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Article ; Online: Venous resection for pancreatic cancer, a safe and feasible option? A systematic review and meta-analysis.

Zwart, E S / Yilmaz, B S / Halimi, A / Ahola, R / Kurlinkus, B / Laukkarinen, J / Ceyhan, G O

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2022 Volume 22, Issue 6, Page(s) 803–809

Abstract: Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to ...

Abstract	Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). Methods: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Results: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. Conclusion: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.
MeSH term(s)	Humans ; Mesenteric Veins/pathology ; Pancreatectomy/methods ; Pancreatic Neoplasms/pathology ; Pancreaticoduodenectomy ; Portal Vein/surgery ; Retrospective Studies ; Pancreatic Neoplasms
Language	English
Publishing date	2022-05-29
Publishing country	Switzerland
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2022.05.001
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Article ; Conference proceedings: Laparoscopic vs. open distal pancreatectomy – a single center experience

Demir, I. E. / Jäger, C. / Göß, R. / Pergolini, I. / Safak, O. / Novotny, A. R. / Ceyhan, G. O. / Friess, H.

Zeitschrift für Gastroenterologie

2023 Volume 61, Issue 08

Event/congress	Viszeralmedizin 2023 77. Jahrestagung der DGVS mit Sektion Endoskopie Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie mit den Arbeitsgemeinschaften der DGAV und Jahrestagung der CACP, Erst online. Dann Hamburg., 2023-09-11
Language	German
Publishing date	2023-08-01
Publisher	Georg Thieme Verlag
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	201387-3
ISSN	1439-7803 ; 0044-2771 ; 0172-8504
ISSN (online)	1439-7803
ISSN	0044-2771 ; 0172-8504
DOI	10.1055/s-0043-1772125
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Zs.A 111: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Resektion von Hauptgang- und Mischtyp-IPMN ≥5 mm.

Ceyhan, G O / Scheufele, F / Friess, H

Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen

2017 Volume 88, Issue 11, Page(s) 913–917

Abstract: The incidence of cystic pancreatic lesions is steadily increasing due to the technical advances in imaging. Within the group of cystic pancreatic lesions intraductal papillary mucinous neoplasms (IPMNs) depict an important entity. Due to a possible ... ...

Title translation	Resection of main duct and mixed type IPMN ≥5 mm.
Abstract	The incidence of cystic pancreatic lesions is steadily increasing due to the technical advances in imaging. Within the group of cystic pancreatic lesions intraductal papillary mucinous neoplasms (IPMNs) depict an important entity. Due to a possible progression to malignancy the clinical strategy has to be well chosen. For primary diagnostic work-up imaging by magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) and computed tomography (CT) scanning is recommended. Additional information can be gained by endosonography and a biopsy of the cystic lesion, allowing analysis of biomarkers, such as GNAS and KRAS mutation as wells as NLR. These can help to differentiate between IPMN and other cystic lesions although the clinical importance for the diagnosis of main duct (MD) and mixed IPMN is limited. The current guidelines (Fukuoka and EU guidelines) recommend resection of MD and mixed IPMN following oncological standards. For the definition of MD-IPMN, a duct dilatation between 5-10 mm is needed when following the current guidelines; however, current publications claim an even lower cut-off of ≥5 mm due to the risk of malignant progression. Intraoperative frozen sections are recommended to evaluate the margins status and extended resection is recommended for residual high-grade dysplasia. Surveillance of potentially at risk patients is recommended at regular intervals of 6-12 months while patients with malignant IPMN should be followed according to pancreatic cancer protocols. A screening for extrapancreatic malignancy is not indicated.
MeSH term(s)	Adenocarcinoma, Mucinous/diagnosis ; Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/surgery ; Carcinoma, Pancreatic Ductal/diagnosis ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/surgery ; Carcinoma, Papillary/diagnosis ; Carcinoma, Papillary/pathology ; Carcinoma, Papillary/surgery ; Guideline Adherence ; Humans ; Magnetic Resonance Imaging ; Neoplasm Invasiveness ; Pancreatic Ducts/pathology ; Pancreatic Ducts/surgery ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Prognosis ; Tomography, X-Ray Computed
Language	German
Publishing date	2017-08-25
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1521-0
ISSN	1433-0385 ; 0009-4722
ISSN (online)	1433-0385
ISSN	0009-4722
DOI	10.1007/s00104-017-0494-0
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Article: A rare case of perivascular epithelioid cell tumor (PEComa) of the pancreas diagnosed by endoscopic ultrasound.

