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Ritschl LM, Singer H, Clasen FC, Haller B, Fichter AM, Deppe H, Wolff KD, Weitz J. Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study. Front Oncol 2024; 14:1371405. [PMID: 38562168 PMCID: PMC10982308 DOI: 10.3389/fonc.2024.1371405] [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: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients' situation, motivation, and treatment course were structurally assessed. Materials and methods All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed. Results In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis. Discussion Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient's persistent motivation for the procedure.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Hannes Singer
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franz-Carl Clasen
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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Ritschl LM, Schwarz M, Klinger F, Wolff KD, Niu M, Weitz J. Extended orbital exenteration, epithetic restoration, and patient supply: A cross-sectional study of a historic cohort. Head Neck 2024; 46:473-484. [PMID: 38095351 DOI: 10.1002/hed.27594] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical course and to redefine an optimized algorithm for OE cases until epithetic restoration. METHODS Indication, defect type according to Kesting, reconstructive technique, incidence of postoperative complications and peri-implantitis, patients' quality of life, timing of periorbital implant insertion, incidence of and interval to implant loss, and time until epithetic restoration were analyzed in 43 patients. RESULTS A significant correlation was detected between wound dehiscence and defect type. Out of 24 patients, 7 were implanted secondarily with a median time interval of 399 days (270-2015) after OE. Eleven out of 83 placed implants were lost in 8 patients with a median time interval of 586 days (264-4485) after insertion. The majority of epithesis carriers had no or few restrictions in their quality of life. CONCLUSIONS We recommend our modified treatment algorithm to further improve and shorten the clinical course.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Schwarz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franziska Klinger
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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Eckert F, Merboth F, Giehl-Brown E, Hasanovic J, Müssle B, Plodeck V, Richter T, Welsch T, Kahlert C, Fritzmann J, Distler M, Weitz J, Kirchberg J. Single chest drain is not inferior to double chest drain after robotic esophagectomy: a propensity score-matched analysis. Front Surg 2023; 10:1213404. [PMID: 37520151 PMCID: PMC10375402 DOI: 10.3389/fsurg.2023.1213404] [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: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023] Open
Abstract
Background Chest drain management has a significant influence on postoperative recovery after robot-assisted minimally invasive esophagectomy (RAMIE). The use of chest drains increases postoperative pain by irritating intercostal nerves and hinders patients from early postoperative mobilization and recovery. To our knowledge, no study has investigated the use of two vs. one intercostal chest drains after RAMIE. Methods This retrospective cohort study evaluated patients undergoing elective RAMIE with gastric conduit pull-up and intrathoracic anastomosis. Patients were divided into two groups according to placement of one (11/2020-08/2022) or two (08/2018-11/2020) chest drains. Propensity score matching was performed in a 1:1 ratio, and the incidences of overall and pulmonary complications, drainage-associated re-interventions, radiological diagnostics, analgesic use, and length of hospital stay were compared between single drain and double drain groups. Results During the study period, 194 patients underwent RAMIE. Twenty-two patients were included after propensity score matching in the single and double chest drain group, respectively. Time until removal of the last chest drain [postoperative day (POD) 6.7 ± 4.4 vs. POD 9.4 ± 2.7, p = 0.004] and intensive care unit stay (4.2 ± 5.1 days vs. 5.3 ± 3.5 days, p = 0.01) were significantly shorter in the single drain group. Overall and pulmonary complications, drainage-associated events, re-interventions, number of diagnostic imaging, analgesic use, and length of hospital stay were comparable between both groups. Conclusion This study is the first to demonstrate the safety of single intercostal chest drain use and, at least, non-inferiority to double chest drains in terms of perioperative complications after RAMIE.
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Affiliation(s)
- F. Eckert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - F. Merboth
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - E. Giehl-Brown
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - J. Hasanovic
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - B. Müssle
- Department of General, Visceral and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital of the University of Ulm, Ravensburg, Germany
| | - V. Plodeck
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - T. Richter
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - T. Welsch
- Department of General, Visceral and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital of the University of Ulm, Ravensburg, Germany
| | - C. Kahlert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - J. Fritzmann
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - M. Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - J. Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - J. Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Centre Dresden - Rossendorf (HZDR), Dresden, Germany
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Weitz J, Grabenhorst A, Singer H, Niu M, Grill FD, Kamreh D, Claßen CAS, Wolff KD, Ritschl LM. Mandibular reconstructions with free fibula flap using standardized partially adjustable cutting guides or CAD/CAM technique: a three- and two-dimensional comparison. Front Oncol 2023; 13:1167071. [PMID: 37228490 PMCID: PMC10203950 DOI: 10.3389/fonc.2023.1167071] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Mandibular reconstruction with the fibula free flap (FFF) is performed freehand, CAD/CAM-assisted, or by using partially adjustable resection/reconstruction aids. The two latter options represent the contemporary reconstructive solutions of the recent decade. The purpose of this study was to compare both auxiliary techniques with regard to feasibility, accuracy, and operative parameters. Methods and materials The first twenty consecutively operated patients requiring a mandibular reconstruction (within angle-to-angle) with the FFF using the partially adjustable resection aids between January 2017 and December 2019 at our department were included. Additionally, matching CAD/CAM FFF cases were used as control group in this cross-sectional study. Medical records and general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time) were analyzed. In addition, the pre- and postoperative Digital Imaging and Communications in Medicine data of the mandibles were converted to standard tessellation language (.stl) files. Conventional measurements - six horizontal distances (A-F) and temporo-mandibular joint (TMJ) spaces - and the root mean square error (RMSE) for three-dimensional analysis were measured and calculated. Results In total, 40 patients were enrolled (20:20). Overall operation time, ischemia time, and the interval between ischemia time start until end of operation showed no significant differences. No significant difference between the two groups were revealed in conventional measurements of distances (A-D) and TMJ spaces. The Δ differences for the distance F (between the mandibular foramina) and the right medial joint space were significantly lower in the ReconGuide group. The RMSE analysis of the two groups showed no significant difference (p=0.925), with an overall median RMSE of 3.1 mm (2.2-3.7) in the CAD/CAM and 2.9 mm (2.2-3.8) in the ReconGuide groups. Conclusions The reconstructive surgeon can achieve comparable postoperative results regardless of technique, which may favor the ReconGuide use in mandibular angle-to-angle reconstruction over the CAD/CAM technique because of less preoperative planning time and lower costs per case.
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Affiliation(s)
- Jochen Weitz
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alex Grabenhorst
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hannes Singer
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian D. Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Kamreh
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carolina A. S. Claßen
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Oral and Maxillofacial Surgery, School of Medicine, University of Saarland, Homburg, Saar, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
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Schulze A, Tran D, Daum MTJ, Kisilenko A, Maier-Hein L, Speidel S, Distler M, Weitz J, Müller-Stich BP, Bodenstedt S, Wagner M. Ensuring privacy protection in the era of big laparoscopic video data: development and validation of an inside outside discrimination algorithm (IODA). Surg Endosc 2023:10.1007/s00464-023-10078-x. [PMID: 37145173 PMCID: PMC10338566 DOI: 10.1007/s00464-023-10078-x] [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: 01/18/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Laparoscopic videos are increasingly being used for surgical artificial intelligence (AI) and big data analysis. The purpose of this study was to ensure data privacy in video recordings of laparoscopic surgery by censoring extraabdominal parts. An inside-outside-discrimination algorithm (IODA) was developed to ensure privacy protection while maximizing the remaining video data. METHODS IODAs neural network architecture was based on a pretrained AlexNet augmented with a long-short-term-memory. The data set for algorithm training and testing contained a total of 100 laparoscopic surgery videos of 23 different operations with a total video length of 207 h (124 min ± 100 min per video) resulting in 18,507,217 frames (185,965 ± 149,718 frames per video). Each video frame was tagged either as abdominal cavity, trocar, operation site, outside for cleaning, or translucent trocar. For algorithm testing, a stratified fivefold cross-validation was used. RESULTS The distribution of annotated classes were abdominal cavity 81.39%, trocar 1.39%, outside operation site 16.07%, outside for cleaning 1.08%, and translucent trocar 0.07%. Algorithm training on binary or all five classes showed similar excellent results for classifying outside frames with a mean F1-score of 0.96 ± 0.01 and 0.97 ± 0.01, sensitivity of 0.97 ± 0.02 and 0.0.97 ± 0.01, and a false positive rate of 0.99 ± 0.01 and 0.99 ± 0.01, respectively. CONCLUSION IODA is able to discriminate between inside and outside with a high certainty. In particular, only a few outside frames are misclassified as inside and therefore at risk for privacy breach. The anonymized videos can be used for multi-centric development of surgical AI, quality management or educational purposes. In contrast to expensive commercial solutions, IODA is made open source and can be improved by the scientific community.
