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Hautz T, Salcher S, Fodor M, Sturm G, Ebner S, Mair A, Trebo M, Untergasser G, Sopper S, Cardini B, Martowicz A, Hofmann J, Daum S, Kalb M, Resch T, Krendl F, Weissenbacher A, Otarashvili G, Obrist P, Zelger B, Öfner D, Trajanoski Z, Troppmair J, Oberhuber R, Pircher A, Wolf D, Schneeberger S. Immune cell dynamics deconvoluted by single-cell RNA sequencing in normothermic machine perfusion of the liver. Nat Commun 2023; 14:2285. [PMID: 37085477 PMCID: PMC10121614 DOI: 10.1038/s41467-023-37674-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/27/2023] [Indexed: 04/23/2023] Open
Abstract
Normothermic machine perfusion (NMP) has emerged as an innovative organ preservation technique. Developing an understanding for the donor organ immune cell composition and its dynamic changes during NMP is essential. We aimed for a comprehensive characterization of immune cell (sub)populations, cell trafficking and cytokine release during liver NMP. Single-cell transcriptome profiling of human donor livers prior to, during NMP and after transplantation shows an abundance of CXC chemokine receptor 1+/2+ (CXCR1+/CXCR2+) neutrophils, which significantly decreased during NMP. This is paralleled by a large efflux of passenger leukocytes with neutrophil predominance in the perfusate. During NMP, neutrophils shift from a pro-inflammatory state towards an aged/chronically activated/exhausted phenotype, while anti-inflammatory/tolerogenic monocytes/macrophages are increased. We herein describe the dynamics of the immune cell repertoire, phenotypic immune cell shifts and a dominance of neutrophils during liver NMP, which potentially contribute to the inflammatory response. Our findings may serve as resource to initiate future immune-interventional studies.
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Affiliation(s)
- T Hautz
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - S Salcher
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - M Fodor
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - G Sturm
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - S Ebner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - A Mair
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - M Trebo
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - G Untergasser
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
- Tyrolpath Obrist Brunhuber GmbH, Zams, Austria
| | - S Sopper
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - B Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - A Martowicz
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
- Tyrolpath Obrist Brunhuber GmbH, Zams, Austria
| | - J Hofmann
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - S Daum
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - M Kalb
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - T Resch
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - F Krendl
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - A Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - G Otarashvili
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - P Obrist
- Tyrolpath Obrist Brunhuber GmbH, Zams, Austria
| | - B Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Z Trajanoski
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - J Troppmair
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - A Pircher
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - D Wolf
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria.
| | - S Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, organLife Laboratory and D. Swarovski Research Laboratory, Medical University of Innsbruck, Innsbruck, Austria.
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Lorenz A, Augustin C, Konschake M, Gehwolf P, Henninger B, Augustin F, Öfner D. The Preperitoneal Space in Hernia Repair. Front Surg 2022; 9:869731. [PMID: 35711709 PMCID: PMC9197412 DOI: 10.3389/fsurg.2022.869731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
The preperitoneal spaces relevant for incisional hernia repair and minimally invasive groin hernia repair are described in terms of surgical anatomy. Emphasis is put on the transversalis fascia and the urogenital fascia and its extensions, the vesicoumbilical fascia, and the spermatic sheath of Stoppa procedure. Steps in hernia surgery where these structures are relevant are reviewed.