Ulrich, J D / Specht, K / Schlitter, A M / Ceyhan, G O / Quante, M / Schmid, R M / Schlag, C

Endoscopy international open

2020 Volume 8, Issue 1, Page(s) E25–E28

Abstract: A 49-year-old woman consulted her general practitioner (GP) regarding epigastric pain that she had experienced for 2 months. Physical examination and laboratory results were unremarkable. An abdominal ultrasound indicated a solid pancreatic tumor, which ... ...

Abstract	A 49-year-old woman consulted her general practitioner (GP) regarding epigastric pain that she had experienced for 2 months. Physical examination and laboratory results were unremarkable. An abdominal ultrasound indicated a solid pancreatic tumor, which was confirmed on subsequent CT and MRI. Endoscopic ultrasound (EUS) showed a well-defined heterogeneous, predominantly hypoechoic mass in the pancreatic body, so a neuroendocrine tumor (NET) was suspected. However, EUS-guided fine-needle aspiration (EUS-FNA) was performed and based on (immuno-)histochemical findings, the extremely rare diagnosis of a perivascular epithelioid cell tumor (PEComa) of the pancreas was made. Due to the malignant potential of pancreatic PEComas, laparoscopic left-sided pancreatectomy was performed. We present a case diagnosed by preoperative EUS-FNA highlighting the clinical and endosonographic features which help to distinguish it from its most important differential diagnosis, neuroendocrine tumors (NETs) of the pancreas.
Language	English
Publishing date	2020-01-08
Publishing country	Germany
Document type	Case Reports
ZDB-ID	2761052-4
ISSN	2196-9736 ; 2364-3722
ISSN (online)	2196-9736
ISSN	2364-3722
DOI	10.1055/a-1038-3852
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Article ; Online: Association of bacteria in pancreatic fistula fluid with complications after pancreatic surgery.

Demir, E / Abdelhai, K / Demir, I E / Jäger, C / Scheufele, F / Schorn, S / Rothe, K / Friess, H / Ceyhan, G O

BJS open

2020 Volume 4, Issue 3, Page(s) 432–437

Abstract: Background: Pancreatic fistula (PF) is a common complication after pancreatic surgery. It is unclear how microbes in PF fluid affect outcomes and which microbes are present after pancreatoduodenectomy (PD) and distal pancreatectomy (DP). The aim of this ...

Abstract	Background: Pancreatic fistula (PF) is a common complication after pancreatic surgery. It is unclear how microbes in PF fluid affect outcomes and which microbes are present after pancreatoduodenectomy (PD) and distal pancreatectomy (DP). The aim of this study was to compare the microbiological spectrum of PF fluid after PD versus DP, and its association with postoperative complications. Methods: Bacterial strains and antibiotic resistance rates of bacterial swabs obtained from the PF fluid of patients who underwent DP or PD were analysed. Cultured bacteria were classified as Enterobacterales and as 'other intestinal and non-intestinal microorganisms' based on whether they are typically part of the normal human intestinal flora. Results: A total of 847 patients had a pancreatic resection (PD 600; DP 247) between July 2007 and December 2016. Clinically relevant PF was detected in 131 patients (15·5 per cent). Bacterial swabs were obtained from 108 patients (DP 47; PD 61), of which 19 (17·6 per cent) were sterile. Enterobacterales were detected in 74 per cent of PF fluid swabs after PD, and in 34 per cent after DP. Infected, polymicrobial or multidrug-resistant PF fluid was more common after PD (rates of 95, 50 and 48 per cent respectively) than after DP (66, 26 and 6 per cent respectively). Patients with higher grade complications (Clavien-Dindo grade IV-V) or grade C PF had more Enterobacterales and multidrug-resistant Enterobacterales in the PF fluid after DP. Conclusion: Enterobacterales and multidrug-resistant bacteria are detected frequently after PD and DP, and are associated with more severe complications and PF in patients undergoing DP.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Bacteria/classification ; Bacteria/isolation & purification ; Female ; Germany ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatectomy/adverse effects ; Pancreatic Fistula/etiology ; Pancreatic Fistula/microbiology ; Pancreatic Juice/microbiology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/microbiology ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2020-04-16
Publishing country	England
Document type	Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.50272
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Article ; Online: In the Era of the Leeds Protocol: A Systematic Review and A Meta-Analysis on the Effect of Resection Margins on Survival Among Pancreatic Ductal Adenocarcinoma Patients.

Kurlinkus, B / Ahola, R / Zwart, E / Halimi, A / Yilmaz, B S / Ceyhan, G O / Laukkarinen, J

Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

2020 Volume 109, Issue 1, Page(s) 11–17

Abstract: Background and aims: A positive resection margin is considered to be a factor associated with poor prognosis after pancreatic ductal adenocarcinoma resection. However, analysis of the resection margin is dependent on the pathological slicing technique. ... ...