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Affiliation(s)
- A Schulze
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - D Tran
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - M T J Daum
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - A Kisilenko
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - L Maier-Hein
- Division of Intelligent Medical Systems, German Cancer Research Center (Dkfz), Heidelberg, Germany
| | - S Speidel
- Department for Translational Surgical Oncology, National Center for Tumor Diseases, Partner Site Dresden, Dresden, Germany
- Center for the Tactile Internet With Human in the Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - M Distler
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B P Müller-Stich
- Clarunis, University Center for Gastrointestinal and Liver Disease, Basel, Switzerland
| | - S Bodenstedt
- Department for Translational Surgical Oncology, National Center for Tumor Diseases, Partner Site Dresden, Dresden, Germany
- Center for the Tactile Internet With Human in the Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - M Wagner
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- National Center for Tumor Diseases, Heidelberg, Germany.
- Center for the Tactile Internet With Human in the Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Müssle B, Kirchberg J, Buck N, Radulova-Mauersberger O, Stange D, Richter T, Müller-Stich B, Klotz R, Larmann J, Korn S, Klimova A, Grählert X, Trips E, Weitz J, Welsch T. Drainless robot-assisted minimally invasive oesophagectomy-randomized controlled trial (RESPECT). Trials 2023; 24:303. [PMID: 37127683 PMCID: PMC10152702 DOI: 10.1186/s13063-023-07233-z] [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: 12/27/2022] [Accepted: 03/09/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The purpose of this randomized trial is to evaluate the early removal of postoperative drains after robot-assisted minimally invasive oesophagectomy (RAMIE). Evidence is lacking about feasibility, associated pain, recovery, and morbidity. METHODS/DESIGN This is a randomized controlled multicentric trial involving 72 patients undergoing RAMIE. Patients will be allocated into two groups. The "intervention" group consists of 36 patients. In this group, abdominal and chest drains are removed 3 h after the end of surgery in the absence of contraindications. The control group consists of 36 patients with conventional chest drain management. These drains are removed during the further postoperative course according to a standard algorithm. The primary objective is to investigate whether postoperative pain measured by NRS on the second postoperative day can be significantly reduced in the intervention group. Secondary endpoints are the intensity of pain during the first week, analgesic use, number of postoperative chest X-ray and CT scans, interventions, postoperative mobilization (steps per day as measured with an activity tracker), postoperative morbidity and mortality. DISCUSSION Until now, there have been no trials investigating different intraoperative chest drain strategies in patients undergoing RAMIE for oesophageal cancer with regard to perioperative complications until discharge. Minimally invasive approaches combined with enhanced recovery after surgery (ERAS) protocols lower morbidity but still include the insertion of chest drains. Reduction and early removal have been proposed after pulmonary surgery but not after RAMIE. The study concept is based on our own experience and the promising current results of the RAMIE procedure. Therefore, the presented randomized controlled trial will provide statistical evidence of the effectiveness and feasibility of the "drainless" RAMIE. TRIAL REGISTRATION ClinicalTrials.gov NCT05553795. Registered on 23 September 2022.
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Affiliation(s)
- B Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- Current Address: Department of General, Visceral and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital of the University of Ulm, Ulm, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
| | - J Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - N Buck
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - O Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - D Stange
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - T Richter
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - B Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - R Klotz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Larmann
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Korn
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - A Klimova
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - X Grählert
- Coordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - E Trips
- Coordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav CarusTechnische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Core Unit for Data Management and Analytics, National Center for Tumour Diseases (NCT), Dresden, Germany
| | - T Welsch
- National Center for Tumour Diseases (NCT/UCC), Dresden, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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7
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El-Shabrawi K, Storck K, Weitz J, Wolff KD, Knopf A. Comparison of T1/2 Tongue Carcinoma with or without Radial Forearm Flap Reconstruction Regarding Post-Therapeutic Function, Survival, and Gender. Cancers (Basel) 2023; 15:cancers15061885. [PMID: 36980773 PMCID: PMC10047362 DOI: 10.3390/cancers15061885] [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: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Flap reconstruction is commonly used in advanced tongue carcinoma in order to compensate for the loss of tongue tissue and function. Surprisingly, a large number of reconstructed early-stage tongue cancer can be found. Survival or functional benefits in these cases remain unclear. METHODS A retrospective data analysis of 384 surgically treated tongue carcinoma patients was conducted aiming to find epidemiologic and survival differences between patients with (n = 158) or without flap reconstruction (n = 226). A prospective functional analysis was performed on 55 early-stage tongue cancer patients, 33 without and 22 with radial-forearm flap reconstruction, focusing on post-therapeutic swallowing function as the primary endpoint, speech as the secondary endpoint, xerostomia, quality of life, and mouth opening. RESULTS Consistent with the current literature, we demonstrated the significantly more frequent use of flap grafts in advanced tongue carcinomas. For the first time, we depicted a higher female ratio in the reconstructed group (p = 0.02). There were no significant differences in survival or functional outcomes between the groups. The none-reconstructed group showed more frequent use of adjuvant C/RT despite presenting fewer N+ stages. CONCLUSIONS The higher female ratio in the reconstruction group is plausible due to the anatomically smaller oral cavity and relatively larger carcinoma in women. A higher presence of close margins in the none-reconstruction group may explain the more frequent use of adjuvant C/RT. Since we found no survival or functional differences between the groups, we propose a critical approach toward flap reconstruction in T1/2 tongue carcinoma. At the same time, proportional aspects and adequate resection margins should be taken into account.
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Affiliation(s)
- Katharina El-Shabrawi
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University, 81675 Munich, Germany
| | - Katharina Storck
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University, 81675 Munich, Germany
| | - Jochen Weitz
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technical University, 81675 Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, 86157 Augsburg, Germany
| | - Klaus-Dietrich Wolff
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technical University, 81675 Munich, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University, 81675 Munich, Germany
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8
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Radulova-Mauersberger O, Oehme F, Missel L, Kahlert C, Welsch T, Weitz J, Distler M. Analysis of predictors for postoperative complications after pancreatectomy--what is new after establishing the definition of postpancreatectomy acute pancreatitis (PPAP)? Langenbecks Arch Surg 2023; 408:79. [PMID: 36746822 PMCID: PMC9902317 DOI: 10.1007/s00423-023-02814-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE We aimed to analyze the predictive value of hyperamylasemia after pancreatectomy for morbidity and for the decision to perform rescue completion pancreatectomy (CP) in a retrospective cohort study. METHODS Data were extracted from a retrospective clinical database. Postoperative hyperamylasemia (POH) and postoperative hyperlipasemia (POHL) were defined by values greater than those accepted as the upper limit at our institution on postoperative day 1 (POD1). The endpoints of the study were the association of POH with postoperative morbidity and the possible predictors for postpancreatectomy acute pancreatitis (PPAP) and severe complications such as the necessity for rescue CP. RESULTS We analyzed 437 patients who underwent pancreaticoduodenectomy over a period of 7 years. Among them, 219 (52.3%) patients had POH and 200 (47.7%) had normal postoperative amylase (non-POH) levels. A soft pancreatic texture (odds ratio [OR] 3.86) and POH on POD1 (OR 8.2) were independent predictors of postoperative pancreatic fistula (POPF), and POH on POD1 (OR 6.38) was an independent predictor of rescue CP. The clinically relevant POPF (49.5% vs. 11.4%, p < 0.001), intraabdominal abscess (38.3% vs. 15.3%, p < 0.001), postoperative hemorrhage (22.8% vs. 5.1%, p < 0.001), major complications (Clavien-Dindo classification > 2) (52.5% vs. 25.6%, p < 0.001), and CP (13% vs. 1.8%, p < 0.001) occurred significantly more often in the POH group than in the non-POH group. CONCLUSION Although POH on POD1 occurs frequently, in addition to other risk factors, it has a predictive value for the development of postoperative morbidity associated with PPAP and CP.
