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Horn J, Höhn P, Strotmann J, Majchrzak-Stiller B, Buchholz M, Uhl W, Herzog T. Next-generation microbiological testing in intraabdominal infections with PCR technology. Langenbecks Arch Surg 2024; 409:108. [PMID: 38570375 PMCID: PMC10990981 DOI: 10.1007/s00423-024-03298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Intraabdominal infections (IAI) are increasing worldwide and are a major contributor to morbidity and mortality. Among IAI, the number of multi-drug resistant organisms (MDRO) is increasing globally. We tested the Unyvero A50® for intraabdominal infections, compared the detected microorganisms and antibiotic resistance, and compared the results with those of routine microbiology. METHODS We prospectively compared samples obtained from surgical patients using PCR-based Unyvero IAI cartridges against routine microbiology for the detection of microorganisms. Additionally, we identified clinical parameters that correlated with the microbiological findings. Data were analyzed using the t-test and Mann-Whitney U test. RESULTS Sixty-two samples were analyzed. The PCR system identified more microorganisms, mostly Bacteroides species, Escherichia coli, and Enterococcus spp. For bacterial resistance, the PCR system results were fully concordant with those of routine microbiology, resulting in a sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of 100%. The sensitivity, specificity, PPV, and NPV for the detection of microorganisms were 74%, 58%, 60%, and 72%, respectively. CRP levels were significantly higher in patients with detectable microorganisms. We identified more microorganisms and bacterial resistance in hospital-acquired intra-abdominal infections by using the PCR system. DISCUSSION IAI warrants early identification of the microorganisms involved and their resistance to allow for adequate antibiotic therapy. PCR systems enable physicians to rapidly adjust their antibiotic treatment. Conventional microbiological culture and testing remain essential for determining the minimal growth inhibition concentrations for antibiotic therapy.
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Affiliation(s)
- Julian Horn
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Philipp Höhn
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Marie Buchholz
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Torsten Herzog
- Department of General Surgery and Visceral Surgery, Klinikum Vest, Ruhr University Bochum, Recklinghausen, Germany
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Ten Winkel M, Salama H, Timrott K, Kleine M, Kleine-Doepke D, Raehder-Johnson S, Meisel H, Rahberi NN, Abdelhadi S, Rückert F, Reissfelder C, Honselmann KC, Braun R, Faerber B, Lapshyn H, Keck T, Uhl W, Belyaev O, Wellner UF, Bolm L. Patient-reported outcomes at three months after pancreatic surgery for benign and malignant diseases - A prospective observational study. Pancreatology 2024; 24:314-322. [PMID: 38310036 DOI: 10.1016/j.pan.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND/OBJECTIVES Pancreatic surgery may have a long-lasting effect on patients' health status and quality of life (QoL). We aim to evaluate patient-reported outcomes (PRO) 3 months after pancreatic surgery. METHODS Patients scheduled for pancreatic surgery were enrolled in a prospective trial at five German centers. Patients completed PRO questionnaires (EQ-5D-5L, EORTC QLQ-PAN26, patient-reported happiness, and HADS-D), we report the first follow-up 3 months after surgery as an interim analysis. Statistical testing was performed using R software. RESULTS From 2019 to 2022 203 patients were enrolled, a three-month follow-up questionnaire was available in 135 (65.5 %). 77 (57.9 %) underwent surgery for malignant disease. Patient-reported health status (EQ-5D-5L) was impaired in 4/5 dimensions (mobility, self-care, usual activities, pain, discomfort) for patients with malignant and 3/5 dimensions (mobility, self-care, usual activities) for patients with benign disease 3 months after surgery (p < 0.05). Patients with malignant disease reported an increase in depressive symptoms, patients with benign disease had a decrease in anxiety symptoms (HADS-D; depression: 5.00 vs 6.51, p = 0.002; anxiety: 8.04 vs. 6.34, p = 0.030). Regarding pancreatic-disease-specific symptoms (EORTC-QLQ-PAN26), patients with malignant disease reported increased problems with taste, weight loss, weakness in arms and legs, dry mouth, body image and troubling side effects at three months. Patients with benign disease indicated more weakness in arms and legs, troubling side effects but less future worries at three months. CONCLUSION Patient-reported outcomes of patients undergoing pancreatic surgery for benign vs. malignant disease show important differences. Patients with malignant tumors report more severely decreased quality of life 3 months postoperatively than patients with benign tumors.
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Affiliation(s)
- Meike Ten Winkel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Hussein Salama
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Kai Timrott
- Department of Surgery, University Hospital, Medical School Hannover, Germany
| | - Moritz Kleine
- Department of Surgery, University Hospital, Medical School Hannover, Germany; Department of Surgery, Vinzenz Hospital Hannover, Germany
| | | | | | | | - Nuh N Rahberi
- Department of Surgery, University Medical Center Mannheim, Germany
| | | | - Felix Rückert
- Department of Surgery, University Medical Center Mannheim, Germany; Department of Surgery, Diakonissen Hospital Speyer, Germany
| | | | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Ruediger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Benedikt Faerber
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany.
| | - Waldemar Uhl
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, St. Joseph-Hospital, Ruhr University Bochum, Germany
| | - Ulrich F Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
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3
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Mueller TC, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender S, Strudthoff J, Lock JF, Wiegering A, Hadian A, Lang H, Albertsmeier M, Neuberger M, Von Ehrlich-Treuenstätt V, Mihaljevic AL, Knebel P, Pianka F, Braumann C, Uhl W, Bouchard R, Petrova E, Bork U, Distler M, Tachezy M, Izbicki JR, Reissfelder C, Herrle F, Vay C, Knoefel WT, Buia A, Hanisch E, Friess H, Reim D. Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surg 2024:2815372. [PMID: 38381428 PMCID: PMC10882507 DOI: 10.1001/jamasurg.2023.7985] [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: 02/22/2024]
Abstract
Importance Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. Objective To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. Design, Setting, and Participants The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Interventions Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. Main Outcome and Measures The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Results Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. Conclusions and Relevance In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. Trial Registration drks.de Identifier: DRKS00012251.
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Affiliation(s)
- Tara Catharina Mueller
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebekka Dimpel
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Judith Strudthoff
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ali Hadian
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Michael Neuberger
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Viktor Von Ehrlich-Treuenstätt
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - André L Mihaljevic
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Phillip Knebel
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Pianka
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Ralf Bouchard
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Vay
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Buia
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Ernst Hanisch
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Hirmas N, Hamacher R, Sraieb M, Kessler L, Pabst KM, Barbato F, Lanzafame H, Kasper S, Nader M, Kesch C, von Tresckow B, Hautzel H, Aigner C, Glas M, Stuschke M, Kümmel S, Harter P, Lugnier C, Uhl W, Hadaschik B, Grünwald V, Siveke JT, Herrmann K, Fendler WP. Diagnostic Accuracy of 68Ga-FAPI Versus 18F-FDG PET in Patients with Various Malignancies. J Nucl Med 2024:jnumed.123.266652. [PMID: 38331453 DOI: 10.2967/jnumed.123.266652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
To assess the diagnostic accuracy of 68Ga-labeled fibroblast activation protein inhibitor (FAPI) and 18F-labeled FDG PET for the detection of various tumors, we performed a head-to-head comparison of both imaging modalities across a range of tumor entities as part of our ongoing 68Ga-FAPI PET observational trial. Methods: The study included 115 patients with 8 tumor entities who received imaging with 68Ga-FAPI for tumor staging or restaging between October 2018 and March 2022. Of those, 103 patients received concomitant imaging with 68Ga-FAPI and 18F-FDG PET and had adequate lesion validation for accuracy analysis. Each scan was evaluated for the detection of primary tumor, lymph nodes, and visceral and bone metastases. True or false positivity and negativity to detected lesions was assigned on the basis of histopathology from biopsies or surgical excision, as well as imaging validation. Results: 68Ga-FAPI PET revealed higher accuracy than 18F-FDG PET in the detection of colorectal cancer (n = 14; per-patient, 85.7% vs. 78.6%; per-region, 95.6% vs. 91.1%) and prostate cancer (n = 22; per-patient, 100% vs. 90.9%; per-region, 96.4% vs. 92.7%). 68Ga-FAPI PET and 18F-FDG PET had comparable per-patient accuracy in detecting breast cancer (n = 16, 100% for both) and head and neck cancers (n = 10, 90% for both modalities). 68Ga-FAPI PET had lower per-patient accuracy than 18F-FDG PET in cancers of the bladder (n = 12, 75% vs. 100%) and kidney (n = 10, 80% vs. 90%), as well as lymphoma (n = 9, 88.9% vs. 100%) and myeloma (n = 10, 80% vs. 90%). Conclusion: 68Ga-FAPI PET demonstrated higher diagnostic accuracy than 18F-FDG PET in the diagnosis of colorectal cancer and prostate cancer, as well as comparable diagnostic performance for cancers of the breast and head and neck. Accuracy and impact on management will be further assessed in an ongoing prospective interventional trial (NCT05160051).
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Affiliation(s)
- Nader Hirmas
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
| | - Rainer Hamacher
- Department of Medical Oncology, West German Cancer Center, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Helena Lanzafame
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Celine Lugnier
- Department of Hematology and Oncology with Palliative Care, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Ruhr University Bochum, Bochum, Germany
| | - Boris Hadaschik
- Department of Urology, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Viktor Grünwald
- Department of Urology, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jens T Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; and
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK partner site Essen), German Cancer Research Center, Heidelberg, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Kessler L, Hirmas N, Pabst KM, Hamacher R, Ferdinandus J, Schaarschmidt BM, Milosevic A, Nader M, Umutlu L, Uhl W, Reinacher-Schick A, Lugnier C, Witte D, Niedergethmann M, Herrmann K, Fendler WP, Siveke JT. 68Ga-Labeled Fibroblast Activation Protein Inhibitor ( 68Ga-FAPI) PET for Pancreatic Adenocarcinoma: Data from the 68Ga-FAPI PET Observational Trial. J Nucl Med 2023; 64:1910-1917. [PMID: 37973185 DOI: 10.2967/jnumed.122.264827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
The fibroblast activation protein (FAP) is highly expressed on carcinoma-associated fibroblasts in the stroma of pancreatic cancer and thus is a promising target for imaging and therapy. Preliminary data on PET imaging with radiolabeled FAP inhibitors (FAPIs) demonstrate superior tumor detection. Here we assess the accuracy of FAP-directed PET in patients with pancreatic cancer. Methods: Of 64 patients with suspected or proven pancreatic cancer, 62 (97%) were included in the data analysis of the 68Ga-FAPI PET observational trial (NCT04571086). All of these patients underwent contrast-enhanced CT, and 38 patients additionally underwent 18F-FDG PET. The primary study endpoint was the association of 68Ga-FAPI PET uptake intensity and histopathologic FAP expression. Secondary endpoints were detection rate, diagnostic performance, interreader reproducibility, and change in management. Datasets were interpreted by 2 masked readers. Results: The primary endpoint was met: The association between 68Ga-FAPI SUVmax and histopathologic FAP expression was significant (Spearman r, 0.48; P = 0.04). For histopathology-validated lesions, 68Ga-FAPI PET showed high sensitivity and positive predictive values (PPVs) on per-patient (sensitivity, 100%; PPV, 96.3%) and per-region (sensitivity, 100%; PPV, 97.0%) bases. In a head-to-head comparison versus 18F-FDG or contrast-enhanced CT, 68Ga-FAPI detected more tumor on a per-lesion (84.7% vs. 46.5% vs. 52.9%), per-patient (97.4% vs. 73.7% vs. 92.1%), or per-region (32.6% vs. 18.8% vs. 23.7%) basis, respectively. 68Ga-FAPI PET readers showed substantial overall agreement on the basis of the Fleiss κ: primary κ, 0.77 (range, 0.66-0.88). Minor and major changes in clinical management occurred in 5 patients (8.4%) after 68Ga-FAPI PET. Conclusion: We confirmed an association of 68Ga-FAPI PET SUVmax and histopathologic FAP expression in pancreatic cancer patients. Additionally, we found high detection rate and diagnostic accuracy, superior to those of 18F-FDG PET/CT. 68Ga-FAPI might become a powerful diagnostic tool for pancreatic cancer work-up.
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Affiliation(s)
- Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Nader Hirmas
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Aleksandar Milosevic
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Celine Lugnier
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - David Witte
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Marco Niedergethmann
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Jens T Siveke
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany;
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Beger HG, Friess H, Uhl W. Whipple Resection for Benign Tumors and Premalignant Neoplasms of the Pancreatic Head: Surgery-Associated Risk for Complications and Late Metabolic Morbidity Matters. Ann Surg Open 2023; 4:e325. [PMID: 37746609 PMCID: PMC10513249 DOI: 10.1097/as9.0000000000000325] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
Benign and premalignant neoplasms of the pancreas are increasingly detected and recommended for surgical treatment. For tumors of the pancreatic head, the challenging decision is: multiorgan resection or local tumor extirpation? Compared with pancreaticoduodenectomy, duodenum-preserving pancreatic head resection is associated with significantly fewer surgery-related serious and severe complications and lower in-hospital mortality. The decisive advantage of duodenum-preserving pancreatic head resection is the maintenance of endocrine and exocrine pancreatic and upper gastrointestinal tract functions.
