Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after... more Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after surgery. As a benchmarking tool, it provides an objective overview of quality of care. Uniform definitions of TO in hepato-pancreato-biliary (HPB) surgery are missing. This study aimed to provide a definition of TO in HPB surgery and identify obstacles and predictors for achieving it. Methods A systematic literature search was conducted using PubMed, Embase, and Cochrane Database according to PRISMA guidelines. Studies published between 1993 and 2021 were retrieved. After selection, two independent reviewers extracted descriptive statistics and derived summary estimates of the occurrence of TO criteria and obstacles for achieving TO using co-occurrence maps. Results Overall, 30 studies were included. TO rates ranged between 16–69 per cent. Commonly chosen co-occurring criteria to define TO included ‘no prolonged length of stay (LOS)’, ‘no complications’, ‘no readmission’, and ‘no deaths...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose Posthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liv... more Purpose Posthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liver resection. Apart from the size and function of the remaining liver remnant, the development of postresection portal hypertension (pHT) plays a crucial role in the development of PHLF. We hypothesize that the umbilical vein in the preserved round ligament (RL) may recanalize in response to new-onset pHT after extended hepatectomy, thus providing a natural portosystemic shunt. Methods In this exploratory study, RL was preserved in 10 consecutive patients undergoing major liver resection. Postoperative imaging was pursued to obtain evidence of reopened umbilical vein in the RL. The postoperative course, including the occurrence of PHLF, as well as the rate of procedure-specific complications were recorded. Results None of the 10 cases presented with an adverse event due to preservation of the RL. In 6 cases, postoperative imaging demonstrated reopening of the umbilical vein with hepatofu...
The Cancer Genome Atlas (TCGA) data show the gene expression of Gal3 (LGALS3) in normal (no value... more The Cancer Genome Atlas (TCGA) data show the gene expression of Gal3 (LGALS3) in normal (no value), ductal breast carcinoma in situ and invasive ductal breast carcinoma (A) or normal (no value), primary site and metastatic site of human breast cancer samples (B). (C) Western blot analysis of whole cell lysates of GI-101A and its derivatives (GI-LM2, GI-LM2C, GI-LM2G) on estrogen receptor (ER) expression. Figure S2 (A) Immunofluorescence staining of GI-LM2C (upper row) and GI-LM2G spheres (lower row) for Gal3 (red), E-cadherin (CDH1, green), and vimentin (gray). (B) Immunofluorescence staining of the same cell lines for cytokeratin 18 (red) and vimentin (green). Counterstaining with DAPI (blue) was used to visualize cell nuclei. Figure S3 (A) Flow cytometric analysis shows that Gal3-positive populations (in red) of the same cell line consistently contain a lower BCSC pool than Gal3-negative populations (in green). (B) Correlation of Gal3 with CD24 and EpCAM expression is listed in a ...
Einleitung: Bei den meisten der primär kurativ operierten Patienten mit Pankreaskarzinom tritt im... more Einleitung: Bei den meisten der primär kurativ operierten Patienten mit Pankreaskarzinom tritt im Verlauf ein Lokalrezidiv oder eine Fernmetastasierung auf. Bislang ist unklar wie bei einer metachronen Lungenmetastasierung therapeutisch vorgegangen werden soll. Insbesondere ist die Rolle der Chirurgie[zum vollständigen Text gelangen Sie über die oben angegebene URL]
PURPOSE With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle l... more PURPOSE With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle leak (CL) has become a more commonly observed complication. Recently, a new consensus definition was established by the International study group of pancreatic surgery (ISGPS). The aim of the present analysis was to evaluate risk factors and treatment options of patients with CL after pancreatic surgery. METHODS Two hundred and twenty-eight patients with serous or chylous drainage after pancreatic surgery were included in this analysis of a prospectively collected database between 01/2014 and 12/2016. Risk factors for CL and treatment options were compared. A subgroup analysis on those patients, who had drain removal despite of persistent CL with respect to the need of subsequent percutaneous drainage or reoperation within three months postoperatively, was performed. RESULTS Sixty patients with CL were identified. Of those, 41 patients were treated with medium-chain triglyceride-diet, with a median duration of therapy of 12 days. In patients with CL, the type of treatment had no effect on time to drain removal (P=0.29) and morbidity (P=0.15). Furthermore, morbidity was not increased in patients who had their drains removed despite persistent CL (P=0.84). None of the latter patients had percutaneous drainage or reoperation for CL after removal of the surgical drains. CONCLUSIONS Dietary treatment may not be very effective in treating CL. Further research is warranted to explore the effect and necessity of CL treatment.
