@article{DewulfDietzMontgomeryetal.2022, author = {Dewulf, Maxime and Dietz, Ulrich A. and Montgomery, Agneta and Pauli, Eric M. and Marturano, Matthew N. and Ayuso, Sullivan A. and Augenstein, Vedra A. and Lambrecht, Jan R. and K{\"o}hler, Gernot and Keller, Nicola and Wiegering, Armin and Muysoms, Filip}, title = {Robotic hernia surgery IV. English version}, series = {Chirurgie}, volume = {93}, journal = {Chirurgie}, number = {Suppl 2}, doi = {10.1007/s00104-022-01779-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323875}, pages = {S129-S140}, year = {2022}, abstract = {The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.}, language = {en} } @article{LenschowWennmannHendricksetal.2022, author = {Lenschow, Christina and Wennmann, Andreas and Hendricks, Anne and Germer, Christoph-Thomas and Fassnacht, Martin and Buck, Andreas and Werner, Rudolf A. and Plassmeier, Lars and Schlegel, Nicolas}, title = {Questionable value of [\(^{99m}\)Tc]-sestamibi scintigraphy in patients with pHPT and negative ultrasound}, series = {Langenbeck's Archives of Surgery}, volume = {407}, journal = {Langenbeck's Archives of Surgery}, number = {8}, doi = {10.1007/s00423-022-02648-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323926}, pages = {3661-3669}, year = {2022}, abstract = {Purpose A successful focused surgical approach in primary hyperparathyroidism (pHPT) relies on accurate preoperative localization of the parathyroid adenoma (PA). Most often, ultrasound is followed by [\(^{99m}\)Tc]-sestamibi scintigraphy, but the value of this approach is disputed. Here, we evaluated the diagnostic approach in patients with surgically treated pHPT in our center with the aim to further refine preoperative diagnostic procedures. Methods A single-center retrospective analysis of patients with pHPT from 01/2005 to 08/2021 was carried out followed by evaluation of the preoperative imaging modalities to localize PA. The localization of the PA had to be confirmed intraoperatively by the fresh frozen section and significant dropping of the intraoperative parathyroid hormone (PTH) levels. Results From 658 patients diagnosed with pHPT, 30 patients were excluded from the analysis because of surgery for recurrent or persistent disease. Median age of patients was 58.0 (13-93) years and 71\% were female. Neck ultrasound was carried out in 91.7\% and localized a PA in 76.6\%. In 23.4\% (135/576) of the patients, preoperative neck ultrasound did not detect a PA. In this group, [\(^{99m}\)Tc]-sestamibi correctly identified PA in only 25.4\% of patients. In contrast, in the same cohort, the use of [\(^{11}\)C]-methionine or [\(^{11}\)C]-choline PET resulted in the correct identification of PA in 79.4\% of patients (OR 13.23; 95\% CI 5.24-33.56). Conclusion [\(^{11}\)C]-Methionine or [\(^{11}\)C]-choline PET/CT are superior second-line imaging methods to select patients for a focused surgical approach when previous ultrasound failed to identify PA.}, language = {en} } @article{HeringDoerriesFlemmingetal.2022, author = {Hering, Ilona and D{\"o}rries, Luise and Flemming, Sven and Krietenstein, Laura and Koschker, Ann-Kathrin and Fassnacht, Martin and Germer, Christoph-Thomas and Hankir, Mohammed K. and Seyfried, Florian}, title = {Impact of preoperative weight loss achieved by gastric balloon on peri- and postoperative outcomes of bariatric surgery in super-obese patients: a retrospective matched-pair analysis}, series = {Langenbeck's Archives of Surgery}, volume = {407}, journal = {Langenbeck's Archives of Surgery}, number = {5}, doi = {10.1007/s00423-022-02472-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323909}, pages = {1873-1879}, year = {2022}, abstract = {Background An intragastric balloon is used to cause weight loss in super-obese patients (BMI > 60 kg/m\(^2\)) prior to bariatric surgery. Whether weight loss from intragastric balloon influences that from bariatric surgery is poorly studied. Methods In this retrospective, single-center study, the effects of intragastric balloon in 26 patients (BMI 69.26 ± 6.81) on weight loss after bariatric surgery (primary endpoint), postoperative complications within 30 days, hospital readmission, operation time, and MTL30 (secondary endpoints) were evaluated. Fifty-two matched-pair patients without intragastric balloon prior to bariatric surgery were used as controls. Results Intragastric balloon resulted in a weight loss of 17.3 ± 14.1 kg (BMI 5.75 ± 4.66 kg/m\(^2\)) with a nadir after 5 months. Surgical and postoperative outcomes including complications were comparable between both groups. Total weight loss was similar in both groups (29.0\% vs. 32.2\%, p = 0.362). Direct postoperative weight loss was more pronounced in the control group compared to the gastric balloon group (29.16 ± 7.53\% vs 23.78 ± 9.89\% after 1 year, p < 0.05 and 32.13 ± 10.5\% vs 22.21 ± 10.9\% after 2 years, p < 0.05), who experienced an earlier nadir and started to regain weight during the follow-up. Conclusion A multi-stage therapeutic approach with gastric balloon prior to bariatric surgery in super-obese patients may be effective to facilitate safe surgery. However, with the gastric balloon, pre-treated patients experienced an attenuated postoperative weight loss with an earlier nadir and earlier body weight regain. This should be considered when choosing the appropriate therapeutic regime and managing patients' expectations.}, language = {en} } @article{ReimerSeyfriedFlemmingetal.2022, author = {Reimer, Stanislaus and Seyfried, Florian and Flemming, Sven and Brand, Markus and Weich, Alexander and Widder, Anna and Plaßmeier, Lars and Kraus, Peter and D{\"o}ring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Lock, Johan F. and Groneberg, Kaja}, title = {Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study}, series = {Surgical Endoscopy}, volume = {36}, journal = {Surgical Endoscopy}, number = {12}, doi = {10.1007/s00464-022-09400-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323953}, pages = {9169-9178}, year = {2022}, abstract = {Background Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients' outcome. Methods All patients treated by EVT at our center during 2012-2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge. Results A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0\% (P = .006). EVT efficacy increased from 80 to 91\% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9\% (P = .013) and reoperations became less frequent (38.0\% vs.15.6\%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9\% vs. 84.4\%, P = .043). Conclusions Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.}, language = {en} } @article{ReibetanzKelmUttingeretal.2022, author = {Reibetanz, Joachim and Kelm, Matthias and Uttinger, Konstantin L. and Reuter, Miriam and Schlegel, Nicolas and Hankir, Mohamed and Wiegering, Verena and Germer, Christoph-Thomas and Fassnacht, Martin and Lock, Johan Friso and Wiegering, Armin}, title = {Differences in morbidity and mortality between unilateral adrenalectomy for adrenal Cushing's syndrome and bilateral adrenalectomy for therapy refractory extra-adrenal Cushing's syndrome}, series = {Langenbeck's Archives of Surgery}, volume = {407}, journal = {Langenbeck's Archives of Surgery}, number = {6}, doi = {10.1007/s00423-022-02568-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323947}, pages = {2481-2488}, year = {2022}, abstract = {Purpose In selected cases of severe Cushing's syndrome due to uncontrolled ACTH secretion, bilateral adrenalectomy appears unavoidable. Compared with unilateral adrenalectomy (for adrenal Cushing's syndrome), bilateral adrenalectomy has a perceived higher perioperative morbidity. The aim of the current study was to compare both interventions in endogenous Cushing's syndrome regarding postoperative outcomes. Methods We report a single-center, retrospective cohort study comparing patients with hypercortisolism undergoing bilateral vs. unilateral adrenalectomy during 2008-2021. Patients with adrenal Cushing's syndrome due to adenoma were compared with patients with ACTH-dependent Cushing's syndrome (Cushing's disease and ectopic ACTH production) focusing on postoperative morbidity and mortality as well as long-term survival. Results Of 83 patients with adrenalectomy for hypercortisolism (65.1\% female, median age 53 years), the indication for adrenalectomy was due to adrenal Cushing's syndrome in 60 patients (72.2\%; 59 unilateral and one bilateral), and due to hypercortisolism caused by Cushing's disease (n = 16) or non-pituitary uncontrolled ACTH secretion of unknown origin (n = 7) (27.7\% of all adrenalectomies). Compared with unilateral adrenalectomy (n = 59), patients with bilateral adrenalectomy (n = 24) had a higher rate of severe complications (0\% vs. 33\%; p < 0.001) and delayed recovery (median: 10.2\% vs. 79.2\%; p < 0.001). Using the MTL30 marker, patients with bilateral adrenalectomy fared worse than patients after unilateral surgery (MTL30 positive: 7.2\% vs. 25.0\% p < 0.001). Postoperative mortality was increased in patients with bilateral adrenalectomy (0\% vs. 8.3\%; p = 0.081). Conclusion While unilateral adrenalectomy for adrenal Cushing's syndrome represents a safe and definitive therapeutic option, bilateral adrenalectomy to control ACTH-dependent extra-adrenal Cushing's syndrome or Cushing's disease is a more complicated intervention with a mortality of nearly 10\%.