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Affiliation(s)
- Hans G. Beger
- From the Department of Surgery, c/o University of Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Gambichler T, Majchrzak-Stiller B, Peters I, Becker JC, Strotmann J, Abu Rached N, Müller T, Uhl W, Buchholz M, Braumann C. The effect of GP-2250 on cultured virus-negative Merkel cell carcinoma cells: preliminary results. J Cancer Res Clin Oncol 2023; 149:10831-10840. [PMID: 37311987 PMCID: PMC10423113 DOI: 10.1007/s00432-023-04960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Even in the novel immunotherapy era, Merkel cell carcinoma (MCC) remains challenging in its treatment. Apart from Merkel cell polyomavirus (MCPyV) associated MCC, this cancer is linked in about 20% of cases to ultraviolet-induced mutational burden frequently causing aberrations in Notch and PI3K/AKT/mTOR signalling pathways. The recently developed agent GP-2250 is capable to inhibit growth of cells of different cancers, including pancreatic neuroendocrine tumors. The objective of the present study was to investigate the effects of GP-2250 on MCPyV-negative MCC cells. METHODS Methods We employed three cell lines (MCC13, MCC14.2, MCC26) which were exposed to different GP-2250doses. GP-2250's effects on cell viability, proliferation, and migration were evaluated by means of MTT, BrdU, and scratch assays, respectively. Flow cytometry was performed for the evaluation of apoptosis and necrosis. Western blotting was implemented for the determination of AKT, mTOR, STAT3, and Notch1 protein expression. RESULTS Cell viability, proliferation, and migration decreased with increasing GP-2250 doses. Flow cytometry revealed a dose response to GP-2250 in all three MCC cell lines. While the viable fraction decreased, the share of necrotic and in a smaller amount the apoptotic cells increased. Regarding Notch1, AKT, mTOR, and STAT3 expression a comparatively time- and dose-dependent decrease of protein expression in the MCC13 and MCC26 cell lines was observed. By contrast, Notch1, AKT, mTOR, and STAT3 expression in MCC14.2 was scarcely altered or even increased by the three dosages of GP-2250 applied. CONCLUSIONS The present study indicates GP-2250 having anti-neoplastic effects in MCPyV-negative tumor cells in regard to viability, proliferation, and migration. Moreover, the substance is capable of downregulating protein expression of aberrant tumorigenic pathways in MCPyV-negative MCC cells.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Ilka Peters
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Jürgen C. Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Nessr Abu Rached
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Marie Buchholz
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 45878 Gelsenkirchen, Germany
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8
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Zamparas A, Herzog T, Förster S, Siglienti I, Uhl W, Strotmann J, Höhn P. Unusual paraneoplastic syndromes in pancreatic cancer: a case report of Lambert-Eaton myasthenic syndrome (LEMS) associated with intraductal papillary mucinous cancer of the pancreas. AME Case Rep 2023; 7:35. [PMID: 37942046 PMCID: PMC10628391 DOI: 10.21037/acr-22-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/09/2023] [Indexed: 11/10/2023]
Abstract
Background Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction. It can occur as a paraneoplastic disorder associated with various types of carcinomas, usually small cell lung cancer or as an autoimmune disease. LEMS can be misdiagnosed as myasthenia gravis or as an oncological sequela, causing delays in diagnosis. We present a rare case of a male adult with confirmed LEMS occurring with pancreatic carcinoma. Case Description A 66-year-old man presented with a newly diagnosed pancreatic tumor. He had been experiencing weakness and fatigue in his lower extremities since the summer of 2020. Over time, the weakness progressed to include his proximal upper extremity muscles. Dysphonia, dysarthria, decreased appetite and significant weight loss were also observed. A computed tomography (CT) scan revealed a 3 cm locally resectable cystic tumor in the pancreatic head. Blood tests showed elevated carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) levels. A Whipple procedure was performed, which revealed a poorly differentiated pancreatic adenocarcinoma inside an intraductal pancreatic mucinous neoplasm. Postoperatively, the patient was admitted to the intensive care unit (ICU) because he had no spontaneous breathing and manifested areflexia signs. A train of four (TOF) monitoring of peripheral nerve stimulation was performed and pyridostigmine therapy was initiated, leading to an improvement in symptoms allowing the extubation and transfer to the peripheral ward. Further diagnostic tests revealed a LEMS and an intravenous therapy with cumulative 100 g immunoglobulin (Ig) G was initiated. Upon discharge, 10 days after starting LEMS treatment, the patient showed subjective and objective improvement in strength. Conclusions Paraneoplastic syndromes are more common than expected, but rare in pancreatic adenocarcinoma. They can appear before abdominal symptoms, facilitating early diagnosis. Successful treatment of cancer may eliminate paraneoplastic symptoms. LEMS may reveal pancreatic cancer. Early recognition of paraneoplastic syndromes is important for pancreatic cancer management. Further investigation is needed to evaluate the diagnostic approach for LEMS in all patients with pancreatic cancer.
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Affiliation(s)
- Athanasios Zamparas
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sarah Förster
- Institute of Pathology, Ruhr University Bochum, Bochum, Germany
| | - Ines Siglienti
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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Majchrzak-Stiller B, Buchholz M, Peters I, Waschestjuk D, Strotmann J, Höhn P, Hahn S, Braumann C, Uhl W, Müller T, Möhler H. GP-2250, a novel anticancer agent, inhibits the energy metabolism, activates AMP-Kinase and impairs the NF-kB pathway in pancreatic cancer cells. J Cell Mol Med 2023. [PMID: 37390227 DOI: 10.1111/jcmm.17825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
GP-2250, a novel anticancer agent, severely limits the energy metabolism, as demonstrated by the inhibition of hexokinase 2 and glyceraldehyde-3-phosphate dehydrogenase and a decrease of ATP. Rescue experiments with supplementary pyruvate or oxaloacetate demonstrated that a TCA cycle deficit largely contributed to cytotoxicity. Activation of the energy-deficit sensor, AMP-dependent protein kinase, was associated with increased phosphorylation of acetyl-CoA carboxylase and Raptor, pointing to a possible deficit in the synthesis of fatty acids and proteins as essential cell components. Binding of p65 to DNA was dose-dependently reduced in nuclear lysates. A transcriptional deficit of NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) was substantiated by the downregulation of cyclin D1 and of the anti-apoptotic Bcl2, in line with reduction in tumour cell proliferation and induction of apoptosis, respectively. The upregulation of p53 concomitant with an excess of ROS supported apoptosis. Thus, the anticancer activity of GP-2250 is a result of disruption of energy metabolism and inhibition of tumour promotion by NF-κB.
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Affiliation(s)
- Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Marie Buchholz
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ilka Peters
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Daniel Waschestjuk
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Hahn
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Gelsenkirchen, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Hanns Möhler
- Institute of Pharmacology, University of Zurich and Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
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D'Haese JG, Uhl W, Schnitzbauer AA, Hoffmann K, Stavrou GA. [Not Available]. Chirurgie (Heidelb) 2023:10.1007/s00104-023-01889-8. [PMID: 37233783 DOI: 10.1007/s00104-023-01889-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Jan G D'Haese
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, LMU Klinikum, Ludwig Maximilians Universität München, München, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Bochum, Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Andreas A Schnitzbauer
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Katrin Hoffmann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Gregor A Stavrou
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Chirurgische Onkologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
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11
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Majchrzak-Stiller B, Buchholz M, Peters I, Strotmann J, Möhrke J, Zelichowski L, Oehlke L, Quensel C, Fein D, Höhn P, Müller T, Uhl W, Braumann C. Oxathiazinane derivatives display both antineoplastic and antibacterial activity: a structure activity study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04799-8. [PMID: 37171614 PMCID: PMC10374762 DOI: 10.1007/s00432-023-04799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The Oxathiazinane substance class is characterized by a high diversity of chemical structures yet to be fully investigated. Our research group recently proved that the 1.4.5-oxathiazine-4.4-dioxide, known as substance GP-2250, possesses antineoplastic properties as shown on pancreatic carcinoma. This current study aims to gain insights into the structure and activity relationship of a series of different Oxathiazinanes regarding their antineoplastic activity and the potential correlation with antibacterial activity. We investigated the newly synthesized Oxathiazinane derivatives: 2255, 2256, 2287, 2289, 2293 and 2296 in comparison to GP-2250. METHODS The antineoplastic effect was evaluated in different cancer entities (breast, skin, pancreas and colon cancer cell lines) by viability, proliferation, and cell migration assays in vitro. Disc diffusion tests were performed on various bacteria strains to examine the antibacterial potential. Additionally, reactive oxygen species (ROS) assays were conducted to investigate mechanistic aspects. RESULTS The substances GP-2250, 2293, 2289 and 2296 not only showed antineoplastic activity in four different cancer entities but also antibacterial effects, as tested on multiple bacteria strains including MRSA (Methicillin-resistant Staphylococcus aureus). Furthermore, these substances also induced high ROS levels up to 110% in the treated cancer cell lines compared to untreated control cells. These results indicate a correlation between an antineoplastic capacity and antibacterial properties of these derivatives. Both activities appear to be ROS driven. The Oxathiazinane derivatives 2255, 2256 and 2287 lacked both, antineoplastic and antibacterial activity. CONCLUSION Thus, a comparable structure activity relationship became apparent for both the antineoplastic and antibacterial activity.
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Affiliation(s)
- B Majchrzak-Stiller
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany.
| | - M Buchholz
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - I Peters
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Strotmann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Möhrke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Zelichowski
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Oehlke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Quensel
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - D Fein
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - P Höhn
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - T Müller
- Geistlich Pharma AG, Wolhusen, Switzerland
| | - W Uhl
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Braumann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Gelsenkirchen, Germany
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12
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D'Haese JG, Uhl W, Schnitzbauer AA, Hoffmann K, Stavrou GA. [Potential risk to patient safety by discontinuation of production of classical T-drains? : Nationwide survey in Germany and statement of the surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV)]. Chirurgie (Heidelb) 2023; 94:419-423. [PMID: 37072621 DOI: 10.1007/s00104-023-01851-8] [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] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/20/2023]
Abstract
The revision of the medical device regulation (MDR) legislation by the European Union and supplementations by the member states has been implemented for good reasons but causes dramatic side effects. It is no longer allowed to produce some rarely used medical devices by various manufacturers that have been successfully used for decades. Before production, a new application to the MDR would be necessary, which is not a realistic business case for companies producing rarely used devices. This problem currently relates to the Kehr T‑drain made from soft rubber or latex that has been in use since the late nineteenth century. A surgically placed T‑drain, although rarely necessary nowadays, is still in use worldwide for special indications in an attempt to avoid severe complications. These special indications include complex hepato-pancreato-biliary (HPB) procedures and perforations of the upper gastrointestinal (GI) tract where T‑drains may be used to secure the hepatojejunostomy or to create a stable fistula. The HPB working group (CALGP) of the German Society of General and Visceral Surgery (DGAV) provides a statement from a surgical perspective on this matter after a survey of all its members. Politics should be very careful not to generalize when implementing useful new regulations at a European and national level. Established and comprehensible treatment concepts should not be restricted and exemption permits should be quickly granted in these cases because the discontinuation of these niche products may lead to potential patient safety issues and even fatalities.
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Affiliation(s)
- Jan G D'Haese
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Standort St. Josef Hospital, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Andreas A Schnitzbauer
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Katrin Hoffmann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Gregor A Stavrou
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Chirurgische Onkologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
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Slavik I, Kostrowski D, Uhl W. Effect of solar radiation on natural organic matter composition in surface waters and resulting impacts on drinking water treatment. Environ Technol 2023; 44:1549-1565. [PMID: 34839798 DOI: 10.1080/09593330.2021.2007289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
Solar radiation experiments showed a shift in the composition of natural organic matter (NOM). Due to irradiation, the concentration of high molecular weight (HMW) molecules decreased, and that of the low molecular weight (LMW) fraction increased. Microbiological analyses showed that biodegradation was neglectable. To assess the consequences for water treatment processes, coagulation jar tests were performed by comparing the removal effectivity for NOM fractions from irradiated and unirradiated raw water. The degree of dissolved organic carbon (DOC) removal by coagulation was lower for irradiated waters. As primarily HMW organic compounds are removed by coagulation, the decrease in coagulation performance is attributed to the increase in the LMW concentration due to photochemical reactions induced by solar radiation. Flocs were about 15% larger for irradiated water. Possibilities to adapt water treatment to respond to changes in DOC composition and concentration are outlined. Ozonation-biofiltration is judged as the most promising treatment process to cope with climate change-related challenges in drinking water treatment.
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Affiliation(s)
- I Slavik
- Hydro-Ingenieure GmbH, Düsseldorf, Germany
- Hochschule Magdeburg-Stendal, FB Wasser, Umwelt, Bau und Sicherheit Magdeburg, Germany
- Water Supply Engineering, Technische Universität Dresden, Dresden, Germany
| | - D Kostrowski
- Water Supply Engineering, Technische Universität Dresden, Dresden, Germany
| | - W Uhl
- Water Supply Engineering, Technische Universität Dresden, Dresden, Germany
- Aquateam COWI AS, Oslo, Norway
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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14
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Seufferlein T, Uhl W, Ettrich TJ. Reply to the Letter to the Editor 'The Neonax study' by M. W. Büchler and J. Neoptolemos. Ann Oncol 2023; 34:443-445. [PMID: 37061251 DOI: 10.1016/j.annonc.2023.01.005] [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: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 04/17/2023] Open
Affiliation(s)
- T Seufferlein
- Department of Internal Medicine I, Ulm University, Ulm, Germany.
| | - W Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University, Ulm, Germany
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15
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Höhn P, Runde F, Luu AM, Fahlbusch T, Fein D, Klinger C, Uhl W, Belyaev O, Keck T, Werner J, Nüssler N, Bartsch DK, Germer CT, Friess H, Mönch C, Oldhafer KJ, Kalff JC. Applicability of the surgical risk calculator by the American College of Surgeons in the setting of German patients undergoing complete pancreatectomy: multicentre study using data from the StuDoQ|Pancreas registry. BJS Open 2023; 7:7071649. [PMID: 36882081 PMCID: PMC9991503 DOI: 10.1093/bjsopen/zrac164] [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] [Received: 08/21/2022] [Revised: 10/16/2022] [Accepted: 11/12/2022] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Surgical risk calculators can estimate risk probabilities for postoperative outcomes utilizing patient-specific risk factors. They provide meaningful information for obtaining informed consent. The aim of the present paper was to evaluate the predictive value of the surgical risk calculators by the American College of Surgeons in German patients undergoing total pancreatectomy. METHODS Data for patients who underwent total pancreatectomy between 2014 and 2018 were acquired from the Study, Documentation, and Quality Center of the German Society for General and Visceral Surgery. Risk factors were entered manually into the surgical risk calculators and calculated risks were compared with actual outcomes. RESULTS Of the 408 patients analysed, predicted risk was higher in patients with complications except for the prediction of re-admission (P = 0.127), delayed gastric emptying (P = 0.243), and thrombosis (P = 0.256). In contrast, classification of patients into below, above, or average risk by the surgical risk calculators only produced meaningful results for discharge to nursing facility (P < 0.001), renal failure (P = 0.003), pneumonia (P = 0.001), serious complications, and overall morbidity (both P < 0.001). Assessment of discrimination and calibration showed poor results (scaled Brier scores 8.46 per cent or less). CONCLUSION Overall surgical risk calculator performance was poor. This finding promotes the development of a specific surgical risk calculator applicable to the German healthcare system.
