1
|
Lunger F, Staerkle RF, Muff JL, Fink L, Holland-Cunz SG, Vuille-Dit-Bille RN. Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis. J Surg Res 2022; 274:1-8. [PMID: 35104694 DOI: 10.1016/j.jss.2021.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/28/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique. METHODS A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death. RESULTS Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]). CONCLUSIONS On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.
Collapse
Affiliation(s)
- Fabian Lunger
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland; Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Ralph F Staerkle
- Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Julian L Muff
- Department of Pediatric Surgery, Children's University Hospital, Basel, Switzerland
| | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St. Gallen, Switzerland
| | | | | |
Collapse
|
2
|
Vuille-Dit-Bille RN, Staerkle RF, Soll C, Troller R, Muff JL, Choudhury R, Holland-Cunz SG, Grochola LF, Samra JS, Puhan MA, Breitenstein S. Extended versus standard lymph node dissection for pancreatic head and periampullary adenocarcinoma: systematic review. Br J Surg 2022; 109:e52-e53. [PMID: 35041744 DOI: 10.1093/bjs/znab451] [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] [Received: 04/30/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- R N Vuille-Dit-Bille
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.,Department of Paediatric Surgery, Children's University Hospital, Basle, Switzerland
| | - R F Staerkle
- Visceral Surgery, Hirslanden Klinik St Anna, Lucerne, Switzerland
| | - C Soll
- Visceral Surgery, Hirslanden Klinik St Anna, Lucerne, Switzerland
| | - R Troller
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - J L Muff
- Department of Paediatric Surgery, Children's University Hospital, Basle, Switzerland
| | - R Choudhury
- Department of Transplant Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - S G Holland-Cunz
- Department of Paediatric Surgery, Children's University Hospital, Basle, Switzerland
| | - L F Grochola
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - J S Samra
- Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - M A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - S Breitenstein
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| |
Collapse
|
3
|
Vuille-Dit-Bille RN, Muff JL, Sommer V, Holland-Cunz SG, Frech-Dörfler M. Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1496-1500. [PMID: 34748421 DOI: 10.1089/lap.2021.0306] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.
Collapse
Affiliation(s)
| | - Julian L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Vivienne Sommer
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Martina Frech-Dörfler
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Muff JL, Guglielmetti LC, Gros SJ, Buchmüller L, Frongia G, Haecker FM, Holland-Cunz SG, de Trey T, Vuille-Dit-Bille RN. Failed preoperative vacuum bell therapy does not affect outcomes following minimally invasive repair of pectus excavatum. Pediatr Surg Int 2021; 37:1429-1435. [PMID: 34272597 PMCID: PMC8408062 DOI: 10.1007/s00383-021-04963-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE It is unknown if failed preoperative vacuum bell (VB) treatment in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), delays repair and/or affects postoperative outcomes. METHODS A retrospective data analysis including all consecutive patients treated at one single institution undergoing MIRPE was performed between 2000 and 2016. Patients were stratified into preoperative VB therapy versus no previous VB therapy. RESULTS In total, 127 patients were included. Twenty-seven (21.3%) patients had preoperative VB treatment for 17 months (median, IQR 8-34). All 27 patients stopped VB treatment due to the lack of treatment effect. Eight (47.1%) of 17 assessed VB patients showed signs of skin irritation or hematoma. VB treatment had no effect on length of hospital stay (p = 0.385), postoperative complications (p = 1.0), bar dislocations (p = 1.0), and duration of bar treatment (p = 0.174). Time spent in intensive care unit was shorter in patients with VB therapy (p = 0.007). Long-term perception of treatment including rating of primary operation (p = 0.113), pain during primary operation (p = 0.838), own perspective of look of chest (p = 0.545), satisfaction with the procedure (p = 0.409), and intention of doing surgery again (p = 1.0) were not different between groups. CONCLUSIONS Failed preoperative VB therapy had no or minimal effect on short-term outcomes and long-term perceptions following MIRPE.
Collapse
Affiliation(s)
- J L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - L C Guglielmetti
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - S J Gros
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - L Buchmüller
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - G Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - F -M Haecker
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St.Gallen, Claudiusstrasse 6, CH-9006, St.Gallen, Switzerland.,Faculty of Medicine, University of Basel, 4056, Basel, Switzerland
| | - S G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - T de Trey
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Raphael N Vuille-Dit-Bille
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
| |
Collapse
|
5
|
Vuille-dit-Bille RN, Staerkle RF, Soll C, Troller R, Muff J, Choudhury R, Holland-Cunz SG, Grochola LF, Samra J, Puhan M, Breitenstein S. Extended lymph node resection versus standard resection for pancreatic head and peri-ampullary adenocarcinoma: A systemic review. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.031] [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: 11/14/2022]
Abstract
Abstract
Objective
For patients with pancreatic and peri-ampullary adenocarcinoma, it has been hypothesized that extended lymphadenectomy may result in higher R0 resection rates and improved survival. As such, the objective of this systematic review was to compare the oncologic outcomes after pancreaticoduodenectomy (PD) with standard lymphadenectomy (SLA) versus PD with extended lymphadenectomy (ELA).
