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Article ; Online: Actual Five-year Survival After Upfront Resection for Pancreatic Ductal Adenocarcinoma: Who Beats the Odds?

Strobel, Oliver / Lorenz, Philipp / Hinz, Ulf / Gaida, Matthias / König, Anna-Katharina / Hank, Thomas / Niesen, Willem / Kaiser, J Ö Rg / Al-Saeedi, Mohammed / Bergmann, Frank / Springfeld, Christoph / Berchtold, Christoph / Diener, Markus K / Schneider, Martin / Mehrabi, Arianeb / Müller-Stich, Beat P / Hackert, Thilo / Jager, Dirk / Büchler, Markus W

Annals of surgery

2020 Volume 275, Issue 5, Page(s) 962–971

Abstract: Objective: To determine actual five-year survival (5YS) rates associated with a strategy of upfront surgery and adjuvant therapy in pancreatic ductal adenocarcinoma (PDAC).: Background: The rate of actual 5YS in PDAC remains controversial. Available ... ...

Abstract	Objective: To determine actual five-year survival (5YS) rates associated with a strategy of upfront surgery and adjuvant therapy in pancreatic ductal adenocarcinoma (PDAC). Background: The rate of actual 5YS in PDAC remains controversial. Available data is restricted to cohorts acquired over several decades and series of resection after patient selection by neoadjuvant therapy. Methods: All patients undergoing upfront resection for resectable and borderline-resectable PDAC from 10/2001 to 12/2011 were identified from a prospective database. Actual overall survival was assessed after a follow-up of at least 5 years. Uni- and multivariable logistic regression analyses were performed. Results: Median survival of 937 patients was 22.1 months. The actual 5YS rate was 17.0% (n = 159) including 89 (9.5%) patients without evidence of disease >5 years after resection. 5YS rates in patients with or without adjuvanttherapy were 18.8% vs. 12.2%, respectively. Tumorgrading, number of positive lymph nodes, a context of intraductal papillary mucinous neoplasia, and vascular resections were independently associated with 5YS. Patient-related parameters and CA 19-9 levels were associated with observed survival up to 3 years, but lost relevance thereafter. The extent of lymph node involvement was the strongest predictor of 5YS. Patients with pN0R0 had a 5YS rate of 38.2%. in patients with exclusively favorable factors the observed 5YS rate was above 50%. Conclusions: This is the largest series of long-term survivors with histologically confirmed PDAC. With upfront resection and adjuvant therapy an actual overall 5YS rate of 18.8% can be expected. in favorable subgroups actual 5YS is above 50%.
MeSH term(s)	Adenocarcinoma/surgery ; Carcinoma, Pancreatic Ductal/pathology ; Humans ; Neoadjuvant Therapy ; Pancreatectomy ; Pancreatic Neoplasms/pathology ; Survival Rate ; Pancreatic Neoplasms
Language	English
Publishing date	2020-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004147
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Article ; Online: Limitations in the implementation of control measures for bovine paratuberculosis in infected Swiss dairy and beef herds.

Klopfstein, Myriam / Leyer, Alexandra / Berchtold, Beat / Torgerson, Paul Robert / Meylan, Mireille

PloS one

2021 Volume 16, Issue 2, Page(s) e0245836

Abstract: Various measures have been advocated for the control of Johne's disease (caused by Mycobacterium avium subsp. paratuberculosis, MAP) in different countries. Farmers' compliance has been reported to be variable depending on disease prevalence and ... ...

Abstract	Various measures have been advocated for the control of Johne's disease (caused by Mycobacterium avium subsp. paratuberculosis, MAP) in different countries. Farmers' compliance has been reported to be variable depending on disease prevalence and incentives to participate in control programs. After the prevalence of MAP shedding and risk factors for within-herd spread of MAP were assessed in 17 Swiss cattle herds (10 dairy and 7 beef), general and herd-specific recommendations were given to the farmers to reduce MAP transmission within the herd. Participation in the study and implementation of control measures were voluntary, no financial incentives were provided for the realization of control measures. After a 3-year period of monitored observation including biannual farm visits and discussion of the situation, the implementation of the recommended control measures and their effect on prevalence of MAP shedding were evaluated. Implementation of recommended general and farm-specific control measures was only partially realized. Neither the number of animals tested positive (before or during the study) nor the farmers' knowledge about paratuberculosis were significantly associated with their compliance for the implementation of management changes. The apparent within-herd prevalence remained constant despite limited implementation of control measures, and no particular group of control measures was found to be associated with changes in prevalence. Farmers' compliance for the implementation of control measures to reduce the impact of Johne's disease in infected farms was very limited under Swiss farming conditions in the frame of voluntary participation in a research project. These results indicate that the losses associated with paratuberculosis in Swiss dairy and beef operations are not estimated to be high enough by the farmers to justify important efforts for control measures, and that incentives may be necessary to achieve efficient implementation of such measures.
Language	English
Publishing date	2021-02-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0245836
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Article ; Online: Limitations in the implementation of control measures for bovine paratuberculosis in infected Swiss dairy and beef herds.

