1
|
Andric M, Stockheim J, Rahimli M, Al-Madhi S, Acciuffi S, Dölling M, Croner RS, Perrakis A. Influence of Certification Program on Treatment Quality and Survival for Rectal Cancer Patients in Germany: Results of 13 Certified Centers in Collaboration with AN Institute. Cancers (Basel) 2024; 16:1496. [PMID: 38672577 PMCID: PMC11047918 DOI: 10.3390/cancers16081496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The certification of oncological units as colorectal cancer centers (CrCCs) has been proposed to standardize oncological treatment and improve the outcomes for patients with colorectal cancer (CRC). The proportion of patients with CRC in Germany that are treated by a certified center is around 53%. Lately, the effect of certification on the treatment outcomes has been critically discussed. AIM Our aim was to investigate the treatment outcomes in patients with rectal carcinoma at certified CrCCs, in German hospitals of different medical care levels. METHODS We performed a retrospective analysis of a prospective, multicentric database (AN Institute) of adult patients who underwent surgery for rectal carcinoma between 2002 and 2016. We included 563 patients from 13 hospitals of different medical care levels (basic, priority, and maximal care) over periods of 5 years before and after certification. RESULTS The certified CrCCs showed a significant increase in the use of laparoscopic approach for rectal cancer surgery (5% vs. 55%, p < 0.001). However, we observed a significantly prolonged mean duration of surgery in certified CrCCs (161 Min. vs. 192 Min., p < 0.001). The overall morbidity did not improve (32% vs. 38%, p = 0.174), but the appearance of postoperative stool fistulas decreased significantly in certified CrCCs (2% vs. 0%, p = 0.036). Concerning the overall in-hospital mortality, we registered a positive trend in certified centers during the five-year period after the certification (5% vs. 3%, p = 0.190). The length of preoperative hospitalization (preop. LOS) was shortened significantly (4.71 vs. 4.13 days, p < 0.001), while the overall length of in-hospital stays was also shorter in certified CrCCs (20.32 vs. 19.54 days, p = 0.065). We registered a clear advantage in detailed, high-quality histopathological examinations regarding the N, L, V, and M.E.R.C.U.R.Y. statuses. In the performed subgroup analysis, a significantly longer overall survival after certification was registered for maximal medical care units (p = 0.029) and in patients with UICC stage IV disease (p = 0.041). In patients with UICC stage III disease, we registered a slightly non-significant improvement in the disease-free survival (UICC III: p = 0.050). CONCLUSIONS The results of the present study indicate an improvement in terms of the treatment quality and outcomes in certified CrCCs, which is enforced by certification-specific aspects such as a more differentiated surgical approach, a lower rate of certain postoperative complications, and a multidisciplinary approach. Further prospective clinical trials are necessary to investigate the influence of certification in the treatment of CRC patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (M.A.); (J.S.); (M.R.); (S.A.-M.); (S.A.); (M.D.); (R.S.C.)
| |
Collapse
|
2
|
Chikunova A, Manley MP, Heijjer CN, Drenth CS, Cramer-Blok AJ, Ahmad MUD, Perrakis A, Ubbink M. Conserved proline residues prevent dimerization and aggregation in the β-lactamase BlaC. Protein Sci 2024; 33:e4972. [PMID: 38533527 DOI: 10.1002/pro.4972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
Evolution leads to conservation of amino acid residues in protein families. Conserved proline residues are usually considered to ensure the correct folding and to stabilize the three-dimensional structure. Surprisingly, proline residues that are highly conserved in class A β-lactamases were found to tolerate various substitutions without large losses in enzyme activity. We investigated the roles of three conserved prolines at positions 107, 226, and 258 in the β-lactamase BlaC from Mycobacterium tuberculosis and found that mutations can lead to dimerization of the enzyme and an overall less stable protein that is prone to aggregate over time. For the variant Pro107Thr, the crystal structure shows dimer formation resembling domain swapping. It is concluded that the proline substitutions loosen the structure, enhancing multimerization. Even though the enzyme does not lose its properties without the conserved proline residues, the prolines ensure the long-term structural integrity of the enzyme.
Collapse
Affiliation(s)
- A Chikunova
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - M P Manley
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - C N Heijjer
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - C S Drenth
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - A J Cramer-Blok
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - M Ud Din Ahmad
- Division of Biochemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Division of Biochemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Perrakis
- Division of Biochemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Division of Biochemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Ubbink
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
- Department of Infectious Diseases, Imperial College, London, UK
- Zocdoc, New York City, New York, USA
- ZoBio BV, Leiden, The Netherlands
| |
Collapse
|
3
|
Al-Madhi S, Acciuffi S, Meyer F, Dölling M, Beythien A, Andric M, Rahimli M, Croner RS, Perrakis A. The Pancreas as a Target of Metastasis from Renal Cell Carcinoma: Is Surgery Feasible and Safe? A Single-Center Experience in a High-Volume and Certified Pancreatic Surgery Center in Germany. J Clin Med 2024; 13:1921. [PMID: 38610686 PMCID: PMC11012243 DOI: 10.3390/jcm13071921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Secondary malignant tumors of the pancreas are rare, representing 2-5% of all pancreatic malignancies. Nevertheless, the pancreas is one of the target organs in cases of metastatic clear cell renal cell carcinoma (CCRCC). Additionally, recurrent metastasis may occur. Surgical resection remains the best and prognostically most favorable therapeutic option in cases of solitary pancreatic metastasis. Aim: To review retrospectively the clinical tumor registry of the University Hospital of Magdeburg, Germany, for this rare entity, performing a clinical systematic single-center observational study (design). Methods: A retrospective cohort analysis of consecutive patients who had undergone pancreatic resection for metastatic CCRC was performed in a single high-volume certified center for pancreatic surgery in Germany from 2010 to 2022. Results: All patients (n = 17) included in this study had a metachronous metastasis from a CCRCC. Surgery was performed at a median time interval of 12 (range, 9-16) years after primary resection for CCRCC. All 17 patients were asymptomatic at the time of diagnosis. Three of those patients (17.6%) presented with recurrent metastasis in a different part of the pancreas during follow-up. In a total of 17 patients, including those with recurrent disease, a surgical resection was performed; Pancreatoduodenectomy was performed in 6 patients (35%); left pancreatectomy with splenectomy was performed in 7 patients (41%). The rest of the patients underwent either a spleen-preserving pancreatic tail resection, local resection of the tumor lesion or a total pancreatectomy. The postoperative mortality rate was 6%. Concerning histopathological findings, seven patients (41%) had multifocal metastasis. An R0 resection could be achieved in all cases. The overall survival at one, three and five years was 85%, 85% and 72%, respectively, during a median follow-up of 43 months. Conclusions: CCRC pancreatic metastases can occur many years after the initial treatment of the primary tumor. Surgery for such a malignancy seems feasible and safe; it offers very good short- and long-term outcomes, as indicated. A repeated pancreatic resection can also be safely performed.
Collapse
Affiliation(s)
- Sara Al-Madhi
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University with University Hospital, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.A.); (F.M.); (A.B.); (M.A.); (M.R.); (R.S.C.); (A.P.)
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Arend J, Franz M, Rose A, March C, Rahimli M, Perrakis A, Lorenz E, Croner R. Robotic Complete ALPPS (rALPPS)-First German Experiences. Cancers (Basel) 2024; 16:1070. [PMID: 38473426 DOI: 10.3390/cancers16051070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND ALPPS leads to fast and effective liver hypertrophy. This enables the resection of extended tumors. Conventional ALPPS is associated with high morbidity and mortality. MILS reduces morbidity and the robot adds technical features that make complex procedures safe. MATERIAL AND METHODS The MD-MILS was screened for patients who underwent rALPPS. Demographic and perioperative data were evaluated retrospectively. Ninety days postoperative morbidity was scored according to the CD classification. The findings were compared with the literature. RESULTS Since November 2021, five patients have been identified. The mean age and BMI of the patients were 50.0 years and 22.7 kg/m2. In four cases, patients suffered from colorectal liver metastases and, in one case, intrahepatic cholangiocarcinoma. Prior to the first operation, the mean liver volume of the residual left liver was 380.9 mL with a FLR-BWR of 0.677%. Prior to the second operation, the mean volume of the residual liver was 529.8 mL with a FLR-BWR of 0.947%. This was an increase of 41.9% of the residual liver volume. The first and second operations were carried out within 17.8 days. The mean time of the first and second operations was 341.2 min and 440.6 min. The mean hospital stay was 27.2 days. Histopathology showed the largest tumor size of 39 mm in diameter with a mean amount of 4.7 tumors. The mean tumor-free margin was 12.3 mm. One complication CD > 3a occurred. No patient died during the 90-day follow up. CONCLUSION In the first German series, we demonstrated that rALPPS can be carried out safely with reduced morbidity and mortality in selected patients.