Methods
A Cochrane systematic review was conducted to identify all randomized controlled trials comparing PD with SLA versus PD with ELA for participants with periampullary or pancreatic cancer. The following electronic databases were reviewed: the Cochrane Central Register of Controlled Trials; MEDLINE; PubMed and EMBASE. The methodological quality of the included studies was assessed using the Cochrane risk of bias criteria and the quality of evidence for important outcomes using GRADE. Extended lymphadenectomy included the interaortocaval space, left side of the celiac trunk, and superior mesenteric artery.
Results
Seven randomized controlled trials were included with 843 patients (421 ELA and 422 SLA). No difference in overall survival (1- and 3-years after surgery) was seen between groups. Mortality and morbidity rates (including pancreatic fistula, delayed gastric emptying, and postoperative bleeding) were similar between the two groups. Operative time was significantly longer following extended resection (Mean Difference 50.1 min; 95% CI 19.2 to 81.1 min; P = 0.001). Total amount of blood loss during surgery was significantly increased following extended resection (Mean Difference 137 ml; 95% CI 12 to 263 ml; P = 0.03), as well as transfusion requirements (Mean Difference 0.15 units; 95% CI 0.13 to 0.17 units; P < 0.00001).
More lymph nodes were retrieved during ELA (Mean Difference 11 nodes; 95% CI 7 to 15 nodes; P < 0.00001). Incidence of positive resection margins was not different between groups.
Conclusion
There is no indication for extended lymphadenectomy in pancreatic head resection as a routine procedure.
Collapse
Affiliation(s)
- R N Vuille-dit-Bille
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - R F Staerkle
- Department of Visceral Surgery, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - C Soll
- Department of Visceral Surgery, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - R Troller
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - J Muff
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - R Choudhury
- Department of Surgery, University of Colorado, Aurora, USA
| | - S G Holland-Cunz
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - L F Grochola
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - J Samra
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - S Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| |
Collapse
|
6
|
Huo Z, Bilang R, Brantner B, von der Weid N, Holland-Cunz SG, Gros SJ. Perspective on Similarities and Possible Overlaps of Congenital Disease Formation-Exemplified on a Case of Congenital Diaphragmatic Hernia and Neuroblastoma in a Neonate. Children (Basel) 2021; 8:children8020163. [PMID: 33671521 PMCID: PMC7926624 DOI: 10.3390/children8020163] [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] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
The coincidence of two rare diseases such as congenital diaphragmatic hernia (CDH) and neuroblastoma is exceptional. With an incidence of around 2–3:10,000 and 1:8000 for either disease occurring on its own, the chance of simultaneous presentation of both pathologies at birth is extremely low. Unfortunately, the underlying processes leading to congenital malformation and neonatal tumors are not yet thoroughly understood. There are several hypotheses revolving around the formation of CDH and neuroblastoma. The aim of our study was to put the respective hypotheses of disease formation as well as known factors in this process into perspective regarding their similarities and possible overlaps of congenital disease formation. We present the joint occurrence of these two rare diseases based on a patient presentation and immunochemical prognostic marker evaluation. The aim of this manuscript is to elucidate possible similarities in the pathogeneses of both disease entities. Discussed are the role of toxins, cell differentiation, the influence of retinoic acid and NMYC as well as of hypoxia. The detailed discussion reveals that some of the proposed pathophysiological mechanisms of both malformations have common aspects. Especially disturbances of the retinoic acid pathway and NMYC expression can influence and disrupt cell differentiation in either disease. Due to the rarity of both diseases, interdisciplinary efforts and multi-center studies are needed to investigate the reasons for congenital malformations and their interlinkage with neonatal tumor disease.
Collapse
Affiliation(s)
- Zihe Huo
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland; (Z.H.); (R.B.); (B.B.); (S.G.H.-C.)
- Department of Clinical Research, University of Basel, 4001 Basel, Switzerland;
| | - Remo Bilang
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland; (Z.H.); (R.B.); (B.B.); (S.G.H.-C.)
- Department of Clinical Research, University of Basel, 4001 Basel, Switzerland;
| | - Benedikt Brantner
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland; (Z.H.); (R.B.); (B.B.); (S.G.H.-C.)
| | - Nicolas von der Weid
- Department of Clinical Research, University of Basel, 4001 Basel, Switzerland;
- Department of Hematology and Oncology, University Children’s Hospital Basel, 4056 Basel, Switzerland
| | - Stefan G. Holland-Cunz
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland; (Z.H.); (R.B.); (B.B.); (S.G.H.-C.)
