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Zeindler J, Hess GF, von Heesen M, Aegerter N, Reber C, Schmitt AM, Muenst S, Bolli M, Soysal SD, Kollmar O. Anatomic versus non-anatomic liver resection for hepatocellular carcinoma-A European multicentre cohort study in cirrhotic and non-cirrhotic patients. Cancer Med 2024; 13:e6981. [PMID: 38477510 DOI: 10.1002/cam4.6981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) is increasing in the western world over the past decades. As liver resection (LR) represents one of the most efficient treatment options, advantages of anatomic (ALR) versus non-anatomic liver resection (NALR) show a lack of consistent evidence. Therefore, the aim of this study was to investigate complications and survival rates after both resection types. METHODS This is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni- and multivariate Cox regression models. RESULTS Two hundred and ninety-eight patients were included. Median follow-up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni- and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS. CONCLUSION No significant differences on RFS and OS rates could be observed. Post-operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post-operative outcome of these patients.
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Affiliation(s)
- Jasmin Zeindler
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Gabriel Fridolin Hess
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Maximilian von Heesen
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
- Department of General- and Visceral Surgery, University Hospital Göttingen, Göttingen, Germany
| | - Noa Aegerter
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Cornelia Reber
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Michael Schmitt
- The Royal Marsden NHS Foundation Trust, London, UK
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology University Hospital Basel, Basel, Switzerland
| | - Martin Bolli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Savas Deniz Soysal
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Otto Kollmar
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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2
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von Heesen M. [Indications in Obesity Therapy - Surgeons First?]. Zentralbl Chir 2022; 147:525-538. [PMID: 36479649 DOI: 10.1055/a-1970-3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is a growing problem worldwide. For the first time since 2010, more people have been overweight than underweight. In particular, obesity-associated diseases, above all type 2 diabetes mellitus, pose enormous challenges to the healthcare system. On July 3, 2020, the German Bundestag recognised obesity as a disease and initiated the development of a diseases management program (DMP), which is currently being drawn up. So far, the indication for treatment of obesity in Germany has been based on the S3 guideline "Surgery of obesity and metabolic diseases" of the DGAV from 2018 and the S3 guideline "Prevention and therapy of obesity" of the German Obesity Society e. V. from 2014. This article gives an overview of the currently available conservative, medical, endoscopic and surgical treatment methods for overweight and obesity in Germany and explains the indications. Against the background of the reorientation of obesity treatment as a part of the DMP and the forthcoming revisions of the guidelines, the previous indication should be discussed critically. The scientific findings of the last few years show that surgical treatment of obesity not only achieves the greatest weight loss in the long term, but also that obesity-associated diseases are then treated more effectively and overall mortality is reduced significantly more effectively than with conservative treatment.
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Affiliation(s)
- Maximilian von Heesen
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen Zentrum Chirurgie, Göttingen, Deutschland
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3
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von Heesen M, Schuld J, Holländer S, Spiliotis AE, Merscher A, Scherber PR, Igna D, Gäbelein G, Glanemann M. Repeated hepatic resection for colorectal liver metastases: is this concept safe and feasible? Eur Surg 2022. [DOI: 10.1007/s10353-022-00783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Summary
Background
The beneficial outcomes of hepatectomy in patients with colorectal metastases have encouraged the attempts of repeated hepatectomy in patients with recurrent disease. Although studies have provided encouraging results regarding perioperative outcomes and survival rates following repeated hepatectomy, it remains unclear whether the reported outcomes reflect the therapeutic results of redo hepatectomy or rather reflect the effect of selection bias. The aim of this study was to investigate differences among patients who underwent single and repeated hepatectomy and to hereby identify prognostic factors that contribute to the premises of repeated resection.
Methods
Patients who underwent hepatectomy due to colorectal metastases were listed in a retrospective database. Study participants were divided into a single partial hepatectomy group, a multiple partial hepatectomies group, and into subgroups of two or more than two hepatectomies.
Results
A total of 338 patients with 439 partial liver resections were included in the analysis. The overall survival rate after 1, 3, and 5 years was 89%, 56%, and 36%, respectively. The survival benefit in patients who underwent multiple partial liver resections versus those with a single partial resection was 10%, 16%, and 4% after 1, 3, and 5 years, respectively. Repeated hepatectomy was not associated with increased rates of surgical and non-surgical complications.