}, language = {en} } @article{KoehlerReeseHendricksetal.2022, author = {K{\"o}hler, Franziska and Reese, Lena and Hendricks, Anne and Kastner, Carolin and M{\"u}ller, Sophie and Lock, Johan F. and Germer, Christoph-Thomas and Wiegering, Armin}, title = {Low-grade mucinous neoplasms (LAMN) of the appendix in Germany between 2011 and 2018: a nationwide analysis based on data provided by the German Center for Cancer Registry Data (ZfKD) at the Robert Koch Institute (RKI)}, series = {Langenbeck's Archives of Surgery}, volume = {407}, journal = {Langenbeck's Archives of Surgery}, number = {8}, doi = {10.1007/s00423-022-02639-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323919}, pages = {3615-3622}, year = {2022}, abstract = {Introduction Low-grade appendiceal mucinous neoplasms (LAMN) are semi-malignant tumors of the appendix which are incidentally found in up to 1\% of appendectomy specimen. To this day, no valid descriptive analysis on LAMN is available for the German population. Methods Data of LAMN (ICD-10: D37.3) were collected from the population-based cancer registries in Germany, provided by the German Center for Cancer Registry Data (Zentrum f{\"u}r Krebsregisterdaten—ZfKD). Data was anonymized and included gender, age at diagnosis, tumor staging according to the TNM-classification, state of residence, information on the performed therapy, and survival data. Results A total of 612 cases were reported to the ZfKD between 2011 and 2018. A total of 63.07\% were female and 36.93\% were male. Great inhomogeneity in reporting cases was seen in the federal states of Germany including the fact that some federal states did not report any cases at all. Age distribution showed a mean age of 62.03 years (SD 16.15) at diagnosis. However, data on tumor stage was only available in 24.86\% of cases (n = 152). A total of 49.34\% of these patients presented with a T4-stage. Likewise, information regarding performed therapy was available in the minority of patients: 269 patients received surgery, 22 did not and for 312 cases no information was available. Twenty-four patients received chemotherapy, 188 did not, and for 400 cases, no information was available. Overall 5-year survival was estimated at 79.52\%. Patients below the age of 55 years at time of diagnosis had a significantly higher 5-year survival rate compared to patients above the age of 55 years (85.77\% vs. 73.27\%). Discussion In this study, we observed an incidence of LAMN in 0.13\% of all appendectomy specimen in 2018. It seems likely that not all cases were reported to the ZfKD; therefore, case numbers may be considered underestimated. Age and gender distribution goes in line with international studies with females being predominantly affected. Especially regarding tumor stage and therapy in depth information cannot be provided through the ZfKD-database. This data analysis emphasizes the need for further studies and the need for setting up a specialized registry for this unique tumor entity to develop guidelines for the appropriate treatment and follow-up.}, language = {en} } @article{DewulfDietzMontgomeryetal.2022, author = {Dewulf, Maxime and Dietz, Ulrich A. and Montgomery, Agneta and Pauli, Eric M. and Marturano, Matthew N. and Ayuso, Sullivan A. and Augenstein, Vedra A. and Lambrecht, Jan R. and K{\"o}hler, Gernot and Keller, Nicola and Wiegering, Armin and Muysoms, Filip}, title = {Robotische Hernienchirurgie Teil IV : Roboterassistierte endoskopische parastomale Hernienversorgung. Videobericht und Ergebnisse}, series = {Chirurgie}, volume = {93}, journal = {Chirurgie}, number = {11}, doi = {10.1007/s00104-022-01715-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323882}, pages = {1051-1062}, year = {2022}, abstract = {Die chirurgische Behandlung parastomaler Hernien gilt als komplex und ist bekanntermaßen komplikationstr{\"a}chtig. In der Vergangenheit wurden diese Hernien durch die Relokation des Stomas oder Nahtverfahren der Austrittstelle versorgt. In den letzten Jahren wurden verschiedene netzbasierte Techniken vorgeschlagen, die heute in der minimal-invasiven Chirurgie eingesetzt werden. Mit der Verbreitung der roboterassistierten Hernienchirurgie wurden die Netzverfahren weiterentwickelt und die Ergebnisse f{\"u}r die Patienten erheblich verbessert. In diesem Beitrag wird ein {\"U}berblick {\"u}ber die verf{\"u}gbaren Techniken der roboterassistierten Versorgung parastomaler Hernien pr{\"a}sentiert. Es werden technische {\"U}berlegungen und erste Ergebnisse des roboterassistierten modifizierten Sugarbaker-Verfahrens, der roboterassistierten Pauli-Technik und der Verwendung des trichterf{\"o}rmigen Netzes IPST vorgestellt. Dar{\"u}ber hinaus werden die Herausforderungen bei der roboterassistierten Versorgung parastomaler Hernien am Ileum-Conduit diskutiert. Die Operationstechniken werden durch Foto- und Videomaterial veranschaulicht.}, language = {de} } @article{AngerLockKleinetal.2022, author = {Anger, Friedrich and Lock, Johan Friso and Klein, Ingo and Hartlapp, Ingo and Wiegering, Armin and Germer, Christoph-Thomas and Kunzmann, Volker and L{\"o}b, Stefan}, title = {Does concurrent cholestasis alter the prognostic value of preoperatively elevated CA19-9 serum levels in patients with pancreatic head adenocarcinoma?}, series = {Annals of Surgical Oncology}, volume = {29}, journal = {Annals of Surgical Oncology}, number = {13}, doi = {10.1245/s10434-022-12460-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323854}, pages = {8523-8533}, year = {2022}, abstract = {Background Pancreatic adenocarcinoma (PDAC) patients with preoperative carbohydrate antigen 19-9 (CA19-9) serum levels higher than 500 U/ml are classified as biologically borderline resectable (BR-B). To date, the impact of cholestasis on preoperative CA19-9 serum levels in these patients has remained unquantified. Methods Data on 3079 oncologic pancreatic resections due to PDAC that were prospectively acquired by the German Study, Documentation and Quality (StuDoQ) registry were analyzed in relation to preoperative CA19-9 and bilirubin serum values. Preoperative CA19-9 values were adjusted according to the results of a multivariable linear regression analysis of pathologic parameters, bilirubin, and CA19-9 values. Results Of 1703 PDAC patients with tumor located in the pancreatic head, 420 (24.5 \%) presented with a preoperative CA19-9 level higher than 500 U/ml. Although receiver operating characteristics (ROC) analysis failed to determine exact CA19-9 cut-off values for prognostic indicators (R and N status), the T, N, and G status; the UICC stage; and the number of simultaneous vein resections increased with the level of preoperative CA19-9, independently of concurrent cholestasis. After adjustment of preoperative CA19-9 values, 18.5 \% of patients initially staged as BR-B showed CA19-9 values below 500 U/ml. However, the postoperative pathologic results for these patients did not change compared with the patients who had CA19-9 levels higher than 500 U/ml after bilirubin adjustment. Conclusions In this multicenter dataset of PDAC patients, elevation of preoperative CA19-9 correlated with well-defined prognostic pathologic parameters. Bilirubin adjustment of CA19-9 is feasible but does not affect the prognostic value of CA19-9 in jaundiced patients.}, language = {en} } @article{GriebschKernHansenetal.2022, author = {Griebsch, Nora-Isabell and Kern, Johanna and Hansen, Jonas and Rullmann, Michael and Luthardt, Julia and Helfmeyer, Stephanie and Dekorsy, Franziska J. and Soeder, Marvin and Hankir, Mohammed K. and Zientek, Franziska and Becker, Georg-Alexander and Patt, Marianne and Meyer, Philipp M. and Dietrich, Arne and Bl{\"u}her, Matthias and Ding, Yu-Shin and Hilbert, Anja and Sabri, Osama and Hesse, Swen}, title = {Central serotonin/noradrenaline transporter availability and treatment success in patients with obesity}, series = {Brain Sciences}, volume = {12}, journal = {Brain Sciences}, number = {11}, issn = {2076-3425}, doi = {10.3390/brainsci12111437}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-290294}, year = {2022}, abstract = {Serotonin (5-hydroxytryptamine, 5-HT) as well as noradrenaline (NA) are key modulators of various fundamental brain functions including the control of appetite. While manipulations that alter brain serotoninergic signaling clearly affect body weight, studies implicating 5-HT transporters and NA transporters (5-HTT and NAT, respectively) as a main drug treatment target for human obesity have not been conclusive. The aim of this positron emission tomography (PET) study was to investigate how these central transporters are associated with changes of body weight after 6 months of dietary intervention or Roux-en-Y gastric bypass (RYGB) surgery in order to assess whether 5-HTT as well as NAT availability can predict weight loss and consequently treatment success. The study population consisted of two study cohorts using either the 5-HTT-selective radiotracer [\(^{11}\)C]DASB to measure 5-HTT availability or the NAT-selective radiotracer [\(^{11}\)C]MRB to assess NAT availability. Each group included non-obesity healthy participants, patients with severe obesity (body mass index, BMI, >35 kg/m\(^2\)) following a conservative dietary program (diet) and patients undergoing RYGB surgery within a 6-month follow-up. Overall, changes in BMI were not associated with changes of both 5-HTT and NAT availability, while 5-HTT availability in the dorsal raphe nucleus (DRN) prior to intervention was associated with substantial BMI reduction after RYGB surgery and inversely related with modest BMI reduction after diet. Taken together, the data of our study indicate that 5-HTT and NAT are involved in the pathomechanism of obesity and have the potential to serve as predictors of treatment outcomes.