Myriam Klopfstein / Alexandra Leyer / Beat Berchtold / Paul Robert Torgerson / Mireille Meylan

PLoS ONE, Vol 16, Iss 2, p e

2021 Volume 0245836

Abstract	Various measures have been advocated for the control of Johne's disease (caused by Mycobacterium avium subsp. paratuberculosis, MAP) in different countries. Farmers' compliance has been reported to be variable depending on disease prevalence and incentives to participate in control programs. After the prevalence of MAP shedding and risk factors for within-herd spread of MAP were assessed in 17 Swiss cattle herds (10 dairy and 7 beef), general and herd-specific recommendations were given to the farmers to reduce MAP transmission within the herd. Participation in the study and implementation of control measures were voluntary, no financial incentives were provided for the realization of control measures. After a 3-year period of monitored observation including biannual farm visits and discussion of the situation, the implementation of the recommended control measures and their effect on prevalence of MAP shedding were evaluated. Implementation of recommended general and farm-specific control measures was only partially realized. Neither the number of animals tested positive (before or during the study) nor the farmers' knowledge about paratuberculosis were significantly associated with their compliance for the implementation of management changes. The apparent within-herd prevalence remained constant despite limited implementation of control measures, and no particular group of control measures was found to be associated with changes in prevalence. Farmers' compliance for the implementation of control measures to reduce the impact of Johne's disease in infected farms was very limited under Swiss farming conditions in the frame of voluntary participation in a research project. These results indicate that the losses associated with paratuberculosis in Swiss dairy and beef operations are not estimated to be high enough by the farmers to justify important efforts for control measures, and that incentives may be necessary to achieve efficient implementation of such measures.
Keywords	Medicine ; R ; Science ; Q
Subject code	630
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Pancreatic Surgery in Children: Complex, Safe and Effective.

Fuchs, Juri / Loos, Martin / Kinny-Köster, Benedict / Hackert, Thilo / Schneider, Martin / Mehrabi, Arianeb / Berchtold, Christoph / Al-Saeedi, Mohammed / Müller, Beat P / Strobel, Oliver / Feißt, Manuel / Kessler, Markus / Günther, Patrick / Büchler, Markus

Annals of surgery

2023

Abstract: Objective: The aim of this study is to assess indications for and report outcomes of pancreatic surgery in pediatric patients.: Background: Indications for pancreatic surgery in children are rare and data on surgical outcomes after pediatric ... ...

Abstract	Objective: The aim of this study is to assess indications for and report outcomes of pancreatic surgery in pediatric patients. Background: Indications for pancreatic surgery in children are rare and data on surgical outcomes after pediatric pancreatic surgery are scarce. Methods: All children who underwent pancreatic surgery at a tertiary hospital specializing in pancreatic surgery between 2003 and 2022 were identified from a prospectively maintained database. Indications, surgical procedures, and perioperative as well as long-term outcomes were analyzed. Results: In total, 73 children with a mean age of 12.8 years (range: 4 months-18 years) underwent pancreatic surgery during the observation period. Indications included chronic pancreatitis (n=35), pancreatic tumors (n=27), and pancreatic trauma (n=11). Distal pancreatectomy was the most frequently performed procedure (n=23), followed by pancreatoduodenectomy (n=19), duodenum-preserving pancreatic head resection (n=10), segmental pancreatic resection (n=7), total pancreatectomy (n=3), and others (n=11). Postoperative morbidity occurred in 25 patients (34.2%), including 7 cases (9.6%) with major complications (Clavien-Dindo≥III). There was no postoperative (90-day) mortality. The 5-year overall survival was 90.5%. The 5-year event-free survival of patients with chronic pancreatitis was 85.7%, and 69.0% for patients with pancreatic tumors. Conclusion: This is the largest single-center study on pediatric pancreatic surgery in a Western population. Pediatric pancreatic surgery can be performed safely. Centralization in pancreatic centers with high expertise in surgery of adult and pediatric patients is important as it both affords the benefits of pancreatic surgery experience and ensures that surgical management is adapted to the specific needs of children.
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006125
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Article ; Online: The size and sternal involvement of chest wall resections for malignant disease predict postoperative morbidity.

