1
|
Roller J, Zimmer V, Bücker A, Glanemann M, Eisele R. Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma: Case report. Medicine (Baltimore) 2022; 101:e29195. [PMID: 35665726 PMCID: PMC9276210 DOI: 10.1097/md.0000000000029195] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Microwave ablation (MWA) has been proven to be an efficient and safe method for local tumor control of liver tumors. Reported complications are rare, but include liver abscess, hematoma, pleural effusion, and occasional thermal injury of the adjacent colon. Intestinal perforation usually requires immediate surgical treatment to prevent generalized peritonitis and sepsis. PATIENT CONCERNS AND DIAGNOSIS Herein, we describe a case of gastric perforation following percutaneous MWA for hepatocellular carcinoma as a bridging therapy prior to liver transplantation. INTERVENTIONS Due to the clinical condition of the patient, conservative treatment was considered sufficient. Nine months after MWA, successful liver transplantation followed. Intraoperative findings revealed a scar in the gastric wall with tight adhesions to the liver, requiring adhesiolysis and subsequent suturing. Postoperative recovery was uneventful. OUTCOME At present, the patient is doing well. No further gastrointestinal events occurred. LESSON To our knowledge, this is the first report of such a complication occurring after MWA. Moreover, in this case, the gastric perforation could be treated conservatively.
Collapse
Affiliation(s)
- J. Roller
- Department for General-, Visceral-, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Saar, Germany
| | - V. Zimmer
- Department for Internal Medicine, Marienkrankenhaus St. Joseph, Neunkirchen, Germany
| | - A. Bücker
- Department for Diagnostic and Interventional Radiology, University Hospital of the Saarland, Homburg, Saar, Germany
| | - M. Glanemann
- Department for General-, Visceral-, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Saar, Germany
| | - R.M. Eisele
- Surgical Center Oranienburg, Oranienburg, Germany
| |
Collapse
|
2
|
Holländer S, Glanemann M. [Nephroprotection in obese patients with renal insufficiency : Gastric bypass vs. best medical treatment]. Chirurg 2021; 92:74-75. [PMID: 33296007 DOI: 10.1007/s00104-020-01308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Holländer
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland.
| |
Collapse
|
3
|
Glanemann M, Jorge C, Müller S, Gafarli S, Igna D, Glanemann M. Metachronous Gastric Tube Cancer After Esophagectomy with Gastric Pull-Up – Case Report. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The progresses in the therapy and methods of diagnosis of malignancies led to a prolonged survival and,
consequently, to an increase in secondary tumors in cancer survivor patients [1-7]. We report the case of a
64-year-old patient who was diagnosed with a second primary adenocarcinoma in the gastric conduit, more
than two years after the esophagectomy with gastric pull-up. We performed a resection of the gastric conduit
and reconstructed with an ileocolon interposition.
Collapse
|
4
|
Saternus R, Stange B, Körner R, Glanemann M, Vogt T, Müller CSL. Fallstricke in der Dermatologie: Hautläsionen am Shuntarm einer Dialysepatientin durch Steal-Phänomen. Akt Dermatol 2019. [DOI: 10.1055/a-1010-3145] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungWir berichten über eine 78-jährige dialysepflichtige Patientin, welche sich mit stark schmerzhaften Nekrosen distal eines Dialyseshunts vorstellte und bei der abschließend ein Steal-Phänomen diagnostiziert wurde. Beim Steal-Syndrom handelt es sich um eine seltene Komplikation eines Gefäßshunts durch Minderperfusion der Extremität distal der AV-Anastomose. Diabetiker sind aufgrund des höheren peripheren Gefäßwiderstandes und der Mikroangiopathie eher gefährdet, ein Steal-Syndrom nach Shuntanlage zu entwickeln. Der vorgestellte Fall soll verdeutlichen, dass das Steal-Syndrom dringlich in die differenzialdiagnostischen Überlegungen bei kutanen Nekrosen am Shuntarm einzuschließen ist und die Patienten schnellstmöglich gefäßchirurgisch vorzustellen sind, um einen Zeitverlust bis zur therapeutischen Intervention mit der Gefahr des irreversiblen Gewebsverlust und damit verbunden ggf. konsekutiv erforderliche Amputationen zu vermeiden.
Collapse
Affiliation(s)
- R. Saternus
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - B. Stange
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - R. Körner
- Hautärztliche Gemeinschaftspraxis, Kleinblittersdorf
| | - M. Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. S. L. Müller
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| |
Collapse
|
5
|
Abstract
Hepatocellular carcinoma (HCC) ranks among the most common primary cancers of the liver. The major risk factor for the formation of HCC is liver cirrhosis. The grade of cirrhosis as well as the extent of the tumor itself, can play an important role in the treatment options and patient prognosis. An operation aimed at an R0 resection is the treatment of choice for patients in an early stage of the disease and is associated with favorable long-term and recurrence-free survival. Liver transplantation offers an even better long-term survival rate after 5 years for selected patients with HCC meeting the Milan criteria as the underlying cirrhosis, the major risk factor for HCC recurrence, is simultaneously treated. Local tumor ablation is the least invasive curative surgical treatment, however, it is associated with an increased local recurrence rate; therefore, the early detection of tumors is of essential importance. As tumor-associated symptoms tend to arise only in advanced tumor stages, it is indispensable to identify patients with typical risk factors and to provide closely monitored screening examinations.
Collapse
Affiliation(s)
- P R Scherber
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - G Gäbelein
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - R M Eisele
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - D Igna
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
| |
Collapse
|
6
|
Abstract
Colorectal carcinoma is one of the most frequent tumor entities worldwide. The treatment of elderly and mostly polymorbid patients is an outstanding challenge in view of the demographic change with a continuously aging community. Due to the demographic changes the numbers of elderly (>65 years) and very old (≥80 years) patients are steadily increasing in surgical cohorts. This has resulted in higher morbidity and mortality rates in comparison to younger patients, with increased wound healing and cardiovascular complications but with comparable numbers of anastomotic insufficiency. Multivariate analysis revealed age ≥80 years, higher ASA status and emergency operations as independent risk factors for increased in-hospital mortality. With respect to the localization of colorectal cancer a shift to the right has been observed with increasing patient age. Whether minimally invasive surgical techniques can reduce postoperative morbidity and mortality rates in elderly patients requires further evaluation. Nevertheless, a reduction of both was reported without compromising the oncological result. Elderly patients require individualized treatment modalities, which take the extent of comorbidities and personal environment into consideration. So far, the cohort of octogenarians has not been adequately considered in current guidelines; therefore, geriatric expertise is recommended to be able to make a better assessment of benefit-risk ratios, as age itself has no impact on the decision for therapy.
Collapse
Affiliation(s)
- J Schuld
- Klinik für Allgemein- und Viszeralchirurgie, Knappschaftsklinikum Saar, 66280, Sulzbach/Saar, Deutschland.,Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
| |
Collapse
|
7
|
Casper M, Linxweiler M, Linxweiler J, Bohner A, Eisele R, Glanemann M, Kim YJ, Weber S, Lammert F. Sec62 Überexpression als molekulares Charakteristikum des HCC – eine Pilotstudie. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1587087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
8
|
Servais F, Kirchmeyer M, Casper M, Hamdorf M, Haan C, Nazarov P, Vallar L, Rubie C, Glanemann M, Lammert F, Kreis S, Behrmann I. Role of microRNAs in signal transduction pathways of the inflammatory cytokine interleukin-6 in hepatocellular carcinoma cell lines and primary hepatocytes. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61630-1] [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: 11/17/2022]
|
9
|
Casper M, Krawczyk M, Behrmann I, Glanemann M, Lammert F. Variant PNPLA3 increases the HCC risk: prospective study in patients treated at the Saarland University Medical Center. Z Gastroenterol 2016; 54:585-6. [DOI: 10.1055/s-0042-106308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. Casper
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - M. Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - I. Behrmann
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg
| | - M. Glanemann
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - F. Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
10
|
Kolokotronis T, Wagner M, Massmann A, Bohle RM, Glanemann M, Schuld J. [Rare case of a mesenteric tumor]. Chirurg 2016; 87:695-7. [PMID: 26879821 DOI: 10.1007/s00104-016-0155-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Kolokotronis
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr, 66421, Homburg/Saar, Deutschland.