}, language = {en} } @article{KelmKusanSuratetal.2022, author = {Kelm, Matthias and Kusan, Simon and Surat, G{\"u}zin and Anger, Friedrich and Reibetanz, Joachim and Germer, Christoph-Thomas and Schlegel, Nicolas and Flemming, Sven}, title = {Disease- and medication-specific differences of the microbial spectrum in perianal fistulizing Crohn's Disease — relevant aspects for antibiotic therapy}, series = {Biomedicines}, volume = {10}, journal = {Biomedicines}, number = {11}, issn = {2227-9059}, doi = {10.3390/biomedicines10112682}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-290281}, year = {2022}, abstract = {Perianal fistulizing Crohn's Disease (CD) with abscess formation represents an aggressive phenotype in Inflammatory Bowel Disease (IBD) with increased morbidity. Treatment is multidisciplinary and includes antibiotics, but knowledge about the microbial spectrum is rare often resulting in inadequate antimicrobial therapy. In this single center retrospective study, all patients who were operated due to perianal abscess formation were retrospectively analyzed and the microbial spectrum evaluated. Patients were divided into a CD and non-CD group with further subgroup analysis. 138 patients were finally included in the analysis with 62 patients suffering from CD. Relevant differences were detected for the microbial spectrum with anaerobic bacteria being significantly more often isolated from non-CD patients. In a subgroup-analysis of CD patients only, medical therapy had a relevant effect on the microbial spectrum since Streptococcus groups and Enterobacterales were significantly more often isolated in patients treated with steroids compared to those being treated by antibodies. In conclusion, the microbial spectrum of patients suffering from CD varies significantly from non-CD patients and immunosuppressive medication has a relevant effect on isolated pathogens. Based on that, adaption of antibiotic treatment might be discussed in the future.}, language = {en} } @article{ReschkeSalvadorSchlegeletal.2022, author = {Reschke, Moritz and Salvador, Ellaine and Schlegel, Nicolas and Burek, Malgorzata and Karnati, Srikanth and Wunder, Christian and F{\"o}rster, Carola Y.}, title = {Isosteviol sodium (STVNA) reduces pro-inflammatory cytokine IL-6 and GM-CSF in an in vitro murine stroke model of the blood-brain barrier (BBB)}, series = {Pharmaceutics}, volume = {14}, journal = {Pharmaceutics}, number = {9}, issn = {1999-4923}, doi = {10.3390/pharmaceutics14091753}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286275}, year = {2022}, abstract = {Early treatment with glucocorticoids could help reduce both cytotoxic and vasogenic edema, leading to improved clinical outcome after stroke. In our previous study, isosteviol sodium (STVNA) demonstrated neuroprotective effects in an in vitro stroke model, which utilizes oxygen-glucose deprivation (OGD). Herein, we tested the hypothesis that STVNA can activate glucocorticoid receptor (GR) transcriptional activity in brain microvascular endothelial cells (BMECs) as previously published for T cells. STVNA exhibited no effects on transcriptional activation of the glucocorticoid receptor, contrary to previous reports in Jurkat cells. However, similar to dexamethasone, STVNA inhibited inflammatory marker IL-6 as well as granulocyte-macrophage colony-stimulating factor (GM-CSF) secretion. Based on these results, STVNA proves to be beneficial as a possible prevention and treatment modality for brain ischemia-reperfusion injury-induced blood-brain barrier (BBB) dysfunction.}, language = {en} } @article{SchickSchlegel2022, author = {Schick, Martin Alexander and Schlegel, Nicolas}, title = {Clinical implication of phosphodiesterase-4-inhibition}, series = {International Journal of Molecular Sciences}, volume = {23}, journal = {International Journal of Molecular Sciences}, number = {3}, issn = {1422-0067}, doi = {10.3390/ijms23031209}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284511}, year = {2022}, abstract = {The pleiotropic function of 3′,5′-cyclic adenosine monophosphate (cAMP)-dependent pathways in health and disease led to the development of pharmacological phosphodiesterase inhibitors (PDE-I) to attenuate cAMP degradation. While there are many isotypes of PDE, a predominant role of PDE4 is to regulate fundamental functions, including endothelial and epithelial barrier stability, modulation of inflammatory responses and cognitive and/or mood functions. This makes the use of PDE4-I an interesting tool for various therapeutic approaches. However, due to the presence of PDE4 in many tissues, there is a significant danger for serious side effects. Based on this, the aim of this review is to provide a comprehensive overview of the approaches and effects of PDE4-I for different therapeutic applications. In summary, despite many obstacles to use of PDE4-I for different therapeutic approaches, the current data warrant future research to utilize the therapeutic potential of phosphodiesterase 4 inhibition.}, language = {en} } @article{HankirBruneauJr2022, author = {Hankir, Mohammed Khair and Bruneau Jr., Michael}, title = {Periphery-brain interactions and leptin in the regulation of whole-body energy metabolism}, series = {Nutrients}, volume = {14}, journal = {Nutrients}, number = {8}, issn = {2072-6643}, doi = {10.3390/nu14081594}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-270581}, year = {2022}, abstract = {No abstract available}, language = {en} } @article{SuratMeyerSautterRueschetal.2022, author = {Surat, G{\"u}zin and Meyer-Sautter, Pascal and R{\"u}sch, Jan and Braun-Feldweg, Johannes and Markus, Christian Karl and Germer, Christoph-Thomas and Lock, Johan Friso}, title = {Cefazolin might be adequate for perioperative antibiotic prophylaxis in intra-abdominal infections without sepsis: a quality improvement study}, series = {Antibiotics}, volume = {11}, journal = {Antibiotics}, number = {4}, issn = {2079-6382}, doi = {10.3390/antibiotics11040501}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-270816}, year = {2022}, abstract = {Background: The adequate choice of perioperative antibiotic prophylaxis (PAP) could influence the risk of surgical site infections (SSIs) in general surgery. A new local PAP guideline was implemented in May 2017 and set the first-generation cefazolin (CFZ) instead the second-generation cefuroxime (CXM) as the new standard prophylactic antibiotic. The aim of this study was to compare the risk of SSIs after this implementation in intra-abdominal infections (IAIs) without sepsis. Methods: We performed a single center-quality improvement study at a 1500 bed sized university hospital in Germany analyzing patients after emergency surgery during 2016 to 2019 (n = 985), of which patients receiving CXM or CFZ were selected (n = 587). Propensity score matching was performed to ensure a comparable risk of SSIs in both groups. None-inferiority margin for SSIs was defined as 8\% vs. 4\%. Results: Two matched cohorts with respectively 196 patients were compared. The rate of SSIs was higher in the CFZ group (7.1\% vs. 3.6\%, p = 0.117) below the non-inferiority margin. The rate of other postoperative infections was significantly higher in the CFZ group (2.0\% vs. 8.7\%, p = 0.004). No other differences including postoperative morbidity, mortality or length-of-stay were observed. Conclusion: Perioperative antibiotic prophylaxis might be safely maintained by CFZ even in the treatment of intra-abdominal infections.}, language = {en} } @article{OttoKastnerSchmidtetal.2022, author = {Otto, Christoph and Kastner, Carolin and Schmidt, Stefanie and Uttinger, Konstantin and Baluapuri, Apoorva and Denk, Sarah and Rosenfeldt, Mathias T. and Rosenwald, Andreas and Roehrig, Florian and Ade, Carsten P. and Schuelein-Voelk, Christina and Diefenbacher, Markus E. and Germer, Christoph-Thomas and Wolf, Elmar and Eilers, Martin and Wiegering, Armin}, title = {RNA polymerase I inhibition induces terminal differentiation, growth arrest, and vulnerability to senolytics in colorectal cancer cells}, series = {Molecular Oncology}, volume = {16}, journal = {Molecular Oncology}, number = {15}, doi = {10.1002/1878-0261.13265}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312806}, pages = {2788-2809}, year = {2022}, abstract = {Ribosomal biogenesis and protein synthesis are deregulated in most cancers, suggesting that interfering with translation machinery may hold significant therapeutic potential. Here, we show that loss of the tumor suppressor adenomatous polyposis coli (APC), which constitutes the initiating event in the adenoma carcinoma sequence for colorectal cancer (CRC), induces the expression of RNA polymerase I (RNAPOL1) transcription machinery, and subsequently upregulates ribosomal DNA (rDNA) transcription. Targeting RNAPOL1 with a specific inhibitor, CX5461, disrupts nucleolar integrity, and induces a disbalance of ribosomal proteins. Surprisingly, CX5461-induced growth arrest is irreversible and exhibits features of senescence and terminal differentiation. Mechanistically, CX5461 promotes differentiation in an MYC-interacting zinc-finger protein 1 (MIZ1)- and retinoblastoma protein (Rb)-dependent manner. In addition, the inhibition of RNAPOL1 renders CRC cells vulnerable towards senolytic agents. We validated this therapeutic effect of CX5461 in murine- and patient-derived organoids, and in a xenograft mouse model. These results show that targeting ribosomal biogenesis together with targeting the consecutive, senescent phenotype using approved drugs is a new therapeutic approach, which can rapidly be transferred from bench to bedside.