Resume Introduction L’etendue de la chirurgie pancreatique pour cancer rend la survenue de fuites... more Resume Introduction L’etendue de la chirurgie pancreatique pour cancer rend la survenue de fuites chyleuses (FC) assez frequente. Recemment une definition consensuelle de FC a ete etablie par l’International Study Group of Pancreatic Surgery (ISGPS). Le but de cette etude etait d’analyser les facteurs de risque et le traitement des FC apres chirurgie pancreatique. Methodes Au total, 228 patients ayant un drainage sereux ou chyleux apres chirurgie pancreatique ont ete inclus dans cette etudes de donnees collectees prospectivement entre janvier 2014 et decembre 2016. Les facteurs de risque et les traitements des FC etaient compares. Une analyse du sous-groupe de patients ayant eu l’ablation des drains malgre une FC persistante etait effectuee avec une etude de la necessite d’un drainage percutane ou une reintervention dans les 3 mois postoperatoires. Resultats Soixante patients ayant eu une FC etaient analyses. Parmi eux, 41 ont eu un regime pauvre en graisses pendant une duree mediane de 12 jours. Le type de traitement n’avait pas d’effet sur la duree du drainage (p = 0,29) et la morbidite (p = 0,15). De plus la morbidite postoperatoire n’etait pas augmentee chez les patients ayant eu une ablation des drains malgre une FC persistante (p = 0,84). Aucun de ces patients n’avait eu un drainage percutane ou une reintervention pour collection postoperatoire. Conclusions Le regime pauvre en graisse n’est probablement pas un traitement efficace des FC. De futures etudes sont necessaires pour explorer l’effet et la necessite d’un traitement des FC.
Background: Intestinal alkaline phosphatase (IAP) as a tissue-specific isozyme of alkaline phosph... more Background: Intestinal alkaline phosphatase (IAP) as a tissue-specific isozyme of alkaline phosphatases is predominantly produced by enterocytes in the proximal small intestine. In recent years, an increasing number of pathologies have been identified to be associated with an IAP deficiency, making it very worthwhile to review the various roles, biological functions, and potential therapeutic aspects of IAP. Summary: IAP primarily originates and acts in the intestinal tract but affects other organs through specific biological axes related to its fundamental roles such as promoting gut barrier function, dephosphorylation/detoxification of lipopolysaccharides (LPS), and regulation of gut microbiota. Key Messages: Numerous studies reporting on the different roles and the potential therapeutic value of IAP across species have been published during the last decade. While IAP deficiency is linked to varying degrees of physiological dysfunctions across multiple organ systems, the supplemen...
Viszeralmedizin 2021 Gemeinsame Jahrestagung Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Sektion Endoskopie der DGVS, Deutsche Gesellschaft für Allgemein und Viszeralchirurgie (DGAV), 2021
BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different under... more BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different underlying pancreatic disorders and characterized by subcutaneous fat necrosis induced by elevated serum lipase levels. These lesions usually affect the lower extremities and may precede abdominal symptoms of pancreatic disease. Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic neoplasm, accounting for only 1%-2% of pancreatic tumors in adults. CASE SUMMARY We present the case of a 72-year-old man with ACC of the pancreatic head and synchronous liver metastases. Both the primary tumor and liver metastases were resected. Serum lipase was elevated before surgery and decreased to normal postoperatively. Rising serum lipase levels at follow-up led to the diagnosis of hepatic recurrence. This disease progression was then accompanied by pancreatic panniculitis, with subcutaneous fat necrosis and acute arthritis. To the best of our knowledge, only 4 cases have been reported in the literature and each showed a similar association of serum lipase levels with pancreatic panniculitis and progression of ACC. CONCLUSION Clinical symptoms and progression of ACC may correlate with serum lipase levels, suggesting potential usefulness as a follow-up biomarker.