| | - M Wagner
- Institut für Allgemeine und Spezielle Pathologie und Neuropathologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - A Massmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - R M Bohle
- Institut für Allgemeine und Spezielle Pathologie und Neuropathologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr, 66421, Homburg/Saar, Deutschland
| | - J Schuld
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
11
|
Abstract
BACKGROUND Vascular malformations and hemangiomas of the thyroid gland are rare disorders. The first case of a patient with recurrent high-flow arterio-venous malformation of the right thyroid gland involving the right endolarynx is presented. PATIENT FINDINGS In June 2013, a 42-year-old female patient presented to the surgical department with recurrent hoarseness and a soft, vibrating mass on the right side of her neck. In 1993, she underwent right subtotal hemithyroidectomy with embolization on the day before surgery for a high-flow arterio-venous malformation of the thyroid gland. Diagnostic work-up in 2013 demonstrated a complex recurrent high-flow arterio-venous malformation on the right side of her neck involving the endolarynx. Full function of the right vocal fold could not be ascertained. The lesion was embolized again and excised the following day. Intraoperative gross bleeding and scar tissue prevented visualization and monitoring of the recurrent laryngeal nerve. Gross bleeding was also noted on hemithyroidectomy after embolization in 1993. No therapy was needed for the endolaryngeal part of the lesion. Histology showed large arterio-venous malformations with thyroid tissue. She remains well without signs of recurrence 18 month later but with a definitive voice handicap. SUMMARY This is the first report of a recurrent high-flow arterio-venous malformation originally developing from the right thyroid gland involving the right endolarynx. Counseling, diagnostic, and therapeutic work-up of the patient was possible only with an interdisciplinary team. The endolaryngeal part of the hemangioma dried out after embolization and completion hemithyroidectomy. Her hoarseness has greatly improved but a definitive voice handicap remains. CONCLUSION High-flow arterio-venous malformations of the thyroid gland are a rare disease, and recurrent lesions have not been reported. Interdisciplinary management of these patients is mandatory due to the complex nature of the underlying pathology. Recurrence might develop after long free intervals.
Collapse
Affiliation(s)
- D H Borchert
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - A Massmann
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - Y J Kim
- 3 Institute of Pathology, Saarland University Hospitals , Homburg, Germany
| | - C A Bader
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - G Wolf
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - R Eisele
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - P Minko
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - A Bücker
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - M Glanemann
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| |
Collapse
|
12
|
Schuld J, Richter S, Eisele RM, Von Heesen M, Roller J, Glanemann M. Anal sphincter function after total mesorectal excision is comparable to that of healthy subjects: results of a matched pair analysis. MINERVA CHIR 2015; 70:167-173. [PMID: 24992327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this paper was to compare healthy subjects and patients after total mesorectal excision concerning anal resting/squeeze pressure and surface-electromyography of the sphincter. METHODS Forty patients (9 female/31 male) after total mesorectal excision due to low or middle rectal cancer were compared to a sex-, age- and BMI-matched group of healthy volunteers by means of anorectal pull-through manometry using a microtip-transducer system and by means of endoanal surface electromyography using a bipolar plug electrode. RESULTS Resting pressure (59.2 ± 3.1 mmHg vs. 68.3 ± 4.3 mmHg; P=0.056) and squeeze pressure (127.3 ± 3.2 mmHg vs. 128.9 ± 4.6 mmHg; P=0.78) were comparable between patients after total mesorectal excision and healthy volunteers whereas surface electromyography amplitude (9.5 ± 0.4 µV vs. 13.9 ± 0.6 µV; P=0.01) was significant lower in patients after total mesorectal excision compared to healthy subjects. Correlation between squeeze and resting pressure as well as between squeeze pressure and surface electromyography were weaker in patients after total mesorectal excision compared to healthy controls. CONCLUSION Objective measurable sphincter pressure after total mesorectal excision seems to be comparable to that of healthy subjects whereas surface-electromyography is significant higher in healthy subjects.
Collapse
Affiliation(s)
- J Schuld
- Department of General Visceral Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany -
| | | | | | | | | | | |
Collapse
|
13
|
Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E. [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 2013; 51:1395-440. [PMID: 24338757 DOI: 10.1055/s-0033-1356220] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- T Seufferlein
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - M Porzner
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - T Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Kiel
| | - V Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin
| | - G Ceyhan
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Esposito
- Institut für Allgemeine Pathologie, Klinikum rechts der Isar, TU München
| | - R Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen
| | - M Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - H Friess
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - P Galle
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
| | - M Geissler
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes Homburg/Saar
| | - T Gress
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - V Heinemann
- Medizinischen Klinik und Poliklinik III, Klinikum der Universität München LMU
| | | | - U Hopt
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg
| | - J Izbicki
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - E Klar
- Klinik für Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock
| | - J Kleeff
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg
| | | | - T Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - J Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus Berlin
| | - M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - M Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - J Lüttges
- Institut für Pathologie, Marienkrankenhaus Hamburg
| | - M Lutz
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Endokrinologie, Infektiologie, Caritasklinikum Saarbrücken
| | - J Mayerle
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - P Michl
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm
| | - M Molls
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, TU München
| | - M Münter
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Stuttgart
| | - M Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin
| | - H Oettle
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim
| | - A Reinacher-Schick
- Abt. für Hämatologie und Onkologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - C Röcken
- Institut für Pathologie, Universitätsklinikum Kiel
| | - E Roeb
- Medizinische Klinik II, SP Gastroenterologie, Universitätsklinikum Gießen und Marburg
| | - H Saeger
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Dresden
| | - R Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - W Schmiegel
- Medizinische Klinik, Klinikum der Ruhr-Universität Bochum
| | | | - J Siveke
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - M Stuschke
- Klinik für Strahlentherapie, Universitätsklinikum Essen
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum
| | - W Uhl
- Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - S Unverzagt
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - B van Oorschot
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg
| | - Y Vashist
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - J Werner
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg
| | - E Yekebas
- Klinik für Allgemein-, Thorax- und Viszeralchirurgie, Klinikum Darmstadt
| | | | | | | |
Collapse
|
14
|
Frick VO, Rubie C, Kölsch K, Wagner M, Ghadjar P, Graeber S, Glanemann M. CCR6/CCL20 chemokine expression profile in distinct colorectal malignancies. Scand J Immunol 2013; 78:298-305. [PMID: 23790181 DOI: 10.1111/sji.12087] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/07/2013] [Indexed: 12/12/2022]
Abstract
Originally, chemokines and their G-protein-coupled receptors were described to regulate multiple physiological functions, particularly tissue architecture and compartment-specific migration of white blood cells. Now, it is established that the chemokine/chemokine receptor system is also used by cancer cells for migration and metastatic spread. Here, we examined the relative levels of CC-chemokine CCL20 and its corresponding receptor CCR6 in resection specimens from patients with different malignant and non-malignant colorectal diseases as well as in colorectal liver metastases (CRLM). CCL20/CCR6 mRNA and protein expression profiles were assessed by quantitative real-time PCR (qRT-PCR), enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC) in resection specimens from patients with ulcerative colitis (UC, n = 15), colorectal adenoma (CRA, n = 15), colorectal adenocarcinoma (CRC, n = 61) and colorectal liver metastases (CRLM, n = 16). Corresponding non-diseased tissues served as control. In contrast to UC tissues, the CCL20/CCR6 system showed a distinct upregulation in CRA, CRC and CRLM related to corresponding non-affected tissues (P < 0.05, respectively). Furthermore, CRA, CRC and CRLM tissue samples displayed significantly higher protein amounts of CCL20 in comparison with UC specimens (P < 0.05, respectively). Our results strongly suggest an association between CCL20/CCR6 expression and the induction of CRA, CRC and the development of CRLM. Therefore, CCL20 and CCR6 may provide potential targets for novel treatment strategies of CRC.