}, language = {en} } @article{DiersBaumLehmannetal.2022, author = {Diers, Johannes and Baum, Philip and Lehmann, Kai and Uttinger, Konstatin and Baumann, Nikolas and Pietryga, Sebastian and Hankir, Mohammed and Matthes, Niels and Lock, Johann F. and Germer, Christoph-Thomas and Wiegering, Armin}, title = {Disproportionately high failure to rescue rates after resection for colorectal cancer in the geriatric patient population - A nationwide study}, series = {Cancer Medicine}, volume = {11}, journal = {Cancer Medicine}, number = {22}, doi = {10.1002/cam4.4784}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312858}, pages = {4256-4264}, year = {2022}, abstract = {Background Colorectal cancer incidence increases with patient age. The aim of this study was to assess, at the nationwide level, in-hospital mortality, and failure to rescue in geriatric patients (≥ 80 years old) with colorectal cancer arising from postoperative complications. Methods All patients receiving surgery for colorectal cancer in Germany between 2012 and 2018 were identified in a nationwide database. Association between age and in-hospital mortality following surgery and failure to rescue, defined as death after complication, were determined in univariate and multivariate analyses. Results Three lakh twenty-eight thousands two hundred and ninety patients with colorectal cancer were included of whom 77,287 were 80 years or older. With increasing age, a significant relative increase in right hemicolectomy was observed. In general, these patients had more comorbid conditions and higher frailty. In-hospital mortality following colorectal cancer surgery was 4.9\% but geriatric patients displayed a significantly higher postoperative in-hospital mortality of 10.6\%. The overall postoperative complication rate as well as failure to rescue increased with age. In contrast, surgical site infection (SSI) and anastomotic leakage (AL) did not increase in geriatric patients, whereas the associated mortality increased disproportionately (13.3\% for SSI and 29.9\% mortality for patients with AI, both p < 0.001). Logistic regression analysis adjusting for confounders showed that geriatric patients had almost five-times higher odds for death after surgery than the baseline age group below 60 (OR 4.86; 95\%CI [4.45-5.53], p < 0.001). Conclusion Geriatric patients have higher mortality after colorectal cancer surgery. This may be partly due to higher frailty and disproportionately higher rates of failure to rescue arising from postoperative complications.}, language = {en} } @article{DiersAcarWagneretal.2022, author = {Diers, Johannes and Acar, Laura and Wagner, Johanna C. and Baum, Philip and Hankir, Mohammed and Flemming, Sven and Kastner, Carolin and Germer, Christoph-Thomas and L'hoest, Helmut and Marschall, Ursula and Lock, Johan Friso and Wiegering, Armin}, title = {Cancer diagnosis is one quarter lower than the expected cancer incidence in the first year of COVID-19 pandemic in Germany: A retrospective register-based cohort study}, series = {Cancer Communications}, volume = {42}, journal = {Cancer Communications}, number = {7}, doi = {10.1002/cac2.12314}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312862}, pages = {673-676}, year = {2022}, abstract = {No abstract available.}, language = {en} } @article{KelmReibetanzKimetal.2022, author = {Kelm, Matthias and Reibetanz, Joachim and Kim, Mia and Schoettker, Kathrin and Brand, Markus and Meining, Alexander and Germer, Christoph-Thomas and Flemming, Sven}, title = {Kono-S anastomosis in Crohn's disease: A retrospective study on postoperative morbidity and disease recurrence in comparison to the conventional side-to-side anastomosis}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {23}, issn = {2077-0383}, doi = {10.3390/jcm11236915}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297334}, year = {2022}, abstract = {Introduction: The rates of postoperative recurrence following ileocecal resection due to Crohn's disease remain highly relevant. Despite this fact, while the Kono-S anastomosis technique initially demonstrated promising results, robust evidence is still lacking. This study aimed to analyze the short- and long-term outcomes of the Kono-S versus side-to-side anastomosis. Methods: A retrospective single-center study was performed including all patients who received an ileocecal resection between 1 January 2019 and 31 December 2021 at the Department of Surgery at the University Hospital of Wuerzburg. Patients who underwent conventional a side-to-side anastomosis were compared to those who received a Kono-S anastomosis. The short- and long-term outcomes were analyzed for all patients. Results: Here, 29 patients who underwent a conventional side-to-side anastomosis and 22 patients who underwent a Kono-S anastomosis were included. No differences were observed regarding short-term postoperative outcomes. The disease recurrence rate postoperatively was numerically lower following the Kono-S anastomosis (median Rutgeert score of 1.7 versus 2.5), with a relevantly increased rate of patients in remission (17.2\% versus 31.8\%); however, neither of these results reached statistical significance. Conclusion: The Kono-S anastomosis method is safe and feasible and potentially decreases the severity of postoperative disease remission.}, language = {en} } @article{WidderKelmReibetanzetal.2022, author = {Widder, Anna and Kelm, Matthias and Reibetanz, Joachim and Wiegering, Armin and Matthes, Niels and Germer, Christoph-Thomas and Seyfried, Florian and Flemming, Sven}, title = {Robotic-assisted versus laparoscopic left hemicolectomy — postoperative inflammation status, short-term outcome and cost effectiveness}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {17}, issn = {1660-4601}, doi = {10.3390/ijerph191710606}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286203}, year = {2022}, abstract = {Robotic-assisted colon surgery may contain advantages over the laparoscopic approach, but clear evidence is sparse. This study aimed to analyze postoperative inflammation status, short-term outcome and cost-effectiveness of robotic-assisted versus laparoscopic left hemicolectomy. All consecutive patients who received minimal-invasive left hemicolectomy at the Department of Surgery I at the University Hospital of Wuerzburg in 2021 were prospectively included. Importantly, no patient selection for either procedure was carried out. The robotic-assisted versus laparoscopic approaches were compared head to head for postoperative short-term outcomes as well as cost-effectiveness. A total of 61 patients were included, with 26 patients having received a robotic-assisted approach. Baseline characteristics did not differ among the groups. Patients receiving a robotic-assisted approach had a significantly decreased length of hospital stay as well as lower rates of complications in comparison to patients who received laparoscopic surgery (n = 35). In addition, C-reactive protein as a marker of systemic stress response was significantly reduced postoperatively in patients who were operated on in a robotic-assisted manner. Consequently, robotic-assisted surgery could be performed in a cost-effective manner. Thus, robotic-assisted left hemicolectomy represents a safe and cost-effective procedure and might improve patient outcomes in comparison to laparoscopic surgery.}, language = {en} } @article{KusanSuratKelmetal.2022, author = {Kusan, Simon and Surat, G{\"u}zin and Kelm, Matthias and Anger, Friedrich and Kim, Mia and Germer, Christoph-Thomas and Schlegel, Nicolas and Flemming, Sven}, title = {Microbial spectrum and antibiotic resistance in patients suffering from penetrating Crohn's disease}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {15}, issn = {2077-0383}, doi = {10.3390/jcm11154343}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281835}, year = {2022}, abstract = {Intraabdominal abscess formation occurs in up to 30\% of patients suffering from Crohn's disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.