- Department of Clinical Research, University of Basel, 4001 Basel, Switzerland;
| | - Stephanie J. Gros
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland; (Z.H.); (R.B.); (B.B.); (S.G.H.-C.)
- Department of Clinical Research, University of Basel, 4001 Basel, Switzerland;
- Correspondence:
| |
Collapse
|
7
|
Huo Z, Lomora M, Kym U, Palivan C, Holland-Cunz SG, Gros SJ. AQP1 Is Up-Regulated by Hypoxia and Leads to Increased Cell Water Permeability, Motility, and Migration in Neuroblastoma. Front Cell Dev Biol 2021; 9:605272. [PMID: 33644043 PMCID: PMC7905035 DOI: 10.3389/fcell.2021.605272] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
The water channel aquaporin 1 (AQP1) has been implicated in tumor progression and metastasis. It is hypothesized that AQP1 expression can facilitate the transmembrane water transport leading to changes in cell structure that promote migration. Its impact in neuroblastoma has not been addressed so far. The objectives of this study have been to determine whether AQP1 expression in neuroblastoma is dependent on hypoxia, to demonstrate whether AQP1 is functionally relevant for migration, and to further define AQP1-dependent properties of the migrating cells. This was determined by investigating the reaction of neuroblastoma cell lines, particularly SH-SY5Y, Kelly, SH-EP Tet-21/N and SK-N-BE(2)-M17 to hypoxia, quantitating the AQP1-related water permeability by stopped-flow spectroscopy, and studying the migration-related properties of the cells in a modified transwell assay. We find that AQP1 expression in neuroblastoma cells is up-regulated by hypoxic conditions, and that increased AQP1 expression enabled the cells to form a phenotype which is associated with migratory properties and increased cell agility. This suggests that the hypoxic tumor microenvironment is the trigger for some tumor cells to transition to a migratory phenotype. We demonstrate that migrating tumor cell express elevated AQP1 levels and a hypoxic biochemical phenotype. Our experiments strongly suggest that elevated AQP1 might be a key driver in transitioning stable tumor cells to migrating tumor cells in a hypoxic microenvironment.
Collapse
Affiliation(s)
- Zihe Huo
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mihai Lomora
- Department of Physical Chemistry, University of Basel, Basel, Switzerland
| | - Urs Kym
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cornelia Palivan
- Department of Physical Chemistry, University of Basel, Basel, Switzerland
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stephanie J Gros
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| |
Collapse
|
8
|
Gros SJ, Holland-Cunz SG, Supuran CT, Braissant O. Personalized Treatment Response Assessment for Rare Childhood Tumors Using Microcalorimetry-Exemplified by Use of Carbonic Anhydrase IX and Aquaporin 1 Inhibitors. Int J Mol Sci 2019; 20:ijms20204984. [PMID: 31600976 PMCID: PMC6834116 DOI: 10.3390/ijms20204984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 08/22/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/19/2022] Open
Abstract
We present a novel approach to a personalized therapeutic concept for solid tumors. We illustrate this on a rare childhood tumor for which only a generalized treatment concept exists using carbonic anhydrase IX and aquaporin 1 inhibitors. The use of microcalorimetry as a refined in vitro method for evaluation of drug susceptibility in organotypic slice culture has not previously been established. Rapid microcalorimetric drug response assessment can refine a general treatment concept when it is applied in cases in which tumors do not respond to conventional chemo-radiation treatment. For solid tumors, which do not respond to classical treatment, and especially for rare tumors without an established protocol rapid microcalorimetric drug response testing presents an elegant novel approach to test alternative therapeutic approaches. While improved treatment concepts have led to improved outcome over the past decades, the prognosis of high risk disease is still poor and rethinking of clinical trial design is necessary. A small patient population combined with the necessity to assess experimental therapies for rare solid tumors rather at the time of diagnosis than in relapsed or refractory patients provides great challenges. The possibility to rapidly compare established protocols with innovative therapeutics presents an elegant novel approach to refine and personalize treatment.
Collapse
Affiliation(s)
- Stephanie J Gros
- Department of Pediatric Surgery, University Children's Hospital Basel, 4031 Basel, Switzerland.
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital Basel, 4031 Basel, Switzerland.
| | - Claudiu T Supuran
- Department Neurofarba, Sezione di Scienze farmaceutiche, University of Florence, 50139 Florence, Italy.
| | - Olivier Braissant
- Biological Calorimetry Lab, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Basel, Switzerland.
| |
Collapse
|