Elahi, Leslie / Zellweger, Matthieu / Abdelnour-Berchtold, Etienne / Gonzalez, Michel / Ris, Hans-Beat / Krueger, Thorsten / Raffoul, Wassim / Perentes, Jean Yannis

Translational cancer research

2021 Volume 11, Issue 5, Page(s) 1162–1172

Abstract: Background: Chest wall resections/reconstructions are a validated approach to manage tumors invading the thorax. However, how resection characteristics affect postoperative morbidity and mortality is unknown. We determined the impact of chest wall ... ...

Abstract	Background: Chest wall resections/reconstructions are a validated approach to manage tumors invading the thorax. However, how resection characteristics affect postoperative morbidity and mortality is unknown. We determined the impact of chest wall resection size and location on patient short and long-term postoperative outcomes. Methods: We reviewed all consecutive patients who underwent resections/reconstructions for chest wall tumors between 2003 and 2018. The impact of chest wall resection size and location and reconstruction on perioperative morbidity/mortality and oncological outcome were evaluated for each patient. Results: Ninety-three chest wall resections were performed in 88 patients for primary (sarcoma, breast cancer, n=66, 71%) and metastatic (n=27, 29%) chest wall tumors. The mean chest bony resection size was 107 (range, 15-375) cm Conclusions: Chest wall resections present good long-term oncological outcomes. A resection size above 114 cm
Language	English
Publishing date	2021-06-14
Publishing country	China
Document type	Journal Article
ZDB-ID	2901601-0
ISSN	2219-6803 ; 2218-676X
ISSN (online)	2219-6803
ISSN	2218-676X
DOI	10.21037/tcr-21-2143
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2023 Volume 14, Page(s) 1085895

Abstract: Members of the Regulator of G-protein signaling (Rgs) family regulate the extent and timing of G protein signaling by increasing the GTPase activity of Gα protein subunits. The Rgs family ... ...

Abstract	Members of the Regulator of G-protein signaling (Rgs) family regulate the extent and timing of G protein signaling by increasing the GTPase activity of Gα protein subunits. The Rgs family member
MeSH term(s)	Animals ; Mice ; CD8-Positive T-Lymphocytes ; GTP-Binding Proteins/metabolism ; Listeria monocytogenes ; Protein Subunits/metabolism ; T-Lymphocyte Subsets
Chemical Substances	GTP-Binding Proteins (EC 3.6.1.-) ; Protein Subunits
Language	English
Publishing date	2023-04-20
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1085895
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Article ; Online: Portal Vein Resection in Pancreatic Cancer Surgery: Risk of Thrombosis and Radicality Determine Survival.

Hackert, Thilo / Klaiber, Ulla / Hinz, Ulf / Strunk, Susanne / Loos, Martin / Strobel, Oliver / Berchtold, Christoph / Kulu, Yakup / Mehrabi, Arianeb / Müller-Stich, Beat P / Schneider, Martin / Büchler, Markus W

Annals of surgery

2022 Volume 277, Issue 6, Page(s) e1291–e1298

Abstract: Objective: To evaluate the outcomes of pancreatic cancer [pancreatic ductal adenocarcinoma (PDAC)] surgery with concomitant portal vein resection (PVR), focusing on the PVR type according to the International Study Group of Pancreatic Surgery (ISGPS).!## ...