Collapse
Affiliation(s)
- V O Frick
- Department of General, Visceral, Vascular and Pediatric Surgery, University of the Saarland, Homburg/Saar, Germany
| | | | | | | | | | | | | |
Collapse
|
15
|
Eisele RM, Denecke T, Glanemann M, Chopra SS. [Minimal-invasive microwave coagulation therapy for liver tumours: laparoscopic and percutaneous access]. Zentralbl Chir 2013; 139:235-43. [PMID: 24241949 DOI: 10.1055/s-0033-1350931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Local ablative treatments play an important role in current surgical treatment strategies. Radiofrequency ablation (RFA) as one of the most popular examples suffers from partly inacceptable local tumour control. Microwave coagulation therapy (MCT) is a comparatively new type of ablation promising several improvements. This series is to the best of our knowledge the first within the central European area, which reports on the successful clinical implementation of MCT in a surgical department. PATIENTS AND MATERIALS A novel 915 MHz system (MedWaves™, AveCure Inc., SanDiego, CA/U. S. A.) was used to treat 47 patients with 80 tumour nodules in 51 treatment sessions. Average tumour size was 2.6 ± 0.9 cm. Indications were hepatocellular carcinoma in 29 patients and metastases in 14 as well as 4 cholangiocellular carcinomas. The approach was laparoscopic (20) or percutaneous (31). High-risk conditions defined by unfavourable tumour localisation like invisibility in native transabdominal ultrasound, superficial tumour site or risk of heat sink phenomena were found in 28 cases (53 %). RESULTS Local recurrence rate was 17 % on a per-patient and 12 % on a per-tumour basis (n = 9). One patient died because of incurable upper gastrointestinal bleeding during the postoperative hospital stay. No MCT-associated complication occurred. Median follow-up period was 20 months. Local tumour recurrence was significantly different on comparing laparoscopic to percutaneous MCT (p = 0.032, χ2 test), as was global recurrence (p = 0.011, χ2 test). In a univariate logistic Cox regression, tumour size, access and high-risk localisation were significant prognostic factors for local tumour recurrence, however, in a multivariate reiteration, only the chosen access to MCT (p = 0.012) and tumour size (p = 0.044) remain significant. CONCLUSION MCT seems to be a useful tool, easy to implement in a surgical environment and may eventually prove to be superior to other local ablative treatment modalities. Even unfavourable tumour localisations could be treated safely and efficiently using MCT without increased risk of local tumour recurrence.
Collapse
Affiliation(s)
- R M Eisele
- Allgemein-, Viszeral-, Gefäß- & Kinderchirurgie, Universitätsklinik des Saarlands, Homburg, Deutschland
| | - T Denecke
- Radiologie, Charité Campus Virchow-Klinikum, Berlin, Deutschland
| | - M Glanemann
- Allgemein-, Viszeral-, Gefäß- & Kinderchirurgie, Universitätsklinik des Saarlands, Homburg, Deutschland
| | - S S Chopra
- Allgemein-, Viszeral- & Transplantationschirurgie, Charité Campus Virchow-Klinikum, Berlin, Deutschland
| |
Collapse
|
16
|
Eisele RM, Chopra SS, Lock JF, Glanemann M. Treatment of recurrent hepatocellular carcinoma confined to the liver with repeated resection and radiofrequency ablation: a single center experience. Technol Health Care 2013; 21:9-18. [PMID: 23358055 DOI: 10.3233/thc-120705] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recurrence of hepatocellular carcinoma (HCC) after surgical treatment is a common problem. It can be treated by radiofrequency ablation (RFA) or repeated hepatic resection (HR). This report compares both in a retrospective, single-institution database. PATIENTS AND METHODS A prospectively collected database was retrospectively analyzed. RFA was performed under ultrasound control using two different monopolar devices. All kinds of access were used: open surgical (n=10), percutaneous (n=13) and laparoscopic (n=4). HR was performed using an ultrasound aspiration device. Indication for a particular treatment was allocated on a case-by-case basis; the final decision was often made intraoperatively. RESULTS Survival after RFA (median 40 months) was similar compared to that after HR (48 months, p=0.641, logRank-test). Tumor-free survival was markedly impaired after RFA (15 vs. 29 months). This difference was however not significant (p=0.07, logRank-test). Both groups were different regarding occurrence of cirrhosis, maximal tumor size, time after initial diagnosis and duration of the procedure. CONCLUSION In this non-randomized retrospective trial, survival and disease-free survival was not significantly different when compared between patients treated by RFA and HR. There was however a tendency towards a longer tumor-free survival in the resected patients.
Collapse
Affiliation(s)
- R M Eisele
- Department of General, Visceral and Transplantation Surgery, Charité Virchow-Clinic, Berlin, Germany. robert
| | | | | | | |
Collapse
|
17
|
Eisele RM, Chopra SS, Kubale R, Glanemann M. [Radiofrequency ablation for treatment of colorectal liver metastases: scientific evidence and clinical reality]. Zentralbl Chir 2013; 139:193-202. [PMID: 23907842 DOI: 10.1055/s-0032-1328595] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Radiofrequency ablation (RFA) of colorectal liver metastases is frequently reported, but, however, lacks clear criteria for indication and reliable, convincing results with 5-year survival ranging from 17 to 48 %. RFA may be the appropriate treatment modality in approximately 3 to 5 % of all patients suffering from colorectal liver metastases. To date, RFA seems to be limited to no more than three metastases, each smaller than 3 cm. The main indication remains irresectability due to number, site, distribution and/or marginal liver function. Tumours in the vicinity of larger vessels (predominantly branches of portal or hepatic veins) are a case for controversy, since advances in hepatobiliary surgery enable a proportion of patients to undergo resections which would have been declared irresectable until most recently, and the oncological value of a thermoablation is questioned, as a certain amount of temperature is lost due to convective heat sinks. RFA is not a curative alternative to hepatic resection unless small tumours appear during open or laparoscopic procedures in a patient with elevated risk for early recurrence or postoperative morbidity following liver resection. The inclusion of RFA into a holistic system of oncological therapy is mandatory. Early RFA followed by systemic (regional?) chemotherapy can rather be recommended than chemo only, RFA only or first-line chemo with subsequent RFA.
Collapse
Affiliation(s)
- R M Eisele
- Allgemein-, Viszeral-, Gefäß- & Kinderchirurgie, Universitätsklinik des Saarlandes, Homburg, Deutschland
| | - S S Chopra
- Allgemein-, Viszeral- & Transplantationschirurgie, Charité Campus Virchow-Klinikum, Berlin, Deutschland
| | - R Kubale
- Diagnostische und Interventionelle Radiologie, Universitätsklinik des Saarlandes, Homburg, Deutschland
| | - M Glanemann
- Allgemein-, Viszeral-, Gefäß- & Kinderchirurgie, Universitätsklinik des Saarlandes, Homburg, Deutschland
| |
Collapse
|
18
|
Thuss-Patience PC, Hofheinz RD, Arnold D, Florschütz A, Daum S, Kretzschmar A, Mantovani-Löffler L, Bichev D, Breithaupt K, Kneba M, Schumacher G, Glanemann M, Schlattmann P, Reichardt P, Gahn B. Perioperative chemotherapy with docetaxel, cisplatin and capecitabine (DCX) in gastro-oesophageal adenocarcinoma: a phase II study of the Arbeitsgemeinschaft Internistische Onkologie (AIO){dagger}. Ann Oncol 2012; 23:2827-2834. [PMID: 22734012 DOI: 10.1093/annonc/mds129] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This prospective multicentre phase II trial assessed the feasibility and efficacy of perioperative chemotherapy with docetaxel, cisplatin and capecitabine (DCX) in patients with gastro-oesophageal adenocarcinoma. METHODS Patients with curatively resectable adenocarcinoma of the stomach, the gastro-oesophageal junction or the lower third of the oesophagus were enrolled. Patients received docetaxel 75 mg/m(2) plus cisplatin 60 mg/m(2) (day 1), followed by oral capecitabine 1875 mg/m(2) divided into two doses (days 1-14) every 3 weeks. There were three cycles preoperatively and three cycles postoperatively. The primary end point was the R0 resection rate. RESULTS Fifty-one patients were recruited and assessed for feasibility and efficacy. 94.1% of patients received all three planned cycles preoperatively, and 52.9% received three cycles postoperatively. The R0 resection rate was 90.2%. 13.7% of patients showed complete pathological remission (pCR). Toxicity was acceptably tolerable. Without prophylactic granulocyte colony-stimulating factor administration, neutropenic fever developed in 21.5% of patients preoperatively (grade 3 or 4) and in 11.1% of patients postoperatively. CONCLUSIONS DCX is a safe and feasible perioperative regimen in the treatment of gastro-oesophageal adenocarcinoma with a high percentage of cycles delivered pre- and postoperatively, compared with standard practice. The high efficacy in terms of R0 resection rate and pCR is very promising.
