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Now showing items 1 - 16 of 36

  • Interventional management after complicated pancreatic surgery

    Putzer, Daniel   Schullian, Peter   Staettner, Stefan   Primavesi, Florian   Braunwarth, Eva   Fodor, Margot   Cardini, Benno   Resch, Thomas   Oberhuber, Rupert   Maglione, Manuel   Margreiter, Christian   Schneeberger, Stefan   Oefner, Dietmar   Bale, Reto   Jaschke, Werner  

    BackgroundDespite technical advances in surgical resection and postoperative management of the pancreas, surgical procedures of the pancreas are associated with a high rate of complications, resulting in arelevant morbidity and mortality. Early diagnosis and management of complications associated with pancreas surgery is mandatory, favoring a multidisciplinary approach.MethodsInterventional radiology offers minimal invasive techniques to manage post-surgical complications. These procedures are highlighted in this review, including percutaneous drainage of fluid collections, percutaneous transhepatic biliary interventions, arterial embolisation and fistula embolisation.ResultsPost-surgical complications of pancreatic surgery are effectively managed by radiological procedures, offering afeasible and safe treatment with low morbidity rates. Accurate patient selection is key to an effective management of clinical situations where these interventions represent the first line approach.ConclusionsRadiologic procedures allow for minimal invasive treatment of postoperative complications after pancreatic surgery, reducing the time of hospitalization and the time of recovery.
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  • Minimally invasive pancreatic surgerywhere are we going?

    Sahakyan, Mushegh A.   Labori, Knut Jorgen   Primavesi, Florian   Soreide, Kjetil   Staettner, Stefan   Edwin, Bjorn  

    BackgroundIntroduced in the mid-1990s, minimally invasive pancreatic surgery (MIPS) developed slowly over the next two decades, and its real-life benefits remained unclear.MethodsIn this review, the current status and evidence on the most common types of MIPS, such as minimally invasive pancreatoduodenectomy (MIPD), distal pancreatectomy, enucleation, and central pancreatectomy are presented.ResultsMinimally invasive distal pancreatectomy (MIDP) is the most frequently used procedure among these, and its indications are nowadays expanding. MIDP for benign and low-grade malignant tumors is advantageous compared to the open approach, suggesting less intraoperative blood loss, shorter hospital stay, faster functional recovery, and better quality of life. The oncological adequacy of MIDP in pancreatic cancer is unclear, as no randomized trials have been published. In contrast, MIPD is atechnically challenging procedure performed in asmall number of centers and in aselected group of patients. Its use remains controversial, as conflicting data have been reported in the literature. Annual volume and learning curve seem to be the key determinants of safety in MIPD. Minimally invasive pancreatic enucleation and central pancreatectomy are less common. Although one randomized trial was published on minimally invasive vs. open central pancreatectomy, current evidence on these procedures is mostly based on retrospective, single-institution series clearly affected by selection bias and small sample size.ConclusionWell-designed prospective studies based on national registries are needed to expand knowledge on MIPS and determine its role in pancreatic surgery. To facilitate further development of MIPS, it has to integrate effectively with the outcome-improving effect of adedicated pancreatic team.
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  • Indications for liver surgery in benign tumours

    Fodor, Margot   Primavesi, Florian   Braunwarth, Eva   Cardini, Benno   Resch, Thomas   Bale, Reto   Putzer, Daniel   Henninger, Benjamin   Oberhuber, Rupert   Maglione, Manuel   Margreiter, Christian   Schneeberger, Stefan   Oefner, Dietmar   Staettner, Stefan  