Abstract	Objective: To evaluate the outcomes of pancreatic cancer [pancreatic ductal adenocarcinoma (PDAC)] surgery with concomitant portal vein resection (PVR), focusing on the PVR type according to the International Study Group of Pancreatic Surgery (ISGPS). Background: Surgery offers the only chance for cure in PDAC. PVR is often performed for borderline or locally advanced tumors. Methods: Consecutive patients with PDAC operated between January 2006 and January 2018 were included. Clinicopathologic characteristics and outcomes were analyzed and tested for survival prediction. Results: Of 2265 PDAC resections, 1571 (69.4%) were standard resections and 694 (30.6%) were resections with PVR, including 149 (21.5%) tangential resections with venorrhaphy (ISGPS type 1), 21 (3.0%) resections with patch reconstruction (type 2), 491 (70.7%) end-to-end anastomoses (type 3), and 33 (4.8%) resections with graft interposition (type 4). The 90-day mortality rate was 2.6% after standard resection and 6.3% after resection with PVR ( P <0.0001). Postoperative portal vein thrombosis and pancreas-specific surgical complications most frequently occurred after PVR with graft interposition (21.2% and 48.5%, respectively). In multivariable analysis, age 70 years and above, ASA stages 3/4, increased preoperative serum carbohydrate antigen 19-9, neoadjuvant treatment, total pancreatectomy, PVR, higher UICC stage, and R+ resections were significant negative prognostic factors for overall survival. Radical R0 (>1 mm) resection resulted in 23.3 months of median survival. Conclusions: This is the largest single-center, comparative cohort study of PVR in PDAC surgery, showing that postoperative morbidity correlates with the reconstruction type. When radical resection is achieved, thrombosis risk is outweighed by beneficial overall survival times of nearly 2 years.
MeSH term(s)	Humans ; Aged ; Cohort Studies ; Portal Vein/surgery ; Portal Vein/pathology ; Pancreatic Neoplasms ; Pancreatectomy/methods ; Carcinoma, Pancreatic Ductal ; Pancreas/surgery ; Pancreaticoduodenectomy/methods ; Venous Thrombosis/pathology ; Retrospective Studies ; Pancreatic Neoplasms
Language	English
Publishing date	2022-07-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005444
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Article ; Online: Surgical treatment of pulmonary metastasis in colorectal cancer patients: Current practice and results.

Zellweger, Matthieu / Abdelnour-Berchtold, Etienne / Krueger, Thorsten / Ris, Hans-Beat / Perentes, Jean Yannis / Gonzalez, Michel

Critical reviews in oncology/hematology

2018 Volume 127, Page(s) 105–116

Abstract: Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a ... ...

Abstract	Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a potentially curative LM resection, but success and benefit are difficult to predict. We discuss prognostic factors of survival after lung metastasectomy in CRC patients under several scenarios (with/ without prior liver metastases; repetitive pulmonary resections). We reviewed all studies (2005-2015) about pulmonary metastases surgical management with curative intent in CRC patients, with a minimum threshold on the number of patients reported (without prior liver metastases: n ≥ 100; with prior resection of liver metastases: n ≥ 50; repetitive thoracic surgery: n ≥ 30). The picture of the prognostic factors of survival is nuanced: surgical management demonstrates clear successes and steady progress, yet there is no single success criterion; stratification of patients and selection bias impact the conclusions. Surgical management of liver and lung metastases may prolong life or cure CRC patients, provided the lesions are fully resected and patients carefully selected. Repeat lung metastasectomy is a safe approach to treat patients in selected cases. In conclusion, there is no standard for surgical management in CRC patients with pulmonary metastases. Patients with isolated unilateral lung metastasis with normal CEA level and no lymph node involvement benefit the most from surgery. Most series report good results in highly selected patients, but instances of long-term disease-free survival remain exceptional.
MeSH term(s)	Colorectal Neoplasms/secondary ; Colorectal Neoplasms/surgery ; Disease-Free Survival ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Metastasectomy/methods ; Metastasectomy/standards ; Pneumonectomy/methods ; Pneumonectomy/standards ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/statistics & numerical data ; Prognosis
Language	English
Publishing date	2018-07
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	605680-5
ISSN	1879-0461 ; 0737-9587 ; 1040-8428
ISSN (online)	1879-0461
ISSN	0737-9587 ; 1040-8428
DOI	10.1016/j.critrevonc.2018.05.001
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Article ; Online: Completion Pancreatectomy After Pancreatoduodenectomy: Who Needs It?

Loos, Martin / König, Anna-Katharina / von Winkler, Nikolai / Mehrabi, Arianeb / Berchtold, Christoph / Müller-Stich, Beat P / Schneider, Martin / Hoffmann, Katrin / Kulu, Yakup / Feisst, Manuel / Hinz, Ulf / Lang, Matthias / Goeppert, Benjamin / Albrecht, Thomas / Strobel, Oliver / Büchler, Markus W / Hackert, Thilo

Annals of surgery

2022 Volume 278, Issue 1, Page(s) e87–e93

Abstract: Objective: The objective of this study was to identify the indications for and report the outcomes of completion pancreatectomy (CPLP) in the postoperative course after pancreatoduodenectomy (PD).: Background: CPLP may be considered or even ... ...