Conclusion
Beneficial outcomes have been found in terms of median overall survival and perioperative morbidity in patients with recurrence of colorectal hepatic metastases after partial and tissue-sparing repeated liver resections.
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Kosinsky RL, Zerche M, Kutschat AP, Nair A, Ye Z, Saul D, von Heesen M, Friton JJ, Schwarzer AC, Paglilla N, Sheikh SZ, Wegwitz F, Sun Z, Ghadimi M, Newberry RD, Sartor RB, Faubion WA, Johnsen SA. RNF20 and RNF40 regulate vitamin D receptor-dependent signaling in inflammatory bowel disease. Cell Death Differ 2021; 28:3161-3175. [PMID: 34088983 PMCID: PMC8563960 DOI: 10.1038/s41418-021-00808-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 02/04/2023] Open
Abstract
Despite the identification of several genetic factors linked to increased susceptibility to inflammatory bowel disease (IBD), underlying molecular mechanisms remain to be elucidated in detail. The ubiquitin ligases RNF20 and RNF40 mediate the monoubiquitination of histone H2B at lysine 120 (H2Bub1) and were shown to play context-dependent roles in the development of inflammation. Here, we aimed to examine the function of the RNF20/RNF40/H2Bub1 axis in intestinal inflammation in IBD patients and mouse models. For this purpose, intestinal sections from IBD patients were immunohistochemically stained for H2Bub1. Rnf20 or Rnf40 were conditionally deleted in the mouse intestine and mice were monitored for inflammation-associated symptoms. Using mRNA-seq and chromatin immunoprecipitation (ChIP)-seq, we analyzed underlying molecular pathways in primary intestinal epithelial cells (IECs) isolated from these animals and confirmed these findings in IBD resection specimens using ChIP-seq.The majority (80%) of IBD patients displayed a loss of H2Bub1 levels in inflamed areas and the intestine-specific deletion of Rnf20 or Rnf40 resulted in spontaneous colorectal inflammation in mice. Consistently, deletion of Rnf20 or Rnf40 promoted IBD-associated gene expression programs, including deregulation of various IBD risk genes in these animals. Further analysis of murine IECs revealed that H3K4me3 occupancy and transcription of the Vitamin D Receptor (Vdr) gene and VDR target genes is RNF20/40-dependent. Finally, these effects were confirmed in a subgroup of Crohn's disease patients which displayed epigenetic and expression changes in RNF20/40-dependent gene signatures. Our findings reveal that loss of H2B monoubiquitination promotes intestinal inflammation via decreased VDR activity thereby identifying RNF20 and RNF40 as critical regulators of IBD.
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Affiliation(s)
- Robyn Laura Kosinsky
- grid.66875.3a0000 0004 0459 167XDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN USA
| | - Maria Zerche
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Ana Patricia Kutschat
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Asha Nair
- grid.66875.3a0000 0004 0459 167XDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | - Zhenqing Ye
- grid.66875.3a0000 0004 0459 167XDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | - Dominik Saul
- grid.66875.3a0000 0004 0459 167XKogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN USA
| | - Maximilian von Heesen
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Jessica J. Friton
- grid.66875.3a0000 0004 0459 167XDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN USA
| | - Ana Carolina Schwarzer
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Nadia Paglilla
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Shehzad Z. Sheikh
- grid.10698.360000000122483208Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Florian Wegwitz
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Zhifu Sun
- grid.66875.3a0000 0004 0459 167XDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | - Michael Ghadimi
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Rodney D. Newberry
- grid.4367.60000 0001 2355 7002Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO USA
| | - R. Balfour Sartor
- grid.10698.360000000122483208Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - William A. Faubion
- grid.66875.3a0000 0004 0459 167XDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN USA
| | - Steven A. Johnsen
- grid.411984.10000 0001 0482 5331Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany ,grid.66875.3a0000 0004 0459 167XGene Regulatory Mechanisms and Molecular Epigenetics Laboratory, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN USA
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Holländer S, von Heesen M, von Heesen A, Spiliotis AE, Gäbelein G, Scherber PR, Glanemann M. Minimally Invasive Cholecystectomy: Transvaginal or Transabdominal Approach-Which Technique Is Preferred by Female Hospital Employees? J Laparoendosc Adv Surg Tech A 2021; 32:515-521. [PMID: 34283667 DOI: 10.1089/lap.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Evidence is lacking concerning a clear benefit of single-port laparoscopic cholecystectomy (SILC) and transvaginal cholecystectomy (TVC) over the classical laparoscopic cholecystectomy (CLC). In this study, we investigated the preferences of the operation techniques among female employees in a tertiary university clinic. Materials and Methods: Study participants in the department of general surgery and gynecology were interviewed regarding their personal felt preferences for the mentioned procedures using a standardized illustrated questionnaire. Results: A total of 111 participants were included in the study. In 70.3% of cases, the transvaginal approach was unknown. The classical techniques were preferred in 95.2% of respondents. Participants with a wish for children showed a higher preference for nontransvaginal techniques (P = .011). The acceptance rate of transvaginal techniques among employees of the department of gynecology was higher than those of the department of general surgery (P = .028). Conclusions: The overall acceptance rate for TVC is low. Especially in case of a wish for children, SILC and CLC represent the preferred techniques. The lack of popularity of TVC could be an explanation for the refusal of this technique. Among employees of the gynecologic department, a transvaginal approach was significantly more often accepted. The cosmetic outcome and the knowledge about an operation technique certainly influence the decision making for the preferred surgical method.