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Affiliation(s)
- A. Lorenz
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C. Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M. Konschake
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - P. Gehwolf
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B. Henninger
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - F. Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Correspondence: Florian Augustin
| | - D. Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Fodor M, Cardini B, Peter W, Weissenbacher A, Oberhuber R, Hautz T, Otarashvili G, Margreiter C, Maglione M, Resch T, Krendl F, Meszaros AT, Bogensperger C, Gasteiger S, Messner F, Henninger B, Zoller H, Tilg H, Öfner D, Schneeberger S. Static cold storage compared with normothermic machine perfusion of the liver and effect on ischaemic-type biliary lesions after transplantation: a propensity score-matched study. Br J Surg 2021; 108:1082-1089. [PMID: 34027968 DOI: 10.1093/bjs/znab118] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given the susceptibility of organs to ischaemic injury, alternative preservation methods to static cold storage (SCS), such as normothermic machine perfusion (NMP) are emerging. The aim of this study was to perform a comparison between NMP and SCS in liver transplantation with particular attention to bile duct lesions. METHODS The outcomes of 59 consecutive NMP-preserved donor livers were compared in a 1 : 1 propensity score-matched fashion to SCS control livers. Postoperative complications, patient survival, graft survival and bile duct lesions were analysed. RESULTS While patients were matched for cold ischaemia time, the total preservation time was significantly longer in the NMP group (21 h versus 7 h, P < 0.001). Patient and graft survival rates at 1 year were 81 versus 82 per cent (P = 0.347) and 81 versus 79 per cent (P = 0.784) in the NMP and SCS groups, respectively. The postoperative complication rate was comparable (P = 0.086); 37 per cent NMP versus 34 per cent SCS patients had a Clavien-Dindo grade IIIb or above complication. There was no difference in early (30 days or less) (NMP 22 versus SCS 19 per cent, P = 0.647) and late (more than 30 days) (NMP 27 versus SCS 36 per cent, P = 0.321) biliary complications. However, NMP-preserved livers developed significantly fewer ischaemic-type bile duct lesions (NMP 3 versus SCS 14 per cent, P = 0.047). CONCLUSION The use of NMP allowed for a significantly prolonged organ preservation with a lower rate of observed ischaemic-type bile duct lesions.
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Affiliation(s)
- M Fodor
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - W Peter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - A Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - T Hautz
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - G Otarashvili
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - T Resch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Krendl
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - A T Meszaros
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Bogensperger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Gasteiger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Messner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - H Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Krapf J, Schuhbeck A, Wendel T, Fritz J, Scholl-Bürgi S, Bösmüller C, Oberhuber R, Margreiter C, Maglione M, Stättner S, Messner F, Berchtold V, Braunwarth E, Primavesi F, Cardini B, Resch T, Karall D, Öfner D, Margreiter R, Schneeberger S. Assessment of the Clinical Impact of a Liver-Specific, BCAA-Enriched Diet in Major Liver Surgery. Transplant Proc 2020; 53:624-629. [PMID: 33139038 DOI: 10.1016/j.transproceed.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relationship between nutrition and liver disease is relevant for the outcome after surgery. Patients with liver cirrhosis characteristically show protein-energy malnutrition with decreased levels of branched-chain amino acids (BCAA) and increased levels of aromatic amino acids. MATERIALS AND METHODS We conducted a prospective controlled clinical trial including 57 patients after liver transplantation or major liver resection surgery in order to test the effect of early postoperative nutrition on the outcome and nutrition profile of these patients. The test group received a dietetic program composed of ingredients naturally rich in BCAA (BCAA group), and the control group received standard hospital meals. Patient survival, liver function tests, subjective well-being, and a nutritional status including amino acid profiles were analyzed immediately and 14 days after major liver surgery (secondary end points). General health and well-being were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (primary end point). RESULTS In-depth analysis of amino acid profiles was performed for patients undergoing liver resection (n = 21) and liver transplantation (n = 36). Interestingly, amino acid profiles did not correlate with body mass index or the Model for End-Stage Liver Disease score. Patients scheduled for liver transplantation showed significantly lower levels of BCAA pretransplant compared to patients undergoing liver resection. Patients in the liver resection subgroup were more likely to benefit from the BCAA cuisine in terms of significantly higher food intake and subjective rating. The clinical liver function tests, however, did not show statistical difference between the BCAA group and the control group in the examination period of 14 days. CONCLUSION Our specifically designed BCAA-enriched diet resulted in greater patient satisfaction and compliance with nutrition. A larger trial or longer-term follow-up may be required to identify an effect on survival, recovery, surgical complications, protein profiles, and amino acid profiles.
