@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} } @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} } @article{AngerDoeringvanDametal.2021, author = {Anger, Friedrich and D{\"o}ring, Anna and van Dam, Jacob and Lock, Johann Frisco and Klein, Ingo and Bittrich, Max and Germer, Christoph-Thomas and Wiegering, Armin and Kunzmann, Volker and van Eijck, Casper and L{\"o}b, Stefan}, title = {Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New International Consensus Criteria}, series = {Annals of Surgical Oncology}, volume = {28}, journal = {Annals of Surgical Oncology}, number = {4}, issn = {1068-9265}, doi = {10.1245/s10434-020-09100-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-235251}, pages = {2325-2336}, year = {2021}, abstract = {Background International consensus criteria (ICC) have redefined borderline resectability for pancreatic ductal adenocarcinoma (PDAC) according to three dimensions: anatomical (BR-A), biological (BR-B), and conditional (BR-C). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumour and vessels but that biological and conditional dimensions also are important. Methods Patients' tumours were retrospectively defined borderline resectable according to ICC. The study cohort was grouped into either BR-A or BR-B and compared with patients considered primarily resectable (R). Differences in postoperative complications, pathological reports, overall (OS), and disease-free survival were assessed. Results A total of 345 patients underwent resection for PDAC. By applying ICC in routine preoperative assessment, 30 patients were classified as stage BR-A and 62 patients as stage BR-B. In total, 253 patients were considered R. The cohort did not contain BR-C patients. No differences in postoperative complications were detected. Median OS was significantly shorter in BR-A (15 months) and BR-B (12 months) compared with R (20 months) patients (BR-A vs. R: p = 0.09 and BR-B vs. R: p < 0.001). CA19-9, as the determining factor of BR-B patients, turned out to be an independent prognostic risk factor for OS. Conclusions Preoperative staging defining surgical resectability in PDAC according to ICC is crucial for patient survival. Patients with PDAC BR-B should be considered for multimodal neoadjuvant therapy even if considered anatomically resectable.}, 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} }