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Affiliation(s)
- Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Maximilian von Heesen
- Department of General- and Visceral Surgery, University Hospital Göttingen, Göttingen, Germany
| | - Anika von Heesen
- Department of Gynecology, University Hospital Göttingen, Göttingen, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Philipp Robert Scherber
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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6
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von Heesen M, Pawlik K, Scherber PR, Schuld J. [Patient satisfaction after thyroidectomy - the width of the scar is more important than the length]. Laryngorhinootologie 2019; 98:480-488. [PMID: 31096269 DOI: 10.1055/a-0891-0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To avoid a scar on the neck, alternative methods of thyroidectomy have been developed. The aim of our study was to determine the significance of the scar and the factors influencing satisfaction after classical thyroidectomy in the long term. MATERIAL AND METHODS 228 patients who underwent partial or total thyroidectomy for benign thyroid disease between 2001 and 2014 participated in a telephone interview. In addition to patient satisfaction, demographic data, the subjective appearance of the scar, and subjective complaints were recorded. RESULTS 93.8 % of the patients were satisfied with the treatment. Female and younger patients tended to be more dissatisfied than both male and older patients. The mean scar length was 6.03 ± 2.36 cm and the mean scar width was 2.01 ± 1.46 mm. The length of the scar did not affect satisfaction. In contrast, patients with a wider prominent or conspicuously stained scar were significantly more dissatisfied. Patients who suffered from symptoms such as pressure or difficulty swallowing postoperatively were also significantly more dissatisfied. Cosmetic problems affect satisfaction more than functional problems. CONCLUSIONS Satisfaction after thyroidectomy is good in the long term. Whether satisfaction can be further improved by using an alternative or minimally invasive procedure is questionable. These procedures may be an alternative for younger and female patients or those who focuses on cosmetics.
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Affiliation(s)
- Maximilian von Heesen
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes.,Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen
| | - Katharina Pawlik
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes
| | - Philipp R Scherber
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes
| | - Jochen Schuld
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes.,Klinik für Allgemein- und Viszeralchirurgie, Knappschaftsklinikum Sulzbach
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7
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Abstract
Cancers at an early stage of disease with a low risk of lymph node metastases or distant spread can be managed endoscopically. Different endoscopic techniques can be applied in the gastrointestinal tract. Furthermore, endoscopic and laparoscopic surgery can be combined in specific indications today. Most of all, resection-related complications can also be solved endoscopically.