Collapse
Affiliation(s)
- Jörg Arend
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Mareike Franz
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Rose
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Christine March
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Eric Lorenz
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| |
Collapse
|
5
|
Shi W, Wartmann T, Accuffi S, Al-Madhi S, Perrakis A, Kahlert C, Link A, Venerito M, Keitel-Anselmino V, Bruns C, Croner RS, Zhao Y, Kahlert UD. Integrating a microRNA signature as a liquid biopsy-based tool for the early diagnosis and prediction of potential therapeutic targets in pancreatic cancer. Br J Cancer 2024; 130:125-134. [PMID: 37950093 PMCID: PMC10781694 DOI: 10.1038/s41416-023-02488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Pancreatic cancer is a highly aggressive cancer, and early diagnosis significantly improves patient prognosis due to the early implementation of curative-intent surgery. Our study aimed to implement machine-learning algorithms to aid in early pancreatic cancer diagnosis based on minimally invasive liquid biopsies. MATERIALS AND METHODS The analysis data were derived from nine public pancreatic cancer miRNA datasets and two sequencing datasets from 26 pancreatic cancer patients treated in our medical center, featuring small RNAseq data for patient-matched tumor and non-tumor samples and serum. Upon batch-effect removal, systematic analyses for differences between paired tissue and serum samples were performed. The robust rank aggregation (RRA) algorithm was used to reveal feature markers that were co-expressed by both sample types. The repeatability and real-world significance of the enriched markers were then determined by validating their expression in our patients' serum. The top candidate markers were used to assess the accuracy of predicting pancreatic cancer through four machine learning methods. Notably, these markers were also applied for the identification of pancreatic cancer and pancreatitis. Finally, we explored the clinical prognostic value, candidate targets and predict possible regulatory cell biology mechanisms involved. RESULTS Our multicenter analysis identified hsa-miR-1246, hsa-miR-205-5p, and hsa-miR-191-5p as promising candidate serum biomarkers to identify pancreatic cancer. In the test dataset, the accuracy values of the prediction model applied via four methods were 94.4%, 84.9%, 82.3%, and 83.3%, respectively. In the real-world study, the accuracy values of this miRNA signatures were 82.3%, 83.5%, 79.0%, and 82.2. Moreover, elevated levels of these miRNAs were significant indicators of advanced disease stage and allowed the discrimination of pancreatitis from pancreatic cancer with an accuracy rate of 91.5%. Elevated expression of hsa-miR-205-5p, a previously undescribed blood marker for pancreatic cancer, is associated with negative clinical outcomes in patients. CONCLUSION A panel of three miRNAs was developed with satisfactory statistical and computational performance in real-world data. Circulating hsa-miRNA 205-5p serum levels serve as a minimally invasive, early detection tool for pancreatic cancer diagnosis and disease staging and might help monitor therapy success.
Collapse
Affiliation(s)
- Wenjie Shi
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Thomas Wartmann
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Sara Accuffi
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Sara Al-Madhi
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Christoph Kahlert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, 39120, Magdeburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, 39120, Magdeburg, Germany
| | - Verena Keitel-Anselmino
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, 39120, Magdeburg, Germany
| | - Christiane Bruns
- Faculty of Medicine and University Hospital Cologne, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Roland S Croner
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany
| | - Yue Zhao
- Faculty of Medicine and University Hospital Cologne, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
| | - Ulf D Kahlert
- Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg, Magdeburg, Germany.
| |
Collapse
|
6
|
Schaufler A, Sanin AY, Sandalcioglu IE, Hartmann K, Croner RS, Perrakis A, Wartmann T, Boese A, Kahlert UD, Fischer I. Concept of a fully-implantable system to monitor tumor recurrence. Sci Rep 2023; 13:16362. [PMID: 37773315 PMCID: PMC10541913 DOI: 10.1038/s41598-023-43226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023] Open
Abstract
Current treatment for glioblastoma includes tumor resection followed by radiation, chemotherapy, and periodic post-operative examinations. Despite combination therapies, patients face a poor prognosis and eventual recurrence, which often occurs at the resection site. With standard MRI imaging surveillance, histologic changes may be overlooked or misinterpreted, leading to erroneous conclusions about the course of adjuvant therapy and subsequent interventions. To address these challenges, we propose an implantable system for accurate continuous recurrence monitoring that employs optical sensing of fluorescently labeled cancer cells and is implanted in the resection cavity during the final stage of tumor resection. We demonstrate the feasibility of the sensing principle using miniaturized system components, optical tissue phantoms, and porcine brain tissue in a series of experimental trials. Subsequently, the system electronics are extended to include circuitry for wireless energy transfer and power management and verified through electromagnetic field, circuit simulations and test of an evaluation board. Finally, a holistic conceptual system design is presented and visualized. This novel approach to monitor glioblastoma patients is intended to early detect recurrent cancerous tissue and enable personalization and optimization of therapy thus potentially improving overall prognosis.
Collapse
Affiliation(s)
- Anna Schaufler
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- Department of Neurosurgery, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- INKA Health Tech Innovation Lab., Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Ahmed Y Sanin
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Karl Hartmann
- Department of Neurosurgery, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Roland S Croner
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Aristotelis Perrakis
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Thomas Wartmann
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Axel Boese
- INKA Health Tech Innovation Lab., Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Ulf D Kahlert
- Molecular and Experimental Surgery, Clinic for General-, Visceral-, Vascular - and Transplant Surgery, Faculty of Medicine, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Igor Fischer
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225, Düsseldorf, Germany.
| |
Collapse
|
7
|
Schildberg C, Kropf S, Perrakis A, Croner RS, Meyer F. [Consultations by senior physicians in general and abdominal surgery for other medical disciplines over 10 years at a tertiary center-Is a fast time-consuming processing necessary? : Spectrum of clinical findings, diagnoses and treatment decision making]. Chirurgie (Heidelb) 2023; 94:625-634. [PMID: 36991159 PMCID: PMC10310552 DOI: 10.1007/s00104-023-01855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The challenges of an adequate, efficient and rational medical treatment and care of patients are always associated with an interprofessional activity of several specialist disciplines. AIM The spectrum of variable diagnoses and the profile of surgical decision-making with further surgical measures within the framework of senior physician consultation in general and visceral surgery for neighboring medical disciplines were analyzed on a representative patient cohort over a defined observational time period. PATIENTS AND METHODS All consecutive patients (n = 549 cases) were documented as part of a clinical systematic prospective single center observational study at a tertiary center using a computer-based patient registry over 10 years (1 October 2006-30 September 2016). The data were analyzed with respect to the spectrum of clinical findings, diagnoses, treatment decisions and the influencing factors as well as gender and age differences and time-dependent developmental trends using χ2-tests and U‑tests. RESULTS (KEY POINTS) The predominant discipline for requests for surgical consultation was cardiology (19.9%) followed by surgical disciplines (11.8%) and gastroenterology (11.3%). Disorders of wound healing (7.1%) and acute abdomen (7.1%) were predominant in the diagnostic profile. In 11.7% of the patients the indications for immediate surgery were derived, whereas in 12.9% elective surgery was recommended. The conformity rate of suspected and definitive diagnoses was only 58.4%. CONCLUSION The surgical consultation work is an important mainstay of a sufficient and especially timely clarification of surgically relevant questions in nearly all medical institutions and especially in a center. This serves i) the quality assurance of surgery in the clinical care of patients with need of additional interdisciplinary needs for surgical treatment in the daily practice of general and abdominal surgery in research on clinical care, ii) clinical marketing and monetary aspects in the sense of patient recruitment and iii) last but not least to provide emergency care of patients. Due to the high proportion of 12% of subsequent emergency operations, which were derived from requests for general and visceral surgical consultations, such requests must be processed promptly during working hours.
Collapse
Affiliation(s)
- C Schildberg
- Klinik für Allgemein und Viszeralchirurgie, Universitätsklinikum der MHB im Verbund Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Deutschland.
| | - S Kropf
- Institut für Biometrie und Medizinische Informatik, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - A Perrakis
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - R S Croner
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - F Meyer
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| |
Collapse
|
8
|
Andric M, Stockheim J, Rahimli M, Klös M, Esser T, Soldatovic I, Dölling M, Al-Madhi S, Acciuffi S, Croner R, Perrakis A. Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany. Innov Surg Sci 2023; 8:39-48. [PMID: 38058775 PMCID: PMC10696938 DOI: 10.1515/iss-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/03/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg. Methods Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649 days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649 days). Subgroup analysis related to conservative or surgical treatment has been performed. Results A total of 385 patients was included in the study, 203 (52.73 %) during Non-COVID-19 period and 182 (47.27 %) during COVID-19 period. Mean age of entire collective was 43.28 years, containing 43.9 % female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7 % of entire collective), increasing from 9.9 % to 15.9 % during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3 % (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5 % vs. 13.1 %, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3 % (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57 days vs. 3.16 days, p<0.001) and it was given longer in the conservative treatment group (5.63 days vs. 4.26 days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67 days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08 days vs. 4.47 days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2 % vs. 7.7 %, p=0.005) and for conservative therapy compared to appendicectomy (2 % vs. 14.3 %, p=0.016). There was no mortality documented. Conclusions According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine.