Collapse
Affiliation(s)
- P C Thuss-Patience
- Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin.
| | - R D Hofheinz
- 3rd Medical Clinic, University Medicine Mannheim, Mannheim
| | - D Arnold
- Hubertus Wald Tumour Center, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg
| | - A Florschütz
- Department of Haematology and Oncology, Städtisches Klinikum Dessau, Dessau
| | - S Daum
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin-Franklin, Charité - University Medicine Berlin, Berlin
| | - A Kretzschmar
- Department of Haematology, Oncology and Tumorimmunology, HELIOS-Klinikum Berlin-Buch, Berlin; Department of Medical Oncology and Haematology, St George's Hospital, Leipzig
| | - L Mantovani-Löffler
- Department of Medical Oncology and Haematology, St George's Hospital, Leipzig
| | - D Bichev
- Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin
| | - K Breithaupt
- Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin
| | - M Kneba
- 2nd Department of Medicine, University Medical Center Schleswig-Holstein, Kiel
| | - G Schumacher
- Department of Surgery, Städtisches Klinikum Braunschweig, Braunschweig; Department of General, Visceral and Transplant Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin
| | - M Glanemann
- Department of General, Visceral and Transplant Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin
| | - P Schlattmann
- Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich-Schiller University Jena, Jena
| | - P Reichardt
- Department of Haematology, Oncology, Palliative Medicine, HELIOS-Klinikum Bad Saarow, Bad Saarow, Germany
| | - B Gahn
- 2nd Department of Medicine, University Medical Center Schleswig-Holstein, Kiel
| |
Collapse
|
19
|
Eckardt AJ, Klein F, Adler A, Veltzke-Schlieker W, Warnick P, Bahra M, Wiedenmann B, Neuhaus P, Neumann K, Glanemann M. Management and outcomes of haemorrhage after pancreatogastrostomy versus pancreatojejunostomy. Br J Surg 2011; 98:1599-607. [DOI: 10.1002/bjs.7623] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2011] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Postpancreatectomy haemorrhage (PPH) is a major cause of morbidity and mortality after pancreaticoduodenectomy (PD). It remains unclear whether performance of a pancreatogastrostomy (PG) instead of a pancreatojejunostomy (PJ) improves outcomes owing to better endoscopic accessibility.
Methods
A large retrospective analysis was undertaken to compare outcomes of PPH, depending on whether a PG or PJ was performed. The primary outcome was the rate of successful endoscopy. A secondary outcome was the therapeutic success after adding surgery.
Results
Of 944 patients who had a PD, 8·4 per cent developed PPH. Endoscopy was the primary intervention in 21 (81 per cent) of 26 patients with a PG and 34 (64 per cent) of 53 with a PJ; it identified the bleeding site in 35 and 25 per cent respectively (P = 0·347). Successful endoscopic treatment was more common in the PG group (31 versus 9 per cent; P = 0·026). Surgery was performed for PPH in 15 patients (58 per cent) with a PG and 35 (66 per cent) with a PJ (P = 0·470). The majority of haemorrhages that required surgery were non-anastomotic intra-abdominal haemorrhages (12 of 15 versus 21 of 35; P = 0·171). Endoscopic or conservative treatment for PPH was successful in 42 per cent of patients with a PG and 32 per cent with a PJ (P = 0·520). The success rate increased to 85 and 91 per cent respectively when surgery was included in the algorithm (P = 0·467).
Conclusion
The type of pancreatic anastomosis and its inherent effect on endoscopic accessibility had very little impact on the outcome of PPH. This was because haemorrhage frequently occurred from intra-abdominal or non-anastomotic intraluminal lesions.
Collapse
Affiliation(s)
- A J Eckardt
- Department of Gastroenterology and Hepatology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - F Klein
- Department of Gastroenterology and Hepatology, Central Interdisciplinary Endoscopy, Campus Virchow, Germany
| | - A Adler
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Germany
| | - W Veltzke-Schlieker
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Germany
| | - P Warnick
- Department of Gastroenterology and Hepatology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - M Bahra
- Department of Gastroenterology and Hepatology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - B Wiedenmann
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Germany
| | - P Neuhaus
- Department of Gastroenterology and Hepatology, Central Interdisciplinary Endoscopy, Campus Virchow, Germany
| | - K Neumann
- Department of Biomathematics, Statistics, Charité, Campus Mitte, Berlin, Germany
| | - M Glanemann
- Department of Gastroenterology and Hepatology, Central Interdisciplinary Endoscopy, Campus Virchow, Germany
| |
Collapse
|
20
|
Denecke T, Grieser C, Podrabsky P, Andreou A, Neuhaus P, Glanemann M. Pankreaslinksresektion mit Resektion des Truncus cöliacus nach radiologisch-interventioneller Präkonditionierung bei lokal fortgeschrittenem Pankreaskarzinom. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279414] [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: 10/18/2022]
|
21
|
Platz KP, Mueller A, Spree E, Schumacher G, Nüssler N, Rayes N, Glanemann M, Bechstein WO, Neuhaus P. Liver transplantation for alcoholic cirrhosis. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02000.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Mueller A, Platz KP, Krause P, Kahl A, Rayes N, Glanemann M, Lang M, Wex C, Bechstein WO, Neuhaus P. Perioperative factors influencing patient outcome after liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02010.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Warnick P, Bahra M, Andreou A, Neuhaus P, Glanemann M. [Second-look operation in pancreatic carcinoma previously assessed as unresectable]. Zentralbl Chir 2010; 135:70-4. [PMID: 20162503 DOI: 10.1055/s-0029-1224749] [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]
Abstract
BACKGROUND The only curative therapy for patients with pancreatic carcinoma consists of -complete surgical tumour removal. Preoperative diagnostic investigations may help, however, the definite decision on tumour resectability can only be made intraoperatively during explorative laparotomy. PATIENTS AND METHODS We report herein on 17 patients who were judged during exploratory laparotomy elsewhere to suffer from non-resectable pancreatic cancer and who underwent a second-look operation after referral to our hospital. RESULTS During the second-look operation 13 patients (76.5 %) underwent tumour resection, where-as in 4 patients (23.5 %) the tumour remained non-resectable. An R0 resection was achieved in 9 of 13 (69 %) and an R1 resection in 4 of 13 (31 %) patients, respectively. The classic Kausch-Whipple operation was performed in 4, pylorus-preserving pancreaticoduodenectomy in 5, and left pancreatic -resection in another 4 patients. Mean survival in patients after tumour resection was increased, reach-ing 17.6 months compared to 6.5 months in patients with non-resectable pancreatic cancer. CONCLUSIONS Our results suggest that the prediction of resectability depends highly on the experience of the surgical team. Although considered as non-resectable during prior laparotomy else-where, the majority of patients (76.5 %) suffered from a resectable tumour disease. Moreover, most of them (69 %) underwent complete (R0) -tumour removal. Thus, complex visceral operations like pancreatic carcinoma resection should preferably be performed in high-volume centres exclusively.