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Affiliation(s)
- Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Fabian Runde
- Faculty of Medicine, Ruhr-Universität Bochum, Bochum, Germany
| | - Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Daniel Fein
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Carsten Klinger
- StuDoQ Registry, German Society for General and Visceral Surgery, Berlin, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Tobias Keck
- Surgical Department, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jens Werner
- Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, Klinikum Großhadern, Ludwig-Maximilians-Universität München, München, Germany
| | - Natascha Nüssler
- Department of General and Visceral Surgery, Endocrine Surgery und Coloproctology, Klinikum Neuperlach, Städt. Klinikum München, München, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Universitätsklinikum Marburg, Marburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, Universitätsklinik Würzburg, Würzburg, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Christian Mönch
- Department of General, Visceral and Transplant Surgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | | | - Jörg C Kalff
- Department of Visceral, Colorectal Surgery and Proctology, Universitätsklinikum Bonn, Bonn, Germany
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Eggers C, Olliges E, Boeck S, Kruger S, Uhl W, Meissner K. Exploring Pain, Quality of Life, and Emotional Well-Being in Patients with Advanced Pancreatic Cancer Practicing Spiritual Meditation: A Pilot Study. Complement Med Res 2023; 30:289-298. [PMID: 36843013 DOI: 10.1159/000529865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Studies on mind-body approaches in patients with advanced pancreatic ductal adenocarcinoma (PDAC) are rare. We performed a pilot study with follow-up until 1 year to explore changes in pain, quality of life (QoL), stress, and negative emotions in patients with advanced PDAC, who regularly practiced a standardized form of spiritual meditation in addition to standard medical care. METHODS At baseline and every 2 months for a maximum of 1 year, global pain, QoL (global, SEIQoL, FACT-G), spiritual well-being (FACIT-Sp), perceived stress (PSQ-20), anxiety and depression (HADS), and diurnal cortisol secretion (cortisol slope) were assessed. Changes from baseline were explored by pairwise comparisons of available cases. RESULTS Twenty participants (11 women, 62 ± 9.9 SD years) participated in the study, of whom 9 patients survived the study year. Pairwise comparisons revealed transient improvements of pain after 4 and 6 months (both p values < 0.05), of global QoL after 4, 6, 8, 10 months (all p values < 0.05), of SeiQoL scores after 4 months (p < 0.05), of FACT-G scores after 6 months (p < 0.05), and of FACIT-Sp scores after 2 and 6 months (both p values < 0.05). Furthermore, overall stress levels (PSQ-20) decreased from baseline to 2, 6, and 8 months (all p values < 0.05), and anxiety declined from baseline to 6 months (p < 0.05). Depression scores and the cortisol slope did not change. CONCLUSION This pilot study demonstrated the acceptability and feasibility of studies on spiritual meditation in patients with advanced PDAC. Randomized controlled trials are warranted to study the effects of spiritual meditation and other mind-body interventions on pain, QoL, and emotional well-being in this patient population. Einleitung Bislang gibt es kaum Studien zu Mind-Body-Ansätzen bei Patienten mit fortgeschrittenem duktalem Adenokarzinom der Bauchspeicheldrüse (PDAC). Wir führten eine explorative Pilotstudie mit einer einjährigen Nachbe- obachtungszeit durch, um Veränderungen von Schmerzen, Lebensqualität, Stress und negativen Emotionen bei Patienten mit fortgeschrittenem PDAC zu untersuchen, die zusätzlich zur medizinischen Standardversorgung regelmäßig eine standardisierte Form der spirituellen Meditation praktizierten. Methoden Zu Beginn der Studie und alle zwei Monate wurden über einen Zeitraum von maximal einem Jahr die globalen Schmerzen, die Lebensqualität (global, SEIQoL, FACT-G), das psychologische Wohlbefinden (FACIT-Sp), Stress (PSQ-20), Angst und Depression (HADS) sowie die circadiane Cortisolausschüttung (Cortisolabfall) untersucht. Die Änderungen gegenüber dem Ausgangswert wurden mit paarweisen Vergleichen der jeweils verfügbaren Fälle auf Signifikanz getestet. Ergebnisse 20 Patienten (11 Frauen, 62 ± 9.9 SD Jahre) nahmen an der Studie teil, von denen 9 das Studienjahr überlebten. Paarweise Vergleiche zeigten vorübergehende Verbesserungen der Schmerzen nach 4 und 6 Monaten (beide p-Werte < 0.05), der globalen Lebensqualität nach 4, 6, 8 und 10 Monaten (alle p-Werte < 0.05), der SeiQoL-Werte nach 4 Monaten ( p < 0.05), der FACT-G-Werte nach 6 Monaten ( p < 0.05) und der FACIT-Sp-Werte nach 2 und 6 Monaten (beide p-Werte < 0.05). Außerdem war der Gesamtstress (PSQ-20) nach 2, 6 und 8 Monaten (alle p-Werte < 0.05) sowie die Ängstlichkeit nach 6 Monaten ( p < 0.05) signifikant gesunken. Die Depressionswerte und der circadiane Cortisolabfall änderten sich nicht. Schlussfolgerung Diese Pilotstudie weist auf die Akzeptanz und Durchführbarkeit von Studien zu spiritueller Meditation bei Patienten mit fortgeschrittenem PDAC hin. Randomisierte kontrollierte Studie sollten folgen, um die Effekte von spiritueller Meditation und anderen Mind-Body-Interventionen auf Schmerzen, Lebensqualität und emotionales Wohlbefinden in dieser Patientengruppe zu untersuchen.
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Affiliation(s)
- Christine Eggers
- Institute of Medical Psychology, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Elisabeth Olliges
- Institute of Medical Psychology, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Stefan Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Kruger
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
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Aghalarov I, Beyer E, Niescery J, Belyaev O, Uhl W, Herzog T. Outcome of combined pancreatic and biliary fistulas after pancreatoduodenectomy. HPB (Oxford) 2023:S1365-182X(23)00051-5. [PMID: 36842945 DOI: 10.1016/j.hpb.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) as well as postoperative biliary fistula (POBF) are considered the main source of postoperative morbidity and mortality after pancreatoduodenectomy (PD). However, little is known about the incidence and complications of combined POPF/POBF compared to isolated POPF or POBF. METHODS This single-center study investigated retrospectively the incidence and postoperative outcome of combined POPF/POBF compared to isolated fistulas following PD in a tertiary German pancreatic center between 2009 and 2018. RESULTS A total of 678 patients underwent PD for benign and malignant periampullary lesions. Combined fistulas occurred in 6%, isolated POPF in 16%, and isolated POBF in 2%. Pancreatic ductal adenocarcinoma and chronic pancreatitis had a protective effect on the occurrence of combined fistulas, whereas serous cystadenoma and pancreatic metastasis were risk factors. Morbidity (Grade C fistula, post-pancreatectomy hemorrhage, revisional surgery) and mortality was significantly higher in patients with combined fistulas than in those with isolated fistula. Moreover, the duration of ICU stay was longer. CONCLUSIONS A combined POPF/POBF is associated with a significant increase of morbidity and mortality compared to isolated fistulas after PD. Early surgical revision in these patients may improve the postoperative survival rate.
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Affiliation(s)
- Ilgar Aghalarov
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany.
| | - Elisabeth Beyer
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Jennifer Niescery
- Department of Anesthesiology, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Torsten Herzog
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
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18
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Buchholz S, Ettrich TJ, Uhl W, Kornmann M, Algül H, Friess H, Koenig A, Gallmeier E, Lutz MP, Wille K, Schimanski CC, Kunzmann V, Geissler M, Waldschmidt D, Daum S, Perkhofer L, Reinacher-Schick AC, Seufferlein T. Perioperative or adjuvant nab-paclitaxel plus gemcitabine for resectable pancreatic cancer: Quality of life results of the randomized phase II AIO-NEONAX trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.694] [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: 01/25/2023] Open
Abstract
694 Background: Perioperative chemotherapy (CTX) in resectable pancreatic adenocarcinoma (rPDAC) is still not considered SoC and data regarding efficacy but also quality of life (QoL) are limited. NEONAX is a prospective, randomized phase II trial in patients with rPDAC with two independent experimental arms examining perioperative (2 pre- and 4 postoperative cycles, arm A) or adjuvant (6 cycles, arm B) of Gem (1000mg/m2) and nab-P (125mg/m2) on days 1,8,15 of a 28-day cycle. The primary endpoint DFS at 18 mo. as well as DFS, OS and safety have already been reported. Here we present the QoL data of the NEONAX trial. Methods: QoL was evaluated by EORTC QLQ-C30, EORTC QLQ-PAN26 and HADS-D questionnaires at baseline, at the beginning of each CTX cycle (neoadj. and adj. in arm A, only adj. in arm B), after neoadj. treatment in arm A as well as prior and post resection and after 6 cycles of CTX. Results: Global health status score (GHS-score) (QLQ-C30) showed no difference between baseline (t1) and the timepoint after 6 cycles of CTX (t2) in the perioperative arm A (66.7/100 at both timepoints). Here patients experienced the lowest GHS-score pre- and postoperatively (50/100 in both cases). Adjuvant arm B showed a deterioration in the GHS-score of 12.5 points from timepoint 1 to 2 (62.5/100 to 50.0/100). Here the lowest GHS-score was observed within 4 weeks post-surgery (41.7/100). Physical function score (QLQ-C30) was decreased by 6.7 points (86.7/100 to 80/100) in perioperative arm A and by 26.7 points (86.7/100 to 60/100) in arm B between both timepoints. Role function (QLQ-C30) was reduced by 16.7 points (83.3/100 to 66.7/100) in arm A and by 33.3 points (83.3/100 to 50/100) in arm B between both timepoints. In the remaining subscales of the used questionnaires the two arms of the trial showed comparable median scores over the whole study period. The number of submitted questionnaires at each timepoint varied but was at large comparable in both arms. Conclusions: QoL was largely preserved in the perioperative as well as the adjuvant arm of the NEONAX trial. GHS-score was lower pre-and postoperatively in arm A. The lowest GHS-score was observed postoperatively in the adjuvant arm B. QoL was restored at the end of the treatment period in the perioperative arm A and remained slightly reduced in arm B suggesting that QoL is not substantially impaired by perioperative treatment in rPDAC. Clinical trial information: NCT02047513 . [Table: see text]
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Affiliation(s)
- Sina Buchholz
- Ulm University Hospital, Department of Internal Medicine I, Ulm, Germany
| | | | - Waldemar Uhl
- Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | | | - Hana Algül
- Technische Universität München, Comprehensive Cancer Center Munich-TUM and Department of Internal Medicine II, Munich, Germany
| | - Helmut Friess
- Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany
| | - Alexander Koenig
- University Medical Center Goettingen, Department of Gastroenterology, Gastrointestinal Oncology, and Endocrinology, Goettingen, Germany
| | - Eike Gallmeier
- Department of Gastroenterology and Endocrinology, Uniklinikum Giessen und Marburg, Marburg, Germany
| | | | - Kai Wille
- University Hospital Ruhr-University-Bochum, Minden, Germany
| | - Carl Christoph Schimanski
- Klinikum Darmstadt GmbH and Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Darmstadt and Mainz, Germany
| | - Volker Kunzmann
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Michael Geissler
- Klinikum Esslingen, Department of Hematology/Oncology, Esslingen, Germany
| | - Dirk Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - Severin Daum
- Charite Medical University Hospital, Berlin, Germany
| | - Lukas Perkhofer
- Ulm University, Department of Internal Medicine I, Ulm, Germany
| | - Anke C. Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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19
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Seufferlein T, Uhl W, Kornmann M, Algül H, Friess H, König A, Ghadimi M, Gallmeier E, Bartsch DK, Lutz MP, Metzger R, Wille K, Gerdes B, Schimanski CC, Graupe F, Kunzmann V, Klein I, Geissler M, Staib L, Waldschmidt D, Bruns C, Wittel U, Fichtner-Feigl S, Daum S, Hinke A, Blome L, Tannapfel A, Kleger A, Berger AW, Kestler AMR, Schuhbaur JS, Perkhofer L, Tempero M, Reinacher-Schick AC, Ettrich TJ. Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer (NEONAX)-a randomized phase II trial of the AIO pancreatic cancer group. Ann Oncol 2023; 34:91-100. [PMID: 36209981 DOI: 10.1016/j.annonc.2022.09.161] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Data on perioperative chemotherapy in resectable pancreatic ductal adenocarcinoma (rPDAC) are limited. NEONAX examined perioperative or adjuvant chemotherapy with gemcitabine plus nab-paclitaxel in rPDAC (National Comprehensive Cancer Network criteria). PATIENTS AND METHODS NEONAX is a prospective, randomized phase II trial with two independent experimental arms. One hundred twenty-seven rPDAC patients in 22 German centers were randomized 1 : 1 to perioperative (two pre-operative and four post-operative cycles, arm A) or adjuvant (six cycles, arm B) gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) on days 1, 8 and 15 of a 28-day cycle. RESULTS The primary endpoint was disease-free survival (DFS) at 18 months in the modified intention-to-treat (ITT) population [R0/R1-resected patients who started neoadjuvant chemotherapy (CTX) (A) or adjuvant CTX (B)]. The pre-defined DFS rate of 55% at 18 months was not reached in both arms [A: 33.3% (95% confidence interval [CI] 18.5% to 48.1%), B: 41.4% (95% CI 20.7% to 62.0%)]. Ninety percent of patients in arm A completed neoadjuvant treatment, and 42% of patients in arm B started adjuvant chemotherapy. R0 resection rate was 88% (arm A) and 67% (arm B), respectively. Median overall survival (mOS) (ITT population) as a secondary endpoint was 25.5 months (95% CI 19.7-29.7 months) in arm A and 16.7 months (95% CI 11.6-22.2 months) in the upfront surgery arm. This difference corresponds to a median DFS (mDFS) (ITT) of 11.5 months (95% CI 8.8-14.5 months) in arm A and 5.9 months (95% CI 3.6-11.5 months) in arm B. Treatment was safe and well tolerable in both arms. CONCLUSIONS The primary endpoint, DFS rate of 55% at 18 months (mITT population), was not reached in either arm of the trial and numerically favored the upfront surgery arm B. mOS (ITT population), a secondary endpoint, numerically favored the neoadjuvant arm A [25.5 months (95% CI 19.7-29.7months); arm B 16.7 months (95% CI 11.6-22.2 months)]. There was a difference in chemotherapy exposure with 90% of patients in arm A completing pre-operative chemotherapy and 58% of patients starting adjuvant chemotherapy in arm B. Neoadjuvant/perioperative treatment is a novel option for patients with resectable PDAC. However, the optimal treatment regimen has yet to be defined. The trial is registered with ClinicalTrials.gov (NCT02047513) and the European Clinical Trials Database (EudraCT 2013-005559-34).