    Background Management of benign liver tumours (BLT) is still object of discussion. Uncertainty still exists about patient selection, details of management, indications for surgical intervention and potential surgery-related complications. The up-to-date strategies for management of the most common benign solid tumours are recapitulated in this article. In addition, recommendations concerning practical issues are presented. Methods Available data from peer-reviewed publications associated with the major controversies concerning treatment strategies of solid BLT were selected through a PubMed literature search. Results Non-randomized controlled trials, retrospective series and case reports dominate the literature. Conservative management in BLT is associated with low overall morbidity and mortality when applied in an appropriate patient population. Surgical intervention is indicated solely in the presence of progressive symptoms and suspicion of a malignant change. Linking abdominal symptoms to BLT should be interpreted with caution. No evidence is recorded for malignant transformation in haemangiomas and focal nodular hyperplasia (FNH), while a subgroup of hepatocellular adenoma (HCA) is associated with malignancy. Follow-up controls of BLT at 3 and 6 months should be sufficient to prove the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely, However, many questions regarding this topic remain without definitive answers in the literature. Conclusion Conservative management of solid BLT is a worldwide trend, but the available literature does not provide high-grade evidence for this strategy. Consequently, further prospective investigations on the unclear aspects are required. Lienee, this article summarises practical highlights of therapeutic strategies.
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  • Advances in the surgical management of pancreatic disease

    Staettner, Stefan   Primavesi, Florian  

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  • Pancreatic cancer in young adults: changes, challenges, and solutions

    Primavesi, Florian   Stattner, Stefan   Schlick, Konstantin   Kiesslich, Tobias   Mayr, Christian   Klieser, Eckhard   Urbas, Romana  

    Despite improvements in multidisciplinary treatments, survival of pancreatic cancer (PC) patients remains dismal. Studies dealing with early onset pancreatic cancer (EOPC) patients are scarce. In this review, we discuss differences between EOPC and late-onset pancreatic cancer based on findings in original papers and reviews with a focus on morphology, genetics, clinical outcomes and therapy. In conclusion, families with a positive history of PC and patients with BRCA 1 or 2 mutations should be monitored. Patients with EOPC usually present with better overall fitness compared to the average PC population, however often with even more aggressive cancer behaviour. Therefore, potent state-of-the-art multi-modal systemic therapies should be applied whenever possible. Large-scale registries and randomized clinical trials dealing with EOPC in regard to distinct biology and outcome are warranted.
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  • Minimally invasive pancreatic surgery—where are we going?

    Sahakyan, Mushegh A.   Labori, Knut Jørgen   Primavesi, Florian   Søreide, Kjetil   Stättner, Stefan   Edwin, Bjørn  

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  • Is bile leakage after hepatic resection associated with impaired long-term survival?

    Braunwarth, Eva   Primavesi, Florian   Goebel, Georg   Cardini, Benno   Oberhuber, Rupert   Margreiter, Christian   Maglione, Manuel   Schneeberger, Stefan   Oefner, Dietmar   Staettner, Stefan  

    Background: Bile leakage (BL) is a frequent and severe complication following liver surgery. The aim of this study was to evaluate risk factors for BE, related other complications and association with long-term survival. Methods: This study included all patients undergoing hepatectomy in a single centre from 2005 to 2016. Perioperative risk factors related to BL were identified using univariable and multivariable analysis. Kaplan-Meier method was used for survival analysis. Results: BL occurred in 48 of 458 patients (11%). BLs were more frequent in patients after major hepatectomy (p =3D 0.001), Portal vein embolization, bilioenteric-anastomosis, lymphadenectomy, vascular reconstruction and operative time were significant factors for developing BL. Comparing patients with or without BL, BL was more commonly associated with other postoperative complications (p =3D 0.001), especially acute kidney failure and surgical-site-infections. There was no difference in 90-day-mortality (p =3D 0.124). The median disease-free survival was comparable (17 vs. 15 months, p =3D 0.976), also no difference was observed when stratifying for different tumour entities. There was no difference in median overall survival (OS) among malignant disease (35 vs. 47 months, p =3D 0.200) and in 3-year OS (46% vs. 59%). Multivariate analysis confirmed that postoperative liver failure and major hepatectomy were risk factors for reduced OS (p =3D 0.010). Conclusions: Many concerns have been raised regarding tumour progression after major complications. In this study, we only found a relevant influence of BL on OS in pCC, whereas no association was seen in other cancer types, indicating that tumour progression might be triggered by BL in cancer types arising from the bile ducts itself. (C) 2019 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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  • Is bile leakage after hepatic resection associated with impaired long-term survival?