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Affiliation(s)
- J Krapf
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University and Tirol Kliniken Medical Center Innsbruck, Innsbruck, Austria
| | | | - T Wendel
- Private Practice, Lindau, Germany
| | - J Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - S Scholl-Bürgi
- Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - C Bösmüller
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - R Oberhuber
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - C Margreiter
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - M Maglione
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - S Stättner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - F Messner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - V Berchtold
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - E Braunwarth
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - F Primavesi
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - B Cardini
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - T Resch
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - D Karall
- Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - D Öfner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - R Margreiter
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - S Schneeberger
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Gasteiger S, Primavesi F, Göbel G, Braunwarth E, Cardini B, Maglione M, Sopper S, Öfner D, Stättner S. Early Post-Operative Pancreatitis and Systemic Inflammatory Response Assessed by Serum Lipase and IL-6 Predict Pancreatic Fistula. World J Surg 2020; 44:4236-4244. [PMID: 32901324 PMCID: PMC7599180 DOI: 10.1007/s00268-020-05768-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
Background Post-operative pancreatic fistula (POPF) remains a critical complication after pancreatic resection. This prospective pilot study evaluates perioperative markers of pancreatitis and systemic inflammation to predict clinically relevant grade B/C-POPF (CR-POPF). Methods All patients undergoing pancreatic resection from December 2017 to April 2019 were prospectively enrolled. Surgical procedures and outcomes were correlated with perioperative blood markers. ROC analysis was performed to assess their predictive value for CR-POPF. Cut-offs were calculated with the Youden index. Results In total, 70 patients were analysed (43 pancreatoduodenectomies and 27 distal pancreatectomies). In-hospital/90-d mortality and morbidity were 5.7/7.1% (n = 4/n = 5) and 75.7% (n = 53). Major complications (Clavien–Dindo ≥ 3a) occurred in 28 (40.0%) patients, CR-POPF in 20 (28.6%) patients. Serum lipase (cut-off > 51U/L) and IL-6 (> 56.5 ng/l) on POD3 were significant predictors for CR-POPF (AUC = 0.799, 95%-CI 0.686–0.912 and AUC = 0.784, 95%-CI 0.668–0.900; combined AUC = 0.858, 95%-CI 0.758–0.958; all p < 0.001). Patients with both or one factor(s) above cut-off more frequently developed CR-POPF than cases without (100 vs. 50% vs. 7.5%, p < 0.001). This also applied for overall and severe complications (p = 0.013 and p = 0.009). Conclusions Post-operative pancreatitis and inflammatory response are major determinants for development of POPF. A combination of serum lipase and IL-6 on POD3 is a highly significant early predictor of CR-POPF and overall complications, potentially guiding patient management. Clinical trial registration The study protocol was registered at clinicaltrials.gov (NCT04294797) Electronic supplementary material The online version of this article (10.1007/s00268-020-05768-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Gasteiger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - F Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Department of General, Vascular and Visceral Surgery, Salzkammergut Klinikum, Dr.-Wilhelm-Bock-Straße 1, 4840, Vöcklabruck, Austria.
| | - G Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria
| | - E Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - S Sopper
- Department of Haematology and Oncology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - S Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of General, Vascular and Visceral Surgery, Salzkammergut Klinikum, Dr.-Wilhelm-Bock-Straße 1, 4840, Vöcklabruck, Austria
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6
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Gasteiger S, Sopper S, Primavesi F, Oberhuber G, Göbel G, Öfner D, Stättner S. Changes of the immunophenotype in pancreatic cancer. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Primavesi F, Klieser E, Cardini B, Marsoner K, Fröschl U, Thalhammer S, Fischer I, Hauer A, Urbas R, Kiesslich T, Neureiter D, Zitt M, Klug R, Wundsam H, Sellner F, Függer R, Cakar-Beck F, Kornprat P, Öfner D, Stättner S. Prognostic Value of C-Reactive Protein in a New Preoperative Clinical Risk Score for Survival after Surgery for Sporadic, Non-Functioning Pancreatic Neuroendocrine Neoplasia. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Margreiter C, Gummerer M, Gallotta V, Scheidl S, Öfner D, Kienzl-Wagner K, Maier HT, Oberhuber R, Margreiter R, Schneeberger S. Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length. Transplant Proc 2018; 50:3199-3203. [PMID: 30577185 DOI: 10.1016/j.transproceed.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies. MATERIAL AND METHODS Between 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5-7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival. RESULTS Using this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups. CONCLUSION Open management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - M Gummerer
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular Surgery, Medical University of Innsbruck, Austria
| | - V Gallotta