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Affiliation(s)
- T Seufferlein
- Department of Internal Medicine I, Ulm University, Ulm, Germany.
| | - W Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - M Kornmann
- Department of General and Visceral Surgery, Ulm University, Ulm, Germany
| | - H Algül
- CCC Munich-TUM and Department of Internal Medicine II, TUM, Munich, Germany
| | - H Friess
- Department of General and Visceral Surgery, TUM, Munich, Germany
| | - A König
- Department of Gastroenterology, GI-Oncology and Endocrinology, University Medical Center, Göttingen, Germany
| | - M Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - E Gallmeier
- Department of Gastroenterology and Endocrinology, University of Marburg, Marburg, Germany
| | - D K Bartsch
- Department of General and Visceral Surgery, University of Marburg, Marburg, Germany
| | - M P Lutz
- Department of Gastroenterology, Caritasklinik St. Theresia, Saarbrücken, Germany
| | - R Metzger
- Department of General and Visceral Surgery, Caritasklinik St. Theresia, Saarbrücken, Germany
| | - K Wille
- Department of Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, Ruhr-University Bochum, Bochum, Germany
| | - B Gerdes
- Department of General and Visceral Surgery Minden, Ruhr-University Bochum, Minden, Germany
| | - C C Schimanski
- Department of Internal Medicine and Gastroenterology, Darmstadt Hospital, Darmstadt, Germany
| | - F Graupe
- Department of General and Visceral Surgery, Darmstadt Hospital, Darmstadt, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - I Klein
- Department of General, Visceral, Vascular and Pediatric Surgery, Julius Maximilians University, Würzburg, Germany
| | - M Geissler
- Department of Hematology and Oncology, Esslingen Hospital, Esslingen, Germany
| | - L Staib
- Department of Surgery, Esslingen Hospital, Esslingen, Germany
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - C Bruns
- Department of Visceral Surgery, University of Cologne, Cologne, Germany
| | - U Wittel
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - S Fichtner-Feigl
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - S Daum
- Department for Gastroenterology, Rheumatology and Infectology, Charite University Hospital Berlin, Berlin, Germany
| | - A Hinke
- Biostatistics, CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - L Blome
- Biometrics, ClinAssess Gesellschaft für klinische Forschung mbH, Leverkusen, Germany
| | - A Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - A Kleger
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - A W Berger
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - A M R Kestler
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - J S Schuhbaur
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - L Perkhofer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - M Tempero
- UCSF Department of Medicine, University of California San Francisco, San Francisco, USA
| | - A C Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University, Ulm, Germany
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20
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Hirmas N, Hamacher R, Sraieb M, Ingenwerth M, Kessler L, Pabst KM, Barbato F, Lueckerath K, Kasper S, Nader M, Schildhaus HU, Kesch C, von Tresckow B, Hanoun C, Hautzel H, Aigner C, Glas M, Stuschke M, Kuemmel S, Harter P, Lugnier C, Uhl W, Niedergethmann M, Hadaschik B, Gruenwald V, Siveke JT, Herrmann K, Fendler WP. Fibroblast activation protein positron emission tomography and histopathology in a single-center database of 324 patients and 21 tumor entities. J Nucl Med 2022; 64:711-716. [PMID: 36581374 DOI: 10.2967/jnumed.122.264689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/31/2022] Open
Abstract
Rationale: We present an overview of our prospective fibroblast activation protein inhibitors (FAPI) registry study across a 3-year period, with head-to-head comparison of tumor uptake in 68Ga-FAPI and 18F-FDG PET, as well as FAP immunohistochemistry. Methods: This is an interim analysis of the ongoing 68Ga-FAPI PET prospective observational trial at our Department. Patients who underwent clinical imaging with 68Ga-FAPI PET between October 2018 and October 2021 were included. Tracer uptake for tumor lesions was quantified by SUVmax and for normal organs by SUVmean. PET tumor volume (40% isocontour) and tumor-to-background ratios (TBR) were calculated. Correlation between SUVmax and FAP staining in tissue samples was analyzed. Results: 324 patients with 21 different tumor entities underwent 68Ga-FAPI imaging; 237 patients additionally received 18F-FDG PET. The most common tumor entities were sarcoma (131/324, 40%), pancreatic carcinoma (67/324, 21%), and primary tumors of the brain (22/324, 7%). Mean primary tumor SUVmax was significantly higher for 68Ga-FAPI than 18F-FDG among pancreatic cancers (13.2 vs. 6.1, p<0.001) and sarcoma (14.3 vs. 9.4, p<0.001), and the same was true for mean SUVmax in metastatic lesions of pancreatic cancers (9.4 vs. 5.5, p<0.001). Mean primary tumor TBRmax was significantly higher for 68Ga-FAPI than 18F-FDG across several tumor entities, most prominently pancreatic cancers (14.7 vs. 3.0, p<0.001) and sarcoma (17.3 vs. 4.7, p<0.001). Compared to 18F-FDG, 68Ga-FAPI showed superior detection for locoregional disease in sarcoma (52 vs. 48 total regions detected) as well as for distant metastatic disease in both, sarcoma (137 vs. 131) and pancreatic cancer (65 vs. 57), respectively. Among 61 histopathology samples, there was a positive correlation between 68Ga-FAPI SUVmax and overall FAP immunohistochemistry score (r=0.352, P = 0.005). Conclusion: 68Ga-FAPI demonstrates higher absolute uptake in pancreatic cancers and sarcoma, as well as higher tumor-to-background uptake along with improved tumor detection for pancreatic cancers, sarcoma, and other tumor entities when compared to 18F-FDG. 68Ga-FAPI is a new tool for tumor staging with theranostic potential.
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Affiliation(s)
- Nader Hirmas
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Rainer Hamacher
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Marc Ingenwerth
- Institute of Pathology, University Hospital Essen, Essen, Germany, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Katharina Lueckerath
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen; Targos Molecular Pathology Inc., Kassel, Germany, Germany
| | - Claudia Kesch
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell Transplantation, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Christine Hanoun
- Department of Hematology and Stem Cell Transplantation, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany; Charite-Universitaetsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Germany
| | - Celine Lugnier
- Department of Hematology and Oncology with Palliative Care, Ruhr-University Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
| | | | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Viktor Gruenwald
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Jens T Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg,, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
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21
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Heid I, Münch C, Karakaya S, Lueong SS, Winkelkotte AM, Liffers ST, Godfrey L, Cheung PFY, Savvatakis K, Topping GJ, Englert F, Kritzner L, Grashei M, Tannapfel A, Viebahn R, Wolters H, Uhl W, Vangala D, Smeets EMM, Aarntzen EHJG, Rauh D, Weichert W, Hoheisel JD, Hahn SA, Schilling F, Braren R, Trajkovic-Arsic M, Siveke JT. Functional noninvasive detection of glycolytic pancreatic ductal adenocarcinoma. Cancer Metab 2022; 10:24. [PMID: 36494842 PMCID: PMC9737747 DOI: 10.1186/s40170-022-00298-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) lacks effective treatment options beyond chemotherapy. Although molecular subtypes such as classical and QM (quasi-mesenchymal)/basal-like with transcriptome-based distinct signatures have been identified, deduced therapeutic strategies and targets remain elusive. Gene expression data show enrichment of glycolytic genes in the more aggressive and therapy-resistant QM subtype. However, whether the glycolytic transcripts are translated into functional glycolysis that could further be explored for metabolic targeting in QM subtype is still not known. METHODS We used different patient-derived PDAC model systems (conventional and primary patient-derived cells, patient-derived xenografts (PDX), and patient samples) and performed transcriptional and functional metabolic analysis. These included RNAseq and Illumina HT12 bead array, in vitro Seahorse metabolic flux assays and metabolic drug targeting, and in vivo hyperpolarized [1-13C]pyruvate and [1-13C]lactate magnetic resonance spectroscopy (HP-MRS) in PDAC xenografts. RESULTS We found that glycolytic metabolic dependencies are not unambiguously functionally exposed in all QM PDACs. Metabolic analysis demonstrated functional metabolic heterogeneity in patient-derived primary cells and less so in conventional cell lines independent of molecular subtype. Importantly, we observed that the glycolytic product lactate is actively imported into the PDAC cells and used in mitochondrial oxidation in both classical and QM PDAC cells, although more actively in the QM cell lines. By using HP-MRS, we were able to noninvasively identify highly glycolytic PDAC xenografts by detecting the last glycolytic enzymatic step and prominent intra-tumoral [1-13C]pyruvate and [1-13C]lactate interconversion in vivo. CONCLUSION Our study adds functional metabolic phenotyping to transcriptome-based analysis and proposes a functional approach to identify highly glycolytic PDACs as candidates for antimetabolic therapeutic avenues.
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Affiliation(s)
- Irina Heid
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Münch
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Sinan Karakaya
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Smiths S. Lueong
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Alina M. Winkelkotte
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Sven T. Liffers
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Laura Godfrey
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Phyllis F. Y. Cheung
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Konstantinos Savvatakis
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Geoffrey J. Topping
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Englert
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Kritzner
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Grashei
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea Tannapfel
- grid.5570.70000 0004 0490 981XInstitute of Pathology, Ruhr University of Bochum, Bochum, Germany
| | - Richard Viebahn
- grid.5570.70000 0004 0490 981XDepartment of Surgery, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Heiner Wolters
- grid.416438.cDepartment of Visceral and General Surgery, St. Josef-Hospital, Dortmund, Germany
| | - Waldemar Uhl
- grid.416438.cClinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Deepak Vangala
- grid.5570.70000 0004 0490 981XDepartment of Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Esther M. M. Smeets
- grid.10417.330000 0004 0444 9382Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H. J. G. Aarntzen
- grid.10417.330000 0004 0444 9382Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Rauh
- grid.5675.10000 0001 0416 9637Faculty of Chemistry and Chemical Biology, TU Dortmund University, Dortmund, Germany ,Drug Discovery Hub Dortmund (DDHD) Am Zentrum Für Integrierte Wirkstoffforschung (ZIW), Dortmund, Germany
| | - Wilko Weichert
- grid.6936.a0000000123222966Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany ,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Jörg D. Hoheisel
- grid.7497.d0000 0004 0492 0584Division of Functional Genome Analysis, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Stephan A. Hahn
- grid.5570.70000 0004 0490 981XDepartment of Molecular GI Oncology, Faculty of Medicine, Ruhr University Bochum, 44780 Bochum, Germany
| | - Franz Schilling
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Marija Trajkovic-Arsic
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Jens T. Siveke
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
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22
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Mahajan UM, Oehrle B, Sirtl S, Alnatsha A, Goni E, Regel I, Beyer G, Vornhülz M, Vielhauer J, Chromik A, Bahra M, Klein F, Uhl W, Fahlbusch T, Distler M, Weitz J, Grützmann R, Pilarsky C, Weiss FU, Adam MG, Neoptolemos JP, Kalthoff H, Rad R, Christiansen N, Bethan B, Kamlage B, Lerch MM, Mayerle J. Independent Validation and Assay Standardization of Improved Metabolic Biomarker Signature to Differentiate Pancreatic Ductal Adenocarcinoma From Chronic Pancreatitis. Gastroenterology 2022; 163:1407-1422. [PMID: 35870514 DOI: 10.1053/j.gastro.2022.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Pancreatic ductal adenocarcinoma cancer (PDAC) is a highly lethal malignancy requiring efficient detection when the primary tumor is still resectable. We previously developed the MxPancreasScore comprising 9 analytes and serum carbohydrate antigen 19-9 (CA19-9), achieving an accuracy of 90.6%. The necessity for 5 different analytical platforms and multiple analytical runs, however, hindered clinical applicability. We therefore aimed to develop a simpler single-analytical run, single-platform diagnostic signature. METHODS We evaluated 941 patients (PDAC, 356; chronic pancreatitis [CP], 304; nonpancreatic disease, 281) in 3 multicenter independent tests, and identification (ID) and validation cohort 1 (VD1) and 2 (VD2) were evaluated. Targeted quantitative plasma metabolite analysis was performed on a liquid chromatography-tandem mass spectrometry platform. A machine learning-aided algorithm identified an improved (i-Metabolic) and minimalistic metabolic (m-Metabolic) signatures, and compared them for performance. RESULTS The i-Metabolic Signature, (12 analytes plus CA19-9) distinguished PDAC from CP with area under the curve (95% confidence interval) of 97.2% (97.1%-97.3%), 93.5% (93.4%-93.7%), and 92.2% (92.1%-92.3%) in the ID, VD1, and VD2 cohorts, respectively. In the VD2 cohort, the m-Metabolic signature (4 analytes plus CA19-9) discriminated PDAC from CP with a sensitivity of 77.3% and specificity of 89.6%, with an overall accuracy of 82.4%. For the subset of 45 patients with PDAC with resectable stages IA-IIB tumors, the sensitivity, specificity, and accuracy were 73.2%, 89.6%, and 82.7%, respectively; for those with detectable CA19-9 >2 U/mL, 81.6%, 88.7%, and 84.5%, respectively; and for those with CA19-9 <37 U/mL, 39.7%, 94.1%, and 76.3%, respectively. CONCLUSIONS The single-platform, single-run, m-Metabolic signature of just 4 metabolites used in combination with serum CA19-9 levels is an innovative accurate diagnostic tool for PDAC at the time of clinical presentation, warranting further large-scale evaluation.
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Bettina Oehrle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Simon Sirtl
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ahmed Alnatsha
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Marlies Vornhülz
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Jakob Vielhauer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ansgar Chromik
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany
| | - Markus Bahra
- Zentrum für Onkologische Oberbauchchirurgie und Robotik, Krankenhaus Waldfriede, Berlin, Germany
| | - Fritz Klein
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Marius Distler
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - M Gordian Adam
- Metanomics Health GmbH, Berlin, Germany; biocrates life sciences ag, Innsbruck, Austria
| | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Holger Kalthoff
- Section for Molecular Oncology, Institut for Experimental Cancer Research (IET), Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Roland Rad
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine and Center for Translational Cancer Research (TranslaTUM), Technische Universität München, Munich, Germany
| | - Nicole Christiansen
- Metanomics Health GmbH, Berlin, Germany; TrinamiX GmbH, Ludwigshafen am Rhein, Rheinland-Pfalz, Germany
| | | | | | - Markus M Lerch
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Ludwig Maximilian University Klinikum, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany.