}, language = {en} } @article{ZaitsevaHoffmannOttoetal.2022, author = {Zaitseva, Olena and Hoffmann, Annett and Otto, Christoph and Wajant, Harald}, title = {Targeting fibroblast growth factor (FGF)-inducible 14 (Fn14) for tumor therapy}, series = {Frontiers in Pharmacology}, volume = {13}, journal = {Frontiers in Pharmacology}, issn = {1663-9812}, doi = {10.3389/fphar.2022.935086}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-290238}, year = {2022}, abstract = {Fibroblast growth factor-inducible 14 (Fn14) is a member of the tumor necrosis factor (TNF) receptor superfamily (TNFRSF) and is activated by its ligand TNF-like weak inducer of apoptosis (TWEAK). The latter occurs as a homotrimeric molecule in a soluble and a membrane-bound form. Soluble TWEAK (sTWEAK) activates the weakly inflammatory alternative NF-κB pathway and sensitizes for TNF-induced cell death while membrane TWEAK (memTWEAK) triggers additionally robust activation of the classical NF-κB pathway and various MAP kinase cascades. Fn14 expression is limited in adult organisms but becomes strongly induced in non-hematopoietic cells by a variety of growth factors, cytokines and physical stressors (e.g., hypoxia, irradiation). Since all these Fn14-inducing factors are frequently also present in the tumor microenvironment, Fn14 is regularly found to be expressed by non-hematopoietic cells of the tumor microenvironment and most solid tumor cells. In general, there are three possibilities how the tumor-Fn14 linkage could be taken into consideration for tumor therapy. First, by exploitation of the cancer associated expression of Fn14 to direct cytotoxic activities (antibody-dependent cell-mediated cytotoxicity (ADCC), cytotoxic payloads, CAR T-cells) to the tumor, second by blockade of potential protumoral activities of the TWEAK/Fn14 system, and third, by stimulation of Fn14 which not only triggers proinflammtory activities but also sensitizes cells for apoptotic and necroptotic cell death. Based on a brief description of the biology of the TWEAK/Fn14 system and Fn14 signaling, we discuss the features of the most relevant Fn14-targeting biologicals and review the preclinical data obtained with these reagents. In particular, we address problems and limitations which became evident in the preclinical studies with Fn14-targeting biologicals and debate possibilities how they could be overcome.}, language = {en} } @article{KoehlerReeseKastneretal.2022, author = {K{\"o}hler, Franziska and Reese, Lena and Kastner, Carolin and Hendricks, Anne and M{\"u}ller, Sophie and Lock, Johan F. and Germer, Christoph-Thomas and Wiegering, Armin}, title = {Surgical site infection following single-port appendectomy: a systematic review of the literature and meta-analysis}, series = {Frontiers in Surgery}, volume = {9}, journal = {Frontiers in Surgery}, issn = {2296-875X}, doi = {10.3389/fsurg.2022.919744}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-276943}, year = {2022}, abstract = {Introduction Surgical site infections (SSIs) are one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have been published on the effect of open versus conventional laparoscopic appendectomy (CLA) reporting faster postoperative recovery and less postoperative pain for CLA. A development from CLA has been the single-port appendectomy (SPA), associated with a better cosmesis but seemingly having a higher risk of wound infections. The aim of this systematic literature review and meta-analysis is to investigate whether reduced port or SPA alters the ratio of SSIs. Methods Pubmed, Embase, and Cochrane databases were screened for suitable articles. All articles published between January 1, 2002, and March 23, 2022, were included. Articles regarding children below the age of 18 were excluded as well as manuscripts that investigated solemnly open appendectomies. Articles were screened for inclusion criteria by two independent authors. Incidence of SSI was the primary outcome. Duration of operation and length of hospital stay were defined as secondary outcomes. Results A total of 25 studies were found through a database search describing 5484 patients. A total of 2749 patients received SPA and 2735 received CLA. There was no statistical difference in the rate of SSI (P = 0.98). A total of 22 studies including 4699 patients reported the duration of operation (2223 SPA and 2476 CLA). There was a significantly shorter operation time seen in CLA. The length of hospital stay was reported in 23 studies (4735 patients: 2235 SPA and 2500 CLA). A shorter hospital stay was seen in the SPA group (P < 0.00001). Separately performed analysis of randomized controlled trials could not confirm this effect (P = 0.29). Discussion SPA is an equally safe procedure considering SSI compared to CLA and does not lead to an increased risk of SSI. A longer operation time for SPA and a minor difference in the length of stay does lead to the use of SPA in selected patients only.}, language = {en} } @article{UttingerRiedmeierReibetanzetal.2022, author = {Uttinger, Konstantin L. and Riedmeier, Maria and Reibetanz, Joachim and Meyer, Thomas and Germer, Christoph Thomas and Fassnacht, Martin and Wiegering, Armin and Wiegering, Verena}, title = {Adrenalectomies in children and adolescents in Germany - a diagnose related groups based analysis from 2009-2017}, series = {Frontiers in Endocrinology}, volume = {13}, journal = {Frontiers in Endocrinology}, issn = {1664-2392}, doi = {10.3389/fendo.2022.914449}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282280}, year = {2022}, abstract = {Background Adrenalectomies are rare procedures especially in childhood. So far, no large cohort study on this topic has been published with data on to age distribution, operative procedures, hospital volume and operative outcome. Methods This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes) of patients between the age 0 and 21 years in Germany were included. Results A total of 523 patient records were identified. The mean age was 8.6 ± 7.7 years and 262 patients were female (50.1\%). The majority of patients were between 0 and 5 years old (52\% overall), while 11.1\% were between 6 and 11 and 38.8\% older than 12 years. The most common diagnoses were malignant neoplasms of the adrenal gland (56\%, mostly neuroblastoma) with the majority being younger than 5 years. Benign neoplasms in the adrenal gland (D350) account for 29\% of all cases with the majority of affected patients being 12 years or older. 15\% were not defined regarding tumor behavior. Overall complication rate was 27\% with a clear higher complication rate in resection for malignant neoplasia of the adrenal gland. Bleeding occurrence and transfusions are the main complications, followed by the necessary of relaparotomy. There was an uneven patient distribution between hospital tertiles (low volume, medium and high volume tertile). While 164 patients received surgery in 85 different "low volume" hospitals (0.2 cases per hospital per year), 205 patients received surgery in 8 different "high volume" hospitals (2.8 cases per hospital per year; p<0.001). Patients in high volume centers were significant younger, had more extended resections and more often malignant neoplasia. In multivariable analysis younger age, extended resections and open procedures were independent predictors for occurrence of postoperative complications. Conclusion Overall complication rate of adrenalectomies in the pediatric population in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a very uneven distribution of patient volume among hospitals.}, language = {en} } @article{KelmAnger2022, author = {Kelm, Matthias and Anger, Friedrich}, title = {Mucosa and microbiota - the role of intrinsic parameters on intestinal wound healing}, series = {Frontiers in Surgery}, volume = {9}, journal = {Frontiers in Surgery}, issn = {2296-875X}, doi = {10.3389/fsurg.2022.905049}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282096}, year = {2022}, abstract = {Mucosal healing in the gut is an essential process when it comes to chronic inflammatory disorders such as inflammatory bowel diseases (IBD) but also to the creation of intestinal anastomosis. Despite an improvement of surgical techniques, the rates of anastomotic leakage remain substantial and represent a significant health-care and socio-economic burden. Recent research has focused on intrinsic factors such as mucosal linings and differences in the intestinal microbiota and identified specific endoluminal bacteria and epithelial proteins which influence intestinal wound healing and re-establishment of mucosal homeostasis. Despite the lack of large clinical studies, previous data indicate that the identified bacteria such as aerotolerant lactobacilli or wound-associated Akkermansia muciniphila as well as epithelial-expressed sialyl Lewis glycans or CD47 might be critical for wound and anastomotic healing in the gut, thus, providing a potential novel approach for future treatment strategies in colorectal surgery and IBD therapy. Since microbiota and mucosa are interacting closely, we outline the current discoveries about both subsets in this review together to demonstrate the significant interplay}, language = {en} } @article{ReimerLockFlemmingetal.2022, author = {Reimer, Stanislaus and Lock, Johan F. and Flemming, Sven and Weich, Alexander and Widder, Anna and Plaßmeier, Lars and D{\"o}ring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Groneberg, Kaja and Seyfried, Florian}, title = {Endoscopic management of large leakages after upper gastrointestinal surgery}, series = {Frontiers in Surgery}, volume = {9}, journal = {Frontiers in Surgery}, issn = {2296-875X}, doi = {10.3389/fsurg.2022.885244}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-274044}, year = {2022}, abstract = {Background Endoscopic vacuum therapy (EVT) is an evidence-based option to treat anastomotic leakages of the upper gastrointestinal (GI) tract, but the technical challenges and clinical outcomes of patients with large defects remain poorly described. Methods All patients with leakages of the upper GI tract that were treated with endoscopic negative pressure therapy at our institution from 2012-2021 were analyzed. Patients with large defects (>30 mm) as an indicator of complex treatment were compared to patients with smaller defects (control group). Results Ninety-two patients with postoperative anastomotic or staplerline leakages were identified, of whom 20 (21.7\%) had large defects. Compared to the control group, these patients required prolonged therapy (42 vs. 14 days, p < 0.001) and hospital stay (63 vs. 26 days, p < 0.001) and developed significantly more septic complications (40 vs. 17.6\%, p = 0.027.) which often necessitated additional endoscopic and/or surgical/interventional treatments (45 vs. 17.4\%, p = 0.007.) Nevertheless, a resolution of leakages was achieved in 80\% of patients with large defects, which was similar compared to the control group (p = 0.42). Multiple leakages, especially on the opposite side, along with other local unfavorable conditions, such as foreign material mass, limited access to the defect or extensive necrosis occurred significantly more often in cases with large defects (p < 0.001). Conclusions Overall, our study confirms that EVT for leakages even from large defects of the upper GI tract is feasible in most cases but comes with significant technical challenges.