Collapse
Affiliation(s)
- P Warnick
- Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Augustenburger Platz 1, 13353 Berlin, Deutschland.
| | | | | | | | | |
Collapse
|
24
|
Abstract
Traverso-Longmire pylorus-preserving pancreatic head resection is regarded as the standard surgical procedure for pancreatic head tumors. The mortality, morbidity, and oncological radicality are as low as with the classic Kausch-Whipple resection, with the additional advantage of shorter operating time and reduced blood loss. Important for long-term survival is, however, not the resection of the stomach but the early diagnosis with subsequent R0 tumor resection. Patients can benefit fundamentally from this procedure if it is carried out at a specialized center.
Collapse
Affiliation(s)
- M Glanemann
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Deutschland.
| | | | | |
Collapse
|
25
|
Spinelli A, Schumacher G, Benckert C, Sauer IM, Schmeding M, Glanemann M, Neumann UP, Jonas S, Neuhaus P. Surgical treatment of a leiomyosarcoma of the inferior vena cava involving the hepatic and renal veins confluences: Technical aspects. Eur J Surg Oncol 2008; 34:831-5. [PMID: 17321715 DOI: 10.1016/j.ejso.2007.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Spinelli
- Department of General, Visceral and Transplantation Surgery, Charitè-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Gäbelein G, Nüssler AK, Morgott F, Ping Y, Nüssler N, Neuhaus P, Glanemann M. Intrasplenic or subperitoneal hepatocyte transplantation to increase survival after surgically induced hepatic failure? ACTA ACUST UNITED AC 2008; 41:253-9. [PMID: 18577870 DOI: 10.1159/000140671] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 01/11/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND As a basis for future clinical questions, we evaluated the efficacy of hepatocyte transplantation in a surgical model using a subperitoneal or intrasplenic approach for cell implantation. METHODS In rats, acute liver failure was induced by subtotal hepatectomy. Series of allogenic hepatocyte transplantations were performed by varying cell number, site, and sequence of cell transplantation. RESULTS Following subperitoneal or intrasplenic cell implantation subsequent to liver surgery, no survival benefit was achieved when compared to the control groups. However, intrasplenic cell implantation 24 h prior to liver surgery revealed a statistically significantly higher animal survival (72 vs. 29%). CONCLUSION According to our experience, both timing and site of cell implantation played an important role in hepatocyte transplantation. Intrasplenic hepatocyte transplantation 1 day before liver surgery showed the best results in terms of survival. Consequently, we were able to establish a model of hepatocyte transplantation which may be the basis for further investigations evaluating potential treatment modalities to overcome deleterious postoperative liver insufficiency.
Collapse
Affiliation(s)
- G Gäbelein
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitatsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
27
|
Bahra M, Jacob D, Langrehr JM, Glanemann M, Schumacher G, Lopez-Hänninen E, Neuhaus P. [Metastatic lesions to the pancreas. When is resection reasonable?]. Chirurg 2008; 79:241-8. [PMID: 17717640 DOI: 10.1007/s00104-007-1390-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The significance of pancreatic resection for pancreatic metastatic lesions has not yet been sufficiently investigated. A retrospective analysis of patients undergoing pancreatic resections for pancreatic metastases was conducted. MATERIAL AND METHODS Twenty patients were resected due to metastatic lesions to the pancreas. Histopathological findings were: renal cell carcinoma (n=9), colon carcinoma (n=1), malignant schwannoma (n=2), leiomyosarcoma (n=2), teratocarcinoma (n=1), adenocarcinoma of the oesophagus (n=1), gallbladder carcinoma (n=1), malignant melanoma (n=1), gastrointestinal stromal tumor (n=1), and spindle cell tumor (n=1). Operative procedures were standard pancreaticoduodenectomy (n=6), pylorus-preserving pancreaticoduodenectomy (n=6), and distal pancreatectomy (n=8). RESULT The overall 5-year survival rate was 61%, for patients with renal cell carcinoma 100%. CONCLUSION Pancreatic metastasectomy is a reasonable therapeutic option in suited patients. Patients with pancreatic metastases of renal cell carcinoma achieved excellent prognoses after radical resection.
Collapse
Affiliation(s)
- M Bahra
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin.
| | | | | | | | | | | | | |
Collapse
|
28
|
Glanemann M, Hoffmeister R, Neumann U, Spinelli A, Langrehr JM, Kaisers U, Neuhaus P. Fast Tracking in Liver Transplantation: Which Patient Benefits From This Approach? Transplant Proc 2007; 39:535-6. [PMID: 17362775 DOI: 10.1016/j.transproceed.2006.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In liver transplantation, "fast tracking" means postoperative extubation in the operating theater immediately after surgery. This procedure was performed in a series of 837 adult liver transplant recipients between January 1997 and April 2005, proving to be safe and feasible in almost 80% of patients without increasing the incidence of reintubation. This patient population experienced a significantly higher survival compared to patients who were extubated in the intensive care unit. Consequently, fast tracking should become the standard procedure after orthotopic liver transplantation. However, special attention is required for recipients with acute liver failure, retransplantation, Child C status, or complicated surgery in terms of increased transfusion of red blood cells. These patients do not participate in fast-tracking protocols, as demonstrated by a uni- and multivariate logistic regression analysis. Moreover, ROC analysis revealed that only intraoperative transfusion of </=6 units of red blood cells was associated with extubation in the operating theater with highest sensitivity (78.9%) and specificity (49.5%), area under the ROC curve = 0.703 (standard error = 0.023; 95% confidence interval = 0.671-0.734).
Collapse
Affiliation(s)
- M Glanemann
- Department of General, Visceral, and Transplantation Surgery, Universitätsmedizin, Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
29
|
Glanemann M, Eipel C, Nussler AK, Vollmar B, Neuhaus P. Hyperperfusion syndrome in small-for-size livers. Eur Surg Res 2006; 37:335-41. [PMID: 16465057 DOI: 10.1159/000090333] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [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: 08/03/2005] [Accepted: 11/04/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Portal hyperperfusion in small-for-size livers might seriously impair postoperative liver regeneration. Using an experimental model, we investigated splenectomy as a measure to reduce portal blood flow and its impact on postoperative recovery following extended liver resection. METHOD Wistar rats underwent partial (90%) hepatectomy with or without splenectomy under temporary inflow occlusion (30 min). In addition to 10-day survival rate, laser Doppler flowmetry of hepatic blood flow and fluorescence microscopic analysis of hepatic microcirculation were performed to assess the effect of splenectomy on initial microvascular reperfusion of liver remnants. RESULTS While postischemic perfusion failure was comparable between both groups, portal blood flow was significantly reduced after simultaneous splenectomy (3.5+/-0.4 vs. 5.4+/-0.4 ml/min). Moreover, red blood cell velocity and volumetric blood flow were reduced in splenectomized animals. These animals experienced lower AST levels (421+/-36 vs. 574+/-73 U/l) and a significantly increased survival rate, reaching 6.6+/-1.3 vs 2.6+/-0.8 days. CONCLUSION Simultaneous splenectomy significantly reduced the risk for postoperative hyperperfusion syndrome in small-for-size livers. Shear-stress-induced liver injury was diminished due to a significant reduction of portal venous blood flow, which positively influenced postoperative regeneration resulting in significantly higher survival.