Abstract	Background and aims: A positive resection margin is considered to be a factor associated with poor prognosis after pancreatic ductal adenocarcinoma resection. However, analysis of the resection margin is dependent on the pathological slicing technique. The aim of this systematic review and meta-analysis was to study the impact of resection margin on the survival of pancreatic ductal adenocarcinoma patients whose specimens were analyzed using the axial slicing technique. Material and methods: A systematic search in the PubMed, Cochrane, and Embase datasets covering the time period from November 2006 to January 2019 was performed. Only studies with axial slicing technique (Leeds Pathology Protocol or Royal College of Pathology Protocol) were included in the final database. Meta-analysis between the marginal distance and survival was performed with the Inverse Variance Method in RevMan. Results: The systematic search resulted in nine studies meeting the inclusion criteria. The median survival for a resection margin 0 mm ranged from 12.3 to 23.4 months, for resection margin <0.5 mm 16 months, for resection margin <1 mm ranged from 11 to 27.5 months, for resection margin <1.5 mm ranged from 16.9 to 21.2 months, and for resection margin >2 mm ranged from 53.9 to 63.1 months. Five studies were eligible for meta-analysis. The pooled multivariable hazard ratio favored resection margin ⩾1 mm (hazard ratio: 1.32 and 95% confidence interval: 1.03-1.68, p = 0.03). Conclusion: Resection margins ⩾1 mm seem to lead to better survival in pancreatic ductal adenocarcinoma patients than resection margin <1 mm. However, there is not enough data to evaluate the effect of oncologic therapy or to analyze the impact of other resection margin distances on survival.
MeSH term(s)	Carcinoma, Pancreatic Ductal/mortality ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/surgery ; Clinical Protocols ; Histocytological Preparation Techniques/methods ; Histocytological Preparation Techniques/standards ; Humans ; Margins of Excision ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery
Language	English
Publishing date	2020-03-10
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2077691-3
ISSN	1799-7267 ; 1457-4969
ISSN (online)	1799-7267
ISSN	1457-4969
DOI	10.1177/1457496920911807
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Article ; Online: bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM)-the active metabolite of the laxatives bisacodyl and sodium picosulfate-enhances contractility and secretion in human intestine in vitro.

Krueger, D / Demir, I E / Ceyhan, G O / Zeller, F / Schemann, M

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

2018 Volume 30, Issue 7, Page(s) e13311

Abstract: Background: Stimulant laxatives are widely used to treat constipation. We investigated in human small and large intestinal preparations the effects of bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), the active metabolite of the laxatives bisacodyl and ... ...

Abstract	Background: Stimulant laxatives are widely used to treat constipation. We investigated in human small and large intestinal preparations the effects of bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), the active metabolite of the laxatives bisacodyl and sodium picosulfate on smooth muscle tone and epithelial secretion. Methods: Circular and longitudinal muscle tone of small or large intestinal preparations were recorded with isometric force transducers. Epithelial ion flux (I Key results: BHPM concentration-dependently (0.5-5 μM) increased the tone of circular and longitudinal muscle from small to large intestine. The effect was strongest in large intestinal longitudinal muscle and smallest in small intestinal circular muscle. Increase in muscle tone was prevented by the L-type Ca Conclusions and interferences: BHPM enhanced mucosal secretion and muscle contractility. Results suggested that the laxative effect of BHPM was a consequence of the increase in muscle tone as well as an increased K
MeSH term(s)	Benzhydryl Compounds/pharmacology ; Bisacodyl/pharmacology ; Citrates/pharmacology ; Gastrointestinal Motility/drug effects ; Gastrointestinal Motility/physiology ; Humans ; Intestinal Mucosa/drug effects ; Intestinal Mucosa/physiology ; Intestine, Large/drug effects ; Intestine, Large/physiology ; Intestine, Small/drug effects ; Intestine, Small/physiology ; Laxatives/pharmacology ; Muscle Contraction/drug effects ; Muscle Contraction/physiology ; Organ Culture Techniques ; Organometallic Compounds/pharmacology ; Picolines/pharmacology
Chemical Substances	Benzhydryl Compounds ; Citrates ; Laxatives ; Organometallic Compounds ; Picolines ; 4-(2-benzyl-4-hydroxy)phenoxy-N-methylbutylamine (101686-64-0) ; Bisacodyl (10X0709Y6I) ; picosulfate sodium (LR57574HN8)
Language	English
Publishing date	2018-02-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.13311
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Article ; Conference proceedings: Inadequate lymph node examination leads to misclassification and affects survival in resected pancreatic ductal adenocarcinoma

Göß, R. / Jäger, C. / Perinel, J. / Pergolini, I. / Demir, E. / Safak, O. / Scheufele, F. / Schorn, S. / Muckenhuber, A. / Adham, M. / Novotny, A. / Ceyhan, G. O. / Friess, H. / Demir, I. E.