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Affiliation(s)
- Arthur Hoffman
- Department of Internal Medicine and Gastroenterology, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Maximilian von Heesen
- Department of General and Visceral Surgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Otto Kollmar
- Department of General and Visceral Surgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Ralf Kiesslich
- Department of Internal Medicine and Gastroenterology, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
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8
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Keppler U, Moussavian MR, Jeanmonod P, Strowitzki MJ, Wagner M, Scheuer C, Menger MD, von Heesen M. Neither Isolated Hepatic Arterial Clamping nor Hepatic Arterial Ligation Induce Ischemic Type Biliary Lesions in Rats. Ann Transplant 2016; 21:649-659. [PMID: 27765937 DOI: 10.12659/aot.898001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Ischemic type biliary lesions (ITBL) is a troublesome complication after liver transplantation. Little is known about its pathogenesis and there is particularly little data about morphological alterations. Prolonged warm and cold ischemia time and reduced hepatic arterial perfusion are risk factors leading to ITBL. There are only a few animal models described in literature. Therefore, we examined the effects of 3 h of hepatic artery ischemia-reperfusion (3 h I/R) and hepatic arterial ligation (HAL), both combined with ligation of the peribiliary plexus (PBP). MATERIAL AND METHODS 3 h I/R was performed by clamping the hepatic artery with microvascular clamps for 3 h. HAL was performed by ligation of the hepatic artery. Both procedures were combined with stenting of the common bile duct with double ligation of the PBP. A sham group without clamping served as control. Serum activities of aspartate transaminase (AST) and alanine transaminase (ALT), direct and total bilirubin (DB/TB), and lactate dehydrogenase (LDH) were measured. Bile flow was analyzed and histological examinations of leukocyte infiltration (CAE), cell proliferation (PCNA), apoptotic cells (HE), and bile ducts morphology (CK7) were performed. Western blots of the vascular endothelial growth factor (VEGF) and caspase 3 were made to investigate vascular growth expression and apoptotic cell death. RESULTS 3 h I/R and HAL were associated with a significant hepatocellular injury and inflammation, shown through increased AST and ALT, leukocyte infiltration, and apoptotic cell death. An increase of bile ducts and a reduction of arteries/bile duct ratio after 30 days was observed in the 3 h I/R group and HAL, but no ITBL-typical bile duct necrosis, intrahepatic strictures, or dilatations of bile ducts occurred. CONCLUSIONS Morphological alterations in a rat animal model of 3 h I/R and HAL could be demonstrated. However, a model of intrahepatic biliary lesions could not be established through hepatic arterial ligation or through 3-h hepatic arterial ischemia and reperfusion.
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Affiliation(s)
- Ulrich Keppler
- Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Mohammed R Moussavian
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/ Saar, Germany
| | - Pascal Jeanmonod
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/ Saar, Germany
| | - Moritz J Strowitzki
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mathias Wagner
- Institute of Pathology, University of Saarland, Homburg/ Saar, Germany
| | - Claudia Scheuer
- Intitute for Clinical and Experimental Surgery, University of Saarland, Homburg/ Saar, Germany
| | - Michael D Menger
- Intitute for Clinical and Experimental Surgery, University of Saarland, Homburg/ Saar, Germany
| | - Maximilian von Heesen
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/ Saar, Germany
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9
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Dold S, Richter S, Kollmar O, von Heesen M, Scheuer C, Laschke MW, Vollmar B, Schilling MK, Menger MD. Portal Hyperperfusion after Extended Hepatectomy Does Not Induce a Hepatic Arterial Buffer Response (HABR) but Impairs Mitochondrial Redox State and Hepatocellular Oxygenation. PLoS One 2015; 10:e0141877. [PMID: 26523932 PMCID: PMC4629903 DOI: 10.1371/journal.pone.0141877] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/14/2015] [Indexed: 01/24/2023] Open
Abstract
Background & Aims Portal hyperperfusion after extended hepatectomy or small-for-size liver transplantation may induce organ dysfunction and failure. The underlying mechanisms, however, are still not completely understood. Herein, we analysed whether hepatectomy-associated portal hyperperfusion induces a hepatic arterial buffer response, i.e., an adaptive hepatic arterial constriction, which may cause hepatocellular hypoxia and organ dysfunction. Methods Sprague-Dawley rats underwent 30%, 70% and 90% hepatectomy. Baseline measurements before hepatectomy served as controls. Hepatic arterial and portal venous flows were analysed by ultrasonic flow measurement. Microvascular blood flow and mitochondrial redox state were determined by intravital fluorescence microscopy. Hepatic tissue pO2 was analysed by polarographic techniques. Hepatic function and integrity were studied by bromosulfophthalein bile excretion and liver histology. Results Portal blood flow was 2- to 4-fold increased after 70% and 90% hepatectomy. This, however, did not provoke a hepatic arterial buffer response. Nonetheless, portal hyperperfusion and constant hepatic arterial blood flow were associated with a reduced mitochondrial redox state and a decreased hepatic tissue pO2 after 70% and 90% hepatectomy. Microvascular blood flow increased significantly after hepatectomy and functional sinusoidal density was found only slightly reduced. Major hepatectomy further induced a 2- to 3-fold increase of bile flow. This was associated with a 2-fold increase of bromosulfophthalein excretion. Conclusions Portal hyperperfusion after extended hepatectomy does not induce a hepatic arterial buffer response but reduces mitochondrial redox state and hepatocellular oxygenation. This is not due to a deterioration of microvascular perfusion, but rather due to a relative hypermetabolism of the remnant liver after major resection.