Collapse
Affiliation(s)
- M Glanemann
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitatsmedizin Berlin, Berlin, Germany.
| | | | | | | | | |
Collapse
|
30
|
Glanemann M, Schirmeier A, Lippert S, Langrehr JM, Neuhaus P, Nussler AK. Cobalt-protoporphyrin induced heme oxygenase overexpression and its impact on liver regeneration. Transplant Proc 2006; 37:3223-5. [PMID: 16213353 DOI: 10.1016/j.transproceed.2005.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cobalt-protoporphyrin (CoPP)-dependent induction of heme oxygenase (HO)-1 has been shown to protect from ischemia-reperfusion injury, which remains a major source of graft loss after liver transplantation. The impact of HO-1 on liver regeneration, especially in reduced-size grafts, has not yet been evaluated. Using an experimental model, we investigated HO-1 induction by CoPP treatment on postoperative recovery of ischemically injured livers following partial (70%) hepatectomy. Wistar rats underwent partial hepatectomy under temporary inflow occlusion (30 minutes). One group of animals received CoPP (5 mg/kg body weight i.p.) 24 hours prior to surgery to induce high levels of HO-1 at the time of surgery, and the second group served as nontreated controls. At postoperative days 1, 4, 7, and 10, animals were exsanguinated, and blood and liver samples were stored for enzymatic (serum AST and ALT levels) and histologic (mitotic index) analyses (n = 5 each day). Additionally, postoperative body weight and weight of the remnant liver were measured. Although serum AST and ALT levels as well as remnant liver weight were comparable between both groups, CoPP-treated animals recovered from surgery more quickly as indicated by postoperative body weight. Moreover, the number of mitotic cells was significantly increased in this group at day 1 (33 +/- 5 versus 20 +/- 5 per 2000 hepatocytes) as compared with nontreated animals. Liver regeneration of ischemically injured livers following partial hepatectomy was improved by HO-1 overexpression following preoperative CoPP administration. Thus, it is conceivable that prevention of ischemia-reperfusion injury by HO-1 overexpression also might be beneficial for reduced-size liver grafts without affecting their proliferative capacity.
Collapse
Affiliation(s)
- M Glanemann
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
UNLABELLED The increasing organ shortage calls for widening the selection criteria for liver transplant donors. However, concern exists about the use of grafts from donors older than 70 years. We report our clinical experience with graft-age related outcomes, presenting data on 41 patients transplanted with grafts from older donors. PATIENTS/METHODS Between January 1995 and October 2003, 41 liver grafts were transplanted from donors older than 70 years. We analyzed patient and graft survival, incidence of retransplantation, initial nonfunction (INF), rejection, intra- and postoperative requirement for red blood cells. We also recorded cholestasis, protein synthesis and urinary retention. RESULTS The mean donor age was 73.4 +/- 0.37 years. After one year, the patient survival was 91% and the graft survival 86%. The retransplantation rate was 9.75%; only one graft was lost due to INF. We observed an incidence of 11 rejection episodes. Of these, five patients needed OKT3 therapy for steroid-resistent rejection. The intra- and postoperative requirement for red blood cells was 4.0 +/- 0.65 and 1.4 +/- 0.25 units. Cholestasis, protein synthesis, and urinary retention parameters were within normal limits. CONCLUSIONS Among donors of mean age 73.4 years, patient and graft survivals were excellent. One organ was lost due to INF. The intra- and postoperative need for red blood cells was within acceptable ranges. Liver function tests, cholestasis, and retention parameters were normal after 1 year follow up. Thus, we recommend to accept liver grafts from donors older than 70 years to expand the organ pool.
Collapse
Affiliation(s)
- D H Borchert
- Department of General, Visceral, and Transplant Surgery, Berlin, Germany
| | | | | | | | | |
Collapse
|
32
|
Efimova EA, Glanemann M, Nussler AK, Schumacher G, Settmacher U, Jonas S, Nussler N, Neuhaus P. Changes in Serum Levels of Growth Factors in Healthy Individuals After Living Related Liver Donation. Transplant Proc 2005; 37:1074-5. [PMID: 15848626 DOI: 10.1016/j.transproceed.2004.12.170] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To obtain better insight into the kinetics of hepatic growth factors following partial hepatectomy for living related liver donation, we investigated the postoperative changes in serum levels of hepatocyte growth factor (HGF), epidermal growth factor (EGF), vascular epidermal growth factor (VEGF), and transforming growth factor-alpha (TGF-alpha). PATIENTS AND METHODS Eighteen healthy donors undergoing right hepatectomy for living related donation were enrolled in this study. Serum levels of HGF, EGF, VEGF, and TGF-alpha were measured using enzyme-linked immunosorbent assay kits before surgery, at 2 hours after resection, and daily during 5 days postoperatively. RESULTS Mean preoperative HGF serum levels in healthy adults were 778 +/- 64 pg/mL. Within 2 hours after operation, they significantly increased to 9608 +/- 3111 pg/mL afterward decreasing to 2726 +/- 241 at day 1 and 2283 +/- 250 pg/mL at day 2. Hereafter HGF serum levels stabilized at increased levels until day 5 (2109 +/- 138, 2047 +/- 219, 2283 +/- 336 pg/mL, respectively). At all time points, the differences between pre- and postoperative HGF levels were significant (P < .01). In contrast, VEGF and EGF serum levels showed no significant differences between pre- and postoperative levels at all time points. TGF-alpha was not detected using a commercially available test with a detection limit of 10 ng/mL, suggesting only low TGF-alpha serum levels following liver resection. CONCLUSION Significantly increased HGF serum levels after hepatectomy demonstrate its crucial role among the other investigated growth factors in regeneration of the remnant liver tissue during the early period after the operation.
Collapse
Affiliation(s)
- E A Efimova
- Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Clinic, University Medicine, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Efimova EA, Glanemann M, Liu L, Schumacher G, Settmacher U, Jonas S, Langrehr JM, Neuhaus P, Nüssler AK. Effects of human hepatocyte growth factor on the proliferation of human hepatocytes and hepatocellular carcinoma cell lines. Eur Surg Res 2005; 36:300-7. [PMID: 15359093 DOI: 10.1159/000079915] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 01/02/2004] [Accepted: 04/07/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatocyte growth factor (HGF) has been suggested to initiate both hepatocyte and tumor cell proliferation after partial hepatectomy, thereby supporting local tumor recurrence. The aim of this study was to clarify the role of HGF in the regeneration of human hepatocyte and the growth of residual hepatocellular carcinoma cells after liver resection. PATIENTS/METHODS 36 patients who underwent partial hepatectomy for hepatocellular carcinoma (HCC) or living liver donation have been analyzed for HGF serum levels at day -1 through day 5 following surgery using an enzyme-linked immunosorbent assay. Isolated human hepatocytes and HCC cell lines (Hep 3B, Hep G2) were treated either with recombinant human (rh)-HGF, or sera from the 36 patients in the presence or absence of anti-HGF in order to measure their proliferative capacity using (3)H-thymidine incorporation. RESULTS Basal HGF levels were significantly higher in HCC than in healthy patients (1,573 +/- 131 vs. 778 +/- 64 pg/ml; p < 0.001), however, the postoperative rise of HGF in healthy patients was higher (9,608 +/- 3111 vs. 2,060 +/- 148 pg/ml) than in HCC patients. Incubation of human hepatocytes and Hep 3B cells with rh-HGF revealed a dose-dependent increase in DNA synthesis, while anti-HGF partially abolished this effect. Sera from normal and resected HCC patients stimulated DNA synthesis only in human hepatocytes, whereas it was inhibited in HCC cell lines. CONCLUSION HGF plays an important role in hepatocyte proliferation but contrary to in vitro results, HGF does not play a major role for the progression of hepatocarcinoma cells in vivo.
Collapse
Affiliation(s)
- Ekaterina A Efimova
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Transjugular intrahepatic portosystemic shunts (TIPS) are indicated in patients with liver cirrhosis and portal hypertension for treatment of variceal bleeding or refractory ascites. Additionally implantation of stents may lead to stent dislocation or thrombosis in up to 20 % of cases. Detailed information about stent dislocation and its impact on subsequent orthotopic liver transplantation (OLT) is rare regarding the literature. We report on a patient suffering from ethyltoxic liver cirrhosis in which OLT was technically complicated by a thrombosed TIPS stent, dislocated in the portal vein. This stent was implanted prior to OLT due to refractory ascites and partial portal vein thrombosis. We conclude that TIPS stent insertion, especially in liver transplant candidates, should only be performed by radiologists in centers with expertise and experience.