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23
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Seufferlein T, Mayerle J, Böck S, Brunner T, Ettrich TJ, Grenacher L, Gress TM, Hackert T, Heinemann V, Kestler A, Sinn M, Tannapfel A, Wedding U, Uhl W. S3-Leitlinie zum exokrinen Pankreaskarzinom – Langversion 2.0 – Dezember 2021 – AWMF-Registernummer: 032/010OL. Z Gastroenterol 2022; 60:e812-e909. [PMID: 36368658 DOI: 10.1055/a-1856-7346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Stefan Böck
- Medizinische Klinik und Poliklinik III, Universitätsklinikum München, Germany
| | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Austria
| | | | | | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Germany
| | - Thilo Hackert
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie Universitätsklinikum, Heidelberg, Germany
| | - Volker Heinemann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Campus Grosshadern, München, Germany
| | | | - Marianne Sinn
- Universitätsklinikum Hamburg-Eppendorf Medizinische Klinik und Poliklinik II Onkologie Hämatologie, Hamburg, Germany
| | | | | | - Waldemar Uhl
- Allgemein- und Viszeralchirurgie, St Josef-Hospital, Bochum, Germany
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24
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Brunner M, Belyaev O, Bösch F, Keck T, Witzigmann H, Grützmann R, Uhl W, Werner J. [Indications for the surgical management of pancreatic neoplasms]. Z Gastroenterol 2022; 60:1517-1527. [PMID: 34820808 DOI: 10.1055/a-1682-7456] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Due to its rising incidence, pancreatic neoplasia, which mainly include adenocarcinomas, neuroendocrine and cystic neoplasia of the pancreas, is becoming increasingly relevant in everyday clinical practice.Based on a systematic literature search, a working group of pancreatic experts developed evidence-based recommendations for surgical indications in pancreatic neoplasia to improve the quality.There is a clear surgical indication for primary or secondary resectable pancreatic carcinomas without metastasis, for functionally active, symptomatic and functionally inactive neuroendocrine neoplasia of more than 2 cm in size and for cystic neoplasm with symptoms or signs of malignancy including all intraductal papillary-mucinous neoplasia (IPMN) of the main duct and mixed type, all mucinous-cystic neoplasia (MCN) > 4 cm and all solid pseudopapillary neoplasia (SPN). Surgery can be indicated for pancreatic carcinomas with isolated arterial vascular infiltration or for long periods of stable oligometastasis, regarding neuroendocrine neoplasias for metastasis or debulking surgery as well as for branch-duct IPMN with risk criteria and MCN <4 cm. There is no primary indication for surgery in locally advanced and metastatic pancreatic cancer or asymptomatic serous-cystic neoplasia (SCN).The indication for surgery should always be individualized taking into account age, comorbidities and patient wishes.
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Affiliation(s)
- Maximilian Brunner
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Orlin Belyaev
- Klinik für Allgemein- und Viszeralchirurgie, St.-Josef-Hospital, Klinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Florian Bösch
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Tobias Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lubeck, Germany
| | - Helmut Witzigmann
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden, Dresden, Germany
| | - Robert Grützmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St.-Josef-Hospital, Klinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Jens Werner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum der Ludwig-Maximilians-Universität München, München, Germany
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25
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Mintziras I, Stollenwerk L, Uhl W, Niescery J, Belyaev O, Luu AM, Munding J, Tannapfel A, Künzli B, Herzog T. Pancreatic Apoplexy: Fulminant Necrotizing Pancreatitis Leading to Completion Pancreatectomy Within 3 Days After Partial Pancreaticoduodenectomy. Pancreas 2022; 51:1128-1132. [PMID: 37078935 DOI: 10.1097/mpa.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Patient characteristics with postoperative acute necrotizing pancreatitis and completion pancreatectomy (CP) after pancreaticoduodenectomy (PD) remain unclear. METHODS Data from all patients who underwent a PD with need for CP (January 2011-December 2019) at a German University Hospital were analyzed regarding the indications and timing of CP, laboratory and histopathological findings, and overall outcome. RESULTS Six hundred twelve patients underwent PD, 33 (5.4%) of them needed a CP. Indications were grade C pancreatic fistula with or without biliary leak (46% and 12%), biliary leak (6%), and hemorrhage due to pancreatic fistula (36%). Eight patients (24%) underwent CP within 3 days after PD. These fulminant courses ("pancreatic apoplexy") were accompanied by significantly higher levels of lactate dehydrogenase, C-reactive protein, serum amylase, serum lipase, drain amylase, and drain lipase compared with patients with CP after the third day. Pancreatic apoplexy was histologically associated with higher rates of pancreatic necrosis (P = 0.044) and hemorrhage (P = 0.001). A trend toward higher mortality was observed (75% vs 36%, P = 0.058). CONCLUSIONS Pancreatic apoplexy, defined as fulminant necrotizing pancreatitis after PD leading to CP within 3 days, is associated with characteristic laboratory and histopathological findings and a trend to higher mortality.
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Affiliation(s)
| | | | - Waldemar Uhl
- From the Departments of General and Visceral Surgery
| | | | - Orlin Belyaev
- From the Departments of General and Visceral Surgery
| | | | - Johanna Munding
- Institute of Pathology, Ruhr University Bochum, Bochum, Germany
| | | | - Beat Künzli
- Department of Visceral Surgery, Kantonsspital Graubünden, Chur, Switzerland
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26
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Kersting S, Janot-Matuschek MS, Schnitzler C, Chourio Barboza DE, Uhl W, Mittelkötter U. GIST: Correlation of risk classifications and outcome. J Med Life 2022; 15:932-943. [PMID: 36188659 PMCID: PMC9514809 DOI: 10.25122/jml-2021-0110] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
In clinical practice, there are often discrepancies between the oncological prognosis of gastrointestinal stromal tumors (GIST) and the actual clinical course. This study aimed to check with our collective how reliably the current classifications (Miettinen, Fletcher) predict the prognosis of GIST and to evaluate whether an extension of the classifications by the parameter proliferation activity could make sense. This prospective study enrolled 58 patients who underwent surgery on GIST from 01/2006 to 12/2016. The postoperative course (curation, recurrence, progress) was correlated with the identified risk classification and the proliferative activity. Coincidences with other tumors were strikingly common in patients with GIST (43%). Based on the risk group assignment of GIST, no assessment of the probability of the occurrence of second neoplasia could be derived. Individual patients were under- or over-graduated concerning the assessment of biological behavior based on the standard risk classifications. The inclusion of proliferative activity did not allow for a more precise predictive power - neither to the risk of recurrence and metastasis nor to the development of a second neoplasia. The study showed that there is currently no parameter or logarithm that reliably predicts the biological behavior of GIST. Due to the frequency of coincidence of second neoplasia and (rare) distant metastases, for everyday clinical practice, appropriate staging diagnostic and regular follow-up care should also be used for benign GIST.
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Affiliation(s)
- Sabine Kersting
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany,Corresponding Author: Sabine Kersting, Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany. E-mail:
| | | | - Carina Schnitzler
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany
| | | | - Waldemar Uhl
- Department of General Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Ulrich Mittelkötter
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany
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Gisder DM, Overheu O, Keller J, Nöpel-Dünnebacke S, Uhl W, Reinacher-Schick A, Tannapfel A, Tischoff I. DAXX, ATRX, and MSI in PanNET and Their Metastases: Correlation with Histopathological Data and Prognosis. Pathobiology 2022; 90:71-80. [PMID: 35691289 DOI: 10.1159/000524920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Studies on pancreatic neuroendocrine tumors (PanNETs) regarding loss of ATRX, DAXX, or frequency of microsatellite instability (MSI) show inconclusive results. So far, data on corresponding metastaseshave not been published. METHODS We performed immunohistochemistry (IHC) of ATRX, DAXX, MSH2, MSH6, MLH1, and PMS2 on 74 PanNETs and 19 metastases. ATRX- and DAXX-negative PanNETs were further sequenced for mutations. We used polymerase chain reaction for MSI on cases with IHC loss of MSH2, MSH6, MLH1, and PMS2. RESULTS Immunohistochemical loss of DAXX and ATRX was observed in 8/74 (11%) and 6/74 (8%) PanNETs. Loss of DAXX immunoreactivity was statistically associated with higher tumor grade and showed a tendency toward a decreased overall survival. Sequencing of DAXX- (7/11 [64%]) and ATRX-negative (5/11 [45%]) PanNETs revealed a mutation in 6/7 (86%) and 2/5 (40%). The specificity of immunohistochemical loss of DAXX and ATRX for mutation was 80% and 67%, respectively. The expression status of DAXX compared to primary tumor differs in 2/12 (17%) lymph node metastases. We further identified 3/74 (4%) tumors as MSI, associated with a poor prognosis. DISCUSSION/CONCLUSION Our study supports the hypothesis that a loss of DAXX immunoreactivity can identify a more aggressive subtype of PanNET with high confidence, while ATRX loss is a weaker indicator. Our results also strengthen the role of DAXX immunolabeling as a prognostic marker. We could show that ATRX might be less suitable as a surrogate for sequencing. Our results indicate that IHC of DAXX and ATRX may identify PanNET subtypes as targets for more aggressive therapy.
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Affiliation(s)
| | - Oliver Overheu
- Department of Haematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Julia Keller
- Institute of Pathology, Ruhr Universität Bochum, Bochum, Germany
| | - Stefanie Nöpel-Dünnebacke
- Department of Haematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Katholisches Klinikum Bochum gGmbH, Institute of General and Visceral Surgery, St. Josef-Hospital, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Haematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr Universität Bochum, Bochum, Germany
| | - Iris Tischoff
- Institute of Pathology, Ruhr Universität Bochum, Bochum, Germany
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Ettrich TJ, Uhl W, Kornmann M, Algül H, Friess H, Koenig A, Gallmeier E, Lutz MP, Wille K, Schimanski CC, Kunzmann V, Geissler M, Waldschmidt D, Daum S, Blome L, Tannapfel A, Perkhofer L, Tempero MA, Reinacher-Schick AC, Seufferlein T. Perioperative or adjuvant nab-paclitaxel plus gemcitabine for resectable pancreatic cancer: Updated final results of the randomized phase II AIO-NEONAX trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4133] [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: 11/20/2022] Open
Abstract
4133 Background: Perioperative chemotherapy (CTX) in resectable pancreatic ductal adenocarcinoma (PDAC) is still not considered standard of care and data are limited. The NEONAX trial examined gemcitabine (Gem) plus nab-paclitaxel (nab-P), in the perioperative or adjuvant therapy of resectable PDAC (NCCN criteria). Methods: NEONAX is a prospective, randomized phase II trial with two independent experimental arms. 127 resectable PDAC patients in 22 German centers were randomized 1:1 to perioperative (2 pre- and 4 postoperative cycles, arm A) or adjuvant (6 cycles, arm B) of Gem (1000mg/m2) and nab-P (125mg/m2) on days 1,8,15 of a 28-day cycle. Results: We previously reported the primary endpoint disease free survival (DFS) at 18 mo. in the modified intention-to-treat (ITT)-population (defined as R0/R1 resected pts. that either started neoadjuvant (A) or adjuvant (B) CTX. The pre-defined DFS rate of 55% at 18 mo. was not reached in both arms (A: 32.2%, B: 41.4%). Here we present the final results of the secondary endpoints median overall survival (mOS), pN0-resection rate, perioperative morbidity/mortality and safety in the ITT-population. Most common grade ≥3 treatment emergent adverse events in the safety population were neutropenia (arm A 21.1%, arm B 12.3%), fatigue (arm A 8.8%, arm B 5.3%) and anemia (arm A 10.5%, arm B 1.8%). The most frequent post-/perioperative complications of all grades in pts. undergoing resection were infections (arm A: 24.4%, arm B: 8.8%), pancreatic fistulas (arm A: 14.6%; arm B: 13.3%) and bleedings (arm A: 9.7%; arm B: 6.7%). Perioperative mortality was 2.4% in the neoadjuvant and 6.7% in the upfront surgery setting. The median number of resected lymph nodes was comparable in both arms (A: n = 21, B: n = 26). The pN0-resection rate was 33.3% in the neoadjuvant/perioperative arm A and 29.5% in the upfront surgery arm B. R0 resection rates were 87.8% in arm A and 67.4% in arm B, respectively. Median OS as a key secondary endpoint in the ITT population was 25.2 mo. in arm A and 16.7 mo. for upfront surgery, a difference of 8.5 mo. This difference corresponds to a mDFS of 11.5 mo. in arm A and 5.9 mo. in arm B. 91.5% of pts. in arm A started and 84.7% completed neoadjuvant CTX but only 42.4% of pts. in arm B started adjuvant CTX. Conclusions: Perioperative treatment with Gem/nab-P was well tolerated and showed an encouraging mOS of 25.2 mo., this is well in the range of the data in SWOG 1505 (23.6 mo.) or PREOPANC (15.7 mo.). The corresponding mOS in the upfront surgery arm was 16.7 mo. The 8.5 mo. difference may be explained by the fact that many pts. in arm B did not receive adjuvant treatment whereas the vast majority of pts. in arm A completed at least preoperative CTX. Neoadjuvant/perioperative treatment is a promising novel option for pts. with resectable PDAC. The optimal treatment regimen is subject of current clinical trials. Clinical trial information: NCT02047513.