Collapse
Affiliation(s)
- Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Michael Klös
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Torben Esser
- Institute of Microbiology and Hospital Hygiene, University Hospital Magdeburg, Magdeburg, Germany
| | - Ivan Soldatovic
- Institute for Medical statistics, Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Maximilian Dölling
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sara Acciuffi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| |
Collapse
|
9
|
Kahlert UD, Shi W, Strecker M, Scherpinski LA, Wartmann T, Dölling M, Perrakis A, Relja B, Mengoni M, Braun A, Croner RS. COL10A1 allows stratification of invasiveness of colon cancer and associates to extracellular matrix and immune cell enrichment in the tumor parenchyma. Front Oncol 2022; 12:1007514. [PMID: 36267978 PMCID: PMC9577326 DOI: 10.3389/fonc.2022.1007514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Treatment options for metastatic colorectal cancer (CRC) are mostly ineffective. We present new evidence that tumor tissue collagen type X alpha 1 (COL10A1) is a relevant candidate biomarker to improve this dilemma. Methods Several public databases had been screened to observe COL10A1 expression in transcriptome levels with cell lines and tissues. Protein interactions and alignment to changes in clinical parameters and immune cell invasion were performed, too. We also used algorithms to build a novel COL10A1-related immunomodulator signature. Various wet-lab experiments were conducted to quantify COL10A1 protein and transcript expression levels in disease and control cell models. Results COL10A1 mRNA levels in tumor material is clinical and molecular prognostic, featuring upregulation compared to non-cancer tissue, increase with histomorphological malignancy grading of the tumor, elevation in tumors that invade perineural areas, or lymph node invasion. Transcriptomic alignment noted a strong positive correlation of COL10A1 with transcriptomic signature of cancer-associated fibroblasts (CAFs) and populations of the immune compartment, namely, B cells and macrophages. We verified those findings in functional assays showing that COL10A1 are decreased in CRC cells compared to fibroblasts, with strongest signal in the cell supernatant of the cells. Conclusion COL10A1 abundance in CRC tissue predicts metastatic and immunogenic properties of the disease. COL10A1 transcription may mediate tumor cell interaction with its stromal microenvironment.
Collapse
Affiliation(s)
- Ulf D. Kahlert
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Wenjie Shi
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Marco Strecker
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Lorenz A. Scherpinski
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Thomas Wartmann
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maximilian Dölling
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Aristotelis Perrakis
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Borna Relja
- Experimental Radiology, University Clinic of Radiology and Nuclear Medicine, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Miriam Mengoni
- University Clinic for Dermatology, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Andreas Braun
- University Clinic for Dermatology, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Roland S. Croner
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
- *Correspondence: Roland S. Croner,
| |
Collapse
|
10
|
Rahimli M, Perrakis A, Andric M, Stockheim J, Franz M, Arend J, Al-Madhi S, Abu Hilal M, Gumbs AA, Croner RS. Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14143360. [PMID: 35884421 PMCID: PMC9320889 DOI: 10.3390/cancers14143360] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.
Collapse
Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
- Correspondence:
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mareike Franz
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Joerg Arend
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mohammed Abu Hilal
- Unità Chirurgia Epatobiliopancreatica, Robotica e Mininvasiva, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, 57, 25124 Brescia, Italy;
| | - Andrew A. Gumbs
- Department of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, France;
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| |
Collapse
|
11
|
Stockheim J, Perrakis A, Sabel BA, Waschipky R, Croner RS. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2022; 17:495-507. [PMID: 35810233 PMCID: PMC10076401 DOI: 10.1007/s11701-022-01444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
Robotic-assisted procedures gain increasing acceptance for daily surgical routine. However, structured training programs are designed for surgeons with high expertise. Hence, a comprehensive training curriculum was established to ensure a basic competence in robotic abdominal surgery for young surgeons during their residency. The aim of the current work is to propose a feasible and effective training concept. The development process of this training curriculum is based on a comprehensive literature review which led to the concept of "robotic curriculum for young surgeons" (RoCS). It was implemented in the daily routine of a German university hospital starting in 2020. The robotic assessment questionnaire (RAQ) was used for electronic data collection. After the initial phase adjustments, it led to an improvement of the initial version of the curriculum. RoCS is a multimodal training program containing basic training through assistance at the operation table during robotic-assisted operations and basic console training. Key elements are the robotic team time-out (rTTO), perioperative process standardization including feasible personnel scheduling and useful procedure clustering into organ systems, procedural steps and procedural step complexity. Evaluation of standardized communication, performance assessment, patient factors and individual overall workload using NASA Task Load Index is realizable. Flexibility and adaptability to internal organization processes of surgical departments are the main advantages of the concept. RoCS is a strong training tool to meet the specific needs of young surgeons and evaluate their learning success of robotic procedural training. Furthermore, comparison within the different robotic systems should be considered. Further studies are needed to validate a multicenter concept design.
Collapse
Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Waschipky
- Department of Information Technology (IT) and Medical Engineering, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
12
|
Rahimli M, Perrakis A, Gumbs AA, Andric M, Al-Madhi S, Arend J, Croner RS. The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery. J Clin Med 2022; 11:jcm11113018. [PMID: 35683406 PMCID: PMC9181538 DOI: 10.3390/jcm11113018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/14/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Liver failure is a crucial predictor for relevant morbidity and mortality after hepatic surgery. Hence, a good patient selection is mandatory. We use the LiMAx test for patient selection for major or minor liver resections in robotic and laparoscopic liver surgery and share our experience here. Patients and methods: We identified patients in the Magdeburg registry of minimally invasive liver surgery (MD-MILS) who underwent robotic or laparoscopic minor or major liver surgery and received a LiMAx test for preoperative evaluation of the liver function. This cohort was divided in two groups: patients with normal (LiMAx normal) and decreased (LiMAx decreased) liver function measured by the LiMAx test. Results: Forty patients were selected from the MD-MILS regarding the selection criteria (LiMAx normal, n = 22 and LiMAx decreased, n = 18). Significantly more major liver resections were performed in the LiMAx normal vs. the LiMAx decreased group (13 vs. 2; p = 0.003). Hence, the mean operation time was significantly longer in the LiMAx normal vs. the LiMAx decreased group (356.6 vs. 228.1 min; p = 0.003) and the intraoperative blood transfusion significantly higher in the LiMAx normal vs. the LiMAx decreased group (8 vs. 1; p = 0.027). There was no significant difference between the LiMAx groups regarding the length of hospital stay, intraoperative blood loss, liver surgery related morbidity or mortality, and resection margin status. Conclusion: The LiMAx test is a helpful and reliable tool to precisely determine the liver function capacity. It aids in accurate patient selection for major or minor liver resections in minimally invasive liver surgery, which consequently serves to improve patients’ safety. In this way, liver resections can be performed safely, even in patients with reduced liver function, without negatively affecting morbidity, mortality and the resection margin status, which is an important predictive oncological factor.
Collapse
Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
- Correspondence: ; Tel.: +49-391-67-15500
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
| | - Andrew A. Gumbs
- Department of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, France;
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
| | - Joerg Arend
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (S.A.-M.); (J.A.); (R.S.C.)
| |
Collapse
|
13
|
Thormann M, Omari J, Pech M, Damm R, Croner R, Perrakis A, Strobel A, Wienke A, Surov A. Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis. Langenbecks Arch Surg 2022; 407:1369-1379. [PMID: 35583832 PMCID: PMC9283156 DOI: 10.1007/s00423-022-02541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/29/2022] [Indexed: 12/03/2022]
Abstract
Purpose To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection. Methods MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument. Results The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis. Conclusion LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC.
Collapse
Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
14
|
Rahimli M, Wex C, Wiesmueller F, Weber F, Dölling M, Rose A, Al-Madhi S, Andric M, Croner R, Perrakis A. Laparoscopic cholecystectomy during the COVID-19 pandemic in a tertiary care hospital in Germany: higher rates of acute and gangrenous cholecystitis in elderly patients. BMC Surg 2022; 22:168. [PMID: 35538571 PMCID: PMC9087165 DOI: 10.1186/s12893-022-01621-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany. Patients and methods We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year. Results A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the “pandemic subgroup”. Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality. Conclusion Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.
Collapse
Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Cora Wex
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Wiesmueller
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Frederike Weber
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maximilian Dölling
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Alexander Rose
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
15
|
Franz M, Arend J, Wolff S, Perrakis A, Rahimli M, Negrini VR, Stockheim J, Lorenz E, Croner R. Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery - valuation of early adopters from Germany. Innov Surg Sci 2021; 6:59-66. [PMID: 34589573 PMCID: PMC8435269 DOI: 10.1515/iss-2020-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences. Methods Actual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively. Results ICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69-100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2-14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers. Conclusions ICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments.
Collapse
Affiliation(s)
- Mareike Franz
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jörg Arend
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Stefanie Wolff
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Victor-Radu Negrini
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Eric Lorenz
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| |
Collapse
|
16
|
Vassos N, Perrakis A, Hohenberger W, Croner RS. Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST). J Clin Med 2021; 10:jcm10194459. [PMID: 34640476 PMCID: PMC8509470 DOI: 10.3390/jcm10194459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. METHODS We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12-140). RESULTS A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42-77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5-13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. CONCLUSION The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.