To assess the perioperative and long-term outcome following pulmonary resection in patients with ... more To assess the perioperative and long-term outcome following pulmonary resection in patients with metachronous metastasis of pancreatic ductal adenocarcinoma (PDAC). Background: Most patients with PDAC relapse or develop tumor spread to secondary organs. Currently, it remains unclear how to proceed with pulmonary metastasis in the metachronous setting. In particular, the role of surgery remains controversial. Methods: Data of patients with pulmonary metachronous metastasis after PDAC collected from 2003 to 2015 in databases of two high-volume pancreatic cancer centers were retrospectively analyzed. Clinical and pathological aspects of primary PDAC as well as the perioperative and long-term outcome following pulmonary metastasectomy (PM) was evaluated, respectively. Patients with synchronous liver metastasis or metastasis to other secondary organs were excluded. Univariate survival analysis was performed. Results: We identified 15 patients undergoing pulmonary resection for suspected metastasis after primary pancreatic resection. Operative and histopathologic evaluation revealed resectable pancreatic pulmonary metastasis in 11 patients (73.3%). The median disease-free survival (DFS) and overall survival (OS) after PM diagnosis was 18 months and 26 months, respectively. The median time to metachronous metastasis (TMM) was 17 months [3-64 months]. Perioperative morbidity was low with only one readmission (8.3%). There was no perioperative mortality. Patients who developed pulmonary metastasis later than 17 months after primary surgery showed better OS compared to those who did earlier (32.2 vs. 14.75 months, p = 0.025). In addition, patients with high-grade tumors had worse survival (12.4 vs. 31 months, p = 0.02). Elevated serum CEA levels or CA 19-9 levels were also not associated with shortened OS. Conclusions: This study suggests that pulmonary metastasectomy after PDAC is safe and effective. Patients with extended DFS after primary pancreatic surgery as well as favorable tumor grading seem to particularly benefit from pulmonary surgery.
cells were cocultured and 3) PDAC patient-derived cells were cultured in the dECM. Results: The t... more cells were cocultured and 3) PDAC patient-derived cells were cultured in the dECM. Results: The three PDAC cell lines displayed remarkably different growth patterns on the dECM scaffolds. MIA PaCa-2 cells became confluent much more quickly, from a lower initial seeding density and with a distinct spatial growth pattern, consisting in multiple layers of cells on the surface of the dECM scaffold. Results using more complex cellular approaches will be presented at the conference. Conclusion: We managed to establish a new PDAC organoid model using dECM. Using different PDAC cell lines and patient-derived material in combination with advanced imaging techniques and histological analyses enables us to perform very detailed characterization of growth patterns and reassembly of tumor characteristics within the scaffolds. We hope to establish this variable organoid system as bridge between oversimplified 2D culture methods and complex in vivo systems.
Methods: Formalin-fixed and paraffin-embedded pancreatic natural/inflammatory/neoplastic tissue s... more Methods: Formalin-fixed and paraffin-embedded pancreatic natural/inflammatory/neoplastic tissue sections from 18 patients were investigated. A computer-aided image analysis system was applied to evaluate the Sirius-red stained collagen fibers amount (CF), their spatial organization, and to simulate the impact of stromal deposition/degradation. Results: An increased deposition from natural pancreatic tissue (nPA: 2.23AE0.28%) to chronic pancreatitis (iPA: 14.27AE1.27%) to PC (22.30AE2.031%), (p<0.0001) and a statistically significant difference in the spatial organization between nPA (1.35AE0.02) vs iPA (1.70AE0.01) and PC (1.73AE0.01) (p<0.0001) were found. A lower CFs spatial organization was detected in iPA and in PC vs nPA, but not between iPA and PC. CFs degradation was longer and slower in iPA and PC, respectively. Conclusion: The increased amount of irregularly shaped CFs is accompanied with a compact organization and characterizes iPA and PC. A proper knowledge of their peculiar structure/spatial distribution in iPA/PC may improve our diagnostic/therapeutic procedures and patients' outcome.