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Affiliation(s)
- O Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
| | - F Oehme
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
| | - L Missel
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
| | - C Kahlert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
| | - T Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrass 74, 01307, Dresden, Germany.
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.
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9
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Eikelboom R, Whitlock R, Nguyen F, Perez R, Weitz J, Belley-Cote E. DIRECT ORAL ANTICOAGULATION VERSUS WARFARIN IN PATIENTS WITH ATRIAL FIBRILLATION AND BIOPROSTHETIC HEART VALVES: A RETROSPECTIVE, REAL WORLD COHORT STUDY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.183] [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: 11/02/2022] Open
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10
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Radulova-Mauersberger O, Distler M, Riediger C, Weitz J, Welsch T, Kirchberg J. How we do it-the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery. Langenbecks Arch Surg 2022; 407:3819-3831. [PMID: 36136152 DOI: 10.1007/s00423-022-02662-x] [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: 02/28/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Extended resections in hepatopancreatobiliary (HPB) surgery frequently require vascular resection to obtain tumor clearance. The use of alloplastic grafts may increase postoperative morbidity due to septic or thrombotic complications. The use of suitable autologous venous interponates (internal jugular vein, great saphenous vein) is frequently associated with additional incisions. The aim of this study was to report on our experience with venous reconstruction using the introperative easily available parietal peritoneum, focusing on key technical aspects. METHODS All patients who underwent HPB resections with venous reconstruction using peritoneal patches at our department between January 2017 and November 2021 were included in this retrospective analysis with median follow-up of 2 months (IQR: 1-8 months). We focused on technical aspects of the procedure and evaluated vascular patency and perioperative morbidity. RESULTS Parietal peritoneum patches (PPPs) were applied for reconstruction of the inferior vena cava (IVC) (13 patients) and portal vein (PV) (4 patients) during major hepatic (n = 14) or pancreatic (n = 2) resections. There were no cases of postoperative bleeding due to anastomotic leakage. Following PV reconstruction, two patients showed postoperative vascular stenosis after severe pancreatitis with postoperative pancreatic fistula and bile leakage, respectively. In patients with reconstruction of the IVC, no relevant perioperative vascular complications occurred. CONCLUSIONS The use of a peritoneal patch for reconstruction of the IVC in HPB surgery is a feasible, effective, and low-cost alternative to alloplastic, xenogenous, or venous grafts. The graft can be easily harvested and tailored to the required size. More evidence is still needed to confirm the safety of this procedure for the portal vein regarding long-term results.
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Affiliation(s)
- O Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - M Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - C Riediger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. .,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.
| | - T Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - J Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
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11
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Oehme F, Hempel S, Distler M, Weitz J. [Highlights of pancreatic surgery: extended indications in pancreatic neuroendocrine tumors]. Chirurgie (Heidelb) 2022; 93:751-757. [PMID: 35789277 DOI: 10.1007/s00104-022-01646-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Advanced pancreatic neuroendocrine tumors (paNET) are mostly characterized by infiltration of vascular structures and/or neighboring organs. The indications for resection in these cases should be measured based on the possibility of an R0 resection. Although the data situation for this rare entity is limited, small case series have shown a significant survival advantage in patients who underwent a radical resection in locally advanced stages of paNET. Both vascular reconstruction and multivisceral resection, when performed at experienced centers, should be considered as curative treatment options. The very special biological behavior of the paNET and the often young patient age justify a much more aggressive approach compared to the pancreatic ductal adenocarcinoma.
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Affiliation(s)
- F Oehme
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
- National Center for Tumor Diseases (NCT/UCC), Dresden, Deutschland.
- German Cancer Research Center (DKFZ), Heidelberg, Deutschland.
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Deutschland.
| | - S Hempel
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- National Center for Tumor Diseases (NCT/UCC), Dresden, Deutschland
- German Cancer Research Center (DKFZ), Heidelberg, Deutschland
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Deutschland
| | - M Distler
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- National Center for Tumor Diseases (NCT/UCC), Dresden, Deutschland
- German Cancer Research Center (DKFZ), Heidelberg, Deutschland
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- National Center for Tumor Diseases (NCT/UCC), Dresden, Deutschland
- German Cancer Research Center (DKFZ), Heidelberg, Deutschland
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Deutschland
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12
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Ritschl LM, Niu M, Pippich K, Schuh P, Rommel N, Fichter AM, Wolff KD, Weitz J. Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks. Front Oncol 2022; 12:879086. [PMID: 35875163 PMCID: PMC9300821 DOI: 10.3389/fonc.2022.879086] [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: 02/18/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Microvascular reconstruction remains challenging in previously operated and irradiated patients, especially when double flaps seem to be the only solution due to osteoradionecrosis. An alternative reconstructive option could be microvascular anastomosis to the temporal vessels to avoid the obligatory cervical incision. Methods and Materials All consecutive cases between January 2013 and 2020 that underwent either mandibular resection and reconstruction with a free fibula flap (FFF) and another soft tissue flap (group I) or pure intraoral resection and reconstruction with an FFF or radial forearm flap (RFF) with temporal microvascular anastomosis (group II) were included. Patients’ general information, indication and extent of surgery, time of ischemia, time of total surgery, and duration of hospital stay as well as incidence of complications were retrospectively recorded and analyzed. Results Seventeen (group I) and 11 (group II) cases were included. In group I, FFF was combined with RFF (n = 9), anterolateral thigh flap (ALT, n = 7), or latissimus dorsi flap (n = 1). Group II consisted of six FFFs and five RFFs. Operation time and hospitalization duration were significantly shorter in group II (p < 0.001 and p = 0.025), whereas ischemic time of FFF was significantly shorter in group I (p = 0.002). All patients in group I required a tracheostomy, while only four cases in group II did (p = 0.004). The complication rate regarding hematoma removal, revision of anastomosis, flap loss, delirium, sepsis, pleural effusion, pneumonia, and pulmonary artery embolism showed no significant differences between the two groups. Conclusions The superficial temporal vessels served as versatile recipient vessels for intraoral mandibular and soft tissue reconstruction and led to reduced operation time, hospitalization duration, and indication for a primary tracheostomy. Thus, this approach may help to avoid cervical incision for reconstruction in irradiated patients.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- *Correspondence: Lucas M. Ritschl,
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katharina Pippich
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Philia Schuh
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Niklas Rommel
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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13
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Oehme F, Hempel S, Pecqueux M, Müssle B, Hau HM, Teske C, von Bechtolsheim F, Seifert L, Distler M, Welsch T, Weitz J, Kahlert C. Short-term preoperative drainage is associated with improved postoperative outcomes compared to that of long-term biliary drainage in pancreatic surgery. Langenbecks Arch Surg 2021; 407:1055-1063. [PMID: 34910230 PMCID: PMC9151545 DOI: 10.1007/s00423-021-02402-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Purpose The treatment of choice for patients presenting with obstructive cholestasis due to periampullary carcinoma is oncologic resection without preoperative biliary drainage (PBD). However, resection without PBD becomes virtually impossible in patients with obstructive cholangitis or severely impaired liver cell function. The appropriate duration of drainage by PBD has not yet been defined for these patients. Methods A retrospective analysis was conducted on 170 patients scheduled for pancreatic resection following biliary drainage between January 2012 and June 2018 at the University Hospital Dresden in Germany. All patients were deemed eligible for inclusion, regardless of the underlying disease entity. The primary endpoint analysis was defined as the overall morbidity (according to the Clavien-Dindo classification). Secondary endpoints were the in-hospital mortality and malignancy adjusted overall and recurrence-free survival rates. Results A total of 170 patients were included, of which 45 (26.5%) and 125 (73.5%) were assigned to the short-term (< 4 weeks) and long-term (≥ 4 weeks) preoperative drainage groups, respectively. Surgical complications (Clavien-Dindo classification > 2) occurred in 80 (47.1%) patients, with significantly fewer complications observed in the short-term drainage group (31.1% vs. 52%; p = 0.02). We found that long-term preoperative drainage (unadjusted OR, 3.386; 95% CI, 1.507–7.606; p < 0.01) and periampullary carcinoma (unadjusted OR, 5.519; 95% CI, 1.722–17.685; p-value < 0.01) were independent risk factors for postoperative morbidity, based on the results of a multivariate regression model. The adjusted overall and recurrence-free survival did not differ between the groups (p = 0.12). Conclusion PBD in patients scheduled for pancreatic surgery is associated with substantial perioperative morbidity. Our results indicate that patients who have undergone PBD should be operated on within 4 weeks after drainage.