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Affiliation(s)
| | - Waldemar Uhl
- Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | | | - Hana Algül
- Technische Universität München, Comprehensive Cancer Center Munich-TUM and Department of Internal Medicine II, Munich, Germany
| | - Helmut Friess
- Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany
| | - Alexander Koenig
- University Medical Center Goettingen, Department of Gastroenterology, Gastrointestinal Oncology, and Endocrinology, Goettingen, Germany
| | - Eike Gallmeier
- Department of Gastroenterology and Endocrinology, Uniklinikum Giessen und Marburg, Marburg, Germany
| | | | - Kai Wille
- University Hospital Ruhr-University-Bochum, Minden, Germany
| | - Carl Christoph Schimanski
- Klinikum Darmstadt GmbH and Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Darmstadt and Mainz, Germany
| | - Volker Kunzmann
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Michael Geissler
- Klinikum Esslingen, Department of Hematology/Oncology, Esslingen, Germany
| | - Dirk Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - Severin Daum
- Charité-University Medicine Berlin, Berlin, Germany
| | - Lisa Blome
- Biometrics, ClinAssess Gesellschaft für klinische Forschung mbH, Leverkusen, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Lukas Perkhofer
- Ulm University, Department of Internal Medicine I, Ulm, Germany
| | - Margaret A. Tempero
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Anke C. Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Seufferlein T, Mayerle J, Böck S, Brunner T, Ettrich TJ, Grenacher L, Gress TM, Hackert T, Heinemann V, Kestler A, Sinn M, Tannapfel A, Wedding U, Uhl W. S3-Leitlinie zum exokrinen Pankreaskarzinom – Kurzversion 2.0 – Dezember 2021, AWMF-Registernummer: 032/010OL. Z Gastroenterol 2022; 60:991-1037. [PMID: 35671996 DOI: 10.1055/a-1771-6811] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Stefan Böck
- Medizinische Klinik und Poliklinik III, Universitätsklinikum München, Germany
| | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Austria
| | | | | | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Germany
| | - Thilo Hackert
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie Universitätsklinikum, Heidelberg, Germany
| | - Volker Heinemann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Campus Grosshadern, München, Germany
| | | | - Marianne Sinn
- Universitätsklinikum Hamburg-Eppendorf Medizinische Klinik und Poliklinik II Onkologie Hämatologie, Hamburg, Germany
| | | | | | - Waldemar Uhl
- Allgemein- und Viszeralchirurgie, St Josef-Hospital, Bochum, Germany
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Lugnier C, Foerster S, Kraeft AL, Feder IS, Christmann J, Kourti E, Overheu O, Sommerlatte S, Uhl W, Schoenlein M, Rosery V, Biermann C, Müller L, Schoffer O, Schmitt J, Modest DP, Heinemann V, Schildmann J, Reinacher-Schick AC, Tannapfel A. Impact of the COVID-19 pandemic on colorectal cancer (CRC) care: Data from 22 German cancer centers (CC) and the Institute of Pathology, Ruhr-University Bochum - the AIO (Working Group for Internal Oncology of the German Cancer Society) CancerCOVID Consortium - AIO-YMO/KRK 520/ass. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3626] [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: 11/20/2022] Open
Abstract
3626 Background: CRC still is one of the leading causes of cancer related death though prognosis has improved through guideline based management. The COVID-19 pandemic lead to re-allocation of resources subordinating all sections of care for CRC patients. We present data on changes of CRC care during the pandemic from 22 German AIO CC and our high volume Institute of Pathology (pathology). Methods: Data was collected retrospectively comparing the months (mo) of the first wave (fw) (4-6/2020) and second wave (sw) (11-12/2020) of the pandemic with corresponding periods (cp) in 2019 focusing on the number of precancerous (ICD-O/0+2) and malignant (ICD-O/3+6) colorectal lesions (CRL) diagnosed by our pathology, the number/stage of primary diagnoses (PD) and the number of surgeries (surg) at AIO CC. There, quality criteria of CRC care were also assessed (number of PD discussed within a multidisciplinary tumor board (tb), received social service (soc)/ psychological (psy) counseling or recruited into a clinical trial). Statistical analysis was performed using students t-test for paired data. Results: Numbers of CRL detected upon histology (row 1-3), number of cases, surg and quality criteria from AIO CC (row 4-9) are displayed in the table. We saw a dip in diagnosed CRL and number of surg (p=0.007) only during fw, whereas PD dipped significantly in both waves. A significant reduction in diagnosis of stage III CRC was detected for 2019 vs. 2020 (p=0.001), not for other stages. Quality criteria showed a significant reduction in clinical trial inclusion, a small dip in soc/psy counseling and persistently high tb presentation. Conclusions: We detected a significant decrease of premalignant lesions and primary cancers during the first year of the pandemic which may impact cancer mortality in the future. Certified German CC provided CRC care with significant reduction in clinical trial inclusion only, suggesting high stability of established certified cancer care infrastructure.[Table: see text]
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Affiliation(s)
- Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sarah Foerster
- Institute of Pathology, Georgius Agricola Stiftung Ruhr, Ruhr-University Bochum, Bochum, Germany, Bochum, Germany
| | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Inke Sabine Feder
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Jens Christmann
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Eleni Kourti
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Oliver Overheu
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University, Bochum, Germany
| | | | - Waldemar Uhl
- Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Martin Schoenlein
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Hamburg, Germany
| | - Vivian Rosery
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Lothar Müller
- Studienzentrum UnterEms und Onkologie UnterEms, Leer, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TechnicalUniversity Dresden, Dresden Germany, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Dominik Paul Modest
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Volker Heinemann
- University Hospital, LMU Munich, Department of Medicine III, and Comprehensive Cancer Center Munich, Munich, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Anke C. Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
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Fietkau R, Ghadimi M, Grützmann R, Wittel UA, Jacobasch L, Uhl W, Croner RS, Bechstein WO, Neumann UP, Waldschmidt D, Boeck SH, Moosmann N, Reinacher-Schick AC, Golcher H, Adler W, Semrau S, Kallies A, Hecht M, Tannapfel A, Oettle H. Randomized phase III trial of induction chemotherapy followed by chemoradiotherapy or chemotherapy alone for nonresectable locally advanced pancreatic cancer: First results of the CONKO-007 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4008 Background: Chemotherapy (CT) is the standard of care in nonresectable locally advanced pancreatic cancer. The CONKO-007 trial studied the role of sequential CT and chemoradiotherapy (CRT). Methods: In this randomized multicenter phase III trial resectability was judged by an independent surgical board. Patients (pts) received induction chemotherapy (IC) for 3 months (3 cycles gemcitabine (Gem, 1000 mg/m² d1, 8, 15, q4w) or FOLFIRINOX (6 cycles, q2w)). After IC pts without progression were randomized to either continuing CT for another 3 months or receiving CRT (cumulative dose of 50.4Gy, single dose 1.8Gy + Gem 300 mg/m² weekly, followed by 1 cycle of Gem 1000 mg/m² at d1, 8, 15). The primary endpoint of the study was overall survival (OS) since the begin of IC. Determination of sample size calculated 590 pts to be randomized. Due to the exclusion of pts with progressive disease after IC a total of 830 pts should be enrolled. Due to delayed patient accrual the primary endpoint was changed to R0 resection rate resulting in an estimated sample size of 525 pts. Results: Between 04/2013 and 02/2021 a total of 525 pts were enrolled in 47 sites. 402 pts received IC with FOLFIRINOX and 93 pts with Gem. After IC 190 pts were excluded due to progression or toxicity, 335 were randomized, their median FU was 16 months. Hematological toxicities were significantly increased in the CRT arm, non-hematological toxicities were comparable. R0 CRM- resection rate and pCR rate was significantly higher in the CRT arm. R1-resections occurred significantly more often in the CT arm. Median progression-free survival (PFS) (HR 0.919, 95% CI 0.702-1.203, p=0.540) and OS (HR 0.964, 95% CI 0.760-1.225, p=0.766) did not differ significantly in both arms, whereas the PFS rate tended to be higher in the CRT arm after 2 years. OS rates for CRM- R0 surgery with 87.5. ± 0.05% (1y) and 67.2 ± 0.05% (2y) were significantly higher (p<0.01) than for CRM+ R0 surgery with 66.7 ± 0.15% (1y) and 41.2 ± 0.1% (2y) as well as for patients without or incomplete surgery with 68.5 ± 0.03% (1y) and 26.4 ± 0.03% (2y). Conclusions: The addition of radiotherapy after IC improves the R0 CRM - resection and pCR rate without significant change in R0 resection rate (primary endpoint). Pts with R0 CRM - resections had a better prognosis compared to patients with either R0 CRM+ or incomplete or without surgery. However, this effect on resectability did not translate into a statistically significant PFS or OS benefit in the whole cohort. Clinical trial information: NCT01827553. [Table: see text]
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Affiliation(s)
- Rainer Fietkau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Robert Grützmann
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe A Wittel
- General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany
| | | | - Waldemar Uhl
- Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Roland S. Croner
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Dirk Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - Stefan Hubert Boeck
- Universitätsklinikum der LMU, Medizinische Klinik und Poliklinik III and Comprehensive Cancer Center Munich, München, Germany
| | - Nicolas Moosmann
- Krankenhaus Barmherzige Brüder, Dept. Hematology and Oncology, Regensburg, Germany
| | - Anke C. Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Henriette Golcher
- Universitätsklinikum Erlangen, Department of Surgery, Erlangen, Germany
| | - Werner Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Annett Kallies
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Helmut Oettle
- Onkologische und Hamatologische Schwerpunktpraxis, Friedrichshafen, Germany
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Buchholz M, Strotmann J, Majchrzak-Stiller B, Hahn S, Peters I, Horn J, Müller T, Höhn P, Uhl W, Braumann C. New Therapy Options for Neuroendocrine Carcinoma of the Pancreas—The Emergent Substance GP-2250 and Gemcitabine Prove to Be Highly Effective without the Development of Secondary Resistances In Vitro and In Vivo. Cancers (Basel) 2022; 14:cancers14112685. [PMID: 35681665 PMCID: PMC9179328 DOI: 10.3390/cancers14112685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Neuroendocrine carcinoma of the pancreas is a highly aggressive form of neuroendocrine tumor associated with poor survival and increasing occurrence. GP-2250 is an emergent substance showing antineoplastic properties, especially in combination with Gemcitabine. This study was the first to evaluate the antineoplastic effects of GP-2250 on pancreatic neuroendocrine carcinoma. The combination of GP-2250 and Gemcitabine showed highly synergistic effects in a cell culture model, as well as in mice, without the development of secondary resistances. These findings form the basis for further clinical evaluation of a highly promising combination therapy. Abstract Neuroendocrine carcinoma of the pancreas (pNEC) is an aggressive form of neuroendocrine tumor characterized by a rising incidence without an increase in survival rates. GP-2250 is an oxathiazinane derivate possessing antineoplastic effects, especially in combination with Gemcitabine on the pancreatic adenocarcinoma. The cytotoxic effects of the monotherapy of GP-2250 (GP-2250mono) and Gemcitabine (Gemmono), as well as the combination therapy of both, were studied in vitro using an MTT-assay on the QGP-1 and BON-1 cell lines, along with in vivo studies on a murine xenograft model of QGP-1 and a patient-derived xenograft model (PDX) of Bo99. In vitro, Gemmono and GP-2250mono showed a dose-dependent cytotoxicity. The combination of GP-2250 and Gemcitabine exhibited highly synergistic effects. In vivo, the combination therapy obtained a partial response in QGP-1, while GP-2250mono and Gemmono showed progressive disease or stable disease, respectively. In Bo99 PDX, the combination therapy led to a partial response, while the monotherapy resulted in progressive disease. No development of secondary resistances was observed, as opposed to monotherapy. This study was the first to evaluate the effects of the emerging substance GP-2250 on pNEC. The substance showed synergism in combination with Gemcitabine. The combination therapy proved to be effective in vitro and in vivo, without the development of secondary resistances.
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Affiliation(s)
- Marie Buchholz
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
- Correspondence: ; Tel.: +49-234-509-6236
| | - Johanna Strotmann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Stephan Hahn
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, 44780 Bochum, Germany;
| | - Ilka Peters
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Julian Horn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | | | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 45879 Gelsenkirchen, Germany
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Schmidt T, Belyaev O, Uhl W, Bruns CJ. [Surgical treatment of pancreatic cancer-What is new?]. Chirurg 2022; 93:446-452. [PMID: 35357553 DOI: 10.1007/s00104-022-01618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/03/2022]
Abstract
The incidence of pancreatic ductal adenocarcinoma is continuously increasing and will become the second leading cause of cancer-related death in Europe and the USA by 2030. With a 5-year overall survival rate of less than 10% the prognosis remains poor. So far surgical tumor resection remains the only curative treatment option, which is now partially supported by multimodal neoadjuvant and adjuvant therapy concepts. Due to the aggressive tumor biology patients with advanced pancreatic cancer in particular can profit from these multimodal therapy concepts. Additionally, in recent years surgical treatment was optimized, the criteria for tumor resectablity were defined and minimally invasive surgery was widely introduced. This review article summarizes the newest developments and the new German S3 guidelines concerning surgery of pancreatic cancer.
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Affiliation(s)
- Thomas Schmidt
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Orlin Belyaev
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Christiane J Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Grenacher L, Juchems M, Schreyer AG, Wessling J, Ringe KI, Uhl W, Mayerle J, Seufferlein T. [Diagnostic Imaging of pancreatic carcinoma-Update of the new guideline]. Chirurg 2022; 93:429-440. [PMID: 35307787 DOI: 10.1007/s00104-022-01617-8] [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] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
The new German S3 guidelines on ductal pancreatic adenocarcinoma were published for the first time on the homepage of the Association of the Scientific Medical Societies in Germany (AWMF) in December 2021 as a new update and thus the second update (first update 2013) and contain a large number of innovations in terms of diagnostics and treatment. The guidelines were organized and led by the German Society for Digestive and Metabolic Diseases (DGVS). In this article we would like to present the central content and innovations related to the radiological diagnostics of ductal pancreatic adenocarcinoma. The most important innovations are the highest recommendation strength in favor of computed tomography (CT) when assessing tumor spread as well as the adaptation of the European guidelines for cystic tumors by magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) as the method of first choice. A further innovation is the implementation of a structured reporting of CT findings for describing the anatomical tumor resectability on the basis of the publication presented by the Abdominal Imaging Working Group and the Oncological Imaging Working Group of the German Radiological Society. There is no evidence for the implementation of radiological imaging in the field of aftercare or in the field of screening.
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Affiliation(s)
- L Grenacher
- Conradia Radiologie München, Augustenstr. 115, 80798, München, Deutschland.
| | - M Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Konstanz, Deutschland
| | - A G Schreyer
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Deutschland
| | - J Wessling
- Zentrum für Radiologie und Neuroradiologie, Clemenshospital, Raphaelsklinik, EVK Münster, Münster, Deutschland
| | - K I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - W Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Joseph-Hospital Bochum, Klinik der Ruhr Universität, Bochum, Deutschland
| | - J Mayerle
- Medizinische Klinik II, Klinikum Großhadern, Universitätsklinikum München, München, Deutschland
| | - T Seufferlein
- Klinik für Innere Medizin I, Zentrum für Innere Medizin, Universitätsklinikum Ulm, Ulm, Deutschland
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Pyras C, Lukas C, Janot-Matuschek M, Herzog T, Tannapfel A, Uhl W, Belyaev O. Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature. Hepatobiliary Surg Nutr 2022; 11:25-37. [PMID: 35284530 PMCID: PMC8847862 DOI: 10.21037/hbsn-20-352] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/07/2020] [Indexed: 11/06/2022]
Abstract
Background Aberrant right hepatic arteries (aRHA) are frequently encountered during pancreaticoduodenectomy (PD). Their effects on surgical morbidity and resection margin are still debated. This study aimed to compare the short term and long term outcomes in patients with and without aRHA. Methods A single-center retrospective analysis of 353 consecutive PD during a 5-year period was done. The type of arterial supply was determined preoperatively by CT and confirmed at surgery. Hiatt types III-VI included some type of aRHA and comprised the study group. Hiatt types I and II were considered irrelevant for PD and used as controls. Primary endpoints were the rates of major postoperative complications and the rate of R0-resection in cases of malignant disease. Secondary endpoints included duration of surgery, postoperative stay, number of harvested lymph nodes and survival in patients with pancreatic cancer. Own results were compared to existent data using a systematic review of the literature. Results No aRHA had to be sacrificed or reconstructed. Surgical morbidity and specific complications such as post-pancreatectomy hemorrhage (PPH), pancreatic fistula and bile leak were the same in patients with and without aRHA. There was no significant difference in operative time, blood loss, length of ICU- and hospital stay. Patients with malignancy had similar high rates of R0-resection and identical number of harvested lymph nodes. Survival of patients with pancreatic cancer was not affected by aRHA. Conclusions aRHA may be preserved in virtually all cases of PD for resectable pancreatic head lesions without increasing surgical morbidity and without compromising oncological radicality in patients with cancer, provided the variant anatomy is being recognised on preoperative CT and a meticulous surgical technique is used.