Abstract	Objective: The objective of this study was to identify the indications for and report the outcomes of completion pancreatectomy (CPLP) in the postoperative course after pancreatoduodenectomy (PD). Background: CPLP may be considered or even inevitable for damage control after PD. Methods: A prospectively maintained database of all patients undergoing PD between 2001 and 2019 was searched for patients who underwent CPLP in the postoperative course after PD. Baseline characteristics, perioperative details, and outcomes of CPLP patients were analyzed and specific indications for CPLP were identified. Results: A total of 3953 consecutive patients underwent PD during the observation period. CPLP was performed in 120 patients (3%) after a median of 10 days following PD. The main indications for CPLP included postpancreatectomy acute necrotizing pancreatitis [n=47 (39%)] and postoperative pancreatic fistula complicated by hemorrhage [n=41 (34%)] or associated with uncontrollable leakage of the pancreatoenteric anastomosis [n=23 (19%)]. The overall 90-day mortality rate of all 3953 patients was 3.5% and 37% for patients undergoing CPLP. Conclusions: Our finding that only very few patients (3%) need CPLP suggests that conservative, interventional, and organ-preserving surgical measures are the mainstay of complication management after PD. Postpancreatectomy acute necrotizing pancreatitis, uncontrollable postoperative pancreatic fistula, and fistula-associated hemorrhage are highly dangerous and represent the main indications for CPLP after PD.
MeSH term(s)	Humans ; Pancreatectomy/adverse effects ; Pancreaticoduodenectomy/adverse effects ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Pancreatitis, Acute Necrotizing/surgery ; Pancreas/surgery ; Postoperative Complications/etiology ; Retrospective Studies
Language	English
Publishing date	2022-07-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005494
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Article ; Online: Celiac Axis Stenosis is an Underestimated Risk Factor for Increased Morbidity After Pancreatoduodenectomy.

Al-Saeedi, Mohammed / Sauer, Hendrik B / Ramouz, Ali / Koch, Julian M / Frank-Moldzio, Leonie / Bruckner, Tom / Loos, Martin / Mayer, Philipp / Klauss, Miriam / Kulu, Yakup / Berchtold, Christoph / Hoffmann, Katrin / Mehrabi, Arianeb / Schneider, Martin / Müller-Stich, Beat / Hackert, Thilo / Büchler, Markus W / Strobel, Oliver

Annals of surgery

2022 Volume 277, Issue 4, Page(s) e885–e892

Abstract: Objective: To assesses the prevalence and severity of CAS in patients undergoing PD/total pancreatectomy and its association with major postoperative complications after PD.: Summary of background data: CAS may increase the risk of ischemic ... ...

Abstract	Objective: To assesses the prevalence and severity of CAS in patients undergoing PD/total pancreatectomy and its association with major postoperative complications after PD. Summary of background data: CAS may increase the risk of ischemic complications after PD. However, the prevalence of CAS and its relevance to major morbidity remain unknown. Methods: All patients with a preoperative computed tomography with arterial phase undergoing partial PD or TP between 2014 and 2017 were identified from a prospective database. CAS was assessed based on computed tomography and graded according to its severity: no stenosis (<30%), grade A (30%-<50%), grade B (50%-≤80%), and grade C (>80%). Postoperative complications were assessed and uni- and multivariable risk analyses were performed. Results: Of 989 patients, 273 (27.5%) had CAS: 177 (17.9%) with grade A, 83 (8.4%) with grade B, and 13 (1.3%) with grade C. Postoperative morbidity and 90-day mortality occurred in 278 (28.1%) patients and 41 (4.1%) patients, respectively. CAS was associated with clinically relevant pancreatic fistula ( P =0.019), liver perfusion failure ( P =0.003), gastric ischemia ( P =0.001), clinically relevant biliary leakage ( P =0.006), and intensive care unit ( P =0.016) and hospital stay ( P =0.001). Multivariable analyses confirmed grade B and C CAS as independent risk factors for liver perfusion failure; in addition, grade C CAS was an independent risk factor for clinically relevant pancreatic fistula and gastric complications. Conclusions: CAS is common in patients undergoing PD. Higher grade of CAS is associated with an increased risk for clinically relevant complications, including liver perfusion failure and postoperative pancreatic fistula. Precise radiological assessment may help to identify CAS. Future studies should investigate measures to mitigate CAS-associated risks.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Risk Factors ; Postoperative Complications/etiology ; Morbidity ; Retrospective Studies
Language	English
Publishing date	2022-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005383
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