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - S Scheidl
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - H T Maier
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Gamerith G, Hackl H, Wallinger P, Fandel L, Kern J, Augustin F, Lorenz E, Hoflehner E, Mildner F, Moser P, Sprung S, Zelger B, Köck S, Amann A, Schäfer G, Öfner D, Maier H, Trajanoski Z, Zwierzina H, Sopper S. Soluble immune checkpoints CD27, Lag3, PD-L2 and Tim3 in early stage NSCLC patients. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grahammer J, Weissenbacher A, Zelger BG, Zelger B, Boesmueller C, Ninkovic M, Mühlbacher A, Peschel I, Brandacher G, Öfner D, Schneeberger S. Benefits and limitations of belatacept in 4 hand-transplanted patients. Am J Transplant 2017; 17:3228-3235. [PMID: 28742936 DOI: 10.1111/ajt.14440] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 02/10/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 01/25/2023]
Abstract
Belatacept (cytotoxic T-lymphocyte-associated protein 4 Ig) is an emerging treatment in kidney transplantation. Lack of nephrotoxicity and possibly an inhibitory effect on the development of donor-specific antibodies (DSAs) make it an interesting agent in hand transplantation. To reduce calcineurin inhibitor immunosuppression and preserve kidney function, we have added belatacept to the therapeutic regimen of 4 hand-transplanted patients at month 4 and at 6, 9, and 13 years after hand-forearm transplantation. Patients received 5 mg/kg belatacept every 2 weeks, and the dosing interval was extended to 4 weeks after 5 applications. Belatacept was initially well tolerated in all cases. Two patients were weaned to a low-dose tacrolimus monotherapy together with monthly belatacept applications. One patient is taking belatacept with lowered tacrolimus and sirolimus trough levels. A fourth patient had significant levels of DSAs at time of conversion and progressed to a severe necrotizing rejection early despite an unaltered baseline immunosuppression. Finger skin necrosis and histologic signs of severe chronic allograft vasculopathy eventually led to amputation of the graft. Implementation of belatacept can be beneficial in hand transplantation. However, our findings indicated both potential and caution and reflection of the immunologic state at the time of conversion.
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Affiliation(s)
- J Grahammer
- Department for Visceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - A Weissenbacher
- Department for Visceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria.,Oxford University Hospitals NHS Foundation Trust, Oxford Transplant Centre, Oxford, UK
| | - B G Zelger
- Department for Pathology, Innsbruck Medical University, Innsbruck, Austria
| | - B Zelger
- Department for Dermatology, Innsbruck Medical University, Innsbruck, Austria
| | - C Boesmueller
- Department for Visceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - M Ninkovic
- Institute for Physical Medicine and Rehabilitation, Innsbruck, Austria
| | - A Mühlbacher
- Institute for Transfusion and Immunology, Innsbruck, Austria
| | - I Peschel
- Division of Medical Biochemistry, Innsbruck Medical University, Innsbruck, Austria
| | - G Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Öfner
- Department for Visceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - S Schneeberger
- Department for Visceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria
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Kogler P, DeVries AF, Eisterer W, Thaler J, Sölkner L, Öfner D. Intensified preoperative chemoradiation by adding oxaliplatin in locally advanced, primary operable (cT3NxM0) rectal cancer : Impact on long-term outcome. Results of the phase II TAKO 05/ABCSG R‑02 trial. Strahlenther Onkol 2017; 194:41-49. [PMID: 29127435 PMCID: PMC5752742 DOI: 10.1007/s00066-017-1219-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/26/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
Purpose The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are improvement of local tumor control, tumor downsizing, and downstaging. Modifications with respect to standardized chemoradiation protocol, e. g., integrating oxaliplatin, are realized with the aim of improving primary tumor response and patient outcome. Patients and methods In this phase II multicenter study, patients with LARC of the mid- or lower rectum, cT3cNxcM0 as staged by MRI, were included and treated preoperatively with a combination of capecitabine and oxaliplatin following a standardized protocol during radiation. The focus of this long-term analysis was overall (OS) and disease-free survival (DFS). Results A total of 60 patients (19 women, 41 men, median age 60.5 years) were initially enrolled, 1 patient was excluded (violation of study protocol), and 1 was patient lost of follow-up, leading to a total of 58 patients for long-term analysis. The 3‑year OS was 85.5%; 3‑year DFS 71.2%. Over time, 15 patients (25.9%) developed tumor recurrence (1 locoregional, 6.7%; 11 distant, 73.3%; 3 locoregional+distant, 20%). Recurrence-specific therapy was planned in the majority of patients, in 9 of 15 patients (60%) with a radical surgical approach. Of these, 4 patients (44.4%) are again tumor-free at the end of investigation. While tumor downsizing (T level) or pathologically complete response did not influence patient survival, lymph node negativity (LNneg) after preoperative chemoradiation showed significant influence. Conclusion LNneg after preoperative treatment for LARC significantly influences patient survival. A radical surgical approach for recurrent LARC (locoregional, distant) should be contemplated when possible as we were able to clearly demonstrate its importance and efficacy.