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Affiliation(s)
- F Oehme
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - S Hempel
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - M Pecqueux
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - B Müssle
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - H M Hau
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - C Teske
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - F von Bechtolsheim
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - L Seifert
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - M Distler
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - T Welsch
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - J Weitz
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Cristoph Kahlert
- Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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14
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Kirchberg J, Blum SFU, Pablik J, Herold S, Hoffmann RT, Baretton G, Weitz J. [Preoperative diagnostics and typing of abdominal soft tissue sarcomas]. Chirurg 2021; 93:5-15. [PMID: 34757436 DOI: 10.1007/s00104-021-01528-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Abdominal sarcomas are a heterogeneous group of rare soft tissue tumors and can be localized intraperitoneally or retroperitoneally. A pretherapeutic differentiated subtyping is essential for planning an individual, multimodal treatment concept in an interdisciplinary team of experts. OBJECTIVE The central aspects of histology acquisition, imaging diagnostics and (molecular) pathological subtyping of abdominal soft tissue sarcomas are described in detail. MATERIAL AND METHODS Imaging and pathological diagnostics are depicted based on the German S3 guidelines on adult soft tissue sarcomas, a current literature search and personal experiences at the Sarcoma Center at the National Center for Tumor Diseases in Dresden (NCT/UCC). RESULTS Preoperative imaging and (molecular) pathological subtyping of abdominal soft tissue sarcomas place high demands on surgeons, radiologists and pathologists. Genome analyses of sarcomas have the potential to identify points of attack for individualized treatment options. The limitations of resectability can only be assessed by experienced sarcoma surgeons at specialized centers. CONCLUSION The treatment of abdominal soft tissue sarcomas at an experienced center is associated with a better prognosis. Even at the first suspicion of an abdominal sarcoma, a referral to an experienced center should be made in order to guarantee optimal expertise in diagnostics and treatment.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland. .,Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - S F U Blum
- Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Pablik
- Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.,Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S Herold
- Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.,Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - R T Hoffmann
- Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - G Baretton
- Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.,Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.,Sarkomzentrum Dresden am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
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15
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Ritschl LM, Kilbertus P, Grill FD, Schwarz M, Weitz J, Nieberler M, Wolff KD, Fichter AM. In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis. Front Oncol 2021; 11:731336. [PMID: 34631563 PMCID: PMC8498593 DOI: 10.3389/fonc.2021.731336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/26/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning. Methods and Materials All consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used. Results Twenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4–7.2), MSD of 0.3 (-0.1–2.9), and HD of 0.7 (0.1–3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5–11.1), MSD of 0.5 (-0.6–6.1), and HD of 1.5 (1.1–6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3–10.7), MSD of -0.1 (-1.0–5.6), and HD of 1.7 (0.1–5.9). Conclusions Open-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Paul Kilbertus
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Schwarz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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16
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Oehme F, Hempel S, Knote R, Addai D, Distler M, Muessle B, Bork U, Weitz J, Welsch T, Kahlert C. Perioperative Blood Management of Preoperative Anemia Determines Long-Term Outcome in Patients with Pancreatic Surgery. J Gastrointest Surg 2021; 25:2572-2581. [PMID: 33575903 DOI: 10.1007/s11605-021-04917-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND/PURPOSE Anemia affects the postoperative course of patients undergoing a major surgical procedure. However, it remains unclear whether anemia has a different impact on the long-term outcome of patients with malignant or benign pancreatic disease. METHODS A retrospective analysis of patients undergoing pancreatic surgery for pancreatic malignancies or chronic pancreatitis was conducted between January 2012 and June 2018 at the University Hospital Dresden, Germany. The occurrence of preoperative anemia and the administration of pre-, intra-, and postoperative blood transfusions were correlated with postoperative complications and survival data by uni- and multivariate analysis. RESULTS A total of 682 patients were included with 482 (70.7%) undergoing surgical procedures for pancreatic malignancies. Univariate regression analysis confirmed preoperative anemia as a risk factor for postoperative complications > grade 2 according to the Clavien-Dindo classification. Multivariate regression analyses indicated postoperative blood transfusion as an independent risk factor for postoperative complications in patients with a benign (OR 20.5; p value < 0.001) and a malignant pancreatic lesion (OR 4.7; p value < 0.01). Univariate and multivariate analysis revealed preoperative anemia and pre-, intra-, and postoperative blood transfusions as independent prognostic factors for shorter overall survival in benign and malignant patients (p value < 0.001-0.01). CONCLUSION Preoperative anemia is a prevalent, independent, and adjustable factor in pancreatic surgery, which poses a significant risk for postoperative complications irrespective of the entity of the underlying disease. It should therefore be understood as an adjustable factor rather than an indicator of underlying disease severity.
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Affiliation(s)
- F Oehme
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - S Hempel
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - R Knote
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - D Addai
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - M Distler
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - B Muessle
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - U Bork
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - J Weitz
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - T Welsch
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - C Kahlert
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
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17
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Dossenbach A, Rothermel M, Lutz P, Weitz J. Indication for temporary tracheotomy in microvascular reconstructions in the head and neck area. Int J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.ijom.2022.03.021] [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: 10/17/2022]
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18
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Bosch F, Wang TF, Di Nisio M, Segers A, Connors J, Garcia D, Mulder F, Weitz J, Buller H, Carrier M, Verhamme P, Grosso M, Raskob G, van Es N. OC-14 Risk factors for recurrence in patients with cancer-associated venous thromboembolism: results from the Hokusai-VTE cancer study. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00156-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Kirchberg J, Fritzmann J, Clemens J, Oppermann N, Johannink J, Kirschniak A, Weitz J, Mees ST. [The suffering surgeon-How do German surgeons protect themselves? : Survey of the German Society of General and Visceral Surgery on the extent of occupational safety measures and health burden among German surgeons]. Chirurg 2021; 92:1114-1122. [PMID: 33599806 PMCID: PMC7890796 DOI: 10.1007/s00104-021-01365-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden. OBJECTIVE In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon". MATERIAL AND METHODS An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care). RESULTS The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548). CONCLUSION Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - J Fritzmann
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Clemens
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - N Oppermann
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Johannink
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - A Kirschniak
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S T Mees
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Deutschland
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20
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Kahlert C, Janda M, Weitz J. [Process management in surgery]. Chirurg 2021; 92:237-243. [PMID: 33495882 DOI: 10.1007/s00104-020-01343-z] [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] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Process management is defined as the concept of identifying processes in a company or healthcare organization, analyzing them and improving productivity and efficiency. In hospitals, process management focuses on patient safety, an increase in economic resources and employee satisfaction. The integration of process management into clinical pathways helps to accelerate workflows and to improve the quality of patient service. The different types of process management encompass the radical concept of process renewal (revolutionary renewal) as well as the concept of evolutionary optimization. Process management in surgery is applied to preoperative, perioperative and postoperative procedures. The development and implementation of evidence-based treatment pathways can help to standardize and structure treatment processes in a surgical department. In this context, the operating room (OR) plays a particularly central role as the most important part of the healthcare provision of perioperative services. Process management is indispensable for the utilization of an optimal OR capacity taking a maximum patient safety and the desired optimal satisfaction of employees into account. The benefits of process management in the OR area are illustrated in an exemplary case study, demonstrating how innovative process management results in an increase of the operation capacity with a simultaneous reduction in costs.