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Affiliation(s)
- Stefan Dold
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Sven Richter
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Otto Kollmar
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Maximilian von Heesen
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
- * E-mail:
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Matthias W. Laschke
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Brigitte Vollmar
- Institute for Experimental Surgery, University of Rostock, Rostock, Germany
| | - Martin K. Schilling
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Michael D. Menger
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
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10
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von Heesen M, Dold S, Müller S, Scheuer C, Kollmar O, Schilling MK, Menger MD, Moussavian MR. Cilostazol improves hepatic blood perfusion, microcirculation, and liver regeneration after major hepatectomy in rats. Liver Transpl 2015; 21:792-800. [PMID: 25772848 DOI: 10.1002/lt.24114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/09/2015] [Accepted: 03/01/2015] [Indexed: 12/19/2022]
Abstract
Major hepatectomy or small-for-size liver transplantation may result in postoperative liver failure. So far, no treatment is available to improve liver regeneration. Herein, we studied whether cilostazol, a selective phosphodiesterase III inhibitor, is capable of improving liver regeneration after major hepatectomy. Sprague-Dawley rats (n = 74) were treated with cilostazol (5 mg/kg daily) or a glucose solution and underwent either 70% liver resection or a sham operation. Before and after surgery, hepatic arterial and portal venous blood flow and hepatic microvascular perfusion were analyzed. Liver morphology, function, and regeneration were studied with histology, immunohistochemistry, western blotting, and bile excretion analysis. Cilostazol significantly increased hepatic blood flow and microcirculation before and after hepatectomy in comparison with sham-operated controls. This was associated with an elevation of hepatic vascular endothelial growth factor expression, an increase of hepatocellular proliferation, and an acceleration of liver regeneration. Furthermore, cilostazol protected the tissue of the remnant liver as indicated by an attenuation of hepatocellular disintegration. In conclusion, cilostazol increases hepatic blood perfusion, microcirculation, and liver regeneration after a major hepatectomy. Thus, cilostazol may represent a novel strategy to reduce the rate of liver failure after both extended hepatectomy and small-for-size liver transplantation.
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Affiliation(s)
| | - Stefan Dold
- Department of General, Visceral, Vascular, and Paediatric Surgery
| | - Simon Müller
- Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Otto Kollmar
- Department of General, Visceral, Vascular, and Paediatric Surgery
| | | | - Michael D Menger
- Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Mohammed R Moussavian
- Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
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11
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von Heesen M, Müller S, Keppler U, Strowitzki MJ, Scheuer C, Schilling MK, Menger MD, Moussavian MR. Preconditioning by cilostazol protects against cold hepatic ischemia-reperfusion injury. Ann Transplant 2015; 20:160-8. [PMID: 25811412 DOI: 10.12659/aot.893031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In liver transplantation, prolonged cold storage and post-transplant reperfusion are associated with endothelial inflammation, organ dysfunction, and graft failure. We herein studied whether cilostazol, a phosphodiesterase-3-inhibitor, attenuates post-ischemic liver injury after prolonged cold storage. MATERIAL AND METHODS Sprague-Dawley rats were assigned to 5 groups (n=6 each): sham animals (cold storage time (CST): 1 h), vehicle-treated (NaCl 0.9%) controls (CST: 24 h), and animals receiving 0.1, 1.0, or 10.0 mg/kg body weight (BW) cilostazol pre-treatment (CST: 24 h). After organ explantation, all livers were stored at 4°C in HTK solution, followed by 60 min of reperfusion with 37°C Krebs Henseleit buffer in a non-recirculating ex situ system. Bile flow was measured to evaluate liver function. To analyze inflammation and morphology, liver tissue samples were taken and histology, immunohistochemistry, and Western blotting were conducted. RESULTS In vehicle-treated controls, prolonged cold storage and warm reperfusion induced inflammation, organ dysfunction, and cell death. This was indicated by an increase of hepatocellular vacuolization, endothelial ICAM-1 expression, and apoptotic cell death compared to sham animals. Cilostazol pre-treatment protected against cold hepatic ischemia-reperfusion injury by preventing hepatocellular disintegration, ICAM-1-associated endothelial inflammation, and apoptotic death. CONCLUSIONS Inhibition of PDE3 reduces endothelial cell activation and hepatocellular injury in cold ischemia/reperfusion of the liver.