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Affiliation(s)
- P Kogler
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - A F DeVries
- Department of Radio-Oncology, Feldkirch Hospital, Feldkirch, Austria
| | - W Eisterer
- Division of Oncology, Department of Internal Medicine, Klagenfurt Hospital, Klagenfurt, Austria
| | - J Thaler
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria
| | - L Sölkner
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - D Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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12
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Cecere F, Kafka R, Maglione M, Öfner D, Wykypiel H. “The abdominal catastrophe”. Eur Surg 2017. [DOI: 10.1007/s10353-017-0490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Ženka J, Caisová V, Uher O, Nedbalová P, Kvardová K, Masáková K, Krejčová G, Paďouková L, Jochmanová I, Wolf KI, Chmelař J, Kopecký J, Loumagne L, Mestadier J, D’agostino S, Rohaut A, Ruffin Y, Croize V, Lemaître O, Sidhu SS, Althammer S, Steele K, Rebelatto M, Tan T, Wiestler T, Spitzmueller A, Korn R, Schmidt G, Higgs B, Li X, Shi L, Jin X, Ranade K, Koeck S, Amann A, Gamerith G, Zwierzina M, Lorenz E, Zwierzina H, Kern J, Riva M, Baert T, Coosemans A, Giovannoni R, Radaelli E, Gsell W, Himmelreich U, Van Ranst M, Xing F, Qian W, Dong C, Xu X, Guo S, Shi Q, Quandt D, Seliger B, Plett C, Amberger DC, Rabe A, Deen D, Stankova Z, Hirn A, Vokac Y, Werner J, Krämer D, Rank A, Schmid C, Schmetzer H, Guerin M, Weiss JM, Regnier F, Renault G, Vimeux L, Peranzoni E, Feuillet V, Thoreau M, Guilbert T, Trautmann A, Bercovici N, Amberger DC, Doraneh-Gard F, Boeck CL, Plett C, Gunsilius C, Kugler C, Werner J, Schmohl J, Kraemer D, Ismann B, Rank A, Schmid C, Schmetzer HM, Markota A, Ochs C, May P, Gottschlich A, Gosálvez JS, Karches C, Wenk D, Endres S, Kobold S, Hilmenyuk T, Klar R, Jaschinski F, Gamerith G, Augustin F, Lorenz E, Manzl C, Hoflehner E, Moser P, Zelger B, Köck S, Amann A, Kern J, Schäfer G, Öfner D, Maier H, Zwierzina H, Sopper S, Prado-Garcia H, Romero-Garcia S, Sandoval-Martínez R, Puerto-Aquino A, Lopez-Gonzalez J, Rumbo-Nava U, Klar R, Hilmenyuk T, Jaschinski F, Coosemans A, Baert T, Van Hoylandt A, Busschaert P, Vergote I, Baert T, Van Hoylandt A, Busschaert P, Vergote I, Coosemans A, Laengle J, Pilatova K, Budinska E, Bencsikova B, Sefr R, Nenutil R, Brychtova V, Fedorova L, Hanakova B, Zdrazilova-Dubska L, Allen C, Ku YC, Tom W, Sun Y, Pankov A, Looney T, Hyland F, Au-Young J, Mongan A, Becker A, Tan JBL, Chen A, Lawson K, Lindsey E, Powers JP, Walters M, Schindler U, Young S, Jaen JC, Yin S, Chen Y, Gullo I, Gonçalves G, Pinto ML, Athelogou M, Almeida G, Huss R, Oliveira C, Carneiro F, Merz C, Sykora J, Hermann K, Hussong R, Richards DM, Fricke H, Hill O, Gieffers C, Pinho MP, Barbuto JAM, McArdle SE, Foulds G, Vadakekolathu JN, Abdel-Fatah TMA, Johnson C, Hood S, Moseley P, Rees RC, Chan SYT, Pockley AG, Rutella S, Geppert C, Hartmann A, Kumar KS, Gokilavani M, Wang S, Merz C, Richards DM, Sykora J, Redondo-Müller M, Heinonen K, Marschall V, Thiemann M, Fricke H, Gieffers C, Hill O, Zhang L, Mao B, Jin Y, Zhai G, Li Z, Wang Z, Qian W, An X, Qiao M, Zhang