Collapse
Affiliation(s)
- M Glanemann
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité, Campus Virchow-Klinikum, Humboldt Universität zu Berlin, Germany.
| | | | | | | | | |
Collapse
|
35
|
Glanemann M, Kaisers U, Langrehr JM, Schenk R, Stange BJ, Müller AR, Bechstein WO, Falke K, Neuhaus P. Incidence and indications for reintubation during postoperative care following orthotopic liver transplantation. J Clin Anesth 2001; 13:377-82. [PMID: 11498321 DOI: 10.1016/s0952-8180(01)00290-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To analyze the incidence and indications for reintubation during postoperative care following orthotopic liver transplantation (OLT). DESIGN Retrospective chart review. SETTING Large metropolitan teaching hospital. PATIENTS 546 adult liver transplant recipients. MEASUREMENTS AND MAIN RESULTS The medical charts of 546 patients who underwent OLT at our institution between January 1992 and September 1996 were reviewed for the incidence and indications of reintubation throughout primary hospitalization. Eighty-one of 546 patients (14.8%) required one or more episodes of reintubation after OLT. In the majority of cases, reintubation was performed for pulmonary complications (44.6%), followed by cerebral (19.1%) and surgical (14.5%) complications. Cardiac (9.1%) and peripheral neurologic (2.7%) complications were less frequent reasons for reintubation. Overall patient survival, according to the Kaplan-Meier estimates, was 89.9%, 87.5%, 86.5%, and 82.2% after 1, 2, 3, and 5 years, respectively. In patients with one or more episodes of reintubation, overall survival decreased to 62.5% after 1, 2, and 3 years, and to 56.4% after 5 years (p < 0.001). CONCLUSIONS The main indications for reintubation after OLT were pulmonary, cerebral, and surgical complications. These reintubation events had a considerable influence on the patient's postoperative recovery, and were associated with a significantly higher rate of mortality, than for OLT patients who did not undo reintubation.
Collapse
Affiliation(s)
- M Glanemann
- Department of General-, Visceral- & Transplantation Surgery, Charité, Campus Virchow Klinikum, Humboldt University Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Glanemann M, Settmacher U, Langrehr JM, Kling N, Hidajat N, Stange B, Staffa G, Bechstein WO, Neuhaus P. Portal vein angioplasty using a transjugular, intrahepatic approach for treatment of extrahepatic portal vein stenosis after liver transplantation. Transpl Int 2001; 14:48-51. [PMID: 11263556 DOI: 10.1007/s001470050742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Symptomatic portal vein stenosis is an uncommon complication after liver transplantation. Portal vein angioplasty has been successfully established for treatment of portal vein stenosis using mesenteric or percutaneous, transhepatic approaches. We herein report on a patient who suffered from variceal bleeding due to portal hypertension 3 months after liver transplantation. After successful endoscopic sclerotherapy, an extrahepatic portal vein stenosis was diagnosed, and portal vein angioplasty was considered as primary therapeutic option. Instead of mesenteric or percutaneous, transhepatic approaches, we adopted a transjugular, intrahepatic access to introduce a 14-mm balloon catheter into the portal vein. Using this technique, angioplasty was successfully performed. After intervention, no further episodes of variceal bleeding occurred. We favour the transjugular, intrahepatic technique for portal vein angioplasty because it does not require general anesthesia, in contrast to the mesenteric approach, and it reduces the risk of intra-abdominal bleeding, compared to the percutaneous, transhepatic approach.
Collapse
Affiliation(s)
- M Glanemann
- Department of Surgery, Charité, Humboldt University Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Mueller AR, Platz KP, Krause P, Kahl A, Rayes N, Glanemann M, Lang M, Wex C, Bechstein WO, Neuhaus P. Perioperative factors influencing patient outcome after liver transplantation. Transpl Int 2001; 13 Suppl 1:S158-61. [PMID: 11111987 DOI: 10.1007/s001470050311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We have previously shown that the development of multiple organ dysfunction syndrome (MODS) after liver transplantation significantly reduced patient survival. Therefore, the question arises of which are the most prominent perioperative donor and recipient factors leading to MODS after transplantation. In total, 634 patients with 700 liver transplants were analyzed. Donor factors included age, increase in transaminases, sex mismatch, requirement for catecholamines, intensive care time, histology, and macroscopic graft appearance. Recipient factors included Child classification, preoperative gastrointestinal (GI) bleeding, mechanical ventilation, hemodialysis, and requirement for catecholamines. MODS was defined by more than two severe organ dysfunctions. The cumulative 2 to 9-year patient survival was 90.9% in patients developing less than 3 severe organ dysfunctions following transplantation. Survival decreased to 60.3% in patients with MODS. Neither any of the donor factors nor the duration of cold ischemia (CIT) was associated with an increase in MODS or decrease in survival. On the other hand, duration of warm ischemia, amount of blood loss, requirement for red packed blood cells, and reoperation had an influence on the development of MODS (40%-56%) and decreased patient survival to 58%-69%. Preoperative therapy with catecholamines, GI bleeding, mechanical ventilation, and hemodialysis were associated with the development of MODS in 54%-88%. Patient survival following MODS decreased to 50%-74%. Initial graft function had a slight influence on the development of MODS, but no influence on the long-term patient survival. In conclusion, patient survival was significantly influenced by the development of postoperative MODS. The most prominent factors in this were recipient and intraoperative ones. No major influence was observed for donor factors, CIT, and initial graft function. Prevention of MODS will further improve the outcome after liver transplantation.
Collapse
Affiliation(s)
- A R Mueller
- Department of Surgery, Humboldt University of Berlin, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Platz KP, Mueller AR, Spree E, Schumacher G, Nüssler NC, Rayes N, Glanemann M, Bechstein WO, Neuhaus P. Liver transplantation for alcoholic cirrhosis. Transpl Int 2001; 13 Suppl 1:S127-30. [PMID: 11111978 DOI: 10.1007/s001470050297] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Because of the donor shortage, there are concerns for liver transplantation in patients with alcoholic cirrhosis. We therefore analyzed patients transplanted for alcoholic cirrhosis at our center with respect to patient and graft survival, recurrence of disease, and postoperative complications. Out of 1000 liver transplantations performed in 911 patients, 167 patients were transplanted for alcoholic cirrhosis; 91 patients received CsA- and 76 patients FK506-based immunosuppression. Recurrence was diagnosed by patient's or relative's declaration, blood alcohol determination, and delirium. Diagnosis and treatment of acute and chronic rejection was performed as previously described. One- (96.8% versus 91.3%) and 9-year patient survival (83.3% versus 80%) compared well with other indications. Five of 15 patients died due to disease recurrence. Recurrence of disease was significantly related to the duration of alcohol abstinence prior to transplantation. In patients who were abstinent for less than 6 months (17.1%), recurrence rate was 65%, including four of the five patients who died of recurrence. Recurrence rate decreased to 11.8%, when abstinence time was 6-12 months and to 5.5%, when the abstinence times was > 2 years. Next to duration of abstinence, alcohol relapse was significantly related to sex, social environment, and psychological stability. The incidence of acute rejection compared well with other indications (38.1%); CsA: 40.1% versus 33.3% in FK506 patients. In all, 18.2% of CsA patients experienced steroid-resistant rejection compared with 2.6% of FK506 patients. Seven patients (7.6%) in the CsA group and one patient (1.3%) in the FK506 group developed chronic rejection. A total of 57.1% developed infections; 5.7% were life-threatening. CMV infections were observed in 14.3% (versus 25% for other indications). New onset of insulin-dependent diabetes was observed in 8.6% and hypertension in 32.4%. In conclusion, alcoholic cirrhosis is a good indication for liver transplantation with respect to graft and patient survival and development of postoperative complications. FK506 therapy was favourable to CsA treatment. Patient selection is a major issue and established criteria should be strictly adhered to. Patients with alcohol abstinence times shorter than 6 months should be excluded, since recurrence and death due to recurrence was markedly increased in this group of patients.