Collapse
Affiliation(s)
- Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-621-383-3921; Fax: +49-621-383-1479
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| |
Collapse
|
17
|
Schlögl M, Pak ES, Bansal AD, Schell JO, Ganai S, Kamal AH, Swetz KM, Maguire JM, Perrakis A, Warraich HJ, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Critical Illness and Heart, Kidney, and Liver Diseases. J Palliat Med 2021; 24:1561-1567. [PMID: 34283924 DOI: 10.1089/jpm.2021.0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Specialty palliative care (PC) clinicians are frequently asked to discuss prognosis with patients and their families. When conveying information about prognosis, PC clinicians need also to discuss the likelihood of prolonged hospitalization, cognitive and functional disabilities, and death. As PC moves further and further upstream, it is crucial that PC providers have a broad understanding of curative and palliative treatments for serious diseases and can collaborate in prognostication with specialists. In this article, we present 10 tips for PC clinicians to consider when caring and discussing prognosis for the seriously ill patients along with their caregivers and care teams. This is the second in a three-part series around prognostication in adult and pediatric PC.
Collapse
Affiliation(s)
- Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| | - Esther S Pak
- Advanced Heart Failure/Transplantation, Philadelphia VA Medical Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amar D Bansal
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Pittsburgh, Pennsylvania, USA.,Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Pittsburgh, Pennsylvania, USA.,Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Arif H Kamal
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Duke Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Keith M Swetz
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer M Maguire
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Haider J Warraich
- Department of Medicine, Brigham and Women's Hospital and Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
18
|
Lorenz E, Arend J, Franz M, Rahimli M, Perrakis A, Negrini V, Gumbs AA, Croner RS. Robotic and laparoscopic liver resection-comparative experiences at a high-volume German academic center. Langenbecks Arch Surg 2021; 406:753-761. [PMID: 33834295 PMCID: PMC8106606 DOI: 10.1007/s00423-021-02152-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/15/2021] [Indexed: 01/21/2023]
Abstract
Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.
Collapse
Affiliation(s)
- E Lorenz
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - J Arend
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - M Franz
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - M Rahimli
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - A Perrakis
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - V Negrini
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - A A Gumbs
- Centre Hospitalier Intercommunal de Poissy/Saint-Germain-En-Laye, 10 Rue du Champ Gaillard, 78300, Poissy, France
| | - R S Croner
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| |
Collapse
|
19
|
Scheidbach H, Horbach T, Perrakis A. Rectal Prolapse with Synchronous Colorectal Cancer. Dtsch Arztebl Int 2021; 117:756. [PMID: 33533329 DOI: 10.3238/arztebl.2020.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Vassos N, Perrakis A, Schmid A, Croner RS, Gruetzmann R, Agaimy A. Diffuse Neuromatosis of Intrahepatic and Extrahepatic Bile Ducts as a Rare Cause of Jaundice. Visc Med 2020; 37:226-232. [PMID: 34250082 DOI: 10.1159/000510486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neuroma of the biliary tree is extremely rare with no more than 100 cases reported so far. They mostly present with obstructive jaundice and have been commonly described after surgery or abdominal trauma. Although involvement of the extrahepatic bile duct is far more common, occurrence in the intrahepatic ducts has not so far been reported. Case Report We describe 3 cases of diffuse biliary tree neuroma affecting 3 females aged 53-68 years. None had a history of neurofibromatosis type1. All presented with progressive obstructive jaundice with no evidence of gallstones. A history of previous surgery was noted in 2 patients. Initial impression on clinical and imaging examination was highly suspicious for bile duct carcinoma in 2 patients. Histology showed diffuse neuromatous proliferation replacing and thickening the bile duct walls. The third patient had concurrent neuroma and recurrent cholangiocarcinoma causing great clinical confusion as initial biopsy showed only benign neuroma, but CA 19-9 was steadily increasing, necessitating a second biopsy which then confirmed recurrent carcinoma. Conclusion This uncommon cause of long-distance bile duct stenosis and progressive jaundice should be included in the differential diagnosis of bile duct neoplasms, in particular when there is a previous surgical history in this abdominal region.
Collapse
Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany.,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | | | - Axel Schmid
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Gruetzmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
21
|
Croner R, Arend J, Franz M, Rahimli M, Negrini VR, Stockheim J, Lorenz E, Andric M, Perrakis A. [Robot-Assisted Right Hemi-Hepatectomy]. Zentralbl Chir 2020; 146:235-238. [PMID: 32942320 DOI: 10.1055/a-1217-0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Roland Croner
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jörg Arend
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mareike Franz
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mirhasan Rahimli
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Victor Radu Negrini
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jessica Stockheim
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Eric Lorenz
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mihalo Andric
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Aristotelis Perrakis
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| |
Collapse
|
22
|
Vassos N, Brunner M, Perrakis A, Göhl J, Grützmann R, Hohenberger W, Croner RS. Oncological outcome after hyperthermic isolated limb perfusion for primarily unresectable versus locally recurrent soft tissue sarcoma of extremities. Surg Oncol 2020; 35:162-168. [PMID: 32882523 DOI: 10.1016/j.suronc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The management of locally advanced extremity soft tissue sarcomas, particularly in terms of a limb salvage strategy, represents a challenge, especially in recurrent tumors. In the context of a patient-tailored multimodal therapy, hyperthermic isolated limb perfusion (ILP) is a promising limb-saving treatment option. We report the outcome of patients with primarily irresectable and locally recurrent soft tissue sarcoma (STS) treated by ILP. PATIENTS AND METHODS Data about patient demographics, clinical und histopathological characteristics, tumor response, morbidity and oncological outcome of all patients with STS, who underwent an ILP at our institution in a 10-year period, were retrospectively detected and analyzed. RESULTS The cohort comprised 30 patients. Two patients were treated with ILP for palliative tumor control, 13 patients because of a local recurrent soft tissue sarcoma (rSTS) and 15 patients because of primarily unresectable soft tissue sarcoma (puSTS). 25 of the 28 patients with curative intention received surgery after ILP (11 pts with rSTS and 14 pts with puSTS). Histopathologically we observed complete response in 6 patients (24%) and partial responses in 19 patients (76%) with a significant better remission in patients with puSTS (p = 0,043). Limb salvage rate was 75%. Mean follow-up was 69 months [range 13-142 months]. Seven (7/11; 64%) patients with rSTS and one (1/14; 7%) patient with puSTS developed local recurrence after ILP and surgery, whereas eight (8/13; 62%) rSTS patients and seven (7/15; 47%) puSTS patients developed distant metastasis. During follow-up, eight patients (28.5%) died of disease (5/13; 38%) rSTS and 3/15 (20%) puSTS. ILP in the group of previously irradiated sarcoma patients (n = 13) resulted in a limb salvage rate of 69% and was not associated in an increased risk for adverse events. DISCUSSION ILP for advanced extremity STS is a treatment option for both puSTS and rSTS resulting in good local control and should be considered in multimodal management. ILP is also a good option for patients after radiation history.
Collapse
Affiliation(s)
- N Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany; Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
| | - M Brunner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - A Perrakis
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - J Göhl
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - W Hohenberger
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| |
Collapse
|
23
|
Rahimli M, Perrakis A, Schellerer V, Andric M, Stockheim J, Lorenz E, Franz M, Arend J, Croner RS. A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery. Sci Rep 2020; 10:12143. [PMID: 32699283 PMCID: PMC7376099 DOI: 10.1038/s41598-020-69211-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/08/2020] [Indexed: 11/09/2022] Open
Abstract
Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS-FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS-FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS-FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS-FLF group (p = 0.114). One patient in the MILS-FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.