J, Shi Q, Weber J, Kluger H, Halaban R, Sznol M, Roder H, Roder J, Grigorieva J, Asmellash S, Oliveira C, Meyer K, Steingrimsson A, Blackmon S, Sullivan R, Boeck CL, Amberger DC, Doraneh-Gard F, Sutanto W, Guenther T, Schmohl J, Schuster F, Salih H, Babor F, Borkhardt A, Schmetzer H, Kim Y, Oh I, Park C, Ahn S, Na K, Song S, Choi Y, Fedorova L, Poprach A, Lakomy R, Selingerova I, Demlova R, Pilatova K, Kozakova S, Valik D, Petrakova K, Vyzula R, Zdrazilova-Dubska L, Aguilar-Cazares D, Galicia-Velasco M, Camacho-Mendoza C, Islas-Vazquez L, Chavez-Dominguez R, Gonzalez-Gonzalez C, Prado-Garcia H, Lopez-Gonzalez JS, Yang S, Moynihan KD, Noh M, Bekdemir A, Stellacci F, Irvine DJ, Volz B, Kapp K, Oswald D, Wittig B, Schmidt M, Chavez-Dominguez R, Aguilar-Cazares D, Prado-Garcia H, Islas-Vazquez L, Lopez-Gonzalez JS, Kleef R, Bohdjalian A, McKee D, Moss RW, Saeed M, Zalba S, Debets R, ten Hagen TLM, Javed S, Becher J, Koch-Nolte F, Haag F, Gordon EM, Sankhala KK, Stumpf N, Tseng W, Chawla SP, Suárez NG, Báez GB, Rodríguez MC, Pérez AG, García LC, Fernández DH, Pous JR, Ramírez BS, Jacoberger-Foissac C, Saliba H, Seguin C, Brion A, Frisch B, Fournel S, Heurtault B, Otterhaug T, Håkerud M, Nedberg A, Edwards V, Selbo P, Høgset A, Jaitly T, Dörrie J, Schaft N, Gross S, Schuler-Thurner B, Gupta S, Taher L, Schuler G, Vera J, Rataj F, Kraus F, Grassmann S, Chaloupka M, Lesch S, Heise C, Endres S, Kobold S, Cadilha BML, Dorman K, Heise C, Rataj F, Endres S, Kobold S. Abstracts from the 4th ImmunoTherapy of Cancer Conference. J Immunother Cancer 2017. [PMCID: PMC5374589 DOI: 10.1186/s40425-017-0219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Öfner D. Surgical training under altered conditions. Eur Surg 2016. [DOI: 10.1007/s10353-016-0427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yasuo S, Kenichi Y, Ueno N, Arimoto A, Hosono M, Yoshikawa T, Toyokawa A, Kakeji Y, Tsai Y, Tsai C, Sul J, Lim M, Park J, Jang CE, Santilli O, Tripoloni D, Santilli H, Nardelli N, Greco A, Estevez M, Sakurai S, Ryu S, Cesana G, Ciccarese F, Uccelli M, Grava G, Castello G, Carrieri D, Legnani G, Olmi S, Naito M, Yamamoto H, Sawada Y, Mandai Y, Asano H, Ino H, Tsukuda K, Nagahama T, Ando M, Ami K, Arai K, Miladinovic M, Kitanovic A, Lechner M, Mayer F, Meissnitzer M, Fortsner R, Öfner D, Köhler G, Jäger T, Kumata Y, Fukushima R, Inaba T, Yaguchi Y, Horikawa M, Ogawa E, Katayama T, Kumar PS, Unal D, Caparlar C, Akkaya T, Mercan U, Kulacoglu H, Barreiro JJ, Baer IG, García LS, Cumplido PL, Florez LJG, Muñiz PF, Fujino K, Mita K, Ohta E, Takahashi K, Hashimoto M, Nagayasu K, Murabayashi R, Asakawa H, Koizumi K, Hayashi G, Ito H, Felberbauer F, Strobl S, Kristo I, Riss S, Prager G, El Komy H, El Gendi A, Nabil W, Karam M, El Kayal S, Chihara N, Suzuki H, Watanabe M, Uchida E, Chen T, Wang J, Wang H, Bouchiba N, Elbakary T, Ramadan A, Elakkad M, Berney C, Vlasov V, Babii I, Pidmurnyak O, Prystupa M, Asakage N, Molinari P, Contino E, Guzzetti L, Oggioni M, Sambuco M, Berselli M, Farassino L, Cocozza E, Crespi A, Ambrosoli A, Zhao Y. Topic: Inguinal Hernia - Unsolved problem in the daily practice. Hernia 2015; 19 Suppl 1:S293-304. [PMID: 26518826 DOI: 10.1007/bf03355374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Yasuo