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Affiliation(s)
- Cedrik Pyras
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Radiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Torsten Herzog
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Fahlbusch T, Luu AM, Höhn P, Klinger C, Werner J, Keck T, Friess H, Köninger J, Kraus T, Alsfasser G, Padberg W, Ritz JP, Uhl W, Belyaev O. Impact of pylorus preservation on delayed gastric emptying after pancreaticoduodenectomy-analysis of 5,000 patients based on the German StuDoQ|Pancreas-Registry. Gland Surg 2022; 11:67-76. [PMID: 35242670 PMCID: PMC8825530 DOI: 10.21037/gs-21-645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 08/11/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after pancreatic head resection. It leads to increased length of hospital stay, high costs for healthcare systems and reduced quality of life. The primary aim of the study was to assess the impact of pylorus preservation, respectively resection on the occurrence of DGE in patients undergoing pancreaticoduodenectomy (PD). METHODS All cases of pylorus-resecting PD (PRPD) and pylorus-preserving PD (PPPD) entered in the StuDoQ|Pancreas nationwide registry of the German Society of General and Visceral Surgery from 01/01/2014 until 31/12/2018 including demographics, surgical techniques, histopathological and perioperative data were retrospectively analyzed. This study was approved by the ethics committee of the Ruhr-University Bochum, Germany. RESULTS Data of 5,080 patients were enrolled. PPPD was the method of choice (70.4%). Pylorus preservation had no impact on the occurrence of DGE (20.3% vs. 21.5%, P=0.33), but further risk factors could be identified. The comparison of PPPD and PRPD groups showed statistically significant differences in the surgical approach (primary open approach, 94.8% vs. 98.0%, P<0.001), duration of surgery (326.4 vs. 352.1 minutes, P<0.001), technique of pancreatic anastomosis (pancreaticojejunostomy vs. pancreaticojejunostomy), 78.6% vs. 85.2%, P<0.001). CONCLUSIONS Patient factors, intraoperative factors, duration of surgery and postoperative factors (postoperative pancreatic fistula, biliary leakage and other surgical complications) were identified as risk factors for DGE. Future research should focus on register-based, prospective, randomised-controlled studies such as the currently recruiting "PyloResPres trial".
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Affiliation(s)
- Tim Fahlbusch
- St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
| | - Andreas Minh Luu
- St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
| | - Philipp Höhn
- St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
| | - Carsten Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, University Hospital Munich, LMU, Munich, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TUM München, Germany
| | - Jörg Köninger
- Klinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Katharinenhospital, Stuttgart, Germany
| | - Thomas Kraus
- Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt am Main, Germany
| | - Guido Alsfasser
- Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany
| | - Winfried Padberg
- Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg, Standort Gießen, Gießen, Germany
| | - Jörg Peter Ritz
- Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany
| | - Waldemar Uhl
- St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
| | - Orlin Belyaev
- St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany
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Welsch T, Müssle B, Korn S, Sturm D, Bork U, Distler M, Grählert X, Klimova A, Trebesius N, Kleespies A, Kees S, Beckert S, Reim D, Friess H, Elwerr M, Kleeff J, Popescu O, Schmitz-Winnenthal H, Janot-Matuschek M, Uhl W, Weber GF, Brunner M, Golcher H, Grützmann R, Weitz J. Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the hepatic artery for prevention of postpancreatectomy haemorrhage: a randomized clinical trial (PANDA trial). Br J Surg 2021; 109:37-45. [PMID: 34746958 DOI: 10.1093/bjs/znab363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postpancreatectomy haemorrhage (PPH) is a rare but potentially fatal complication after pancreatoduodenectomy. Preventive strategies are lacking with scarce data for support. The aim of this study was to investigate whether a prophylactic falciform ligament wrap around the hepatic and gastroduodenal artery can prevent PPH from these vessels. METHODS In a randomized, controlled, multicentre trial, patients who were scheduled for elective open partial pancreatoduodenectomy with pancreatojejunostomy between 5 November 2015 and 2 April 2020 were randomly allocated in a 1 : 1 ratio to undergo pancreatoduodenectomy with (intervention) or without (control) a falciform ligament wrap around the hepatic artery. The primary endpoint was the rate of clinically relevant PPH from the hepatic artery or gastroduodenal artery stump within 3 months after pancreatoduodenectomy. Secondary endpoints were the rates of associated postoperative complications, for example postoperative pancreatic fistula (POPF) and PPH. RESULTS Altogether, 445 patients were randomized with 222 and 223 in each group. Among the patients included in modified intention-to-treat analysis (207 in the intervention group and 210 in the control group), the primary endpoint was observed in six of 207 in the intervention group compared with 15 of 210 in the control group (2.9 versus 7.1 per cent respectively; odds ratio 0.39 (95 per cent c.i. 0.15 to 1.02); P = 0.071). Per protocol analysis showed a significant reduction in the intervention group (odds ratio 0.26 (95 per cent c.i. 0.09 to 0.80); P = 0.017). A soft pancreas texture (43 per cent) and the rate of a clinically relevant POPF were evenly (20 per cent) distributed between the groups. The rate of any clinically relevant PPH including the primary endpoint and other bleeding sites was not significantly different between intervention and control groups (9.7 versus 14.8 per cent respectively). CONCLUSION A falciform ligament wrap may reduce PPH from the hepatic artery or gastroduodenal artery stump and should be considered during pancreatoduodenectomy. Registration number: NCT02588066 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sandra Korn
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dorothée Sturm
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Xina Grählert
- Coordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- Core Unit for Data Management and Analytics, National Centre for Tumour Diseases (NCT), Dresden, Germany
| | - Nicole Trebesius
- Department of General, Visceral, Thoracic and Oncological Surgery, Helios Amper Hospital Dachau, Dachau, Germany
| | - Axel Kleespies
- Department of General, Visceral, Thoracic and Oncological Surgery, Helios Amper Hospital Dachau, Dachau, Germany
| | - Stefan Kees
- Department of General, and Visceral Surgery, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Stefan Beckert
- Department of General, and Visceral Surgery, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Malik Elwerr
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Octavian Popescu
- Department of General, Visceral and Vascular Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Hubertus Schmitz-Winnenthal
- Department of General, Visceral and Vascular Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Monika Janot-Matuschek
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Georg F Weber
- Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maximilian Brunner
- Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Henriette Golcher
- Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Adam MG, Beyer G, Christiansen N, Kamlage B, Pilarsky C, Distler M, Fahlbusch T, Chromik A, Klein F, Bahra M, Uhl W, Grützmann R, Mahajan UM, Weiss FU, Mayerle J, Lerch MM. Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects. Gut 2021; 70:2150-2158. [PMID: 33541865 PMCID: PMC8515121 DOI: 10.1136/gutjnl-2020-320723] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. Due to a lack of specific biomarkers, diagnosis is based on symptoms and specific but insensitive imaging features, preventing an early diagnosis and appropriate management. DESIGN We conducted a type 3 study for multivariable prediction for individual prognosis according to the TRIPOD guidelines. A signature to distinguish CP from controls (n=160) was identified using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry on ethylenediaminetetraacetic acid (EDTA)-plasma and validated in independent cohorts. RESULTS A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95% CI 0.79 to 0.91). External validation in two independent cohorts (total n=502) resulted in similar accuracy for detection of CP compared with non-pancreatic controls in EDTA-plasma (AUC 0.85 (95% CI 0.81 to 0.89)) and serum (AUC 0.87 (95% CI 0.81 to 0.95)). CONCLUSIONS This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP.
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Affiliation(s)
| | - Georg Beyer
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | | | | | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Marius Distler
- Clinic and Outpatient Clinic for Visceral-, Thorax- and Vascular Surgery, Dresden University Hospital, Dresden, Sachsen, Germany
| | - Tim Fahlbusch
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Ansgar Chromik
- Askleipios Clinic Harburg, Department for General and Visceral Surgery, Asklepios Hospital Group, Hamburg, Hamburg, Germany
| | - Fritz Klein
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Waldemar Uhl
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Frank U Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Julia Mayerle
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Abstract
BACKGROUND Late metastasizing into pancreatic tissue is a special hallmark of renal cell carcinomas (RCC). A very low prevalence leads to scarce data about therapy, prognosis and spreading pathways. The aim of the study was to analyze whether a high fat content in the pancreas facilitates RCC metastases formation. A model for density measurement of pancreatic tissue has been developed and evaluated. Pancreatic fat content was measured comparing Hounsfield units (HU) of CT scans. METHODS In a consecutive single centre retrospective database of 3600 patients with pancreatic resections, only 12 patients (0.3%) cases of RCC metastases in the pancreas were found. HU were measured in 3 pancreatic regions: head, body and tail in patients' CT scans. HU values were compared to a control population and results aligned with recent literature. RESULTS We revealed a prevalence of pancreatic metastases of RCC in 0.3% of cases. The formation of RCC in the pancreas occurred within 14 ± 5.6 years after initial diagnosis of RCC. 83.3% of the patients were alive after a follow-up period of up to 48 months. Clinical data analysis revealed an affinity for metastatic formation to lipomatous pancreas. This could be objectivized by HU analysis in CT scans. CONCLUSION Pancreatic metastases occur late after the first diagnosis of renal carcinoma and show an affinity for lipomatous pancreatic tissues. Due to its rarity in occurrence, multicentric studies are highly recommended to further analyze this correlation between fatty pancreas and RCC.
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Affiliation(s)
- T. Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A. M. Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - C. Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - C. Lukas
- Diagnostic and Interventional Radiology, St. Josef-Hospital, University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - W. Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - B. M. Künzli
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
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Großerüschkamp F, Schörner S, Kraeft AL, Schuhmacher D, Sternemann C, Jütte H, Feder I, Wisser S, Lugnier C, Overheu O, Arnold D, Teschendorf C, Mueller L, Uhl W, Timmesfeld N, Mosig A, Reinacher-Schick A, Gerwert K, Tannapfel A. 385O Automated detection of microsatellite status in early colon cancer (CC) using artificial intelligence (AI) integrated infrared (IR) imaging on unstained samples from the AIO ColoPredictPlus 2.0 (CPP) registry study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mahajan UM, Alnatsha A, Li Q, Oehrle B, Weiss FU, Sendler M, Distler M, Uhl W, Fahlbusch T, Goni E, Beyer G, Chromik A, Bahra M, Klein F, Pilarsky C, Grützmann R, Lerch MM, Lauber K, Christiansen N, Kamlage B, Regel I, Mayerle J. Plasma Metabolome Profiling Identifies Metabolic Subtypes of Pancreatic Ductal Adenocarcinoma. Cells 2021; 10:1821. [PMID: 34359990 PMCID: PMC8305839 DOI: 10.3390/cells10071821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Developing biomarkers for early detection and chemotherapeutic response prediction is crucial to improve the dismal prognosis of PDAC patients. However, molecular cancer signatures based on transcriptome analysis do not reflect intratumoral heterogeneity. To explore a more accurate stratification of PDAC phenotypes in an easily accessible matrix, plasma metabolome analysis using MxP® Global Profiling and MxP® Lipidomics was performed in 361 PDAC patients. We identified three metabolic PDAC subtypes associated with distinct complex lipid patterns. Subtype 1 was associated with reduced ceramide levels and a strong enrichment of triacylglycerols. Subtype 2 demonstrated increased abundance of ceramides, sphingomyelin and other complex sphingolipids, whereas subtype 3 showed decreased levels of sphingolipid metabolites in plasma. Pathway enrichment analysis revealed that sphingolipid-related pathways differ most among subtypes. Weighted correlation network analysis (WGCNA) implied PDAC subtypes differed in their metabolic programs. Interestingly, a reduced expression among related pathway genes in tumor tissue was associated with the lowest survival rate. However, our metabolic PDAC subtypes did not show any correlation to the described molecular PDAC subtypes. Our findings pave the way for further studies investigating sphingolipids metabolisms in PDAC.
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Affiliation(s)
- Ujjwal Mukund Mahajan
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Ahmed Alnatsha
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Qi Li
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Bettina Oehrle
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.-U.W.); (M.S.)
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.-U.W.); (M.S.)
| | - Marius Distler
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, 01307 Dresden, Germany;
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, 44791 Bochum, Germany; (W.U.); (T.F.)
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, 44791 Bochum, Germany; (W.U.); (T.F.)
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Ansgar Chromik
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg, 21075 Hamburg, Germany;
| | - Markus Bahra
- Zentrum für Onkologische Oberbauchchirurgie und Robotik, Krankenhaus Waldfriede, 14163 Berlin, Germany;
| | - Fritz Klein
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13353 Berlin, Germany;
| | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, 91054 Erlangen, Germany; (C.P.); (R.G.)
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, 91054 Erlangen, Germany; (C.P.); (R.G.)
| | | | - Kirsten Lauber
- Department of Radiation Oncology, LMU Munich, 81377 Munich, Germany;
| | | | | | - Ivonne Regel
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (A.A.); (Q.L.); (B.O.); (E.G.); (G.B.); (I.R.); (J.M.)
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.-U.W.); (M.S.)
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Luu AM, Braumann C, Belyaev O, Janot-Matuschek M, Rudolf H, Praktiknjo M, Uhl W. Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int 2021; 20:271-278. [PMID: 33349608 DOI: 10.1016/j.hbpd.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival (LTS) and its contributing factors. METHODS This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. RESULTS The overall rate of LTS after PD for PDAC was 20.4% (34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis (P < 0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. CONCLUSIONS Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery.
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Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany.