    Braunwarth, Eva   Primavesi, Florian   Göbel, Georg   Cardini, Benno   Oberhuber, Rupert   Margreiter, Christian   Maglione, Manuel   Schneeberger, Stefan   Öfner, Dietmar   Stättner, Stefan  

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  • Management of blunt hepatic and splenic trauma in Austria:anational questionnaire study

    Fodor, Margot   Primavesi, Florian   Morell-Hofert, Dagmar   Haselbacher, Matthias   Braunwarth, Eva   Cardini, Benno   Gassner, Eva   OEfner, Dietmar   Staettner, Stefan  

    Background Treatment of hepatic and splenic injuries has significantly evolved over the past 30 years: Non-operative management (NOM) has increasingly become standard of care for the majority of patients in specialised centres. However, patient selection and details of practical management such as time to reinitiating oral intake, duration of restricted activity, or necessity of repeated imaging are still a matter of debate. This national multicentre questionnaire study aims to give across-sectional overview of current management of blunt liver and splenic trauma in Austrian hospitals. Methods The survey was addressed to all Austrian surgical departments and trauma units. After three months, responses were electronically and anonymously recorded, data were analysed using descriptive statistics. Data collection involved electronic-based questionnaires comprising questions on centre structure, selection criteria for NOM and practical aspects of consecutive treatment. Results In total, a 60% response rate could be achieved, and 24% of all contacted centres filled out the full questionnaire completely. A widespread shift to NOM within recent years could be observed. More than 70% of injuries were treated conservatively. Forty percent of hospitals currently follow a clinical algorithm. Further details about specific questionnaire results are presented, revealing diverse approaches in a number of treatment aspects. Conclusion Non-operative management is the standard of care for blunt hepatic and splenic injuries in Austria. In many clinically relevant questions there is still a lack of consensus. Based on this experience, national standard protocols may be generated for systematisation of care in blunt liver and spleen trauma.
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  • Toll-like receptor 3 mediates ischaemia/reperfusion injury after cardiac transplantation

    Gollmann-Tepekoeylue, Can   Graber, Michael   Poelzl, Leo   Naegele, Felix   Moling, Rafael   Esser, Hannah   Summerer, Bianca   Mellitzer, Vanessa   Ebner, Susanne   Hirsch, Jakob   Schaefer, Georg   Hackl, Hubert   Cardini, Benno   Oberhuber, Rupert   Primavesi, Florian   Oefner, Dietmar   Bonaros, Nikolaos   Troppmair, Jakob   Grimm, Michael   Schneeberger, Stefan   Holfeld, Johannes   Resch, Thomas  

    OBJECTIVES: Ischaemia and subsequent reperfusion during heart transplantation inevitably result in donor organ injury. Toll-like receptor (TLR)-3 is a pattern recognition receptor activated by viral and endogenous RNA released by injured cells. We hypothesized that ischaemia/reperfusion injury (IRI) leads to RNA release with subsequent TLR3 activation in transplanted hearts. METHODS: Human endothelial cells were subjected to IRI and treated with TLR3 agonist polyinosinic-polycytidylic acid or a TLR3/double-stranded RNA complex inhibitor. TLR3 activation was analysed using reporter cells. Gene expression profiles were evaluated via next-generation sequencing. Neutrophil adhesion was assessed in vitro. Syngeneic heart transplantation of wild-type or Tlr3(-/-) mice was performed following 9h of cold ischaemia. Hearts were analysed for inflammatory gene expression, cardiac damage, apoptosis and infiltrating leucocytes. RESULTS: IRI resulted in RNA release with subsequent activation of TLR3. Treatment with a TLR3 inhibitor abrogated the inflammatory response upon IRI. In parallel, TLR3 stimulation caused activation of the inflammasome. Endothelial IRI resulted in TLR3-dependent adhesion of neutrophils. Tlr3(-/-) animals showed reduced intragraft and splenic messenger ribonucleic acid (mRNA) expression of proinflammatory cytokines, resulting in decreased myocardial damage, apoptosis and infiltrating cells. Tlr3 deficiency protected from cardiac damage, apoptosis and leucocyte infiltration after cardiac transplantation. CONCLUSIONS: We uncover the release of RNA by injured cells with subsequent activation of TLR3 as a crucial pathomechanism of IRI. Our data indicate that TLR3 represents a novel target in the prevention of IRI in solid organ transplantation.
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  • Pharmacological Inhibition of Class IIA HDACs by LMK-235 in Pancreatic Neuroendocrine Tumor Cells