Background: A recently published nomogram, the Blood Use Risk Score (BURS) [1], predicts packed r... more Background: A recently published nomogram, the Blood Use Risk Score (BURS) [1], predicts packed red cell (PRC) use following surgery. Post-pancreatectomy haemorrhage has been defined as early or late (under or over 24 hours after surgery) [2]. This study assessed the BURS among patients exclusively undergoing pancreatoduodenectomy to predict early and late need for PRC. Methods: Risk factors for early or late PRC use were identified in uni-and multivariable analyses. Results: Among 628 patients, 99 (16%) and 144 (23%) received early and late PRC. The BURS was associated with early (AUROC 0.700, p<0.001) but not late use of PRC (AUROC 0.525, p=0.360). In multivariable analysis, preoperative haemoglobin and need for venous resection were related to early PRC use. Late PRC use was related with a Whipple resection, lack of biliary stent and narrow pancreatic duct. After accounting for these factors, late PRC usage was associated with post-operative pancreatic fistula (POPF) and increasing severity (OR 2.00, 3.06 and 9.96 for grade A, B and C POPF respectively). Conclusion: Two largely different sets of variables are related to early and late PRC use following pancreatoduodenectomy. The BURS identified early but not late PRC use. An understanding of POPF risk allows assessment of the need for late PRC use. References [1]
72. Jahrestagung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten mit Sektion Endoskopie – 11. Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie gemeinsam mit den Arbeitsgemeinschaften der DGAV, 2017
profile in the bile. Discrimination between benign disease and different tumor types may be possi... more profile in the bile. Discrimination between benign disease and different tumor types may be possible with a bile miRNA signature. There is potential to use these bile-based miRNAs to inform treatment decisions and improve diagnosis and survival. Additional validation is needed in an independent cohort.
s / Pancreatology 16 (2016) S1eS130 S14 pancreas. In addition, lack of Akt1 resulted in reduced a... more s / Pancreatology 16 (2016) S1eS130 S14 pancreas. In addition, lack of Akt1 resulted in reduced acinar cell proliferation and de-differentiation into acinar-to-ductal metaplasia. Molecular analyses revealed a down-regulation of TGF-b signaling in Akt1-/mice. Conclusion: Our results revealed that Akt1 signaling does not mediate the initial acinar cell damage observed at the onset of AP. However, Akt1 signaling promotes both the inflammatory response and the regeneration of the pancreatic tissue. These findings provide novel insights into the molecular pathways governing pancreatic inflammation and tissue regeneration, with potential therapeutic implications.
While liver transplantation was initially considered as a curative treatment modality only for he... more While liver transplantation was initially considered as a curative treatment modality only for hepatocellular carcinoma, the indication has been increasingly extended to other tumor entities over recent years, most recently to the treatment of non-resectable colorectal liver metastases. Although oncologic outcomes after liver transplantation (LT) are consistently good, organ shortage forces stringent selection of suitable candidates. Dynamic criteria based on tumor biology fulfill the prerequisite of an individual oncological prediction better than traditional morphometric criteria based on tumor burden. The availability of specific (neo-)adjuvant therapies and customized modern immunosuppression may further contribute to favorable post-transplantation outcomes on the one hand and simultaneously open the path to LT as a curative option for advanced stages of tumor patients. Herein, we provide an overview of the oncological LT indications, the selection process, and expected oncologi...
Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after... more Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after surgery. As a benchmarking tool, it provides an objective overview of quality of care. Uniform definitions of TO in hepato-pancreato-biliary (HPB) surgery are missing. This study aimed to provide a definition of TO in HPB surgery and identify obstacles and predictors for achieving it. Methods A systematic literature search was conducted using PubMed, Embase, and Cochrane Database according to PRISMA guidelines. Studies published between 1993 and 2021 were retrieved. After selection, two independent reviewers extracted descriptive statistics and derived summary estimates of the occurrence of TO criteria and obstacles for achieving TO using co-occurrence maps. Results Overall, 30 studies were included. TO rates ranged between 16–69 per cent. Commonly chosen co-occurring criteria to define TO included ‘no prolonged length of stay (LOS)’, ‘no complications’, ‘no readmission’, and ‘no deaths...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose Posthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liv... more Purpose Posthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liver resection. Apart from the size and function of the remaining liver remnant, the development of postresection portal hypertension (pHT) plays a crucial role in the development of PHLF. We hypothesize that the umbilical vein in the preserved round ligament (RL) may recanalize in response to new-onset pHT after extended hepatectomy, thus providing a natural portosystemic shunt. Methods In this exploratory study, RL was preserved in 10 consecutive patients undergoing major liver resection. Postoperative imaging was pursued to obtain evidence of reopened umbilical vein in the RL. The postoperative course, including the occurrence of PHLF, as well as the rate of procedure-specific complications were recorded. Results None of the 10 cases presented with an adverse event due to preservation of the RL. In 6 cases, postoperative imaging demonstrated reopening of the umbilical vein with hepatofu...
The Cancer Genome Atlas (TCGA) data show the gene expression of Gal3 (LGALS3) in normal (no value... more The Cancer Genome Atlas (TCGA) data show the gene expression of Gal3 (LGALS3) in normal (no value), ductal breast carcinoma in situ and invasive ductal breast carcinoma (A) or normal (no value), primary site and metastatic site of human breast cancer samples (B). (C) Western blot analysis of whole cell lysates of GI-101A and its derivatives (GI-LM2, GI-LM2C, GI-LM2G) on estrogen receptor (ER) expression. Figure S2 (A) Immunofluorescence staining of GI-LM2C (upper row) and GI-LM2G spheres (lower row) for Gal3 (red), E-cadherin (CDH1, green), and vimentin (gray). (B) Immunofluorescence staining of the same cell lines for cytokeratin 18 (red) and vimentin (green). Counterstaining with DAPI (blue) was used to visualize cell nuclei. Figure S3 (A) Flow cytometric analysis shows that Gal3-positive populations (in red) of the same cell line consistently contain a lower BCSC pool than Gal3-negative populations (in green). (B) Correlation of Gal3 with CD24 and EpCAM expression is listed in a ...
Einleitung: Bei den meisten der primär kurativ operierten Patienten mit Pankreaskarzinom tritt im... more Einleitung: Bei den meisten der primär kurativ operierten Patienten mit Pankreaskarzinom tritt im Verlauf ein Lokalrezidiv oder eine Fernmetastasierung auf. Bislang ist unklar wie bei einer metachronen Lungenmetastasierung therapeutisch vorgegangen werden soll. Insbesondere ist die Rolle der Chirurgie[zum vollständigen Text gelangen Sie über die oben angegebene URL]
PURPOSE With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle l... more PURPOSE With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle leak (CL) has become a more commonly observed complication. Recently, a new consensus definition was established by the International study group of pancreatic surgery (ISGPS). The aim of the present analysis was to evaluate risk factors and treatment options of patients with CL after pancreatic surgery. METHODS Two hundred and twenty-eight patients with serous or chylous drainage after pancreatic surgery were included in this analysis of a prospectively collected database between 01/2014 and 12/2016. Risk factors for CL and treatment options were compared. A subgroup analysis on those patients, who had drain removal despite of persistent CL with respect to the need of subsequent percutaneous drainage or reoperation within three months postoperatively, was performed. RESULTS Sixty patients with CL were identified. Of those, 41 patients were treated with medium-chain triglyceride-diet, with a median duration of therapy of 12 days. In patients with CL, the type of treatment had no effect on time to drain removal (P=0.29) and morbidity (P=0.15). Furthermore, morbidity was not increased in patients who had their drains removed despite persistent CL (P=0.84). None of the latter patients had percutaneous drainage or reoperation for CL after removal of the surgical drains. CONCLUSIONS Dietary treatment may not be very effective in treating CL. Further research is warranted to explore the effect and necessity of CL treatment.
