectal cancer of stage Dukes' C were randomly assigned to an observation regimen or to postoperative treatment with 500 mg of 17-1A antibody, followed by four 100 mg infusions each month. A balance of risk factors in the two groups was achieved by dynamic randomisation procedure. After a median follow-up of 5 years, antibody treatment reduced the overall death rate by 30% (Cox's proportional hazard, p = 0.04, log-rank p = 0.05) and decreased the recurrence rate by 27% (p = 0.03, p = 0.05). The effect of antibody was most pronounced in patients who had distant metastasis as first sign of a relapse (p = 0.0014, p = 0.002), an effect that was not seen for local relapses (p = 0.74, p = 0.67). Toxic effects of 17-1A antibody were infrequent, consisting mainly of mild constitutional and gastrointestinal symptoms. During 371 infusions four anaphylactic reactions were seen, all controllable by intravenous steroids and none necessitated admission to hospital. Adjuvant therapy with 17-1A antibody extends life and prolongs remission in patients with colorectal cancer of Dukes' stage C.

Preoperative immunostimulation by Propionibacterium granulosum KP-45 in colorectal cancer

In order to improve the perioperative resistance to the spread of cancer during operation the effect of preoperative stimulation of the immunesystem by Propionibacterium granulosum KP-45 was investigated in patients with colorectal carcinoma. In a prospective randomized trial 101 patients were allocated to either treatment (n = 51) or control (n = 50). In the treatment 10 mg of Propioni bacteria were administered intravenously between the seventh and third day prior to surgical treatment. At the time of operation 21 tumours were classified as stage I (treatment n = 12, control n = 9), 22 as stage II (treatment n = 10, control n = 2). Postoperatively wound infections requiring treatment were more prevalent in the control group (n = 4) than in the treated group (n = 0). All patients were subsequently followed up for 76 months. For stage I carcinoma the survival rates, excluding perioperative deaths, were 91% in the treated and 63% in the control group respectively. One case of tumour metastasis was seen in the control group. For stage II carcinoma the survival rate was 90% for the treated group with distant spread in 1 case and 45% in the control group where the rate of recurrence was 55%. For stages III and IV there was no statistically significant difference in survival between the treated and the control groups.

Prospective randomized study of preoperative bowel cleansing for patients undergoing colorectal surgery

Three different methods of preoperative bowel preparation were tested in a prospective randomized trial examining efficacy and morbidity. In all, 163 patients were treated by gut irrigation with Ringer's lactate, Prepacol or polyethylene glycol (PEG). Fluid retention, cleansing effect, postoperative complications and subjective acceptance were documented. Relevant weight gain and decrease in haematocrit indicating fluid retention were seen only after the use of Ringer's lactate. There were no significant differences in bowel cleansing. In the Prepacol group the postoperative complication rate was significantly increased. Prepacol was tolerated best, with few side-effects. PEG was better tolerated than Ringer's lactate, but vomiting occurred in 2 and 21 per cent of patients respectively. PEG is most suitable for bowel preparation in patients undergoing colorectal surgery.

The impact of patient's age on surgical therapy of colorectal liver metastases

In a consecutive series of 90 hepatic resections for colorectal liver metastases which were performed during a 10-year period at one institution, the influence of patient's age on surgical strategies and postoperative results was investigated. The mean age of all patients was 61 +/- 11 years with a range from 27-78 years; 19 patients (21%) were younger than 50 years and 18 patients (20%) were older than 70 years. Thirty-six (40%) major and 54 (60%) minor hepatic resections were performed. The postoperative complication rate was 26% and resection mortality 3%. Estimated overall median survival time was 27 months, operative mortality included. 1-, 3-, and 5-year survival rates were 78%, 45%, and 32%, respectively. Although there is some suggestion that selection criteria are more aggressive in younger patients, neither surgical procedures nor postoperative results were found to be determined by the numeric age of the patient in a significant way.

Closure of partial median sternotomy with absorbable sutures: a practical and safe option

A technique for the closure of upper median sternotomy with absorbable polyglycolid acid sutures is described. In a consecutive series of 130 refixations, no major complications occurred. After a mean follow-up period of 66 +/- 61 months, the long-term results concerning sternotomy closure were determined in 86 patients: 84 (98%) sternotomies were completely consolidated, in 75 cases (87%) without any dislocation and in nine cases (11%) with a minor dislocation in the transverse osteotomy. In two patients (2%) who had received postoperative radio- and chemotherapy, an isolated pseudarthrosis of the transverse osteotomy was observed, whereas the median sternotomy was consolidated completely. As a result of our clinical experience, we consider the closure of partial upper sternotomy with absorbable polyglycoid acid sutures as a practical and safe technique.

Prospective randomized study of one- or two-layer anastomosis following oesophageal resection and cervical oesophagogastrostomy

In a prospective randomized study, one- and two-layer anastomoses were compared following subtotal oesophagectomy and gastric substitution with cervical oesophagogastric anastomosis. After 54 one- and 53 two-layer procedures the rates of anastomotic leakage were the same (19 per cent). After a mean follow-up of 44 weeks, 13 of 51 patients (25 per cent) undergoing one-layer anastomosis and 28 of 50 (56 per cent) having the two-layer procedure complained of cervical dysphagia and required dilatation. The anastomotic strictures were fibrotic in 11 of 51 patients (22 per cent) undergoing one-layer anastomosis and in 24 of 50 (48 per cent) receiving the two-layer operation. Strictures were malignant in two and four patients (4 and 8 per cent) respectively. The lower incidence of fibrotic stricture following one-layer anastomosis was significant (P < 0.01), but not that of malignant stricture. With comparable leakage rates, one-layer anastomosis is superior to the two-layer procedure because of the lower incidence of fibrotic stricture.

[Pyogenic liver abscess. Analysis and follow-up examination of a personal patient sample 1981-1992]

From January 1, 1981 to January 1, 1992 a total of 30 liver abscesses were treated in the University Clinic for Surgery in Cologne. 23 patients underwent an primary operative treatment and seven patients received a controlled guided percutaneous drainage. During the observation period four patients (13.3%) died by the effect of the liver abscess. 20 patients (66.7%) were subjected to clinical, laboratorical and computertomographical post examinations. The primary rate of operation success amounted to 47.8%, that of controlled guided percutaneous drainage of 42.8% (NS). The secondary success rate (that means after successful operative reintervention) amounted to 86.9% by the operative and to 85.7% by the percutaneous drainaged cases. During the post examination no relapse was determinated. Larger or chambered liver abscesses as well as extrahepatic spreading required operative drainage and, in cases of multifocal spreading, a resection with concomitant antibiotics. In case of solitary abscesses the controlled guided percutaneous drainage is the least harmful and low-prices method.