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Affiliation(s)
- C Kahlert
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - M Janda
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, der Universitätsmedizin Rostock, Rostock, Deutschland
| | - J Weitz
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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21
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Riediger C, Weitz J. SP-0624: The surgeon's point of view. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00646-0] [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: 10/22/2022]
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Weitz J, Spaas C, Wolff KD, Meyer B, Shiban E, Ritschl LM. A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach. Front Oncol 2019; 9:1130. [PMID: 31709189 PMCID: PMC6823187 DOI: 10.3389/fonc.2019.01130] [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] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.
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Affiliation(s)
- Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Christophe Spaas
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Neurosurgery Department, University Hospital of Augsburg, Augsburg, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
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Holmer C, Benz S, Fichtner-Feigl S, Jehle EC, Kienle P, Post S, Schiedeck T, Weitz J, Kreis ME. [Transanal total mesorectal excision-a critical appraisal]. Chirurg 2019; 90:478-486. [PMID: 30911795 DOI: 10.1007/s00104-019-0945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Total mesorectal excision (TME) is the international standard for rectal cancer surgery. In addition to laparoscopic TME (lapTME), transanal TME (taTME) was developed in recent years to reduce the rate of incomplete TME, conversion to open surgery and postoperative functional impairment. Despite limited evidence, this technique is becoming increasingly more popular and is already routinely used by many hospitals for rectal cancer in varying tumor level locations. The aim of this review was to evaluate the taTME compared to anterior rectal resection with lapTME as the standard of care in rectal cancer surgery based on currently available evidence. METHOD The databases PubMed and Medline were systematically searched for publications on transanal total mesorectal excision (taTME) and transanal minimally invasive surgery (TAMIS). Relevant studies were selected and further research based on the reference lists was undertaken. RESULTS A total of 16 studies analyzing 3782 patients were identified. The taTME does not lead to a higher rate of complete TME-resected specimens compared to the standard procedure. So far, superiority could not be demonstrated for complication rates or for functional or oncological results. Serious complications secondary to dissection in incorrect planes were observed. The anastomotic level generally seems to be closer to the sphincter after taTME versus anterior lapTME. CONCLUSION Considering current evidence, taTME failed to show superiority compared to conventional anterior lapTME. Although taTME has some potential advantages, it carries substantial risks. If performed outside of clinical trials, it should therefore only be used in carefully selected patients with a high possibility of conversion, following adequate patient informed consent and after intense and systematic training of the surgeon.
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Affiliation(s)
- C Holmer
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - S Benz
- Klinikum Sindelfingen-Böblingen, Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Klinikverbund Südwest, Böblingen, Deutschland
| | - S Fichtner-Feigl
- Klinik für Allgemein- und Viszeralchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - E C Jehle
- Klinik für Allgemein- und Viszeralchirurgie, St. Elisabethen-Klinikum, Ravensburg, Deutschland
| | - P Kienle
- Klinik für Allgemein- und Viszeralchirurgie, Theresienkrankenhaus, Mannheim, Deutschland
| | - S Post
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - T Schiedeck
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Dresden, Deutschland
| | - M E Kreis
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Hindenburgdamm 30, 12200, Berlin, Deutschland.
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Abstract
The superiority of minimally invasive operative methods compared to open surgery with respect to various parameters of short-term outcome with adequate oncological long-term results has already been confirmed for many tumor entities in high-quality studies. The continuously expanding robotic surgery offers certain additional benefits in minimally invasive oncological visceral surgery, such as a high-resolution stable 3‑dimensional view, optimal freedom of movement in situ, elimination of natural tremor and better ergonomics. This article evaluates whether these postulated advantages are reflected in an improvement of the short-term perioperative and long-term oncological results compared to conventional minimally invasive surgery in oncological visceral surgery (rectum, colon, stomach, esophagus, pancreas, liver) according to the criteria of evidence-based medicine. With the exception of colorectal surgery, there are currently no randomized controlled studies comparing robotic to laparoscopic surgery in oncological visceral surgery. There is still a clear imbalance between the exponentially expanding application of robotic surgery and the existing lack of high-quality evidence. Further randomized controlled clinical trials urgently need to be performed especially considering the great technological development potential of robotic surgery.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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25
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Hofheinz R, Fokas E, Allgäuer M, Polat B, Klautke G, Grabenbauer G, Fietkau R, Kuhnt T, Staib L, Brunner T, Grosu A, Schmiegel W, Jacobasch L, Weitz J, Folprecht G, Germer C, Grützmann R, Schwarzbach M, Bechstein W, Friede T, Ghadimi M, Rödel C. Randomized phase 2 trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bruzzi M, Auclin E, Lo Dico R, Voron T, Karoui M, Espin E, Cianchi F, Weitz J, Buggenhout A, Malafosse R, Denimal F, Le Malicot K, Vernerey D, Douard R, Emile JF, Lepage C, Laurent-Puig P, Taieb J. Influence of Molecular Status on Recurrence Site in Patients Treated for a Stage III Colon Cancer: a Post Hoc Analysis of the PETACC-8 Trial. Ann Surg Oncol 2019; 26:3561-3567. [PMID: 31209667 DOI: 10.1245/s10434-019-07513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recurrence patterns in stage III colon cancer (CC) patients according to molecular markers remain unclear. The objective of the study was to assess recurrence patterns according to microsatellite instability (MSI), RAS and BRAFV600E status in stage III CC patients. METHODS All stage III CC patients from the PETACC-8 randomized trial tested for MSI, RAS and BRAFV600E status were included. The site and characteristics of recurrence were analyzed according to molecular status. Survival after recurrence (SAR) was analyzed. RESULTS A total of 1650 patients were included. Recurrence occurred in 434 patients (26.3%). Microsatellite stable (MSS) patients had a significantly higher recurrence rate (27.2% vs. 18.7%, P = 0.02) with a trend to more pulmonary recurrence (28.8% vs. 12.9%, P = 0.06) when compared to MSI patients. MSI patients experienced more regional lymph nodes compared to MSS (12.9% vs. 4%, P = 0.046). In the MSS population, the recurrence rate was significantly higher in RAS (32.2%) or BRAF (32.3%) patients when compared to double wild-type patients (19.9%) (p < 0.001); no preferential site of recurrence was observed according to RAS and BRAFV600E mutations. Finally, decreased SAR was observed in the case of peritoneal recurrence or more than two recurrence sites. CONCLUSIONS Microsatellite, RAS and BRAFV600E status influences recurrence rates in stage III CC patients. However, only microsatellite status seems to be associated with specific recurrence patterns. More than two recurrence sites and recurrence in the peritoneum were associated with poorer SAR.