    Wanek, Julia   Gaisberger, Martin   Beyreis, Marlena   Mayr, Christian   Helm, Katharina   Primavesi, Florian   Jaeger, Tarkan   Di Fazio, Pietro   Jakab, Martin   Wagner, Andrej   Neureiter, Daniel   Kiesslich, Tobias  

    Histone deacetylases (HDACs) play a key role in epigenetic mechanisms in health and disease and their dysfunction is implied in several cancer entities. Analysis of expression patterns in pancreatic neuroendocrine tumors (pNETs) indicated HDAC5 to be a potential target for future therapies. As a first step towards a possible treatment, the aim of this study was to evaluate the in vitro cellular and molecular effects of HDAC5 inhibition in pNET cells. Two pNET cell lines, BON-1 and QGP-1, were incubated with different concentrations of the selective class IIA HDAC inhibitor, LMK-235. Effects on cell viability were determined using the resazurin-assay, the caspase-assay, and Annexin-V staining. Western Blot and immunofluorescence microscopy were performed to assess the effects on HDAC5 functionality. LMK-235 lowered overall cell viability by inducing apoptosis in a dose- and time-dependent manner. Furthermore, acetylation of histone-H3 increased with higher LMK-235 concentrations, indicating functional inhibition of HDAC4/5. Immunocytochemical analysis showed that proliferative activity (phosphohistone H3 and Ki-67) decreased at highest concentrations of LMK-235 while chromogranin and somatostatin receptor 2 (SSTR2) expression increased in a dose-dependent manner. HDAC5 expression was found to be largely unaffected by LMK-235. These findings indicate LMK-235 to be a potential therapeutic approach for the development of an effective and selective pNET treatment.
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  • First Episode of Spontaneous Pneumothorax:CT-based Scoring to Select Patients for Early Surgery

    Primavesi, Florian   Jaeger, Tarkan   Meissnitzer, Thomas   Buchner, Selina   Reich-Weinberger, Silvia   Oefner, Dietmar   Hutter, Joerg   Aspalter, Manuela  

    Although recurrence of primary spontaneous pneumothorax (PSP) is frequent, guidelines do not routinely recommend surgery after first presentation. A CT-based lung dystrophy severity score (DSS) has recently been proposed to predict recurrence following conservative therapy. This study compares the DSS in surgically and conservatively treated patients. This is a retrospective analysis of first episode PSP patients, comparing video-assisted thoracic surgery (VATS; group A) to conservative treatment with or without chest drainage (group B). CT scans were reviewed for blebs or bullae, and patients were assigned DSS values and stratified into risk groups (low and high-grade). Primary end point was ipsilateral or contralateral recurrence. Fifty-six patients were included, 33 received VATS and 23 conservative treatment. In total, 37.5 % experienced recurrence, with a 5-year estimated recurrence rate of 40.7 % (group A: 13.3 %; group B: 73.9 %; p < 0.001). In group B, detection of any dystrophic lesions resulted in significantly higher 5-year recurrence rates (86.7 vs. 50.0 %; p = 0.03), there was no significant difference in group A (17.7 vs. 7.7 %; p = 0.50). Greater DSS values correlated with higher 5-year recurrence rates in group B (p = 0.02), but not in group A (p = 0.90). Comparing low- and high-grade patients in group B resulted in a significant 5-year recurrence rate of 53.8 versus 100 % (p = 0.023). The DSS is useful to indicate VATS after the first episode. For routine application, assigning patients to low- and high-grade groups seems most practical. We recommend CT-evaluation for every PSP patient and early surgery for those with lesions exceeding one bleb. After VATS, the preoperative DSS is not beneficial in predicting recurrence.
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  • First Episode of Spontaneous Pneumothorax: CT-based Scoring to Select Patients for Early Surgery