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Affiliation(s)
- Maximilian von Heesen
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Simon Müller
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Ulrich Keppler
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Moritz J Strowitzki
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Martin K Schilling
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
| | - Mohammed R Moussavian
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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von Heesen M. Isoflurane does not Protect from Brain Death-Associated Aggravation of Cold Hepatic Ischemia-Reperfusion Injury. Ann Transplant 2015; 20:36-43. [DOI: 10.12659/aot.892302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maximilian von Heesen
- Department of General, Vascular and Pediatric Surgery, Saarland University Hospital, Homburg, Germany
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13
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Strowitzki MJ, Dold S, von Heesen M, Körbel C, Scheuer C, Moussavian MR, Schilling MK, Kollmar O, Menger MD. The phosphodiesterase 3 inhibitor cilostazol does not stimulate growth of colorectal liver metastases after major hepatectomy. Clin Exp Metastasis 2014; 31:795-803. [DOI: 10.1007/s10585-014-9669-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/07/2014] [Indexed: 12/27/2022]
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14
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Jeanmonod P, Laschke MW, Gola N, von Heesen M, Glanemann M, Dold S, Menger MD, Moussavian MR. Silver acetate coating promotes early vascularization of Dacron vascular grafts without inducing host tissue inflammation. J Vasc Surg 2013; 58:1637-43. [PMID: 23684426 DOI: 10.1016/j.jvs.2013.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/29/2013] [Accepted: 02/01/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Silver acetate is frequently used as an antimicrobial coating of prosthetic vascular grafts. However, the effects of this coating on the early inflammatory and angiogenic host tissue response still remain elusive. Therefore, the aim of the present in vivo study was to analyze the biocompatibility and vascularization of silver acetate-coated and uncoated vascular grafts during the initial phase after implantation. METHODS Two different prosthetic vascular grafts (ie, uncoated Dacron and silver acetate-coated Dacron Silver) were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study angiogenesis and leukocytic inflammation at the implantation site by means of repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, collagen formation, apoptosis, and cell proliferation were analyzed in the newly developed granulation tissue surrounding the implants by histology and immunohistochemistry. RESULTS During the initial 14 days after implantation, Dacron Silver exhibited an improved vascularization, as indicated by a significantly increased functional capillary density compared with Dacron. This was not associated with a stronger leukocytic inflammatory host tissue response to the implants. Moreover, silver acetate coating did not affect collagen formation, apoptosis, and cell proliferation at the implantation site. CONCLUSIONS Silver acetate coating of prosthetic vascular grafts improves their early vascularization without inducing severe inflammatory side effects. Accordingly, this material modification crucially contributes to an improved incorporation of the implants into the host tissue, which may decrease the risk of vascular graft infection.
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Affiliation(s)
- Pascal Jeanmonod
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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15
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von Heesen M, Schuld J, Sperling J, Grünhage F, Lammert F, Richter S, Schilling MK, Kollmar O. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 2011; 397:383-95. [PMID: 22089696 DOI: 10.1007/s00423-011-0872-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 11/03/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatic resection of colorectal liver metastases is the only curative treatment option. As clinical and experimental data indicate that the extent of liver resection correlates with growth of residual metastases, the present study analyzes the potential benefit of a parenchyma-preserving liver surgery approach. METHODS Data from a prospectively maintained database of patients undergoing liver resection for colorectal metastases were reviewed. Evaluation of outcome was performed using the Kaplan-Meier method. Correlations were calculated between clinical-pathological variables. RESULTS One hundred sixty-three patients underwent 198 liver resections for colorectal metastases: 26 major hepatectomies, 65 minor anatomical resections, 78 non-anatomical resections, as well as 29 combinations of minor anatomical and non-anatomical procedures. Overall 1-, 3-, and 5-year survival was 93%, 62%, and 40%, respectively. Patients with repeated liver resections had a 5-year survival of 27%. Interestingly, large dissection areas were associated with a significant reduction of the 5-year survival rate (33%). Five-year survival after major hepatectomy was not significantly reduced. CONCLUSION For colorectal liver metastases, minor resections offer a prolonged survival compared to major hepatectomies. As patients with stage IV colorectal disease are candidates for repeat resections, preservation of hepatic parenchyma is of increasing importance in the setting of multi-modal and repeated therapy approaches.