}, language = {en} } @article{HendricksMeirHankiretal.2022, author = {Hendricks, Anne and Meir, Michael and Hankir, Mohammed and Lenschow, Christina and Germer, Christoph-Thomas and Schneider, Michael and Wiegering, Armin and Schlegel, Nicolas}, title = {Suppurative thyroiditis caused by ingested fish bone in the thyroid gland: a case report on its diagnostics and surgical therapy}, series = {BMC Surgery}, volume = {22}, journal = {BMC Surgery}, number = {1}, doi = {10.1186/s12893-022-01542-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299775}, year = {2022}, abstract = {Background Accidental ingestion of fish bone is a common cause of otolaryngological emergency. Migration of the ingested bone into the thyroid gland, however, occurs very rarely. The associated clinical presentation, symptoms and duration of discomfort are also highly variable between patients and can be diagnostically challenging. Case presentation Here, we report the case of a 71-year-old female patient presenting with an ingested fish bone that migrated into the right thyroid lobe as a rare cause of suppurative thyroiditis with the clinical features of sepsis. We outline the diagnostic approach, peri- and intraoperative management as well as complications. It is proposed that besides endoscopy, imaging methods such as ultrasound or computed tomography may be necessary to verify the diagnosis and location of an ingested fish bone. Prompt surgical removal of the foreign body and resection of the infectious focus is recommended to minimize the risk of local inflammation, recurrent nerve lesions and septic complications arising from the spread of infection. Conclusion Fish bone migration into the thyroid gland is an extremely rare event, the successful detection and surgical management of which can be achieved through a careful interdisciplinary approach.}, language = {en} } @phdthesis{OsterholtgebCallies2022, author = {Osterholt [geb. Callies], Simone Caroline}, title = {Die Bedeutung von tumorzellassoziierter CD137L-Aktivierung f{\"u}r das Proliferationsverhalten und das Proteinexpressions- und -sekretionsprofil von humanen Kolonkarzinomzellen}, doi = {10.25972/OPUS-29338}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-293382}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {CD137 und CD137L stellen ein Rezeptor-Liganden-Paar dar, welches auf vielen Immunzellen exprimiert wird und eine wichtige Rolle im Rahmen der Immunstimulation spielt. CD137L fungiert jedoch nicht nur als Ligand sondern auch als Rezeptor und vermittelt als ein solcher Signale in die ihn exprimierende Zelle. Neben seinem Vorkommen auf Immunzellen wird CD137L auch von einigen Tumorzellen exprimiert, unter anderem auch auf denen des Kolonkarzinoms. In dieser Tumorentit{\"a}t korreliert eine hohe CD137L-Expression mit dem Auftreten von Fernmetastasen und einer insgesamt schlechteren Prognose. Die genaue Rolle von CD137L im Kolonkarzinom ist bislang kaum erforscht. Im Rahmen dieser Arbeit wurden daher die Auswirkungen einer CD137L-Aktivierung auf die Proliferation sowie die Proteinexpression und -sekretion von Kolonkarzinomzellen untersucht. Die Ergebnisse deuten erstmals darauf hin, dass die CD137L-Stimulation in vitro die Proliferation der entarteten Zellen reduziert und die Expression bzw. Sekretion der Proteine Vimentin, TLR7, VEGF und PDGF steigert. Hieraus wird geschlossen, dass eine Stimulation des von den Kolonkarzinomzellen exprimierten CD137L dazu f{\"u}hrt, dass sich der Ph{\"a}notyp der Tumorzellen von einem epithelialen in Richtung eines mesenchymalen Zelltyps ver{\"a}ndert. Dar{\"u}ber hinaus werden vermehrt Proteine exprimiert und sezerniert, welche {\"u}ber unterschiedliche Signalwege an der Invasion und Migration der entarteten Zellen beteiligt sind. Folglich l{\"a}sst sich annehmen, dass CD137L eine entscheidende Rolle im Metastasierungsprozess von humanen Kolonkarzinomzellen spielt. Sollte sich dies in weiterf{\"u}hrenden Untersuchungen best{\"a}tigen, k{\"o}nnte eine pharmazeutische Beeinflussung der beteiligten Signalwege m{\"o}glicherweise die Prognose von an Kolonkarzinomen erkrankten Patient:innen deutlich verbessern.}, subject = {Colonkrebs}, language = {de} } @article{HendricksMuellerFassnachtetal.2022, author = {Hendricks, Anne and M{\"u}ller, Sophie and Fassnacht, Martin and Germer, Christoph-Thomas and Wiegering, Verena A. and Wiegering, Armin and Reibetanz, Joachim}, title = {Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma — a systematic review and meta-analysis}, series = {Cancers}, volume = {14}, journal = {Cancers}, number = {2}, issn = {2072-6694}, doi = {10.3390/cancers14020291}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254798}, year = {2022}, abstract = {(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I-III) and those including all tumor stages (I-IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001-2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I-III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95\% confidence interval (95\% CI): 0.26-0.68). Based on results of studies including patients with ACC stage I-IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95\% CI: 0.70-1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I-III).}, language = {en} } @article{MetznerHerzogHeckeletal.2022, author = {Metzner, Valentin and Herzog, Gloria and Heckel, Tobias and Bischler, Thorsten and Hasinger, Julia and Otto, Christoph and Fassnacht, Martin and Geier, Andreas and Seyfried, Florian and Dischinger, Ulrich}, title = {Liraglutide + PYY\(_{3-36}\) combination therapy mimics effects of Roux-en-Y bypass on early NAFLD whilst lacking-behind in metabolic improvements}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {3}, issn = {2077-0383}, doi = {10.3390/jcm11030753}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-255244}, year = {2022}, abstract = {Background: Treatment options for NAFLD are still limited. Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB), has been shown to improve metabolic and histologic markers of NAFLD. Glucagon-like-peptide-1 (GLP-1) analogues lead to improvements in phase 2 clinical trials. We directly compared the effects of RYGB with a treatment using liraglutide and/or peptide tyrosine tyrosine 3-36 (PYY\(_{3-36}\)) in a rat model for early NAFLD. Methods: Obese male Wistar rats (high-fat diet (HFD)-induced) were randomized into the following treatment groups: RYGB, sham-operation (sham), liraglutide (0.4 mg/kg/day), PYY\(_{3-36}\) (0.1 mg/kg/day), liraglutide+PYY\(_{3-36}\), and saline. After an observation period of 4 weeks, liver samples were histologically evaluated, ELISAs and RNA sequencing + RT-qPCRs were performed. Results: RYGB and liraglutide+PYY\(_{3-36}\) induced a similar body weight loss and, compared to sham/saline, marked histological improvements with significantly less steatosis. However, only RYGB induced significant metabolic improvements (e.g., adiponectin/leptin ratio 18.8 ± 11.8 vs. 2.4 ± 1.2 in liraglutide+PYY\(_{3-36}\)- or 1.4 ± 0.9 in sham-treated rats). Furthermore, RNA sequencing revealed a high number of differentially regulated genes in RYGB treated animals only. Conclusions: The combination therapy of liraglutide+PYY\(_{3-36}\) partly mimics the positive effects of RYGB on weight reduction and on hepatic steatosis, while its effects on metabolic function lack behind RYGB.}, language = {en} } @phdthesis{ChristagebLudwig2022, author = {Christa [geb. Ludwig], Natalie Yvonne}, title = {Persistierender Urachus - h{\"a}ufiger als gedacht? Eine retrospektive Datenanalyse}, doi = {10.25972/OPUS-28743}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287438}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Eine retrospektive Datenanalyse der Urachusoperationen von 2009- 2019 an der Kinderchirurgischen Klinik des Universit{\"a}tsklinikums in W{\"u}rzburg. Es zeigte sich, dass der Urachus h{\"a}ufiger als gedacht vorkommt und dies oft als intraoperativer Zufallsbefund.