Resume Introduction L’etendue de la chirurgie pancreatique pour cancer rend la survenue de fuites... more Resume Introduction L’etendue de la chirurgie pancreatique pour cancer rend la survenue de fuites chyleuses (FC) assez frequente. Recemment une definition consensuelle de FC a ete etablie par l’International Study Group of Pancreatic Surgery (ISGPS). Le but de cette etude etait d’analyser les facteurs de risque et le traitement des FC apres chirurgie pancreatique. Methodes Au total, 228 patients ayant un drainage sereux ou chyleux apres chirurgie pancreatique ont ete inclus dans cette etudes de donnees collectees prospectivement entre janvier 2014 et decembre 2016. Les facteurs de risque et les traitements des FC etaient compares. Une analyse du sous-groupe de patients ayant eu l’ablation des drains malgre une FC persistante etait effectuee avec une etude de la necessite d’un drainage percutane ou une reintervention dans les 3 mois postoperatoires. Resultats Soixante patients ayant eu une FC etaient analyses. Parmi eux, 41 ont eu un regime pauvre en graisses pendant une duree mediane de 12 jours. Le type de traitement n’avait pas d’effet sur la duree du drainage (p = 0,29) et la morbidite (p = 0,15). De plus la morbidite postoperatoire n’etait pas augmentee chez les patients ayant eu une ablation des drains malgre une FC persistante (p = 0,84). Aucun de ces patients n’avait eu un drainage percutane ou une reintervention pour collection postoperatoire. Conclusions Le regime pauvre en graisse n’est probablement pas un traitement efficace des FC. De futures etudes sont necessaires pour explorer l’effet et la necessite d’un traitement des FC.
Background: Intestinal alkaline phosphatase (IAP) as a tissue-specific isozyme of alkaline phosph... more Background: Intestinal alkaline phosphatase (IAP) as a tissue-specific isozyme of alkaline phosphatases is predominantly produced by enterocytes in the proximal small intestine. In recent years, an increasing number of pathologies have been identified to be associated with an IAP deficiency, making it very worthwhile to review the various roles, biological functions, and potential therapeutic aspects of IAP. Summary: IAP primarily originates and acts in the intestinal tract but affects other organs through specific biological axes related to its fundamental roles such as promoting gut barrier function, dephosphorylation/detoxification of lipopolysaccharides (LPS), and regulation of gut microbiota. Key Messages: Numerous studies reporting on the different roles and the potential therapeutic value of IAP across species have been published during the last decade. While IAP deficiency is linked to varying degrees of physiological dysfunctions across multiple organ systems, the supplemen...
Viszeralmedizin 2021 Gemeinsame Jahrestagung Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Sektion Endoskopie der DGVS, Deutsche Gesellschaft für Allgemein und Viszeralchirurgie (DGAV), 2021
BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different under... more BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different underlying pancreatic disorders and characterized by subcutaneous fat necrosis induced by elevated serum lipase levels. These lesions usually affect the lower extremities and may precede abdominal symptoms of pancreatic disease. Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic neoplasm, accounting for only 1%-2% of pancreatic tumors in adults. CASE SUMMARY We present the case of a 72-year-old man with ACC of the pancreatic head and synchronous liver metastases. Both the primary tumor and liver metastases were resected. Serum lipase was elevated before surgery and decreased to normal postoperatively. Rising serum lipase levels at follow-up led to the diagnosis of hepatic recurrence. This disease progression was then accompanied by pancreatic panniculitis, with subcutaneous fat necrosis and acute arthritis. To the best of our knowledge, only 4 cases have been reported in the literature and each showed a similar association of serum lipase levels with pancreatic panniculitis and progression of ACC. CONCLUSION Clinical symptoms and progression of ACC may correlate with serum lipase levels, suggesting potential usefulness as a follow-up biomarker.