Collapse
Affiliation(s)
- M Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - A Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - V Schellerer
- Department of Pediatric Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - M Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - E Lorenz
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - M Franz
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J Arend
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - R S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
24
|
Croner R, Franz M, Arend J, Rahimli M, Stockheim J, Negrini VR, Lorenz E, Andric M, Perrakis A, Wex C. [Indocyanine-Green-Guided, Robot-Assisted Left Hemihepatectomy]. Zentralbl Chir 2020; 146:377-380. [PMID: 32599636 DOI: 10.1055/a-1157-9754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Roland Croner
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mareike Franz
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jörg Arend
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mirhasan Rahimli
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jessica Stockheim
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Victor Radu Negrini
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Eric Lorenz
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mihalo Andric
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Aristotelis Perrakis
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Cora Wex
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| |
Collapse
|
25
|
Perrakis A, Vassos N, Weber K, Matzel KE, Papadopoulos K, Koukis G, Perrakis E, Croner RS, Hohenberger W. Introduction of complete mesocolic excision with central vascular ligation as standardized surgical treatment for colon cancer in Greece. Results of a pilot study and bi-institutional cooperation. Arch Med Sci 2019; 15:1269-1277. [PMID: 31572473 PMCID: PMC6764310 DOI: 10.5114/aoms.2018.80040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/28/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Complete mesocolic excision (CME) is generally accepted as state of the art in colon cancer surgery. However, the long-term impact of CME has not been systematically examined. Therefore cohort studies might be a possible way to clarify any differences between conventional resections and CME. Following bilateral cooperation between the Department of Surgery/University Hospital of Erlangen and the 1st Surgical Department of the General Hospital of Nikaia/Piraeus, including teaching activities for introduction of CME, a cohort study was performed, considering surgical quality criteria and clinical outcome. MATERIAL AND METHODS All patients with colon carcinomas (CME group, n = 31) referred to the 1st Surgical Department of General Hospital, Nikaia/Piraeus, Greece for surgery from January 2012 to December 2013 were prospectively analyzed and compared with patients who underwent conventional surgery for colon cancer between January 2008 and December 2011 (non-CME group, n = 35). Patients' follow-up was at least 48 months. RESULTS There were significantly better results in terms of lymph node yield (CME group: 29.6 vs. non-CME group: 17.85; p < 0.001) and lymph node ratio (LNR) (CME group: 0.12 vs. non-CME group: 0.24; p < 0.001) and recurrence-free survival in favor of the CME group (CME group: n = 0 vs. non-CME group: n = 5) without any increase in surgical morbidity (CME group: n = 6 vs. non-CME group: n = 11; p = 0.10). CONCLUSIONS Complete mesocolic excision appears to offer a superior oncological result without any increase of postoperative morbidity and mortality. Furthermore, CME represents a surgical technique which can be established in a surgical department after previous teaching without increasing the postoperative complication rate.
Collapse
Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Klaus Weber
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Klaus E. Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Georgios Koukis
- 1 Surgical Department, General Hospital of Piraeus/Nikaia, Piraeus/Nikaia, Greece
| | - Evangelos Perrakis
- 1 Surgical Department, General Hospital of Piraeus/Nikaia, Piraeus/Nikaia, Greece
| | - Roland S. Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | | |
Collapse
|
26
|
Wiesmueller F, Agaimy A, Perrakis A, Arkudas A, Horch RE, Grützmann R, Vassos N. Dermatofibrosarcoma protuberans: surgical management of a challenging mesenchymal tumor. World J Surg Oncol 2019; 17:90. [PMID: 31138233 PMCID: PMC6540534 DOI: 10.1186/s12957-019-1627-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade malignant mesenchymal tumor of the soft tissue, characterized by slow infiltrative growth and common local recurrence, with rare distant metastases. Patients and methods We present a retrospective study of nineteen patients who were diagnosed with DFSP and operated at our institution in > 10-year period. We examined the clinicopathological parameters with special emphasis on the margin status regarding the clinical outcome and the follow-up. Results A total of eight cases underwent re-excision at our institution following primary excision or incisional biopsy performed at a different institution. Seven cases received excision after incisional biopsy at our institution. Four patients developed recurrent disease following primary excision with histological R0 margins at other institutions and received re-excision at our institution. All excisions at our institution resulted in R0 margins with no recurrence recorded at last follow-up (6 to 175; mean 84 months). The mean margin for those who received resection at our institution was 1.67 cm. Negative margins upon primary excision were achieved using a mean margin width of 2.04 cm. Most common tumor localization was the trunk (10 cases). Conclusion Awareness of this rare entity is important for a prompt diagnosis and a proper management of the disease. The greatest clinical challenge in the management of DFSP is achieving local control. Complete excision of the tumor with surgical margin widths of at least 2 cm is recommended.
Collapse
Affiliation(s)
- Felix Wiesmueller
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.,Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany. .,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
| |
Collapse
|
27
|
Apostolakis S, Ioannidis A, Koutserimpas C, Patrikakos P, Perrakis A, Velimezis G. Mesothelial cyst of the round ligament. G Chir 2018; 34:323-325. [PMID: 30444483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mesothelial cyst of the round ligament is a rare finding in females, with only a few cases reported so far. A case of a 25 year old female patient presenting with a palpable mass in her right inguinal region is presented. The preoperative investigation through ultrasound (U/S), computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an intraabdominal cystic lobular mass in the inguinal canal, in contact with the femoral vessels. The mass was excised and the diagnosis of a benign mesothelial cyst was made through pathological examination. Even though it is a rare condition, it is advisable that clinicians consider in the differential diagnosis when evaluating a non-reducible mass in the inguinal region of a female patient.
Collapse
|
28
|
Mekras A, Krenn V, Perrakis A, Croner RS, Kalles V, Atamer C, Grützmann R, Vassos N. Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract. BMC Surg 2018; 18:47. [PMID: 30045739 PMCID: PMC6060462 DOI: 10.1186/s12893-018-0379-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Schwannomas of gastrointestinal tract are rare, mostly benign and notably different neoplasms from conventional schwannomas that arise in soft tissue or the central nervous system. These tumors are of clinical importance since they should always be considered in the differential diagnosis of submucosal lesions of gastrointestinal tract. METHODS Seven patients with a pathologically proven gastrointestinal schwannoma were identified in our series of mesenchymal tumors and reviewed retrospectively. Clinicopathological and immunohistochemical parameters along with the follow-up results were analysed. RESULTS The series included two males and five females, with a mean age 69 years (range, 39-81). Most patients were asymptomatic on presentation, except for two patients with abdominal pain. In the other cases (n = 5), the tumor was an incidental finding during other medical, imaging or surgical procedures. The tumors were located in the stomach (n = 4) and in the small intestine (n = 3) with an average size of 29 mm (range, 12-70). A preoperative diagnosis was achieved only in one case with a CT-guided core biopsy. Otherwise the clinical, intraoperative, endoscopic or radiological findings were unspecific. Patients with gastric tumor underwent either laparoscopic (n = 2) or open (n = 2) gastric wedge resection of the tumor; in the cases of intestinal tumor (n = 3) a segmentectomy was performed. Pathological examination revealed solid homogenous tumors, which were highly cellular and composed of spindle cells with positive staining for S100 protein, and confirmed the diagnosis of schwannoma. All tumors were negative for c-Kit, smooth muscle actin, desmin and DOG-1 and showed very low proliferation index. There were negative resection margins and no malignant variants were recognized. At an average follow-up of 60 months (range, 24-185) all patients were free of disease with no signs of recurrence or metastases and acceptable gastrointestinal function. CONCLUSIONS Schwannomas are rare, slow-growing and mostly asymptomatic gastrointestinal mesenchymal tumors. They are difficult to be diagnosed preoperatively as endoscopic and radiological findings are nonspecific but histological and immunohistochemical features are of paramount importance to differentiate between benign and malignant schwannomas, or other spindle cell sarcomas. The treatment of choice is complete surgical excision without a conclusive preoperative diagnosis, and the long-term outcome is excellent as these lesions are mostly benign.
Collapse
Affiliation(s)
- Alexandros Mekras
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Vasileios Kalles
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Cem Atamer
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| |
Collapse
|
29
|
Rico EM, Veen MV, Van de Wetering K, Puig DL, Kedziora K, Jalink K, Sidenius N, Perrakis A, Moolenaar W. PO-188 Loss of uPAR function and suppression of malignant cell behaviour by a GPI-specific phospholipase C. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Polo FS, Van Veen M, Leyton-Puig D, Van den Broek B, Perrakis A, Jalink K, Moolenaar W, Matas-Rico E. PO-228 Regulation of GDE2 membrane localization and trafficking. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
31
|
Perrakis A, Vassos N, Grützmann R, Croner RS. What is Changing in Indications and Treatment of Focal Nodular Hyperplasia of the Liver. Is There Any Place for Surgery? Ann Hepatol 2017; 16:333-341. [PMID: 28425402 DOI: 10.5604/16652681.1235475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Focal nodular hyperplasia (FNH) is a common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH represents a polyclonal lesion characterized by local vascular abnormalities and is a truly benign lesion without any potential for malignant transformation. A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and operative mortality and morbidity have been analysed. Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months. Systematic follow-up remains the gold standard in asymptomatic patients with FNH. However elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgery for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.
Collapse
Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| |
Collapse
|
32
|
Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Perrakis E, Perrakis A. Incarcerated recurrent inguinal hernia containing an acute appendicitis (Amyand hernia): an extremely rare surgical situation. Arch Med Sci 2017; 13:702-704. [PMID: 28507592 PMCID: PMC5420623 DOI: 10.5114/aoms.2016.60403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/31/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND The advantages of minimally invasive liver resections for selected patients are evident. Robots provide new innovations that will influence minimally invasive liver surgery in the future. This article presents our initial experience with this technology in our patient population. Material und Methods: In 14 patients with benign or malignant liver tumours, robotic-assisted liver surgery was performed. Selection criteria were compensated liver function and resection of ≤ 3 liver segments. Chronic liver disease or previous abdominal surgery were no exclusion criteria. RESULTS Malignant liver tumours were removed in 10 patients (71%) and benign symptomatic liver tumors in 3 patients (21%), respectively, with histopathologically negative margins (R0). One patient suffering from HCC underwent intraoperative ablation. In one case (7%) conversion was necessary. Mean operation time was 296 min (120-458 min); mean estimated blood loss was 319 ± 298 ml. The mean hospital stay of the patients was 8 days (3-17 days). Three patients (21%) suffered from postoperative complications, which were manageable by conservative treatment (Clavien-Dindo I) in 2 cases (14%). One patient (7%) needed endoscopic treatment for postoperative bile leak (Clavien-Dindo III a). No patient died intra- or perioperatively. CONCLUSION Robotic-assisted liver surgery is a safe procedure, which provides patients with all benefits of minimally invasive surgery. This highly advanced technology requires surgeons to strive for an increasing level of specialisation, in addition to being well-trained in liver surgery. Hence, a clear definition of the procedures and standardised teaching programs are necessary.