}, subject = {Urachus}, language = {de} } @phdthesis{Zeeb2022, author = {Zeeb, Luisa}, title = {Bedeutung der Expression von MMP-1 und MMP-13 beim Barrett assoziierten Adenokarzinom}, doi = {10.25972/OPUS-27872}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-278723}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Es wird vermutet, dass das {\"o}sophageale Adenokarzinom (EAC) durch gastroosophagealen Reflux auf dem Boden des Barrett-{\"O}sophagus (BE) entsteht. Bei der Tumorprogression k{\"o}nnten Matrix-Metalloproteasen eine wichtige Rolle spielen. Die Expression von MMP-1 und MMP-13 wurde im {\"O}sophaguskarziom (n=41 EAC mit BE, n=19 EAC ohne BE, n=10 Plattenepithelkarzinom, ESCC) sowie im nicht-dysplastischen BE (n=18) untersucht. Die Koexpression von MMP-1 und Cdx-2 (intestinale Metaplasie) und die Koexpression von MMP-1 und Ki-67 (Proliferation) wurde mittels Immunhistochemie und auf mRNA-Ebene untersucht. Die Ergebnisse wurde mit klinisch-pathologischen Eigenschaften korreliert. Im gesunden Plattenepithel wurde weder MMP-1 noch MMP-13 exprimiert. In allen EAC ohne BE wurde MMP-1 exprimiert (100\%). Im EAC mit BE, war in 95\% MMP-1 im EAC nachweisbar. Die Expression von MMP-1 im BE ohne IN lag bei 56\%. Das ESCC exprimierte in 60\% MMP-1. Bei der quantitativen Analyse zeigten sich 48\% MMP-1 positive Zellen im EAC mit BE und 35\% im angrenzendem BE (p<0,05). Mit 44\% MMP-1 positiver Zellen im EAC ohne BE, lag die Expression signifikant {\"u}ber der im BE mit EAC (p<0,05). Im ESCC (32\% MMP-1 positiv) lag eine im Vergleich zu allen EACs signifikant geringere Expression vor. Im BE ohne IN waren 4\% der Zellen MMP-1 positiv. Die RT-PCR best{\"a}tigte die Ergebnisse der IHC auf mRNA-Ebene. Eine Pr{\"a}parate waren negativ f{\"u}r MMP-13. Die Untersuchung der Koexpression von MMP-1 in Ki-67 positiven Zellen zeigte eine starke direkte Korrelation (r=0,943 f{\"u}r BE und r= 0,811 f{\"u}r EAC). Eine hohe MMP-1 Expression war mit einem positiven Lymphknotenstatus assoziiert aber nicht mit einem schlechterem {\"U}berleben (p=0,307). Die Ergebnisse zeigen, dass MMP-1 eine wichtige Rolle bei der Invasion und Metastasierung des Barrett assoziierten EAC spielen k{\"o}nnte. Die Assoziation eines positiven Lymphknotenstatus mit hoher MMP-1-Expression spricht daf{\"u}r, dass MMP-1 ein wichtiger Faktor bei der malignen Progression sein k{\"o}nnte.}, subject = {Adenocarcinom}, language = {de} } @phdthesis{Doering2022, author = {D{\"o}ring, Anna Maria}, title = {Einfluss der minimalen Distanz zwischen Tumor und Resektatrand auf die Prognose kurativ resezierter Patienten mit hepatocellul{\"a}rem Carcinom}, doi = {10.25972/OPUS-27668}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-276687}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Dies ist eine retrospektive unizentrische Analyse um den Einfluss des Resektionsabstandes auf prognostische Faktoren wie das rezidivfreie und Gesamt{\"u}berleben bei Patienten mit hepatocellul{\"a}ren Carcinom zu untersuchen. Es ließ sich kein Vorteil eines weiten (>5mm) tumorfreien Abstands zum Resektatrand gegen{\"u}ber einem schmalen (5mm) tumorfreien Abstand nachweisen. Allerdings wurden andere tumor- und patientenspezifische unabh{\"a}ngige Risikofaktoren f{\"u}r das rezidivfreie und Gesamt{\"u}berleben identifiziert. So ist ein pr{\"a}operativer AFP-Wert >15µg/l mit einem signifikant schlechteren krankheitsfreien und Gesamt{\"u}berleben assoziiert. Ebenso haben schlecht differenzierte (G3) HCCs, sowie HCC mit einer vaskul{\"a}ren Invasion (V1/V2) ein deutlich reduziertes rezidivfreies {\"U}berleben. Auch eine Tumorgr{\"o}ße >5cm war in dieser Studie ein unabh{\"a}ngiger Risikofaktor f{\"u}r ein verk{\"u}rztes Gesamt{\"u}berleben.}, subject = {Leberzellkrebs}, language = {de} } @phdthesis{Doerries2022, author = {D{\"o}rries, Luise}, title = {Einfluss der pr{\"a}operativen Konditionierung mittels Magenballon vor bariatrischer Operation auf den Therapieerfolg bei extremer Adipositas - Eine retrospektive Vergleichsstudie}, doi = {10.25972/OPUS-27294}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-272945}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die Adipositaschirurgie ist die effektivste Methode in der Behandlung der Adipositas. Bei extrem adip{\"o}sen Patientin ist eine prim{\"a}re Operation oftmals riskant. Die Anlage eines Magenballons als erster Schritt von Mehrstufenkonzepten kann die Operabilit{\"a}t gew{\"a}hrleisten und die perioperative Sicherheit erh{\"o}hen. Durch den Magenballon wird ein signifikanter Gewichtsverlust erreicht. Der postoperative Gewichtsverlust f{\"a}llt allerdings schw{\"a}cher aus. Es ist wichtig, den Patienten realistische Therapieergebnisse zu vermitteln, um {\"u}berh{\"o}hte Erwartungen und Unzufriedenheit zu vermeiden. Die Sleevegastrektomie eignet sich besonders f{\"u}r extrem adip{\"o}se Patienten, da diese eine geringere Komplikationsrate aufweist und einfach in einen Roux-en-Y Bypass umzuwandeln ist.}, subject = {Sleeve-Resektion}, language = {de} } @phdthesis{Widder2022, author = {Widder, Anna Ursula}, title = {Einfluss unterschiedlicher Lehrmethoden zum Vermitteln laparoskopischer Fertigkeiten - eine randomisierte, kontrollierte Studie}, doi = {10.25972/OPUS-27186}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-271869}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Hintergrund. Training an Simulatoren ist eine effektive Methode zum Erlernen laparoskopischer Fertigkeiten. Dennoch besteht weiterhin die Notwendigkeit, Lehrmethoden zu optimieren, um praktischen {\"U}bungsaufwand zu reduzieren. In dieser Studie wurde die Auswirkung der mentalen {\"U}bung "deconstruction into key steps" (DIKS) auf die f{\"u}r den Erwerb laparoskopischer Fertigkeiten ben{\"o}tigte Zeit untersucht. Methoden. Medizinstudierende des 10. Fachsemesters nahmen an einem Laparoskopiekurs teil und wurden in zwei Gruppen randomisiert. Dabei wurde in der Experimentalgruppe (EG) eine Verk{\"u}rzung der praktischen {\"U}bungszeit um 58\% im Vergleich zur KG zu Gunsten des mentalen Trainings DIKS untersucht. Die laparoskopischen Eingangsfertigkeiten wurden an Simulatoren getestet (t0). Anschließend wurde der Lernerfolg in einer zweiten Pr{\"u}fung kontrolliert (t1). Nach neun Tagen erfolgte eine dritte Pr{\"u}fung (t2). Alle Messzeitpunkte wurden per Videomittschnitt nach validierten Kriterien bewertet. Potenzielle Pr{\"a}diktoren wurden mit Hilfe eines Fragebogens standardisiert erhoben. Ergebnisse. Sowohl die EG (n=58) als auch die KG (n=58) wiesen einen signifikanten Lernzuwachs auf (p<0,001). Es zeichnete sich jedoch ein signifikanter Unterschied im Lernzuwachs in bestimmten Zeitabschnitten ab. Die KG zeigte einen signifikant h{\"o}heren Lernzuwachs von t0-t1. Nach einer Woche wurde der Vorsprung der KG bei einem signifikant besseren Lernzuwachs der EG im zweiten Abschnitt egalisiert. Motivierte sowie geschickte Studierende zeigten eine signifikant bessere Leistung in Qualit{\"a}t und Quantit{\"a}t. M{\"a}nnern war es m{\"o}glich eine signifikant bessere Leistung in Qualit{\"a}t und Quantit{\"a}t zu erzielen. Schlussfolgerung. W{\"a}hrend initial ein verl{\"a}ngertes praktisches {\"U}ben zu einer unmittelbaren Leistungssteigerung f{\"u}hrte, wurde durch die zus{\"a}tzliche mentale {\"U}bung 'DIKS' bei gleichzeitig verk{\"u}rzter praktischer {\"U}bungszeit ein gleichwertiges Ergebnis erreicht.}, subject = {Laparoskopie}, language = {de} } @phdthesis{Nordbeck2022, author = {Nordbeck, Arno Wilhelm}, title = {Roux-en-Y Magenbypass spezifische metabolomische Ver{\"a}nderungen in Urin, Faeces und Plasma - Charakterisierung im Zucker (fa/fa) Rattenmodel}, doi = {10.25972/OPUS-26869}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-268694}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Es wurde ein etabliertes Tiermodell mit Zucker Ratten (fa/fa) verwendet, um postoperative, gewichtsverlustunabh{\"a}ngige metabolomische Effekte des Roux-en-Y Magenbypass (RYGB) zu ermitteln. Es galt Hypothesen zu generieren, welche globalen Metabolite die positiven Auswirkungen des Magenbypass verursachen k{\"o}nnen. Beispielsweise war γ-Amino-Butters{\"a}ure (GABA) f{\"a}kal nach RYGB vermehrt nachweisbar und somit ein potentieller Mediator f{\"u}r einen Bypass-spezifischen Effekt. Die Ergebnisse zeigen die Komplexit{\"a}t der metabolomischen Ver{\"a}nderungen durch RYGB und Nahrungsrestriktion. Die genauen Mechanismen nach metabolisch-bariatrischer Operation, die zu dem therapeutischen Effekt f{\"u}hren, bleiben weiterhin unklar, sodass es weiterer Studien bedarf, um kausale Zusammenh{\"a}nge nachzuweisen.}, subject = {Tiermodell}, language = {de} } @phdthesis{Uttinger2022, author = {Uttinger, Konstantin Lukas}, title = {Der antiproliferative Effekt des RNA-Polymerase I Inhibitors CX-5461 in Zellen kolorektaler Karzinomzelllinien auf zellul{\"a}rer und molekularer Ebene}, doi = {10.25972/OPUS-26503}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265033}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die halbmaximale (Proliferations-) inhibitorische Konzentration (IC50) vom RNA-Polymerase I-Inhibitor CX-5461 liegt f{\"u}r die getesteten sieben humanen kolorektalen Karzinomzell¬linien zwischen 0,7 und 3,1 µmol/L, f{\"u}r nicht-transformierte Fibroblasten bei 8,1 µmol/L. Der deutlich st{\"a}rkere antiproliferative Effekt von CX-5461 auf Tumorzellen l{\"a}sst somit ein m{\"o}gliches therapeutisches Fenster erkennen. CX-5461 (1 µmol/L und weniger) induziert einen persistierenden Zellzyklus-arretierten Zellph{\"a}notyp mit Seneszenz-assoziierter (SA) -Galaktosidase-Aktivit{\"a}t (SA-β-Gal). Die durch CX-5461 ausgel{\"o}ste verringerte Synthese ribosomaler RNA (rRNA)-Transkripte im Nucleolus, ein Subkompartiment des Nucleus, in dem die Transkription der ribosomalen DNA und Bildung von Pr{\"a}-Ribosomen stattfinden, hat eine St{\"o}rung der Ribosomen¬biogenese zur Folge. Diese als nucleol{\"a}rer Stress bezeichnete Situation ist mit zahlreichen Einzelph{\"a}nomen assoziiert wie der Akkumulation ribosomaler Proteine aufgrund eines durch CX-5461 verursachten Missverh{\"a}ltnisses bei der Synthese ribosomaler Proteine und rRNAs. Auch kommt es bei nucleol{\"a}rem Stress zur Aktivierung Zellzykusarrest-f{\"u}hrender Signalwege vermittelt durch DNA-Damage-Response, p53 und Retinoblastom (Rb). Die durch CX-5461 induzieren seneszenten Zellen lassen sich durch Kombination mit dem Bcl-Inhibitor und Senotlytikum Navitoclax in Apoptose {\"u}berf{\"u}hren. Das kombinierte Strategiekonzept demonstriert, dass der pro-proliferative Ph{\"a}notyp von Tumorzellen mit CX-5461 durch Induktion von Seneszenz effektiv gestoppt werden kann, um anschließend diese Zellen mit dem Bcl-Inhibitor Navitoclax gezielt in Apoptose zu {\"u}berf{\"u}hren. Der durch CX-5461 ausgel{\"o}ste seneszente Zellph{\"a}notyp zeigt sich sensitiv gegen{\"u}ber dem Apoptose-ausl{\"o}senden Effekt von Navitoclax - im Ggs. zu nicht-seneszenten Zellen. Basierend auf diesem Konzept deutet sich eine potentielle neue Strategie f{\"u}r eine Tumortherapie an, deren Grundlage die kombinierte Adressierung der beiden antiproliferativen Ph{\"a}nomene Seneszenz und Apoptose in soliden Tumorzellen wie dem kolorektalen Karzinom darstellt.