To assess the perioperative and long-term outcome following pulmonary resection in patients with ... more To assess the perioperative and long-term outcome following pulmonary resection in patients with metachronous metastasis of pancreatic ductal adenocarcinoma (PDAC). Background: Most patients with PDAC relapse or develop tumor spread to secondary organs. Currently, it remains unclear how to proceed with pulmonary metastasis in the metachronous setting. In particular, the role of surgery remains controversial. Methods: Data of patients with pulmonary metachronous metastasis after PDAC collected from 2003 to 2015 in databases of two high-volume pancreatic cancer centers were retrospectively analyzed. Clinical and pathological aspects of primary PDAC as well as the perioperative and long-term outcome following pulmonary metastasectomy (PM) was evaluated, respectively. Patients with synchronous liver metastasis or metastasis to other secondary organs were excluded. Univariate survival analysis was performed. Results: We identified 15 patients undergoing pulmonary resection for suspected metastasis after primary pancreatic resection. Operative and histopathologic evaluation revealed resectable pancreatic pulmonary metastasis in 11 patients (73.3%). The median disease-free survival (DFS) and overall survival (OS) after PM diagnosis was 18 months and 26 months, respectively. The median time to metachronous metastasis (TMM) was 17 months [3-64 months]. Perioperative morbidity was low with only one readmission (8.3%). There was no perioperative mortality. Patients who developed pulmonary metastasis later than 17 months after primary surgery showed better OS compared to those who did earlier (32.2 vs. 14.75 months, p = 0.025). In addition, patients with high-grade tumors had worse survival (12.4 vs. 31 months, p = 0.02). Elevated serum CEA levels or CA 19-9 levels were also not associated with shortened OS. Conclusions: This study suggests that pulmonary metastasectomy after PDAC is safe and effective. Patients with extended DFS after primary pancreatic surgery as well as favorable tumor grading seem to particularly benefit from pulmonary surgery.
cells were cocultured and 3) PDAC patient-derived cells were cultured in the dECM. Results: The t... more cells were cocultured and 3) PDAC patient-derived cells were cultured in the dECM. Results: The three PDAC cell lines displayed remarkably different growth patterns on the dECM scaffolds. MIA PaCa-2 cells became confluent much more quickly, from a lower initial seeding density and with a distinct spatial growth pattern, consisting in multiple layers of cells on the surface of the dECM scaffold. Results using more complex cellular approaches will be presented at the conference. Conclusion: We managed to establish a new PDAC organoid model using dECM. Using different PDAC cell lines and patient-derived material in combination with advanced imaging techniques and histological analyses enables us to perform very detailed characterization of growth patterns and reassembly of tumor characteristics within the scaffolds. We hope to establish this variable organoid system as bridge between oversimplified 2D culture methods and complex in vivo systems.
Methods: Formalin-fixed and paraffin-embedded pancreatic natural/inflammatory/neoplastic tissue s... more Methods: Formalin-fixed and paraffin-embedded pancreatic natural/inflammatory/neoplastic tissue sections from 18 patients were investigated. A computer-aided image analysis system was applied to evaluate the Sirius-red stained collagen fibers amount (CF), their spatial organization, and to simulate the impact of stromal deposition/degradation. Results: An increased deposition from natural pancreatic tissue (nPA: 2.23AE0.28%) to chronic pancreatitis (iPA: 14.27AE1.27%) to PC (22.30AE2.031%), (p<0.0001) and a statistically significant difference in the spatial organization between nPA (1.35AE0.02) vs iPA (1.70AE0.01) and PC (1.73AE0.01) (p<0.0001) were found. A lower CFs spatial organization was detected in iPA and in PC vs nPA, but not between iPA and PC. CFs degradation was longer and slower in iPA and PC, respectively. Conclusion: The increased amount of irregularly shaped CFs is accompanied with a compact organization and characterizes iPA and PC. A proper knowledge of their peculiar structure/spatial distribution in iPA/PC may improve our diagnostic/therapeutic procedures and patients' outcome.