Zeitschrift für Gastroenterologie

2023 Volume 61, Issue 08

Event/congress	Viszeralmedizin 2023 77. Jahrestagung der DGVS mit Sektion Endoskopie Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie mit den Arbeitsgemeinschaften der DGAV und Jahrestagung der CACP, Erst online. Dann Hamburg., 2023-09-11
Language	German
Publishing date	2023-08-01
Publisher	Georg Thieme Verlag
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	201387-3
ISSN	1439-7803 ; 0044-2771 ; 0172-8504
ISSN (online)	1439-7803
ISSN	0044-2771 ; 0172-8504
DOI	10.1055/s-0043-1772082
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Zs.A 111: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.A 111/X: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer.

Nitsche, U / Stöß, C / Stecher, L / Wilhelm, D / Friess, H / Ceyhan, G O

The British journal of surgery

2017 Volume 105, Issue 7, Page(s) 784–796

Abstract: Background: It is not clear whether resection of the primary tumour (when there are metastases) alters survival and/or whether resection is associated with increased morbidity. This systematic review and meta-analysis assessed the prognostic value of ... ...

Abstract	Background: It is not clear whether resection of the primary tumour (when there are metastases) alters survival and/or whether resection is associated with increased morbidity. This systematic review and meta-analysis assessed the prognostic value of primary tumour resection in patients presenting with metastatic colorectal cancer. Methods: A systematic review of MEDLINE/PubMed was performed on 12 March 2016, with no language or date restrictions, for studies comparing primary tumour resection versus conservative treatment without primary tumour resection for metastatic colorectal cancer. The quality of the studies was assessed using the MINORS and STROBE criteria. Differences in survival, morbidity and mortality between groups were estimated using random-effects meta-analysis. Results: Of 37 412 initially screened articles, 56 retrospective studies with 148 151 patients met the inclusion criteria. Primary tumour resection led to an improvement in overall survival of 7·76 (95 per cent c.i. 5·96 to 9·56) months (risk ratio (RR) for overall survival 0·50, 95 per cent c.i. 0·47 to 0·53), but did not significantly reduce the risk of obstruction (RR 0·50, 95 per cent c.i. 0·16 to 1·53) or bleeding (RR 1·19, 0·48 to 2·97). Neither was the morbidity risk altered (RR 1·14, 0·77 to 1·68). Heterogeneity between the studies was high, with a calculated I Conclusion: Primary tumour resection may provide a modest survival advantage in patients presenting with metastatic colorectal cancer.
MeSH term(s)	Colorectal Neoplasms/complications ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/secondary ; Colorectal Neoplasms/surgery ; Combined Modality Therapy ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/prevention & control ; Postoperative Complications/mortality ; Survival Analysis
Language	English
Publishing date	2017-10-31
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.10682
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Article ; Online: Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma.

Schorn, S / Demir, I E / Samm, N / Scheufele, F / Calavrezos, L / Sargut, M / Schirren, R M / Friess, H / Ceyhan, G O

BJS open

2018 Volume 2, Issue 2, Page(s) 52–61

Abstract: Background: Neoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on ... ...

Abstract	Background: Neoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on patterns of recurrence. Methods: A systematic review was performed of articles identified through the PubMed, Scopus, Embase, Ovid and Google Scholar databases that analysed the relationship between neoadjuvant therapy and recurrence published to January 2016. The main endpoint was overall tumour recurrence. Other endpoints included local recurrence, any kind of distant, hepatic, pulmonary or peritoneal metastasis. Results: A total of 4257 citations were reviewed. Twelve observational studies comprising 1365 patients were analysed. Neoadjuvant therapy significantly reduced the risk of overall (risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·90; P < 0·001) and local (RR 0·42, 0·32 to 0·55; P < 0·001) recurrence. Neoadjuvant therapy did not reduce the risk of any kind of distant (RR 1·02, 0·91 to 1·14; P = 0·78), hepatic (RR 0·86, 0·68 to 1·10; P = 0·23), pulmonary (RR 0·99, 0·37 to 2·66; P = 0·98) or peritoneal (RR 0·88, 0·57 to 1·38; P = 0·58) metastasis. Conclusion: Neoadjuvant therapy reduced the risk of local recurrence but not that of distant metastasis.
Language	English
Publishing date	2018-03-30
Publishing country	England
Document type	Journal Article ; Review
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.46
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