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Monika Janot-Matuschek
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitaetsstrasse 105, Bochum 44789, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine, University of Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
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Kersting S, Götz M, Uzunoglu FG, Uhl W, Izbicki JR, Blessin NC, Janot-Matuschek MS. [Solid pseudopapillary neoplasms of the pancreas : Diagnostics, surgical treatment and postoperative outcome]. Chirurg 2021; 93:72-81. [PMID: 33938959 DOI: 10.1007/s00104-021-01420-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant solid pseudopapillary neoplasms (SPN) are rare tumor entities of the pancreas. The prognosis for SPN is generally excellent, although some tumors have malignant potential and tend to metastasize or relapse. OBJECTIVE The aim was to investigate whether there are histopathological or surgical risk factors that enable the biological potential of SPN to be estimated. PATIENTS AND METHODS Data from patients with SPN treated in two large German pancreas centers from 2009 to 2018 were evaluated with respect to the occurrence of SPN, surgical management, histopathological tumor characteristics and the postoperative outcome. RESULTS A total of 22 patients with SPN (17 women, 5 men) were operated on. The median age of the patients was 37 years (range 19-69 years). At the time of surgery 20 patients showed tumor growth limited to the pancreas. A female patient with recurrence of an externally resected SPN had lymph node involvement. Another female patient had a hepatic metastatic recurrence (Union Internationale contre Cancer (UICC) stage IV) of an externally resected SPN. Although all patients survived recurrence-free during the follow-up, this patient developed liver metastases again. The survival rate up to the end of the follow-up (median 43 months; range 1-132 months) of this study was 100%. CONCLUSION There is a lack of knowledge of the possible parameters that can be used to predict the biological behavior of SPN. Apart from an increased likelihood of recurrence after resection of an SPN recurrence, no clear risk factors could be identified in the examined patient collective that could indicate an increased malignant potential and a possibly poorer outcome. Only a radical surgical resection with lymphadenectomy enables a reliable assessment of the tumor stage and the removal of possibly affected lymph nodes, which could be the cause of a recurrence if left intact.
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Affiliation(s)
- Sabine Kersting
- Abteilung für Chirurgie, Christliches Klinikum Unna, Obere Husemannstr. 2, 59423, Unna, Deutschland
| | - Mara Götz
- Klinik für Allgemein- und Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Faik Güntac Uzunoglu
- Klinik für Allgemein- und Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Jakob Robert Izbicki
- Klinik für Allgemein- und Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Niclas Christian Blessin
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Monika Silvia Janot-Matuschek
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
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Aghalarov I, Förster S, Tannapfel A, Ubrig B, Uhl W, Belyaev O. A Double Metachronous Ureter Metastasis following Curative Resection of Rectal Cancer. Case Rep Gastroenterol 2021; 15:450-455. [PMID: 34054399 PMCID: PMC8138232 DOI: 10.1159/000512424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
A malignant ureteral obstruction is most often due to primary tumors of the ureter. However, it can occur secondary due to external tumor compression or metastatic infiltration. Distant metastases to the ureter are extremely rare. We present a case of a rare double distant metachronic metastasis to the right ureter as well as to the right renal pelvis in a 58-year-old female with a history of anterior resection for rectal cancer 2 years earlier. She presented with recurrent urinary tract infection and right hydronephrosis caused by an ureteral mass. The patient underwent a right nephroureterectomy via laparotomy. Two metastases of the rectal cancer in the ureteral mucosa were verified at histology. On account of the infiltration of the right ureteral orifice, a completion transurethral resection of the tumor was performed. A follow-up 3 and 6 months later showed no signs of tumor relapse and the patient was doing well. The differential diagnosis of malignant ureteral obstruction in patients with history of colorectal cancer should include the rare possibility of distant metastasis from the primary tumor.
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Affiliation(s)
- Ilgar Aghalarov
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sarah Förster
- Institute of Pathology, Ruhr University Bochum, Bochum, Germany
| | | | - Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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Uhl W, Oldhafer K, Schnitzbauer AA, Bruns C, Schön M, Belyaev O. [Statement of the surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV) on rapid report V19-03: association between volume of cases and quality in complex pancreatic surgery]. Chirurg 2021; 92:444-447. [PMID: 33871663 DOI: 10.1007/s00104-021-01396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/26/2022]
Abstract
The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G‑BA) to carry out a systematic literature search and assessment of the evidence for the association between the hospital and surgeon volume of cases and the quality of the treatment results in complex pancreatic surgery. The results are presented in the rapid report V19-03. The report confirms an association between the number of cases and the quality of the treatment results in favor of hospitals and surgeons with high volume case numbers; however, a statement with respect to the minimum numbers of complex pancreatic interventions is not given. The surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV) comments on these conclusions.
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Affiliation(s)
- Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Klinik der Ruhr-Universität Bochum, St. Josef-Hospital Bochum, Bochum, Deutschland.
| | - Karl Oldhafer
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Andreas A Schnitzbauer
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Frankfurt/Main, Deutschland
| | - Christiane Bruns
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum, Köln, Deutschland
| | - Michael Schön
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum, Karlsruhe, Deutschland
| | - Orlin Belyaev
- Klinik für Allgemein- und Viszeralchirurgie, Klinik der Ruhr-Universität Bochum, St. Josef-Hospital Bochum, Bochum, Deutschland
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Luu AM, Belyaev O, Höhn P, Praktiknjo M, Janot M, Uhl W, Braumann C. Late recurrences of pancreatic cancer in patients with long-term survival after pancreaticoduodenectomy. J Gastrointest Oncol 2021; 12:474-483. [PMID: 34012641 PMCID: PMC8107632 DOI: 10.21037/jgo-20-433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pancreatic cancer remains a relevant clinical problem due to poor prognosis. Even after curative pancreaticoduodenectomy tumor recurrences occur in up to 80%. Risk factors for postoperative tumor recurrences have been identified before, but data on risk factors for tumor recurrences in patients with long-term-survival is scarce. METHODS In this retrospective study consecutive long-term survival-patients (defined as at least 60 months survival) undergoing pancreaticoduodenectomy for pancreatic cancer from 2007-2014 were identified in the 2nd largest pancreatic surgery center in Germany. Clinical, pathohistological and laboratory values were analyzed to identify risk factors for tumor recurrence. RESULTS Thirty-four of one-hundred-sixty-seven patients were identified as long-term-survival-patients in the study period. Of those, 10 patients (29.4%) suffered from tumor recurrence. Lymph vessel invasion was identified as an independent risk factor (P=0.031, hazard ratio 13.127, 95% confidence interval: 1.270-135.698). Median postoperative time to tumor recurrence in long-term-survival-patients was 49 months. Overall survival after diagnosis of tumor recurrence was 33 months. 80% (N=8) of the patients were asymptomatic. Half of the patients (N=5) suffered from local disease, with 40% undergoing curative tumor resection. CA 19-9 levels were significantly elevated at 57 U/mL (normal <27 U/mL). CONCLUSIONS Tumor recurrence in long-term-survival-patients is typically asymptomatic. Especially long-term-survival-patients with lymph vessel invasion are more likely to develop tumor recurrence. Therefore, a structured follow-up program including CT-scans and CA 19-9 surveillance must be continued in all patients undergoing pancreaticoduodenectomy even in cases of long-term-survival.
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Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | | | - Monika Janot
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
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Quast DR, Breuer TGK, Nauck MA, Janot-Matuschek M, Uhl W, Meier JJ. Insulinbedarf und Glukosehomöostase bei Menschen nach partieller und totaler Pankreatektomie im Vergleich zu Menschen mit anderen Diabetesformen. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1344-0323] [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: 02/07/2023]
Abstract
Zusammenfassung
Einleitung Pankreasresektionen werden bei schwerwiegenden Pankreaserkrankungen durchgeführt. Bei Komplikationen einer chronischen Pankreatitis, teilweise jedoch auch bei Raumforderungen, kann eine Pankreasteilresektion sinnvoll sein. Eine totale Pankreatektomie führt zum absoluten Insulinmangel und der Notwendigkeit einer Insulintherapie. Bei Teilresektionen (partielle Pankreatektomie) werden weniger gravierende Konsequenzen für den Glukosemetabolismus erwartet. Es ist das Ziel der vorliegenden Arbeit, die Insulinregime nach Pankreatektomie mit denen anderer Diabetesformen zu vergleichen.
Material und Methodik Es wurden Patientencharakteristika und Details der postoperativen Insulintherapie von pankreasoperierten Patienten einer spezialisierten Universitätsklinik für Viszeralchirurgie ausgewertet. Diese Daten wurden mit Kohorten nicht operierter Patienten mit Typ-1-Diabetes (T1DM; absoluter Insulinmangel) bzw. Typ-2-Diabetes (T2DM; Insulinresistenz und relativer Insulinmangel), jeweils unter Insulintherapie, verglichen. Ergänzt wurde diese Datenanalyse durch eine Literaturrecherche zu den Stichworten „pancreatogenic diabetes“, „type 3c diabetes“ und „pancreatectomy diabetes“.
Ergebnisse Daten von 32 (68,8 % Frauenanteil) bzw. 41 (43,9 % Frauenanteil) Patienten nach totaler bzw. partieller Pankreatektomie wurden analysiert. Vor der totalen Pankreatektomie hatten 56,3 % der Patienten einen Diabetes mellitus, postoperativ bestand bei allen Patienten eine Insulinpflichtigkeit. Dabei waren die Insulindosierungen im Vergleich mit Patienten mit T1DM (unter intensivierter Insulintherapie) signifikant niedriger (p < 0,0001). Die Dosierungen von Basal- (48,6 % weniger) und Mahlzeiteninsulin (38,1 % weniger) waren gleichermaßen betroffen. Eine partielle Pankreatektomie führte deutlich seltener zu einem Diabetes mellitus, und eine Insulintherapie war nur bei 26,8 % der Patienten erforderlich.
Diskussion Der basale und prandiale Insulinbedarf nach Pankreatektomie ist niedriger als bei einem T1DM und einem T2DM. Dies sollte bei der Blutzuckereinstellung nach Pankreatektomie berücksichtigt werden.
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Affiliation(s)
- Daniel Robert Quast
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Thomas Georg Karl Breuer
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Michael Albrecht Nauck
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz
| | - Monika Janot-Matuschek
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Juris Jendrik Meier
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
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Luu AM, Olchanetski B, Herzog T, Tannapfel A, Uhl W, Belyaev O. Is primary total pancreatectomy in patients with high-risk pancreatic remnant justified and preferable to pancreaticoduodenectomy? -a matched-pairs analysis of 200 patients. Gland Surg 2021; 10:618-628. [PMID: 33708545 PMCID: PMC7944076 DOI: 10.21037/gs-20-670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/15/2020] [Accepted: 11/11/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Total pancreatectomy (TP) eliminates the risk of postoperative pancreatic fistula (POPF) and its associated secondary complications. Hence, it may theoretically offer advantages over pancreaticoduodenectomy (PD) regarding early postoperative outcome of patients with high-risk pancreatic remnant. METHODS Ninety-day mortality and morbidity of 100 TP vs. 100 PD for pancreatic head lesions were retrospectively compared. Groups were matched for pancreatic texture, pancreatic duct size, final histology, age, gender and surgeon. Only patients at high risk for POPF due to soft pancreatic texture and small pancreatic duct <3 mm were included. RESULTS Preoperatively, the TP-group was characterized by poorer general condition, more comorbidities and more pronounced obesity than the PD-group. Postoperatively, overall morbidity was lower after TP (63% vs. 88%, P<0.001) due to less mild complications. Postpancreatectomy hemorrhage rate was lower after TP than after PD (2% vs. 12%, P=0.014). Duration of surgery, hospital stay, major morbidity (30%) and mortality (7% vs. 5%) were the same. POPF was the most common complication after PD with 32%. Emergency completion pancreatectomy was necessary in 10% of PD with a significantly higher mortality compared to elective TP (50% vs. 7%, P=0.001). CONCLUSIONS TP may reduce severe POPF-associated complications and prevent mortality related to emergency completion pancreatectomy in some elderly, obese and polymorbid patients with high-risk pancreatic remnant. Careful individual selection by an experienced pancreatic surgeon is mandatory.
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Affiliation(s)
- Andreas Minh Luu
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Bella Olchanetski
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Luu AM, Vogel SR, Braumann C, Praktiknjo M, Höhn P, Förster S, Janot M, Uhl W, Belyaev O. Risk factors for perforated marginal ulcers following pancreaticoduodenectomy and prospective analysis of marginal ulcer development. Gland Surg 2021; 10:739-750. [PMID: 33708556 DOI: 10.21037/gs-20-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Perforated marginal ulcers (PMUs) are a feared long-term complication following pancreaticoduodenectomy (PD), which always require relaparotomy compared to marginal ulcers. Methods First, we performed a retrospective chart review for all patients who underwent PD from 2007-2016 to identify incidence and risk factors associated with PMUs. Second, we analyzed follow up gastroscopies in all patients undergoing PD from 2007-2011 to identify the overall incidence of marginal ulcers. Results A total of 725 patients underwent PD in the retrospective study period. 17 patients (2.3%) suffered from PMU at a median postoperative time of 13 months. These patients were significantly younger (median age: 49 vs. 62 years; P=0.02) and suffered most often from chronic pancreatitis (P<0.001). Smoking and alcohol consumption were significantly more common (P=0.01 and P=0.023). An elevated level of carcinoembryonic antigen and chronic pancreatitis were identified as independent risk factors. Overall, 373 patients were enrolled for prospective analysis. Marginal ulcers occurred in 5-5.9% over a postoperative period of 5 years. Conclusions Continuous treatment with proton-pump inhibitors for at least 5 years, immediate smoking cessation and follow-up gastroscopies are obligate for patients undergoing PD to avoid marginal ulcers and PMUs.
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Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Sina Rabea Vogel
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Sarah Förster
- Department of Pathology, University-Hospital Bergmannsheil, Bürkle de la Camp Platz 1, 44789 Bochum, Germany
| | - Monika Janot
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Luu AM, Braumann C, Uhl W, Janot-Matuschek M, Herzog T. Does autologous fibrin sealant (vivostat ©) reduce the incidence of postoperative pancreatic fistula after distal pancreatectomy? - a matched pairs analysis. Acta Chir Belg 2021; 121:16-22. [PMID: 31433745 DOI: 10.1080/00015458.2019.1658354] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is the most common complication following distal pancreatectomy. This retrospective study investigated the effects of autologous fibrin sealant (Vivostat©) in reducing the incidence of POPF after distal pancreatectomy. METHODS A matched pairs analysis was performed to compare the incidence of clinically relevant POPF of 41 patients who underwent a distal pancreatectomy with application of autologous fibrin sealant (Vivostat©) with a historical control group. RESULTS Clinically relevant POPF were present in 11 patients in the study group (27%) and in 13 patients in the control group (32%, p = .639). No patient of the study group required emergency angiographic treatment for postoperative hemorrhage due to POPF, whereas three patients were identified in the control group (7%, p = .079). CONCLUSIONS POPF cannot be prevented under treatment with autologous fibrin sealant (Vivostat©). We observed the tendency of a lower rate of postoperative pancreatic hemorrhage due to POPF. However, prospective randomized controlled studies are required.
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Affiliation(s)
- Andreas Minh Luu
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monika Janot-Matuschek
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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