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Affiliation(s)
- M Bruzzi
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - E Auclin
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Lo Dico
- Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris, France
| | - T Voron
- Department of Digestive and General Surgery, Saint Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - M Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris VI University Institute of Cancerology, Paris, France
| | - E Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - F Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Dresden, Germany
| | - A Buggenhout
- Department of Surgical Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - R Malafosse
- Department of Digestive Surgery, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - F Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche Sur Yon, France
| | - K Le Malicot
- Statistical Department, Fédération Francophone de Cancérologie Digestive, EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, Dijon, France
| | - D Vernerey
- Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Douard
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - J F Emile
- Pathology Department, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - C Lepage
- Hepato-Gastroenterology Department, Dijon University Hospital and EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - P Laurent-Puig
- Department of Biology, European Georges Pompidou Hospital, AP-HP, INSERM-UMR-S1147, Paris, France
| | - J Taieb
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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Diefenhardt M, Hofheinz R, Beissbarth T, Arnold D, Müller von den Grün J, Liersch T, Ströbel P, Grabenbauer G, Fietkau R, Weitz J, Ghadimi M, Rödel C, Fokas E. OC-0499 Neutrophilia as prognostic factor for outcome in the CAO/ARO/AIO-04 phase 3 rectal cancer trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30919-3] [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: 10/26/2022]
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Goetz C, Burian NM, Weitz J, Wolff KD, Bissinger O. Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat? J Craniomaxillofac Surg 2019; 47:642-646. [DOI: 10.1016/j.jcms.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 01/18/2023] Open
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Fritzmann J, Kirchberg J, Sturm D, Ulrich AB, Knebel P, Mehrabi A, Büchler MW, Weitz J, Reissfelder C, Rahbari NN. Randomized clinical trial of stapler hepatectomy versus LigaSure™ transection in elective hepatic resection. Br J Surg 2019; 105:1119-1127. [PMID: 30069876 DOI: 10.1002/bjs.10902] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/19/2018] [Revised: 04/07/2018] [Accepted: 05/04/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies have demonstrated stapler hepatectomy and use of various energy devices to be safe alternatives to the clamp-crushing technique in elective hepatic resection. In this randomized trial, the effectiveness and safety of stapler hepatectomy were compared with those of parenchymal transection with the LigaSure™ vessel sealing system. METHOD Patients scheduled for elective liver resection at two tertiary-care centres were randomized during surgery to stapler hepatectomy or transection with the LigaSure™ device. Total intraoperative blood loss was the primary efficacy endpoint. Transection time, duration of operation, perioperative complications and length of hospital stay were recorded as secondary endpoints. RESULTS A total of 138 patients were analysed, 69 in the LigaSure™ and 69 in the stapler hepatectomy group. Baseline characteristics were well balanced between the groups. Mean intraoperative blood loss was significantly higher in the LigaSure™ group than the stapler hepatectomy group: 1101 (95 per cent c.i. 915 to 1287) versus 961 (752 to 1170) ml (P = 0·028). The parenchymal transection time was significantly shorter in the stapler group (P = 0·005), as was the total duration of operation (P = 0·027). Surgical morbidity did not differ between the groups, nor did the grade of complications. CONCLUSION Stapler hepatectomy was associated with reduced blood loss and a shorter duration of operation than the LigaSure™ device for parenchymal transection in elective partial hepatectomy. Registration number: NCT01858987 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Fritzmann
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - J Kirchberg
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Sturm
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - A B Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - J Weitz
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - C Reissfelder
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - N N Rahbari
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
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Weitz J, Wolff KD, Kesting MR, Nobis CP. Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap. J Craniomaxillofac Surg 2018; 46:1975-1978. [DOI: 10.1016/j.jcms.2018.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
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Frohwitter G, Wimmer S, Goetz C, Weitz J, Ulbig M, Kortuem KU, Dangelmaier J, Ritschl L, Doll C, Ristow O, Kesting MR, Koerdt S. Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital floor fractures. J Craniomaxillofac Surg 2018; 46:1550-1554. [DOI: 10.1016/j.jcms.2018.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/17/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
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Crowther MA, Johnston M, Weitz J, Ginsberg JS. Free Protein S Deficiency May Be Found in Patients with Antiphospholipid Antibodies who Do not Have Systemic Lupus Erythematosus. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn order to determine if there is a relationship between antiphospholipid antibodies and reduced free protein S levels, we evaluated 21 patients who had an antiphospholipid antibody but had neither a history of venous thromboembolism nor systemic lupus erythematosus (cases) and 55 matched controls, who did not have an antiphospholipid antibody, a history of thrombosis or systemic lupus erythematosus. Cases and controls had similar protein C and antithrombin levels. Six of 21 cases had reduced free protein S antigen levels, compared to 5 of 55 controls (x
2 = 5.823 p <0.025). In addition, the mean free protein S level was significantly lower in cases than in controls (0.30 ± 0.09 units vs 0.39 ± 0.13 units, p <0.01, two-tailed Student’s t-test). We conclude that antiphospholipid antibodies are associated with a significant decrease in free protein S levels, and that this acquired free protein S deficiency may contribute to the thrombotic diathesis seen in patients with antiphospholipid antibodies.
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Affiliation(s)
- M A Crowther
- The Departments of Medicine and Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M Johnston
- The Departments of Medicine and Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J Weitz
- The Departments of Medicine and Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J S Ginsberg
- The Departments of Medicine and Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada
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Ginsberg JS, Nurmohamed MT, Gent M, MacKinnon B, Stevens P, Weitz J, Maraganore J, Hirsh J. Effects on Thrombin Generation of Single Injections of Hirulog™ in Patients with Calf Vein Thrombosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648907] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary1. Study objective: To determine whether single injections of Hirulog, a direct thrombin inhibitor, can inhibit thrombin generation in patients with calf vein thrombosis and, if so, if the inhibition is sustained.2. Design: Phase II open label cohort study.3. Setting: Tertiary-care referral centres, university affiliated hospitals.4. Patients: 10 patients with venographically-demonstrated calf vein thrombosis.5. Intervention: Patients received a single injection of Hirulog, either 1.0 mg/kg subcutaneously or 0.6 mg/kg as a 15 min intravenous infusion. Prothrombin fragment (F1+2) levels, as an index of thrombin generation, were measured before as well as 6 h post- and 24 h post-Hirulog administration. Patients were followed with non-invasive tests to detect thrombus extension into the proximal veins.6. Results: There was a significant reduction in the levels of F1+2 with both regimens, 6 h after Hirulog. The Fl+2 levels 24 h post-Hirulog showed a significant increase relative to the 6 h post-Hirulog results. One patient developed thrombus extension into the popliteal vein and was treated with conventional anticoagulants.7. Conclusion: The single injections of Hirulog used in the study produced incomplete and temporary suppression of F1+2. Complete and permanent inhibition of thrombin generation with Hirulog in patients with calf vein thrombosis may require higher doses, multiple subcutaneous injections and/or prolonged intravenous infusion.