Collapse
Affiliation(s)
- K P Platz
- Department of Surgery, Humboldt University of Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Neumann UP, Lang M, Moldenhauer A, Langrehr JM, Glanemann M, Kahl A, Frei U, Bechstein WO, Neuhaus P. SIGNIFICANCE OF A T-LYMPHOCYTOTOXIC CROSSMATCH IN LIVER AND COMBINED LIVER-KIDNEY TRANSPLANTATION. Transplantation 2001; 71:1163-8. [PMID: 11374419 DOI: 10.1097/00007890-200104270-00025] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In contrast to kidney transplants a positive crossmatch is no contraindication for liver transplantation (OLT). In liver transplantation, antibody mediated rejections are rarely reported and a liver graft is suspected to have protective effects for kidney grafts when transplanted simultaneously. The aim of this study was to evaluate the effect of a positive crossmatch on outcome after OLT and combined liver and kidney transplantation (CLKTx). METHODS We analyzed retrospectively the impact of a positive crossmatch on graft survival and rejection episodes after OLT (793pats) and CLKTx (18pats, 2.2%). Immunosuppression consisted of either Cyclosporine- or Tacrolimus-based regimens. RESULTS A total of 50/811 (6%) of patients had a positive crossmatch, 45/793 (5.6%) with liver transplantation alone and 5/18 (28%) of patients with CLKTx. Follow-up ranged from 1 to 122.5 months (median 45.8 months). One- and 5-year graft survival rates of liver transplants alone with a positive crossmatch were 89.6% and 75.3%, respectively and were 88% and 77.5% in crossmatch negative recipients. Additionally, the incidence of acute and steroid-resistant rejection (44% and 15.5%) was not significantly increased in patients with a positive crossmatch when compared with patients with a negative crossmatch (38% and 19%). None of the patients with a positive crossmatch and CLKTx underwent a hyperacute-rejection episode after transplantation, and kidney graft survival 100%. CONCLUSIONS In conclusion, a positive crossmatch is no contraindication for OLT and CLKTx. Furthermore, not having to wait for results of donor/recipient crossmatching can shorten cold ischemia time and may improve the clinical outcome.
Collapse
Affiliation(s)
- U P Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Virchow-Klinikum, Humboldt Universität zu Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Glanemann M, Langrehr J, Kaisers U, Schenk R, Müller A, Stange B, Neumann U, Bechstein WO, Falke K, Neuhaus P. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand 2001; 45:333-9. [PMID: 11207470 DOI: 10.1034/j.1399-6576.2001.045003333.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The duration of postoperative mechanical ventilation and its influence on pulmonary function in liver transplant recipients is still debated controversially. METHODS We retrospectively analyzed the incidence of immediate tracheal extubation, prolonged mechanical ventilation (>24 h following surgery), and episodes of reintubation in 546 patients who underwent orthotopic liver transplantation (OLT) at our institution. RESULTS Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. In these, median time of extubation was 49.5 h, whereas the remaining 70.1% of patients required ventilation support for a median 5 h after OLT. As risk factors for prolonged mechanical ventilation we identified the indications of acute liver failure and retransplantation, as well as factors such as mechanical ventilation prior to OLT, massive intraoperative bleeding, and severe reperfusion injury of the liver graft. The incidence of reintubation was 8.8% in patients who were immediately extubated following surgery, and 13.1% in patients who underwent extubation within 24 h. The incidence was significantly increased in patients requiring prolonged mechanical ventilation (36.1%). CONCLUSIONS Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later. However, special attention should be given to transplant recipients presenting in reduced clinical condition at the time of OLT, undergoing complicated surgery, or receiving liver allografts with severe reperfusion injury because of an increased risk for prolonged mechanical ventilation.
Collapse
Affiliation(s)
- M Glanemann
- Department of General, Visceral & Transplantation Surgery, Charité, Humboldt University Berlin, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Glanemann M, Klupp J, Langrehr JM, Platz KP, Schröer G, Raakow R, Stange B, Settmacher U, Bechstein WO, Neuhaus P. Mycophenolate mofetil is superior in combination with tacrolimus compared to cyclosporine for immunosuppressive therapy after liver transplantation. Transplant Proc 2001; 33:1069-70. [PMID: 11267194 DOI: 10.1016/s0041-1345(00)02419-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Glanemann
- Department of General-, Visceral- & Transplantation Surgery, Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Affiliation(s)
- R Raakow
- Department of Surgery, Charité, Campus Virchow Clinics, Humboldt University Berlin, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
43
|
Stange B, Glanemann M, Nüssler NC, Bechstein WO, Neuhaus P, Settmacher U. Indication, technique, and outcome of portal vein arterialization in orthotopic liver transplantation. Transplant Proc 2001; 33:1414-5. [PMID: 11267352 DOI: 10.1016/s0041-1345(00)02533-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- B Stange
- Department of Surgery, Charité, Campus Virchow-Klinikum, Humboldt University Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- B Stange
- Department of Surgery, Charité, Campus Virchow-Klinikum, Humboldt University Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
45
|
Glanemann M, Settmacher U, Langrehr JM, Kling N, Stange B, Staffa G, Bechstein WO, Neuhaus P, Hidajat N. Portal vein angioplasty using a transjugular, intrahepatic approach for treatment of extrahepatic portal vein stenosis after liver transplantation. Transpl Int 2001. [DOI: 10.1111/j.1432-2277.2001.tb00009.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Abstract
Complications involving the portal vein or the vena cava, are rare after orthotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 911 patients. Twenty-six of the adult patients (2.7%) suffered from portal complications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd-Chiari syndrome) accounted for the majority of complications of the vena cava, whereas alteration of the vessel wall or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modification of the standard end-to-end veno-venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8.3%, whereas only 2.4% of patients who received a standard anastomosis of the portal vein experienced complications of the portal vein. Furthermore, splenectomy during transplantation was also associated with an increased incidence of portal vein complications (10.5 vs. 2.2% in patients without splenectomy). Treatment was dependent on the signs and symptoms of the patients, and varied considerably between patients with portal vein complications and patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one-third of the patients, whereas in patients with occlusion of the portal vein, retransplantation was necessary in only 15%, and more than half of the patients suffering from portal vein complications did not require any treatment at all. Usually, treatment of patients with portal vein complications only became necessary when additional complications such as arterial occlusion or bile duct injuries occurred.
Collapse
Affiliation(s)
- U Settmacher
- Department of Surgery, Charité, Virchow-Klinikum, Humboldt-University Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
47
|
Glanemann M, Klupp J, Langrehr JM, Schröer G, Platz KP, Stange B, Settmacher U, Bechstein WO, Neuhaus P. Higher immunosuppressive efficacy of mycophenolate mofetil in combination with FK 506 than in combination with cyclosporine A. Transplant Proc 2000; 32:522-3. [PMID: 10812095 DOI: 10.1016/s0041-1345(00)00872-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Glanemann
- Department of Surgery, Charité, Campus Virchow Clinic, Humboldt University, Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Glanemann M, Settmacher U, Stange B, Haase R, Lopez-Häninnen E, Podrabsky P, Bechstein WO, Neuhaus P. Caval complications after orthotopic liver transplantation. Transplant Proc 2000; 32:539-40. [PMID: 10812103 DOI: 10.1016/s0041-1345(00)00880-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Glanemann
- Department of Surgery, Charité, Virchow Clinic, Humboldt University, Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- B Stange
- Department of Surgery, Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- M Glanemann
- Department of Surgery, Charitié, Virchow Clinics, Humboldt University, Berlin, Germany
| | | | | | | | | | | |
Collapse
|