27404
2022
eng
9
article
1
--
2022-05-09
--
Endoscopic management of large leakages after upper gastrointestinal surgery
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.
Frontiers in Surgery
2296-875X
10.3389/fsurg.2022.885244
urn:nbn:de:bvb:20-opus-274044
2022-05-31T05:44:44+00:00
sword
swordwue
attachment; filename=deposit.zip
549d6abc3465248fb187df5e4ac2968f
Frontiers in Surgery (2022) 9:85244. doi:10.3389/fsurg.2022.885244
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Stanislaus Reimer
Johan F. Lock
Sven Flemming
Alexander Weich
Anna Widder
Lars Plaßmeier
Anna Döring
Ilona Hering
Mohammed K. Hankir
Alexander Meining
Christoph-Thomas Germer
Kaja Groneberg
Florian Seyfried
eng
uncontrolled
anastomotic leakage
eng
uncontrolled
endoluminal
eng
uncontrolled
vacuum-assisted closure
eng
uncontrolled
negative pressure
eng
uncontrolled
endoscopic
Medizin und Gesundheit
open_access
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
Medizinische Klinik und Poliklinik II
Import
Förderzeitraum 2022
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/27404/fsurg-09-885244.pdf
32395
2022
eng
9169-9178
12
36
article
1
--
--
--
Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study
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.
Surgical Endoscopy
10.1007/s00464-022-09400-w
urn:nbn:de:bvb:20-opus-323953
@articleReimer.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 Döring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Lock, Johan F. and Groneberg, Kaja, year = 2022, title = Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study, pages = 9169–9178, volume = 36, number = 12, journal = Surgical endoscopy, doi = 10.1007/s00464-022-09400-w
md5:eb9182d0664a0035e4684be510a5b556
2023-08-12T09:01:06+00:00
/tmp/phpvihHh5
bibtex
64d74a5205a688.90874886
Surgical Endoscopy (2022) 36:12, 9169-9178. DOI: 10.1007/s00464-022-09400-w
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Stanislaus Reimer
Florian Seyfried
Sven Flemming
Markus Brand
Alexander Weich
Anna Widder
Lars Plaßmeier
Peter Kraus
Anna Döring
Ilona Hering
Mohammed K. Hankir
Alexander Meining
Christoph-Thomas Germer
Johan F. Lock
Kaja Groneberg
eng
uncontrolled
anastomotic leak
eng
uncontrolled
gastrointestinal perforation
eng
uncontrolled
esophageal perforation
eng
uncontrolled
endoluminal
eng
uncontrolled
vacuum-assisted closure
eng
uncontrolled
negative pressure
Chirurgie und verwandte medizinische Fachrichtungen
open_access
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
Medizinische Klinik und Poliklinik II
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/32395/s00464-022-09400-w.pdf
27668
2022
deu
doctoralthesis
1
2022-06-19
--
2022-05-06
Einfluss der minimalen Distanz zwischen Tumor und Resektatrand auf die Prognose kurativ resezierter Patienten mit hepatocellulärem Carcinom
How the resection margin influences the survival after curative liver resection in patients with hepatocellular carcinoma
Dies ist eine retrospektive unizentrische Analyse um den Einfluss des Resektionsabstandes auf prognostische Faktoren wie das rezidivfreie und Gesamtüberleben bei Patienten mit hepatocellulären Carcinom zu untersuchen. Es ließ sich kein Vorteil eines weiten (>5mm) tumorfreien Abstands zum Resektatrand gegenüber einem schmalen (5mm) tumorfreien Abstand nachweisen. Allerdings wurden andere tumor- und patientenspezifische unabhängige Risikofaktoren für das rezidivfreie und Gesamtüberleben identifiziert. So ist ein präoperativer AFP-Wert >15µg/l mit einem signifikant schlechteren krankheitsfreien und Gesamtüberleben assoziiert. Ebenso haben schlecht differenzierte (G3) HCCs, sowie HCC mit einer vaskulären Invasion (V1/V2) ein deutlich reduziertes rezidivfreies Überleben. Auch eine Tumorgröße >5cm war in dieser Studie ein unabhängiger Risikofaktor für ein verkürztes Gesamtüberleben.
This is a retrospective single center study regarding the influence of the resection margin after liver resection in patients with hepatocellular carcinoma. Therefore, we identified all patients undergoing liver resection between 2004-2018 at the university hostpital Würzburg for curative intention with hepatocellular carcinoma. Regarding the resection margin the study group was dichtomised in two groups, the LRwide group (resection margin >5mm) and the LRnarrow group (resection margin 5mm). We could not find a difference in disease free or overall survival between the groups. Nevertheless, we could identify the preoperative AFP levels >15µg/l to be an independent risk factor for worse disease free and overall survival. Also, large tumors (>5cm) are associates with reduced overall survival.
urn:nbn:de:bvb:20-opus-276687
10.25972/OPUS-27668
publish
X 130077
CC BY-SA: Creative-Commons-Lizenz: Namensnennung, Weitergabe unter gleichen Bedingungen 4.0 International
Anna Maria Döring
deu
swd
Leberzellkrebs
deu
swd
Leberresektion
deu
uncontrolled
Resektionsabstand
eng
uncontrolled
margin
deu
uncontrolled
Alpha Fetoprotein
Medizin und Gesundheit
open_access
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
Universität Würzburg
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/27668/Doering_Anna_Maria_Dissertation.pdf
23525
2021
eng
2325–2336
4
28
article
1
2021-04-22
--
--
Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New International Consensus Criteria
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.
Annals of Surgical Oncology
1068-9265
10.1245/s10434-020-09100-6
urn:nbn:de:bvb:20-opus-235251
publish
Annals of Surgical Oncology 28, 2325–2336 (2021). https://doi.org/10.1245/s10434-020-09100-6
true
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Friedrich Anger
Anna Döring
Jacob van Dam
Johann Frisco Lock
Ingo Klein
Max Bittrich
Christoph-Thomas Germer
Armin Wiegering
Volker Kunzmann
Casper van Eijck
Stefan Löb
eng
uncontrolled
pancreatic head cancer
Medizin und Gesundheit
open_access
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
Medizinische Klinik und Poliklinik II
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/23525/10434_2020_Article_9100.pdf