Collapse
Affiliation(s)
- R Croner
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - A Perrakis
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - R Grützmann
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - W Hohenberger
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - M Brunner
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| |
Collapse
|
34
|
Perrakis A, Stirkat F, Croner RS, Vassos N, Raptis D, Yedibela S, Hohenberger W, Müller V. Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation. Arch Med Sci 2016; 12:372-9. [PMID: 27186183 PMCID: PMC4848368 DOI: 10.5114/aoms.2016.59264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the diagnostic accuracy of procalcitonin (PCT) as a marker for complications and as a prognostic factor for mortality after liver transplantation. MATERIAL AND METHODS Liver transplant patients between January 2007 and April 2011 were prospectively included in the study. Procalcitonin serum concentration was recorded before, 6 h after reperfusion and then daily. Postoperative clinical course was prospectively analyzed from admission to discharge. Main surgical data such as operating procedure, type of reperfusion, operating and ischemic times, high urgency (HU) status and MELD score at the time of transplantation were also recorded. RESULTS Sixteen patients with initial PCT > 5 ng/ml suffered ≥ 1 complication (p = 0.03). However, there was no association between the level of the 1(st) peak PCT and the further postoperative course or the occurrence of complications. Patients in whom a 2(nd) PCT peak occurred had a significantly higher risk for a complicated course, for a complicated sepsis course and for mortality (p < 0.0001). Warm ischemic time over 58 min, operating time over 389 min and HU status were significant independent factors for a complicated postoperative course (p < 0.001, p < 0.001 and p = 0.03 respectively). CONCLUSIONS Based on our results, we believe that PCT course and the occurrence of a 2(nd) peak seem to possess important diagnostic and prognostic power in the post-transplant setting after liver transplantation.
Collapse
Affiliation(s)
| | - Falk Stirkat
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Süleyman Yedibela
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Volker Müller
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
35
|
Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia. Arch Med Sci 2016; 12:469-72. [PMID: 27186195 PMCID: PMC4848376 DOI: 10.5114/aoms.2016.59273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Evangelos Perrakis
- Department of Surgery, Western Attica General Hospital, Athens, Greece
- Department of Surgery, General Hospital Nikea, Piraeus, Greece
| | | |
Collapse
|
36
|
Vassos N, Raptis D, Lell M, Klein P, Perrakis A, Köhler J, Croner RS, Hohenberger W, Agaimy A. Intra-abdominal localized hyaline-vascular Castleman disease: imaging characteristics and management of a rare condition. Arch Med Sci 2016; 12:227-32. [PMID: 26925142 PMCID: PMC4754385 DOI: 10.5114/aoms.2016.57600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/25/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Lell
- Institute of Diagnostic and Interventional Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter Klein
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Jens Köhler
- Department of Surgery, Nuremberg Medical Center, Nuremberg, Germany
| | - Roland S. Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
37
|
Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Left-sided Gallbladder in the Era of Laparoscopic Cholecystectomy: A Single-center Experience. Am Surg 2015; 81:1249-1252. [PMID: 26736163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The malposition of gallbladder under the liver segment III, defined as left-sided gallbladder (LSG), is an unexpected situation for the laparoscopic surgeon. The purpose of this study is to present our experience in treating patients with cholecystitis and LSG discovered incidentally during laparoscopic surgical procedure. Between 1993 and 2009, 5569 patients underwent laparoscopic cholecystectomy in our surgical department. Their records were reviewed and seven patients revealed having LSG (0.12%). Analysis parameters included demographic data, diagnostic methods, mode of surgery, and postoperative outcome. Mean follow-up was 140 months. Of the seven patients, five were women. Mean patient age was 56.7 years. All patients were referred to our department with clinical symptoms of classic cholelithiasis and the diagnosis was established in all of them during surgery. Laparoscopic cholecystectomy was successful in five patients, while in two patients, a conversion to open procedure was needed. A postoperative complication, i.e., biliary leakage was registered in one patient, which was treated successfully. Laparoscopic cholecystectomy is safe even in LSG, but the surgeon must consider the possibility for more anatomical anomalies, adjust the technique of dissection, and must not hesitate, if in doubt, to strive for conversion to open procedure to avoid serious complications.
Collapse
|
38
|
Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Left-sided Gallbladder in the Era of Laparoscopic Cholecystectomy: A Single-center Experience. Am Surg 2015. [DOI: 10.1177/000313481508101227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The malposition of gallbladder under the liver segment III, defined as left-sided gallbladder (LSG), is an unexpected situation for the laparoscopic surgeon. The purpose of this study is to present our experience in treating patients with cholecystitis and LSG discovered incidentally during laparoscopic surgical procedure. Between 1993 and 2009, 5569 patients underwent laparoscopic cholecystectomy in our surgical department. Their records were reviewed and seven patients revealed having LSG (0.12%). Analysis parameters included demographic data, diagnostic methods, mode of surgery, and postoperative outcome. Mean follow-up was 140 months. Of the seven patients, five were women. Mean patient age was 56.7 years. All patients were referred to our department with clinical symptoms of classic cholelithiasis and the diagnosis was established in all of them during surgery. Laparoscopic cholecystectomy was successful in five patients, while in two patients, a conversion to open procedure was needed. A postoperative complication, i.e., biliary leakage was registered in one patient, which was treated successfully. Laparoscopic cholecystectomy is safe even in LSG, but the surgeon must consider the possibility for more anatomical anomalies, adjust the technique of dissection, and must not hesitate, if in doubt, to strive for conversion to open procedure to avoid serious complications.
Collapse
Affiliation(s)
- Georgios Velimezis
- Department of Surgery, Western Attica General Hospital, Athens, Greece; and
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Evangelos Perrakis
- Department of Surgery, Western Attica General Hospital, Athens, Greece; and
| | | |
Collapse
|
39
|
Novitsky Y, Fayezizadeh M, Majumder A, Yee S, Petro C, Orenstein S, Woeste G, Reinisch A, Bechstein WO, Rosen M, Carbonell A, Cobb W, Bauer J, Selzer D, Chao J, Harmaty M, Poulose B, Matthews B, Goldblatt M, Jacobsen G, Rosman C, Hansson B, Prabhu A, Fathi A, Skipworth J, Younis I, Floyd D, Shankar A, Olmi S, Cesana G, Ciccarese F, Uccelli M, Carrieri D, Castello G, Legnani G, Lyo V, Irwin C, Xu X, Harris H, Zuvela M, Galun D, Petrovic J, Palibrk I, Koncar I, Basaric D, Tian W, Fei Y, Pittman M, Jones E, Schwartz J, Mikami D, Perrakis A, Knüttel D, Klein P, Croner RS, Hohenberger W, Perrakis E, Müller V, Grande M, Villa M, Lisi G, Esser A, De Sanctis F, Petrella G, Birolini C, Miranda JS, Tanaka EY, Utiyama EM, Rasslan S, Shi Y, Guo XB, Zhuo HQ, Li LP, Liu HJ, Bauder A, Gerety P, Epps G, Pannucci C, Fischer J, Kovach S. Incisional Hernia: Difficult Cases 2. Hernia 2015; 19 Suppl 1:S105-11. [PMID: 26518784 DOI: 10.1007/bf03355335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Y Novitsky
- Case Comprehensive Hernia Center, Cleveland, USA
| | | | - A Majumder
- Case Comprehensive Hernia Center, Cleveland, USA
| | - S Yee
- Case Comprehensive Hernia Center, Cleveland, USA
| | - C Petro
- Case Comprehensive Hernia Center, Cleveland, USA
| | - S Orenstein
- Case Comprehensive Hernia Center, Cleveland, USA
| | - G Woeste
- Department of Surgery, Goethe University, Frankfurt, Germany
| | - A Reinisch
- Department of Surgery, Goethe University, Frankfurt, Germany
| | - W O Bechstein
- Department of Surgery, Goethe University, Frankfurt, Germany
| | - M Rosen
- Cleveland Clinic Foundation, Cleveland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Fathi
- Case Comprehensive Hernia Center, Cleveland, USA
| | - J Skipworth
- Hospital Complex Hernia Unit, Royal Free and University College London, London, UK
| | - I Younis
- Hospital Complex Hernia Unit, Royal Free and University College London, London, UK
| | - D Floyd
- Hospital Complex Hernia Unit, Royal Free and University College London, London, UK
| | - A Shankar
- Hospital Complex Hernia Unit, Royal Free and University College London, London, UK
| | - S Olmi
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Cesana
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - F Ciccarese
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - M Uccelli
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - D Carrieri
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Castello
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Legnani
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - V Lyo
- Division of General Surgery, University of California San Francisco, San Francisco, USA
| | - C Irwin
- Division of Plastic & Reconstructive Surgery, University of California San Francisco, San Francisco, USA
| | - X Xu
- Division of Plastic & Reconstructive Surgery, University of California San Francisco, San Francisco, USA
| | - H Harris
- Division of General Surgery, University of California San Francisco, San Francisco, USA