    Primavesi, Florian   J?ger, Tarkan   Meissnitzer, Thomas   Buchner, Selina   Reich-Weinberger, Silvia   ?fner, Dietmar   Hutter, J?rg   Aspalter, Manuela  

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  • Molecular biology in pancreatic ductal adenocarcinoma:implications for future diagnostics and therapy

    Soreide, Kjetil   Primavesi, Florian   Labori, Knut J.   Watson, Martin M.   Staettner, Stefan  

    BackgroundNovel technology has enabled researchers to better characterize pancreatic cancers at the molecular level. We wanted to explore some of the emerging discoveries, such as molecular subclassification, use of liquid biopsy and use of organoids in cancer assessment.MethodsAliterature review with asearch specific to the topic, with recent reviews in major journals and afocus on the last 5years (until December 2018), was done.ResultsPancreatic ductal adenocarcinoma (PDAC) may now be classified into clinical subgroups based on the predominant genomic profiles, but consensus on one classification system is lacking. Several subtypes have been suggested, including categories such as basal-like, stroma-activated, desmoplastic, pure classical and immune classical types. Further refinement may translate into clinically meaningful groups for therapeutic or prognostic purposes. Liquid biopsies (by means of circulating cancer cells, cell-free DNA, exosomes or other constituents of cancer cells in blood) may aid in earlier diagnosis, define prognostic groups and even predict therapy response and resistance. Organoids are increasingly used for the opportunity to investigate druggable and effective targets ex vivo and should facilitate personalized and precise, targeted therapy in the near future. While immunotherapy has not yet proved to be effective, abetter understanding of molecular subgroups and specific immune profiles may help identify candidates for this approach in amore selective approach.ConclusionNovel molecular techniques have the potential to accelerate the road to improved outcomes in patients with pancreatic cancer.
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  • Molecular biology in pancreatic ductal adenocarcinoma: implications for future diagnostics and therapy

    Søreide, Kjetil   Primavesi, Florian   Labori, Knut J.   Watson, Martin M.   Stättner, Stefan  

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  • Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

    Niesen, Willem   Primavesi, Florian   Gasteiger, Silvia   Neoptolemos, John   Hackert, Thilo   Staettner, Stefan  

    BackgroundPancreatic cancer (PC) remains adisease characterized by an extremely poor prognosis, which is often limited by advanced tumor stage at diagnosis. As surgery remains the only option for long-term survival, indications for resection to achieve acomplete tumor removal have been extended in recent years, including locally advanced as well as metastatic disease.MethodsHere, we provide aliterature overview of modern multimodal treatment concepts of metastatic PC focused on surgery and local interventions including neoadjuvant concepts, stratification of patients, prognostic parameters, and oncological outcomes.ResultsThe current literature lacks levelI evidence studies on surgery in stageIV PC. The available observational studies show that resection for liver metastasis has been increasingly performed in recent years, outcomes improve after neoadjuvant therapy, and certain prognostic parameters can identify patients who benefit from this approach. In addition, interventional or radio-oncological liver-directed therapies have been evaluated showing the possibility of some disease control. Resection of pulmonary metastases is rarely performed, although this patient subgroup may have amore favorable prognosis than patients with stageIV liver cancer. Surgery in the setting of peritoneal carcinomatosis remains experimental without any valid supporting data.ConclusionsThere are promising data to support resection of metastatic PC, presuming this approach is embedded in amultimodal oncological concept with modern and effective multi-agent chemotherapies and proper patient selection. Based on this, future studies should specify distinct groups of patients who benefit from extended surgical approaches including synchronous or staged metastasectomy.
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