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Affiliation(s)
- J S Ginsberg
- The Department of Medicine, McMaster University, Hamilton, Canada
| | - M T Nurmohamed
- Department of Thrombosis and Haemostasis, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Gent
- Clinical Epidemiology and Biostatistics, Hamilton Civic Hospitals Research Centre, Hamilton, Canada
| | - B MacKinnon
- Clinical Epidemiology and Biostatistics, Hamilton Civic Hospitals Research Centre, Hamilton, Canada
| | - P Stevens
- The Department of Medicine, McMaster University, Hamilton, Canada
| | - J Weitz
- The Department of Medicine, McMaster University, Hamilton, Canada
| | | | - J Hirsh
- The Department of Medicine, McMaster University, Hamilton, Canada
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Andrew M, Brooker L, Leaker M, Paes B, Weitz J. Fibrin Clot Lysis by Thrombolytic Agents Is Impaired in Newborns due to a Low Plasminogen Concentration. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656374] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAlthough thrombolytic drugs have been extensively used in adults, there is sparse information on their effectiveness in newborns whose fibrinolytic system differs significantly from adults. The purpose of this study was to determine if low plasma levels of plasminogen in cord plasma limited the therapeutic effectiveness of thrombolytic agents. Urokinase (UK), streptokinase (SK) and tissue plasminogen activator (TPA) were compared for their ability to lyse washed 125I-labelled adult or cord fibrin clots suspended in cord or adult plasma. 125I-labelled fibrin clots were prepared by recalcifying cord or adult plasma spiked with labelled fibrinogen and then placed into cord or adult plasma which contained either saline or differing amounts of a specific thrombolytic agent. After a 60 min incubation, the remaining 125I-fibrin in clots released 125I-fibrin fragments, and concentrations of fibrinogen, α2-antiplasmin, and plasminogen in the bathing plasma were measured and compared to starting values. Cord fibrin clots were more resistant than adult fibrin clots to all thrombolytic drugs tested (p <0.001). On average, the cord system retained 27% more 125I-fibrin in clots, and released 32% less 125I-fibrin fragments into plasma. Fibrinogenolysis was also decreased in cord plasmas compared to adult plasmas. The degree of fibrinolysis and fibrinogenolysis in cord plasma increased to adult values when plasminogen concentrations were increased in the bathing plasma. Thus, cord fibrin clots have an impaired response to thrombolytic agents secondary to low levels of plasminogen. We speculate that the clinical response of newborns to thrombolytic agents is also impaired and will not be enhanced by increasing doses of thrombolytic agents but may be enhanced by increasing the concentration of plasminogen.
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Affiliation(s)
- M Andrew
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - L Brooker
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - M Leaker
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - B Paes
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - J Weitz
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
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Lo T, Piper I, Depreitere B, Meyfroidt G, Poca M, Sahuquillo J, Durduran T, Enblad P, Nilsson P, Ragauskas A, Kiening K, Morris K, Agbeko R, Levin R, Weitz J, Park C, Davis P. KidsBrainIT: A New Multi-centre, Multi-disciplinary, Multi-national Paediatric Brain Monitoring Collaboration. Acta Neurochir Suppl 2018; 126:39-45. [PMID: 29492529 DOI: 10.1007/978-3-319-65798-1_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Validated optimal cerebral perfusion pressure (CPP) treatment thresholds in children do not exist. To improve the intensive care unit (ICU) management of the paediatric traumatic brain injury (TBI) population, we are forming a new paediatric multi-centre collaboration to recruit standardised ICU data for running and reporting upon models for assessing autoregulation and optimal CCP (CPPopt). MATERIALS AND METHODS We are adapting the adult BrainIT group's approach to develop a new Paediatric Brain Monitoring and Information Technology Group (KidsBrainIT), which will include a repository to store prospectively collected high-resolution physiological, clinical, and outcome data. In the first phase of this project there are 7 UK Paediatric Intensive Care Units, 1 Spanish, 1 Belgium, and 1 Romanian Centre interested in participating. In subsequent phases, we plan to open recruitment to other centres both within Europe, US and abroad. We are collaborating with the Leuven Group and plan to use their LAx (low-frequency autoregulation index), DATACAR (dynamic adaptive target of active cerebral autoregulation), CPPopt and visualisation methodologies. We also plan to use the continuous diffuse optical monitoring and tomography technology developed in Barcelona as an acute surrogate end-point for optimising brain perfusion. This technology allows non-invasive continuous monitoring of deep tissue perfusion and oxygenation in adults but its clinical application in infants and children with TBI has not been studied previously. RESULTS We report on the current status of setting up this new collaboration and also on pilot analyses in two centres which are the basis of our rationale for the need for a prospective validation study of CPPopt in children. Specifically, we demonstrated that CPPopt varied with time for each patient during their paediatric intensive care unit (PICU) stay, and the median overall CPPopt levels for children aged 2-6 years, 7-11 years and 12-16 years were 68.83, 68.09, and 72.17 mmHg respectively. Among survivors and patients with favourable outcome (GOS 4 and 5), there were significantly higher proportions with CPP monitoring time within CPPopt (p = 0.04 and p = 0.01 respectively). CONCLUSIONS There is a need and an interest in forming a multi-centre PICU collaboration for acquiring data and performing analyses for determining validated CPPopt thresholds in the paediatric TBI population. KidsBrainIT is being formed to meet that need.
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Affiliation(s)
- T Lo
- Royal Hospital for Sick Children, Edinburgh, UK
| | - I Piper
- Queen Elizabeth University Hospital, Glasgow, UK.
| | | | | | - M Poca
- Val D'hebron University Hospital, Barcelona, Spain
| | - J Sahuquillo
- Val D'hebron University Hospital, Barcelona, Spain
| | - T Durduran
- Val D'hebron University Hospital, Barcelona, Spain
| | - P Enblad
- Uppsala University Hospital, Uppsala, Sweden
| | - P Nilsson
- Uppsala University Hospital, Uppsala, Sweden
| | - A Ragauskas
- Kaunas University of Technology, Kaunas, Lithuania
| | - K Kiening
- Heidelberg University Hospital, Heidelberg, Germany
| | - K Morris
- Birmingham Children's Hospital, Birmingham, UK
| | - R Agbeko
- Great Northern Children's Hospital, Newcastle Upon Tyne, UK
| | - R Levin
- Royal Hospital for Children, Glasgow, UK
| | - J Weitz
- Oxford Radcliffe Hospitals NHS Foundation Trust, Oxford, UK
| | - C Park
- Alder Hey Childrens NHS Foundation Trust, Liverpool, UK
| | - P Davis
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Stange DE, Weitz J, Welsch T. Chirurgische Therapie von Adenokarzinomen des gastroösophagealen Übergangs und des Magens. Gastroenterologe 2017; 12:401-406. [DOI: 10.1007/s11377-017-0190-0] [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: 08/30/2023]
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Abstract
BACKGROUND The indications for resection of pancreatic cystic lesions (PCL) are often complex and the operative risk has to be balanced against the risk of malignant transformation. The aim of the study was to provide a synopsis of the current treatment results of minimally invasive surgery for PCL. METHODS A systematic literature search was performed using the Medline database (PubMed). Subsequently, the retrieved literature was selectively reviewed. RESULTS No published prospective randomized controlled trials have yet addressed the comparison of open and minimally invasive surgery of PCL; however, retrospective case studies have demonstrated the feasibility, safety and a comparable morbidity after minimally invasive distal pancreatectomy (DP), pancreatoduodenectomy (PD), central (CP) or total pancreatectomy and enucleation. Whereas most DPs are performed laparoscopically, the experience of minimally invasive PD has been consolidated for the robot-assisted approach but is concentrated in only a few centers. The number of published reports on minimally invasive organ-sparing pancreas procedures (e. g. CP or enucleation) for PCL is scarce; however, the available (selected) results are promising. CONCLUSION Minimally invasive surgery for PCL has the potential to reduce the operative trauma to the patients, while at the same time causing comparable or less morbidity. This requires an increasing specialization of complex minimally invasive resections. The clinical use of robotic systems will grow for the latter cases. A prospective registry of the results should be mandatory for quality management.
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Affiliation(s)
- T Welsch
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland.
| | - M Distler
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
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Rommel N, Kesting MR, Rohleder NH, Bauer FMJ, Wolff KD, Weitz J. Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning. J Craniomaxillofac Surg 2017; 45:1246-1250. [DOI: 10.1016/j.jcms.2017.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/08/2017] [Accepted: 04/21/2017] [Indexed: 01/08/2023] Open
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Kolk A, Haidari S, Wolff KD, Fichter A, Kehl V, Götz C, Kesting M, Weitz J. The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success? J Reconstr Microsurg Open 2017. [DOI: 10.1055/s-0037-1604343] [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: 10/19/2022] Open
Abstract
Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction.
Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study.
Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001).
Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.
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Affiliation(s)
- Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - S. Haidari
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - K.-D. Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - A. Fichter
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - V. Kehl
- Department of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - C. Götz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - M. Kesting
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
| | - J. Weitz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
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Müssle B, Distler M, Wolk S, Shrikhande SV, Aust DE, Arlt A, Weitz J, Hackert T, Welsch T. Management of patients with pancreatic cystic lesions: A case-based survey. Pancreatology 2017; 17:431-437. [PMID: 28456590 DOI: 10.1016/j.pan.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/19/2017] [Accepted: 04/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cystic lesions (PCL), including intraductal papillary mucinous neoplasia (IPMN), harbor different malignant potential and the optimal management is often challenging. The present study aims to depict the compliance of experts with current consensus guidelines and the accuracy of treatment recommendations stratified by the medical specialty and hospital volume. METHODS An international survey was conducted using a set of 10 selected cases of PCL that were presented to a cohort of international experts on pancreatology. All presented cases were surgically resected between 2004 and 2015 and histopathological examination was available. Accuracy of the treatment recommendations was based on the European and international consensus guideline algorithms, and the histopathological result. RESULTS The response rate of the survey was 26% (46 of 177 contacted experts), consisting of 70% surgeons and 30% gastroenterologists/oncologists (GI/Onc). In the case of main-duct IPMN (MD-IPMN), surgeons preferred more often the surgical approach in comparison with the GI/Onc (55 versus 44%). The mean accuracy rate based on the European and international consensus guidelines, and the histopathological result, were 71/76/38% (surgeons), and 70/73/34% (GI/Onc), respectively. High-volume centers achieved insignificantly higher accuracy scores with regard to the histopathology. Small branch-duct IPMN with cysts <2 cm and malignant potential were not identified by the guideline algorithms. CONCLUSION The survey underlines the complexity of treatment decisions for patients with PCL; less than 40% of the recommendations were in line with the final histopathology in this selected case panel. Experts and consensus guidelines may fail to predict malignant potential in small PCL.
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Affiliation(s)
- B Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - M Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - S Wolk
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - S V Shrikhande
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India
| | - D E Aust
- Institute for Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - A Arlt
- Department of Internal Medicine I, Christian-Albrechts-University & UKSH Campus Kiel, Kiel, Germany
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - T Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
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Probst M, Richter V, Weitz J, Kirschke JS, Ganter C, Troeltzsch M, Nittka M, Cornelius CP, Zimmer C, Probst FA. Magnetic resonance imaging of the inferior alveolar nerve with special regard to metal artifact reduction. J Craniomaxillofac Surg 2017; 45:558-569. [DOI: 10.1016/j.jcms.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/08/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
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Abstract
Although robot-assisted pancreatic surgery has been considered critically in the past, it is nowadays an established standard technique in some centers, for distal pancreatectomy and pancreatic head resection. Compared with the laparoscopic approach, the use of robot-assisted surgery seems to be advantageous for acquiring the skills for pancreatic, bile duct and vascular anastomoses during pancreatic head resection and total pancreatectomy. On the other hand, the use of the robot is associated with increased costs and only highly effective and professional robotic programs in centers for pancreatic surgery will achieve top surgical and oncological quality, acceptable operation times and a reduction in duration of hospital stay. Moreover, new technologies, such as intraoperative fluorescence guidance and augmented reality will define additional indications for robot-assisted pancreatic surgery.
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Affiliation(s)
- B Müssle
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - M Distler
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - T Welsch
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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43
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Kesting M, Rommel N, Koerdt S, Frohwitter G, Wolff K, Weitz J. The sandwich technique: an operative approach in the prevention of complications by extensive defects in the head and neck. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.626] [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: 11/15/2022]
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Bissinger O, Probst FA, Wolff KD, Jeschke A, Weitz J, Deppe H, Kolk A. Comparative 3D micro-CT and 2D histomorphometry analysis of dental implant osseointegration in the maxilla of minipigs. J Clin Periodontol 2017; 44:418-427. [DOI: 10.1111/jcpe.12693] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Oliver Bissinger
- Department of Oral and Maxillofacial Surgery; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
| | - Anke Jeschke
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
- Institute of Molecular Immunology - Experimental Oncology; Klinikum rechts der Isar der Technischen Universität München; Munich Germany
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Abstract
In the last few years robotic surgery has progressed from being confined to a small niche to a widespread application in routine visceral surgery; however, evidence for superiority of robotic surgery compared to laparoscopy from randomized studies with a sufficient number of patients is still lacking in most fields of visceral surgery. For complex operations that necessitate an extensive reconstruction phase, such as pancreatectomy, gastrectomy and esophagectomy, there is a potential benefit for the permanent and justified use of robotic surgery. Even in operations where delicate nerve preparation and radical surgical resection are simultaneously necessary, such as rectal resection, robotic surgery may provide certain benefits. In the long term there is a great potential for the integration of innovative techniques, such as navigation or other medical imaging procedures into robotic surgery, which can currently only partially be estimated. Care must be taken to avoid premature euphoria; however, due to the assumed great potential there is an urgent need for randomized studies to evaluate the possible benefits of robotic surgical techniques in visceral surgery in order to generate evidence for the welfare of patients.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - T Mees
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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46
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Köhler K, Weitz J, Reißfelder C. Der seltene und besondere Notfall: Ösophagusperforation. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1586315] [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: 10/21/2022]
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47
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Weitz J, Bauer F, Hapfelmeier A, Rohleder N, Wolff KD, Kesting M. Accuracy of mandibular reconstruction by three-dimensional guided vascularised fibular free flap after segmental mandibulectomy. Br J Oral Maxillofac Surg 2016; 54:506-10. [DOI: 10.1016/j.bjoms.2016.01.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022]
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Abstract
Pancreatic surgery is one of the most challenging fields in visceral surgery. However, laparoscopic pancreatic surgery has not become the standard of care as yet, especially because of the very demanding reconstruction of anastomoses in pancreaticoduodenectomy. Robotic surgery has been a recent advance in laparoscopy. Its benefits are a better 3D view, a greater degree of freedom corresponding to that of the human hand, and tremor elimination. These factors greatly facilitate the intracorporeal suturing and knot-tying, which offers a technical advantage in performing pancreaticojejunostomy as compared with laparoscopic resections. However, only a few centres are offering this procedure for pancreatic resections. Retrospective analyses show that robotic pancreatic resections are safe und oncologically adequate if performed by experienced surgeons. Prospective, randomised trials comparing laparoscopic and robotic pancreatic resection techniques are not available to date.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Deutschland
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49
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Nitschke P, Bork U, Plodeck V, Podlesek D, Sobottka SB, Schackert G, Weitz J, Kirsch M. [Importance of preoperative and intraoperative imaging for operative strategies]. Chirurg 2016; 87:179-88. [PMID: 26939896 DOI: 10.1007/s00104-016-0163-8] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy.
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Affiliation(s)
- P Nitschke
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Bork
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - V Plodeck
- Institut für Radiologie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - D Podlesek
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S B Sobottka
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Schackert
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Kirsch
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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50
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Abstract
Sarcomas are a heterogeneous group of rare tumors that originate from mesenchymal tissue. Radical R0 resection is the only curative option, which is especially challenging in retroperitoneal or intra-abdominal sarcomas. This article describes the current data on optimal interdisciplinary and primarily surgical therapy of visceral sarcomas. Surgical resection of retroperitoneal sarcomas must be performed according to the principle of radical compartmental resection, i.e. with complete excision of the mass along with en bloc visceral resection of adjacent organs and tissues covering the tumor, which also contains any not obviously infiltrated neighboring organs. The main objective is R0 resection without opening the tumor capsule in the primary operation because the best long-term results can be achieved with this approach.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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