}, subject = {Dickdarmkrebs}, language = {de} } @article{WillmsSchwabvonWebskyetal.2022, author = {Willms, A. G. and Schwab, R. and von Websky, M. W. and Berrevoet, F. and Tartaglia, D. and S{\"o}relius, K. and Fortelny, R. H. and Bj{\"o}rck, M. and Monchal, T. and Brennfleck, F. and Bulian, D. and Beltzer, C. and Germer, C. T. and Lock, J. F.}, title = {Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry. Surgical technique matters}, series = {Hernia}, volume = {26}, journal = {Hernia}, number = {1}, organization = {EURAHS Open Abdomen Group}, issn = {1265-4906}, doi = {10.1007/s10029-020-02336-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234871}, pages = {61-73}, year = {2022}, abstract = {Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46\%), abdominal compartment syndrome (20.5\%), burst abdomen (11.3\%), abdominal trauma (9\%), and other conditions (13.2\%). The overall definitive fascial closure rate was 57.5\% in the intention-to-treat analysis and 71\% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.}, language = {en} } @phdthesis{Fuhr2022, author = {Fuhr, Sebastian}, title = {Behandlungsoptionen Offene Abdomen Therapie - Entwicklung und Validierung eines multizentrischen Registers}, doi = {10.25972/OPUS-25708}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257080}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die Offene Abdomen Therapie (OAT) stellt eine der gr{\"o}ßten Herausforderungen im Bereich der Chirurgie dar. Ziel war es ein offenes, kostenloses und internationales Register zu entwickeln, um eine Basis f{\"u}r zuk{\"u}nftige Therapien und den Weg zu einer evidenzbasierten Leitlinie zu legen. Es wurden 630 F{\"a}lle identifiziert welche mittels OAT behandelt wurden und im Rahmen einer gemischt retrospektiven als auch prospektiven Datenauswertung in das von uns entwickelte Register eingetragen. Schwerpunkte waren dabei einerseits die Praktikabilit{\"a}t des Registers zu testen als auch Einflussfaktoren f{\"u}r eine erfolgreiche OAT zu finden. Es konnte gezeigt werden, dass das Register in seiner Konzeption funktioniert und in der ersten Auswertungen Einflussfaktoren f{\"u}r eine erh{\"o}hte Faszienverschlussrate gefunden werden konnten. Der verbesserte Faszienverschluss am Ende der Therapie mit zeitgleich reduzierter Komplikationsrate ist m{\"o}glich. Aus diesem Grund besitzt die konsequente Nutzung des Registers von behandelnden Einrichtungen, die wo immer m{\"o}gliche l{\"u}ckenlose Dokumentation, sowie die multizentrische Auswertung der Daten einen hohen Stellenwert in Hinsicht auf Pr{\"a}vention, Therapie und Nachsorge der OAT.}, subject = {Chirurgie}, language = {de} } @phdthesis{Schlueter2022, author = {Schl{\"u}ter, Dominique Carolin}, title = {Pr{\"a}operative Leberfunktionsevaluation mittels LiMAx Test beim Hepatozellul{\"a}ren Karzinom}, doi = {10.25972/OPUS-25447}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254478}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die Therapieentscheidung beim HCC richtet sich derzeit nach den BCLC-Kriterien. Die effektivste Therapieoption, eine Resektion, wird allerdings nur in den fr{\"u}hen Stadien empfohlen. Um postoperative Komplikationen zu vermeiden, ben{\"o}tigt es unter anderem eine effiziente pr{\"a}operative Leberfunktionsevaluation zur Auswahl der Resektionskandidaten. Fr{\"u}here Studien konnten zeigen, dass der LiMAx-Test hierf{\"u}r geeignet ist. Da aber Daten zu HCC-Patienten noch fehlen, war das Ziel dieser Studie zu untersuchen, ob der LiMAx-Test die pr{\"a}operative Evaluation von HCC-Patienten erleichtert und so die postoperative Morbidit{\"a}t und Mortalit{\"a}t insbesondere f{\"u}r Patienten mit Leberzirrhose gesenkt werden kann. Insgesamt erhielten 92 HCC Patienten zur Therapieevaluation eine LiMAx-Messung und wurden in eine Gruppe mit Zirrhose (LZ-Gruppe) und eine ohne (NL-Gruppe) eingeteilt und miteinander verglichen. Jeder Fall wurde in einer Tumorkonferenz besprochen und anhand der erhobenen Leberfunktionsparameter entschieden. 46 Patienten erhielten eine Resektion, 46 wurden abgelehnt, 17 aufgrund zu schlechter LiMAx-Ergebnisse. Die LiMAx-Werte der Resezierten waren mit 388 vs. 322µg/kg/h h{\"o}her als die der abgelehnten Patienten (p=0,004). Zudem waren sie ein unabh{\"a}ngiger Risikofaktor f{\"u}r eine Leberzirrhose und Pr{\"a}diktoren f{\"u}r eine unzureichende Leberfunktionsreserve. Ein unterer Grenzwert von 221µg/kg/h wurde ermittelt, bei welchem auch bei Zirrhosepatienten eine Resektion noch sicher durchgef{\"u}hrt werden kann. Generell gab es in der LZ-Gruppe nicht mehr postoperative Komplikationen als in der NL-Gruppe. Eine Vorhersage zur Entwicklung eines postoperativen Leberversagens durch den LiMAx-Test konnte in unserer Studie nicht gezeigt werden. Pr{\"a}operativ eingesetzt, erm{\"o}glicht der LiMAx-Test somit eine effektive und sichere Evaluation von HCC Patienten, die von einer Resektion profitieren, mit niedriger postoperativer Morbidit{\"a}ts- und Mortalit{\"a}tsrate, sowohl bei Patienten mit oder ohne Leberzirrhose.}, subject = {Leberfunktion}, language = {de} } @phdthesis{Scheler2022, author = {Scheler, Maximilian Heinrich Julius}, title = {Die operative Versorgung des Thoraxmagens - Eine Langzeitanalyse von 2008-2015}, doi = {10.25972/OPUS-25301}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-253018}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Der Thoraxmagen beschreibt eine zirkul{\"a}re Schwachstelle der phreniko{\"o}sophagealen Membran mit einer schrittweisen Dislozierung der Magenkardia und des {\"O}sophagus nach mediastinal. Die Therapie des Thoraxmagens kann konservativ im Sinne des „watchful waiting" oder operativ erfolgen. Aufgrund der m{\"o}glichen Komplikationen wird die elektive Operation durch die amerikanischen Leitlinien empfohlen. Ein zentrales Problem der Hiatushernienchirurgie stellt die hohe Anzahl an Rezidiven dar. Ob die Gr{\"u}nde hierf{\"u}r in der Zwerchfellrekonstruktion, Speiser{\"o}hrenl{\"a}nge, Fundoplicatio oder Netzaugmentation liegen, wird nach wie vor kontrovers diskutiert. In dieser Arbeit wurde die operative Versorgung des Thoraxmagens von 124 Patienten des Universit{\"a}tsklinikums W{\"u}rzburg im Zeitraum von September 2008 bis Juni 2015 untersucht. Hierf{\"u}r war neben den perioperativen Daten auch die Rezidiv- und Letalit{\"a}tsrate von Relevanz. Das Patientenkollektiv wurde sowohl in Hinblick auf das Lebensalter als auch auf die verschiedenen Versorgungsarten analysiert. Um die postoperative Lebensqualit{\"a}t zu beurteilen, erfolgte die Patientenbefragung mit Hilfe eines Symptomfragebogens und dem Gastrointestinalen Lebensqualit{\"a}tsindex nach Eypasch (GIQLI). Zus{\"a}tzlich wurden 17 Patienten postoperativ mittels MRT untersucht, um eine optimierte MRT-Sequenz zur Beurteilung der Hiatusregion zu evaluieren. Im Vergleich der Altersgruppen zeigte sich trotz einer erh{\"o}hten Komorbidit{\"a}tsrate bei dem Patientenkollektiv ≥ 75 Jahre (p=0,002) kein signifikanter Unterschied bei Betrachtung der intraoperativen Komplikationen. Die Rezidivrate lag unabh{\"a}ngig vom Alter bei 20,2\% im Untersuchungszeitraum, jedoch konnte eine verminderte Rezidivrate bei Patienten mit U-Shape Versorgung (p=0,015) festgestellt werden. In der postoperativen Patientenbefragung zeigten sich 87,0\% der Patienten, unabh{\"a}ngig vom Alter und der Versorgungsart, zufrieden mit dem Operationsergebnis und beschrieben ihren Zustand im Vergleich zu pr{\"a}operativ als gebessert. Die Ergebnisse des GIQLI erbrachten in dem untersuchten Patientenkollektiv ein gegen{\"u}ber der Allgemeinbev{\"o}lkerung erniedrigten Wert mit 95,4 Punkten. Die optimierte MRT-Sequenz zeichnete sich durch eine hohe diagnostische Konfidenz bei guter Bildqualit{\"a}t, kurzer Untersuchungsdauer und gleichzeitig hoher Akzeptanz der Patienten gegen{\"u}ber dieser Art der Diagnostik aus. Zusammenfassend stellt die operative Versorgung von Thoraxm{\"a}gen, unabh{\"a}ngig des Patientenalters, eine sichere Therapieform dar, die zu einer hohen Patientenzufriedenheit f{\"u}hrt. Die modifizierte MRT-Untersuchung hat sich als diagnostische Methode bew{\"a}hrt und stellt eine Alternative zu strahlenexponierenden oder von Seiten der Patienten weniger gut tolerierten Untersuchungsmodalit{\"a}ten dar.}, subject = {Zwerchfellkrankheit}, language = {de} }