TY - JOUR A1 - Wischnewsky, Manfred A1 - Schwentner, Lukas A1 - Diessner, Joachim A1 - De Gregorio, Amelie A1 - Joukhadar, Ralf A1 - Davut, Dayan A1 - Salmen, Jessica A1 - Bekes, Inga A1 - Kiesel, Matthias A1 - Müller-Reiter, Max A1 - Blettner, Maria A1 - Wolters, Regine A1 - Janni, Wolfgang A1 - Kreienberg, Rolf A1 - Wöckel, Achim A1 - Ebner, Florian T1 - BRENDA-Score, a hghly significant, internally and externally validated prognostic marker for metastatic recurrence: analysis of 10,449 primary breast cancer patients JF - Cancers N2 - Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatment options. This underscores the importance to develop a metastatic recurrence score to escalate or de-escalate treatment strategies. Patients and methods Data from 10,499 patients were available from 17 clinical cancer registries (BRENDA-project. In total, 8566 were used to develop the BRENDA-Index. This index was calculated from the regression coefficients of a Cox regression model for metastasis-free survival (MFS). Based on this index, patients were categorized into very high, high, intermediate, low, and very low risk groups forming the BRENDA-Score. Bootstrapping was used for internal validation and an independent dataset of 1883 patients for external validation. The predictive accuracy was checked by Harrell's c-index. In addition, the BRENDA-Score was analyzed as a marker for overall survival (OS) and compared to the Nottingham prognostic score (NPS). Results: Intrinsic subtypes, tumour size, grading, and nodal status were identified as statistically significant prognostic factors in the multivariate analysis. The five prognostic groups of the BRENDA-Score showed highly significant (p < 0.001) differences regarding MFS:low risk: hazard ratio (HR) = 2.4, 95%CI (1.7–3.3); intermediate risk: HR = 5.0, 95%CI.(3.6–6.9); high risk: HR = 10.3, 95%CI (7.4–14.3) and very high risk: HR = 18.1, 95%CI (13.2–24.9). The external validation showed congruent results. A multivariate Cox regression model for OS with BRENDA-Score and NPS as covariates showed that of these two scores only the BRENDA-Score is significant (BRENDA-Score p < 0.001; NPS p = 0.447). Therefore, the BRENDA-Score is also a good prognostic marker for OS. Conclusion: The BRENDA-Score is an internally and externally validated robust predictive tool for metastatic recurrence in breast cancer patients. It is based on routine parameters easily accessible in daily clinical care. In addition, the BRENDA-Score is a good prognostic marker for overall survival. Highlights: The BRENDA-Score is a highly significant predictive tool for metastatic recurrence of breast cancer patients. The BRENDA-Score is stable for at least the first five years after primary diagnosis, i.e., the sensitivities and specificities of this predicting system is rather similar to the NPI with AUCs between 0.76 and 0.81 the BRENDA-Score is a good prognostic marker for overall survival. KW - breast cancer KW - risk KW - prediction KW - BRENDA KW - score KW - follow up Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241064 SN - 2072-6694 VL - 13 IS - 13 ER - TY - JOUR A1 - Balafoutas, Dimitrios A1 - Wöckel, Achim A1 - Wulff, Christine A1 - Joukhadar, Ralf T1 - Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures JF - Archives of Gynecology and Obstetrics N2 - Purpose Robotic surgery represents the latest development in the field of minimally invasive surgery and offers many technical advantages. Despite the higher costs, this novel approach has been applied increasingly in gynecological surgery. Regarding the implementation of a new operative method; however, the most important factor to be aware of is patient safety. In this study, we describe our experience in implementing robotic surgery in a German University Hospital focusing on patient safety after 110 procedures. Methods We performed a retrospective analysis of 110 consecutive robotic procedures performed in the University Hospital of Würzburg between June 2017 and September 2019. During this time, 37 patients were treated for benign general gynecological conditions, 27 patients for gynecological malignancies, and 46 patients for urogynecological conditions. We evaluated patient safety through standardized assessment of intra- and postoperative complications, which were categorized according to the Clavien–Dindo classification. Results No complications were recorded in 90 (81.8%) operations. We observed Clavien–Dindo grade I complications in 8 (7.3%) cases, grade II complications in 5 (4.5%) cases, grade IIIa complications in 1 case (0.9%), and grade IIIb complications in 6 (5.5%) cases. No conversion to laparotomy or blood transfusion was needed. Conclusion Robotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates. KW - robotic hysterectomy KW - robotic sacrocolpopexy KW - implementation KW - robotic complications KW - polyvinylidene fluoride (PVDF) Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232650 SN - 0932-0067 VL - 302 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Joukhadar, Ralf A1 - Wöckel, Achim A1 - Herbert, Saskia-Laureen A1 - Curtaz, Carolin A1 - Wulff, Christine T1 - A 3D printed model of the female pelvis for practical education of gynecological pelvic examination JF - 3D Printing in Medicine N2 - Background Pelvic palpation is a core component of every Gynecologic examination. It requires vigorous training, which is difficult due to its intimate nature, leading to a need of simulation. Up until now, there are mainly models available for mere palpation which do not offer adequate visualization of the concerning anatomical structures. In this study we present a 3D printed model of the female pelvis. It can improve both the practical teaching of gynecological pelvic examination for health care professionals and the spatial understanding of the relevant anatomy. Methods We developed a virtual, simplified model showing selected parts of the female pelvis. 3D printing was used to create a physical model. Results The life-size 3D printed model has the ability of being physically assembled step by step by its users. Consequently, it improves teaching especially when combining it with commercial phantoms, which are built solely for palpation training. This is achieved by correlating haptic and visual sensations with the resulting feedback received. Conclusion The presented 3D printed model of the female pelvis can be of aid for visualizing and teaching pelvic anatomy and examination to medical staff. 3D printing provides the possibility of creating, multiplying, adapting and sharing such data worldwide with little investment of resources. Thus, an important contribution to the international medical community can be made for training this challenging examination. KW - gynecology KW - pelvic examination KW - pelvic palpation KW - 3D printing KW - FDM KW - SLA KW - teaching KW - visualization KW - education Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313347 VL - 8 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Wöckel, Achim A1 - Herbert, Saskia-Laureen A1 - Curtaz, Carolin A1 - Diessner, Joachim A1 - Joukhadar, Ralf A1 - Wulff, Christine T1 - Introducing a novel model for simulating large loop excision of the transformation zone (LLETZ) using 3D printing technique JF - Archives of Gynecology and Obstetrics N2 - Purpose Electrosurgery is the gold-standard procedure for the treatment of cervical dysplasia. The quality of the outcome depends on the accuracy of performance, which underlines the role of adequate training of surgeons, especially, as this procedure is often performed by novice surgeons. According to our knowledge, medical simulation has up until now lacked a model, which focuses on realistically simulating the treatment of cervical dysplasia with the concerning anatomy. Methods and Result In our work, we present a model created using 3D printing for holistically simulating diagnostic, as well as surgical interventions of the cervix, as realistically as possible. Conclusion This novel simulator is compared to an existing model and both are evaluated. By doing so, we aim to provide novice gynecologists with standardized and high-quality simulation models for practicing to improve their proficiency. KW - fused deposition modeling (FDM) KW - 3D printing KW - virtual KW - gynecology KW - dysplasia KW - large loop excision of the transformation zone (LLETZ) Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266739 SN - 1432-0711 VL - 305 IS - 3 ER -