| | - M Zuvela
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia.,Medical School, University of Belgrade, Belgrade, Serbia
| | - D Galun
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia.,Medical School, University of Belgrade, Belgrade, Serbia
| | - J Petrovic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - I Palibrk
- Medical School, University of Belgrade, Belgrade, Serbia.,Clinical center of Serbia, Clinic for vascular and endovascular surgery, Belgrade, Serbia
| | - I Koncar
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia.,Medical School, University of Belgrade, Belgrade, Serbia
| | - D Basaric
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - W Tian
- Department of General Surgery, 1st affiliated hospital of PLA general hospital, Beijing, China
| | | | - M Pittman
- The Ohio State University Medical Center, Columbus, USA
| | | | | | | | - A Perrakis
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - D Knüttel
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - P Klein
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - R S Croner
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - W Hohenberger
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - E Perrakis
- Department of Surgery, Omilos Iatrikoo Kentrou Athinon, Iatriko Kentro Peristeriou, Athens, Greece
| | - V Müller
- Department of Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - M Grande
- University Hospital of Tor Vergata, Rome, Italy
| | - M Villa
- University Hospital of Tor Vergata, Rome, Italy
| | - G Lisi
- University Hospital of Tor Vergata, Rome, Italy
| | - A Esser
- University Hospital of Tor Vergata, Rome, Italy
| | | | - G Petrella
- University Hospital of Tor Vergata, Rome, Italy
| | - C Birolini
- Abdominal Wall and Hernia Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - J S Miranda
- Abdominal Wall and Hernia Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - E Y Tanaka
- Abdominal Wall and Hernia Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - E M Utiyama
- Abdominal Wall and Hernia Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - S Rasslan
- Abdominal Wall and Hernia Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Y Shi
- Department of Gastrointestinal Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | | | | | | | | | - A Bauder
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - P Gerety
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - G Epps
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - C Pannucci
- Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, USA
| | - J Fischer
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - S Kovach
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
40
|
Croner RS, Perrakis A, Brunner M, Matzel KE, Hohenberger W. Pioneering Robotic Liver Surgery in Germany: First Experiences with Liver Malignancies. Front Surg 2015; 2:18. [PMID: 26052515 PMCID: PMC4440394 DOI: 10.3389/fsurg.2015.00018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/03/2015] [Indexed: 12/12/2022] Open
Abstract
Background Minimally invasive liver surgery is growing worldwide with obvious benefits for the treated patients. These procedures maybe improved by robotic techniques, which add several innovative features. In Germany, we were the first surgical department implementing robotic assisted minimally invasive liver resections. Material and methods Between June 2013 and March 2015, we performed robotic based minimally invasive liver resections in nine patients with malignant liver disease. Five off these patients suffered from primary and four from secondary liver malignancies. We retrospectively analyzed the perioperative variables of these patients and the oncological follow up. Results Mean age of the patients was 63 years (range 45–71). One patient suffered from intrahepatic cholangiocellular, four from hepatocellular carcinoma, and four patients from colorectal liver metastases. In six patients, left lateral liver resection, in two cases single segment resection, and in one case minimally invasive guided liver ablation were performed. Five patients underwent previous abdominal surgery. Mean operation time was 312 min (range 115–458 min). Mean weight of the liver specimens was 182 g (range 62–260 g) and mean estimated blood loss was 251 ml (range 10–650 ml). The mean tumor size was 4.4 cm (range 3.5–5.5 cm). In all cases, R0 status was confirmed with a mean margin of 0.6 cm (range 0.1–1.5 cm). One patient developed small bowel fistula on postoperative day 5, which could be treated conservatively. No patient died. Mean hospital stay of the patients was 6 days (range 3–10 days). During a mean follow up of 12 months (range 1–21 months), two patients developed tumor recurrence. Conclusion Robotic-based liver surgery is feasible in patients with primary and secondary liver malignancies. To achieve perioperative parameters comparable to open settings, the learning curve must be passed. Minor liver resections are good candidates to start this technique. But the huge benefits of robotic-based liver resections should be expected in extended procedures beyond minor liver resections with the currently available technology.
Collapse
Affiliation(s)
- Roland S Croner
- Department of Surgery and Liver Center, University Hospital Erlangen , Erlangen , Germany
| | - Aristotelis Perrakis
- Department of Surgery and Liver Center, University Hospital Erlangen , Erlangen , Germany
| | - Maximillian Brunner
- Department of Surgery and Liver Center, University Hospital Erlangen , Erlangen , Germany
| | - Klaus E Matzel
- Department of Surgery and Liver Center, University Hospital Erlangen , Erlangen , Germany
| | - Werner Hohenberger
- Department of Surgery and Liver Center, University Hospital Erlangen , Erlangen , Germany
| |
Collapse
|
41
|
Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, Hohenberger W. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal Dis 2014; 29:1223-9. [PMID: 25060216 DOI: 10.1007/s00384-014-1971-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) is nowadays state of the art in the treatment of colon cancer. In cases of carcinoma of transverse colon and of both flexures an extramesocolic lymph node metastasis can be found in the infrapancreatic lymph node region (ILR) and across the gastroepiploic arcade (GLR). These direct metastatic routes were not previously systematically considered. In order to validate our hypothesis of these direct metastatic pathways and to obtain evidence of our approach of including dissection of these areas as part of CME, we initiated a prospective study evaluating these lymph node regions during surgery. METHODS Forty-five consecutive patients with primary tumour manifestation in transverse colon and both flexures between May 2010 and January 2013 were prospectively analyzed. Patients were followed up for at least 6 months. Mode of surgery, histopathology, morbidity and mortality were evaluated. RESULTS Twenty-six patients had a carcinoma of transverse colon, 16 patients one of hepatic flexure and four patients one of splenic flexure. The median lymph node yield was 40. Occurrence of lymph node metastasis in ILR was registered in five patients and in GLR in four patients. The mean lymph node ratio was 0.085. Postoperative complications occurred in nine patients, and postoperative mortality was 2 %. CONCLUSIONS We were able to demonstrate this novel metastatic route of carcinomas of the transverse colon and of both flexures in ILR and GLR. These could be considered as regional lymph node regions and have to be included into surgery for cancer of the transverse colon including both flexures.
Collapse
Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany,
| | | | | | | | | | | | | |
Collapse
|
42
|
Müller V, Förtsch T, Gündel M, Croner RS, Langheinrich M, Yedibela S, Lohmüller C, Küffner M, Hohenberger W, Perrakis A. Long-term outcome of liver transplantation as treatment modality in patients with hepatocellular carcinoma in cirrhosis: a single-center experience. Transplant Proc 2014; 45:1957-60. [PMID: 23769082 DOI: 10.1016/j.transproceed.2013.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/03/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is among the most frequent malignant diseases worldwide. In the vast majority of cases, it is associated with liver cirrhosis. Liver transplantation (OLT) is potentially the gold standard treatment for patients suffering HCC in cirrhosis, because of synchronous eradication of HCC and of the underlying hepatic disease. The aim of this study was to evaluate long-term outcomes of OLT in HCC patients. MATERIAL AND METHODS Between January 2000 and December 2011, 43 patients who were diagnosed with HCC in liver cirrhosis and underwent OLT in our department, were identified from a prospective database. All patients received their grafts from deceased donors. We analyzed demographic data, laboratory values, number and size of lesions, primary liver disease, diagnostic methods, bridging therapy modalities, and postoperative outcomes, including complications, recurrences, and their treatment. RESULTS Patient follow-up as of January 2012 or to death ranged from 0 to 138 months (median, 59; mean, 63). None of the patients were lost to follow-up. The gender bias was 85%:15% (male:female) and the median age, 57.8 years (range, 44-69). The most common underlying diseases for cirrhosis and HCC were alcoholic (n = 12) and hepatitis C (n = 16). Thirty-one subjects underwent bridging therapy through transarterial chemoembolization (TACE), and/or radiofrequency ablation. All patients underwent OLT within the Milan criteria according to the preoperative evaluation and histopathologic examination of the explanted liver. Twenty-one of them suffered postoperative complications (48.8%). HCC recurrence, which occurred in 5 (10.4%), was treated by surgery (n = 3), systemic chemotherapy with sorafenib (n = 1), or TACE (n = 1). CONCLUSIONS OLT for HCC in cirrhosis, displays a relatively high complication rate. It shows good survivals with and low recurrence.