Background: A recently published nomogram, the Blood Use Risk Score (BURS) [1], predicts packed r... more Background: A recently published nomogram, the Blood Use Risk Score (BURS) [1], predicts packed red cell (PRC) use following surgery. Post-pancreatectomy haemorrhage has been defined as early or late (under or over 24 hours after surgery) [2]. This study assessed the BURS among patients exclusively undergoing pancreatoduodenectomy to predict early and late need for PRC. Methods: Risk factors for early or late PRC use were identified in uni-and multivariable analyses. Results: Among 628 patients, 99 (16%) and 144 (23%) received early and late PRC. The BURS was associated with early (AUROC 0.700, p<0.001) but not late use of PRC (AUROC 0.525, p=0.360). In multivariable analysis, preoperative haemoglobin and need for venous resection were related to early PRC use. Late PRC use was related with a Whipple resection, lack of biliary stent and narrow pancreatic duct. After accounting for these factors, late PRC usage was associated with post-operative pancreatic fistula (POPF) and increasing severity (OR 2.00, 3.06 and 9.96 for grade A, B and C POPF respectively). Conclusion: Two largely different sets of variables are related to early and late PRC use following pancreatoduodenectomy. The BURS identified early but not late PRC use. An understanding of POPF risk allows assessment of the need for late PRC use. References [1]
72. Jahrestagung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten mit Sektion Endoskopie – 11. Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie gemeinsam mit den Arbeitsgemeinschaften der DGAV, 2017
profile in the bile. Discrimination between benign disease and different tumor types may be possi... more profile in the bile. Discrimination between benign disease and different tumor types may be possible with a bile miRNA signature. There is potential to use these bile-based miRNAs to inform treatment decisions and improve diagnosis and survival. Additional validation is needed in an independent cohort.
s / Pancreatology 16 (2016) S1eS130 S14 pancreas. In addition, lack of Akt1 resulted in reduced a... more s / Pancreatology 16 (2016) S1eS130 S14 pancreas. In addition, lack of Akt1 resulted in reduced acinar cell proliferation and de-differentiation into acinar-to-ductal metaplasia. Molecular analyses revealed a down-regulation of TGF-b signaling in Akt1-/mice. Conclusion: Our results revealed that Akt1 signaling does not mediate the initial acinar cell damage observed at the onset of AP. However, Akt1 signaling promotes both the inflammatory response and the regeneration of the pancreatic tissue. These findings provide novel insights into the molecular pathways governing pancreatic inflammation and tissue regeneration, with potential therapeutic implications.
While liver transplantation was initially considered as a curative treatment modality only for he... more While liver transplantation was initially considered as a curative treatment modality only for hepatocellular carcinoma, the indication has been increasingly extended to other tumor entities over recent years, most recently to the treatment of non-resectable colorectal liver metastases. Although oncologic outcomes after liver transplantation (LT) are consistently good, organ shortage forces stringent selection of suitable candidates. Dynamic criteria based on tumor biology fulfill the prerequisite of an individual oncological prediction better than traditional morphometric criteria based on tumor burden. The availability of specific (neo-)adjuvant therapies and customized modern immunosuppression may further contribute to favorable post-transplantation outcomes on the one hand and simultaneously open the path to LT as a curative option for advanced stages of tumor patients. Herein, we provide an overview of the oncological LT indications, the selection process, and expected oncologi...
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