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Affiliation(s)
- Maximilian von Heesen
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg/Saar, Germany
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16
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von Heesen M, Seibert K, Hülser M, Scheuer C, Wagner M, Menger MD, Schilling MK, Moussavian MR. Multidrug donor preconditioning protects steatotic liver grafts against ischemia-reperfusion injury. Am J Surg 2011; 203:168-76. [PMID: 21782153 DOI: 10.1016/j.amjsurg.2011.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Graft dysfunction of steatotic livers (SL) still remains a major challenge in liver transplantation. Different mechanisms are thought to be involved in the impaired tolerance of SL to ischemia-reperfusion injury. Thus, different pharmacologic strategies may need to be combined to effectively protect SL and to reduce graft dysfunction after transplantation. Therefore, we analyzed the effectiveness of a multidrug donor preconditioning (MDDP) procedure to protect SL from cold ischemia-reperfusion injury. METHODS Liver steatosis was induced by a high-carbohydrate, fat-free diet. A total of 24 Sprague-Dawley rats were divided into 3 groups (n = 8 each), including a control group with nonsteatotic livers (Con), a vehicle-treated SL group (SL-Con), and a SL group undergoing MDDP (SL-MDDP), including pentoxyphylline, glycine, deferoxamine, N-acetylcysteine, erythropoietin, melatonin, and simvastatin. MDDP was applied before liver perfusion with 4°C histidine-tryptophan-ketoglutarate (HTK) solution and organ harvest. After 24 hours of cold storage in HTK, postischemic reperfusion was performed in an isolated liver reperfusion model using 37°C Krebs-Henseleit bicarbonate buffer. RESULTS After 60 minutes of reperfusion, SL showed a significant reduction of bile flow as well as a marked increase of liver enzyme levels and apoptotic cell death compared with Con. This was associated with an increased malondialdehyde formation, interleukin-1 production, and leukocytic tissue infiltration. MDDP completely abolished the inflammatory response and was capable of significantly reducing parenchymal dysfunction and injury. CONCLUSIONS MDDP decreases SL injury after cold storage and reperfusion. The concept of MDDP as a simple and safe preoperative regime, thus may be of interest in clinical use, expanding the donor pool from marginal donors.
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Affiliation(s)
- Maximilian von Heesen
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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17
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von Heesen M, Hülser M, Seibert K, Scheuer C, Dold S, Kollmar O, Wagner M, Menger MD, Schilling MK, Moussavian MR. Split-liver procedure and inflammatory response: improvement by pharmacological preconditioning. J Surg Res 2011; 168:e125-35. [PMID: 21435665 DOI: 10.1016/j.jss.2011.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Final outcome of split-liver (SL) transplantation is impaired due to an increased rate of vascular complications and primary non-function. Herein, we hypothesized that an in situ split-liver procedure induces an inflammatory response and a deterioration of graft quality. We further studied whether graft quality can be improved by pharmacologic preconditioning. MATERIAL AND METHODS SL-procedure was performed in rats. One group (SL-HPP; n = 8) was pretreated according to a defined protocol [Homburg preconditioning protocol (HPP)], including pentoxyphylline, glycine, deferoxamine, N-acetylcysteine, erythropoietin, melatonin, and simvastatin. A second SL group (SL-Con; n = 8) received NaCl. Untreated non-SL served as controls (Sham; n = 8). Cytokines release, leukocyte invasion, endothelial activation and liver morphology were studied directly after liver harvest and after 8 h cold storage. Lung tissue was studied to determine remote injury. RESULTS The SL-procedure induced an increase of TNF-α concentration, intercellular-adhesion-molecule 1 (ICAM-1) expression, leukocytic-tissue infiltration and vacuolization. This was associated with an increased number of apoptotic hepatocytes. HPP reduced TNF-α release, ICAM-1 expression, the number of infiltrated leukocytes, as well as hepatocellular vacuolization and apoptosis. In lung tissue, the SL-procedure caused an increased IL-1 and IL-6 concentration and leukocyte infiltration. CONCLUSIONS HPP was capable of abrogating cytokine-mediated leukocytic response. Pharmacologic preconditioning of liver donors prevents the SL procedure-mediated inflammatory response, resulting in an improved graft quality.
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Affiliation(s)
- Maximilian von Heesen
- Department of General, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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