Collapse
Affiliation(s)
- V Müller
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Yedibela S, Alibek S, Müller V, Aydin U, Langheinrich M, Lohmüller C, Hohenberger W, Perrakis A. Management of hemangioma of the liver: surgical therapy or observation? World J Surg 2014; 37:1303-12. [PMID: 23354918 DOI: 10.1007/s00268-013-1904-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Elective surgery for liver hemangioma is controversial. We reviewed long-term outcomes following elective hepatectomy or observation only for symptomatic and asymptomatic liver hemangioma. METHODS All patients (n = 307) with liver hemangioma referred to our hospital for surgical evaluation from January 1988 to December 2009 were identified, and imaging results, tumor characteristics, surgical indication, surgical mode, outcome of observation, clinical and/or postoperative outcome, and adverse events were retrospectively evaluated. RESULTS Complete median follow-up for 246 patients was 124 months. Elective surgery was performed in 103 patients (symptomatic [n = 62] and asymptomatic [n = 41]). Postoperative morbidity occurred in 17 % of the patients and was significantly lower in asymptomatic patients (p = 0.002). No perioperative mortality was registered. Surgery relieved complaints in most (88 %) patients. In the observation group (n = 143), 56 % of patients had persistent or new onset of hemangioma-associated symptoms. Major hemangioma-related complications occurred in 12 patients (9 %) during the follow-up period, and 2 patients died after traumatic hemangioma rupture. Overall the rate of adverse events was by trend lower in the surgical group than in the observation group (35 versus 57 %; p = 0.08). CONCLUSIONS The majority of patients with liver hemangioma can be safely managed by clinical observation. In a subset of patients, especially those with giant hemangioma and/or occurrence of symptoms, surgical treatment could be considered and is justified in high-volume centers.
Collapse
Affiliation(s)
- Süleyman Yedibela
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr.12, 91054, Erlangen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Perrakis A, Förtsch T, Niebling N, Croner RS, Nissler V, Yedibela S, Lohmüller C, Zopf S, Kammerer F, Hohenberger W, Müller V. The Diagnostic Value of Systolic Acceleration Time and Resistive Index as Noninvasive Modality for Detection of Graft Rejection After Orthotopic Liver Transplantation. Transplant Proc 2013; 45:1961-5. [DOI: 10.1016/j.transproceed.2013.01.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 11/30/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A Perrakis
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Perrakis A, Förtsch T, Del Medico A, Croner R, Vassos N, Yedibela S, Lohmüller C, Zopf S, Hohenberger W, Müller V. Liver Transplantation for Hepatitis B-Induced Liver Disease: Long-Term Outcome and Effectiveness of Antiviral Therapy for Prevention of Recurrent Hepatitis B Infection. Transplant Proc 2013; 45:1953-6. [DOI: 10.1016/j.transproceed.2012.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 01/11/2023]
|
46
|
Abstract
BACKGROUND The necessity for radical lymph node dissection for solid tumours was discussed in the past controversially. The aim of this study was to correlate the oncologic results of radical surgery for colon cancer with potential complications. METHODS A total of 1,453 patients with R0-resected colon cancer operated on between 1978 and 2004 were analysed in a prospective database. The follow-up was at least 5 years. Rates of survival, locoregional and distant recurrences and complications were calculated. RESULTS To compare the oncological outcome, the time frame was divided into five periods. In the last cohort (2000-2004), we observed in stage I-III tumours a 5-year cancer-related survival rate of 90.1 %, compared to 82.1 % in the first cohort (1978-1984) (p = 0.061). The local recurrence rate could be reduced from 6.5 to 3.2 % in the same cohorts (p = 0.059). It reached the level of significance in the multivariate analysis. The rates of distant metastases did not change. For patients with stage III, the 5-year cancer survival rates increased from 62.0 to 81.8 % (p = 0.005). Morbidity and mortality were comparable to other studies even to those with limited lymph node dissections. CONCLUSION Radical lymph node dissection in colon cancer is not associated with obvious disadvantages to the patient. Specific considerable side effects were not observed when the preparation is performed in embryonic planes preserving the autonomous nerves. The complication rates were not increased compared to other studies, even to those with limited lymphatic dissection. In addition, radical lymph node dissection in colon cancer may improve survival.
Collapse
Affiliation(s)
- K Weber
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | | | | | | |
Collapse
|
47
|
Schildberg CW, Perrakis A, Croner R, Schellerer V, Haupt W, Weidinger T, Hohenberger W, Horbach T. [Results of surgical treatment of hiatal hernia]. Zentralbl Chir 2012; 139:66-71. [PMID: 23115031 DOI: 10.1055/s-0032-1315116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hiatus hernias are considered as the most prominent form of diaphragmatic hernias. The passage is defined through the oesophageal hiatus, resulting in a superdiaphragmatic displacement of parts of the stomach or the complete stomach, respectively. In our work we investigated the treatment of partial thoracic stomach with both open and minimally invasive surgical procedures emphasising the view on operating data, the success of the surgery and recurrence rates. Patients with mesh insertion for hernia defect closures were considered separately. MATERIAL AND METHOD 94 Patients were treated in the period from 01.01.2003 to 01.06.2010. The ratio male/female was 2 : 1. The median age was 66 years. All data were prospectively collected by means of surgical protocols and data from the central patient records and analysed retrospectively. The statistical analyses were performed with SPSS 18.0 (SPSS Inc., Chicago, IL, USA). Any existing significances were determined using the T-test. RESULTS Of the 94 patients, 65 were operated laparoscopically. In the case of nine patients an initial laparoscopic surgery had to be changed to an open procedure. The reasons for switching surgical procedures were splenic bleeding in the case of 2 patients, intestinal injury due to perforation by the trocar in one case and unclear surgical situs in 6 cases. The postoperative complication rate was 24 %. The main reasons were a delayed achievement of passage. The mortality rate was 0 %. The comparison between laparoscopic and open groups showed, by comparable complication and recurrence rates, a shorter recovery time in favour of patients operated on laparoscopically. Additionally it can be stated that a bridge closure with mesh (ePTFE) had no significant influence on the postoperative outcome. Therefore we cannot confirm the postulated poor postoperative results of other groups. CONCLUSION In summary, the clear trend in the surgical treatment of hiatus hernias is to minimally invasive surgery. Only for patients with multiple previous operations, who are expected to have strong adhesions, the operation with comparable morbidity and mortality rates can also be planned primarily as open. In this case, however, longer postoperative recovery times must be expected. Large defects can be treated with comparable complication and recurrence rates by mesh insertion (ePTFE).
Collapse
Affiliation(s)
| | - A Perrakis
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - R Croner
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - V Schellerer
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - W Haupt
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - T Weidinger
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - W Hohenberger
- Chirurgie, Universität Erlangen, Erlangen, Deutschland
| | - T Horbach
- Chirurgie, Stadtkrankenhaus Schwabach, Schwabach, Deutschland
| |
Collapse
|
48
|
Langheinrich MC, Schellerer V, Perrakis A, Lohmüller C, Schildberg C, Naschberger E, Stürzl M, Hohenberger W, Croner RS. Molecular mechanisms of lymphatic metastasis in solid tumors of the gastrointestinal tract. Int J Clin Exp Pathol 2012; 5:614-623. [PMID: 22977656 PMCID: PMC3438765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/22/2012] [Indexed: 06/01/2023]
Abstract
Tumor cell dissemination from the primary tumor site to distant organs is one of the characteristic properties of malignant tumors and represents a crucial step in the progression of disease. Although the pattern of spread may vary in different types of carcinomas, dissemination via the lymphatic system represents a common event in metastasis. The extent of lymph node metastasis is one of the major determinants for the prognosis of patients with gastrointestinal carcinomas and guides the therapeutically management. During the last decades, significant attention has been given to the molecular mechanisms that control lymphatic metastasis. The process of lymphangiogenesis has come into the focus. Lymphangiogenesis, the formation of newly lymphatics, comprises a series of complex cellular events and is controlled by a balance between pro- and anti-lymphangiogenic signals. This article will briefly describe the lymphatic system and then provide an overview of the molecular players involved in tumor lymphangiogenesis.
Collapse
Affiliation(s)
| | | | | | | | | | - Elisabeth Naschberger
- Department of Surgery, University Hospital Erlangen, Division of Molecular and Experimental SurgeryGermany
| | - Michael Stürzl
- Department of Surgery, University Hospital Erlangen, Division of Molecular and Experimental SurgeryGermany
| | | | | |
Collapse
|
49
|
Daniel EJ, Wierenga RW, Diprose JM, Berry IM, Esnouf RM, Stuart DI, Seroul G, Marquez J, deVries D, Perrakis A, Launer L, Walsh M, Griffiths SL, Wilson K, Pajon A, Lin B, Morris C. xtalPiMS: a tool for managing your crystallization experiments. Acta Crystallogr A 2012. [DOI: 10.1107/s010876731209767x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
50
|
Perrakis A, Velimezis G, Kapogiannatos G, Koronakis D, Perrakis E. Spigel hernia: a single center experience in a rare hernia entity. Hernia 2012; 16:439-44. [DOI: 10.1007/s10029-012-0925-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 05/11/2012] [Indexed: 11/29/2022]
|