- Department of Surgery. Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Saiseikai Wakakusa Hospital, Yokohama, Japan
| | - Y Kenichi
- Department of Surgery. Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Saiseikai Wakakusa Hospital, Yokohama, Japan
| | - N Ueno
- Department of General Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - A Arimoto
- Department of General Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - M Hosono
- Division of Gastrointestinal Surgery, Kobe University Hospital, Kobe, Japan
| | - T Yoshikawa
- Department of General Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - A Toyokawa
- Department of General Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Y Kakeji
- Division of Gastrointestinal Surgery, Kobe University Hospital, Kobe, Japan
| | - Y Tsai
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - C Tsai
- Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - J Sul
- Chungnam National University Hospital, Daejeon, South Korea
| | - M Lim
- Chungnam National University Hospital, Daejeon, South Korea
| | - J Park
- Chungnam National University Hospital, Daejeon, South Korea
| | | | - O Santilli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - D Tripoloni
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - H Santilli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - N Nardelli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - A Greco
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - M Estevez
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - S Sakurai
- St. Luke's International Hospital, Tokyo, Japan
| | - S Ryu
- Samsung Changwon Hospital, Changwon-si, Gyeongsangnam-do, South Korea
| | - G Cesana
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - F Ciccarese
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - M Uccelli
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Grava
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Castello
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - D Carrieri
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Legnani
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - S Olmi
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - M Naito
- Department of Surgery, Okayama Medical Center, Okayama, Japan
| | - H Yamamoto
- Department of Surgery, Okayama Medical Center, Okayama, Japan
| | - Y Sawada
- Himeji Daiichi Hospital, Himeji, Japan
| | - Y Mandai
- Okayama University Hospital, Okayama, Japan
| | - H Asano
- Okayama University Hospital, Okayama, Japan
| | - H Ino
- Okayama University Hospital, Okayama, Japan
| | - K Tsukuda
- Okayama University Hospital, Okayama, Japan
| | - T Nagahama
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - M Ando
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - K Ami
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - K Arai
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | | | - A Kitanovic
- Surgery ward, General hospital, Krusevac, Serbia
| | - M Lechner
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Meissnitzer
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - R Fortsner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - D Öfner
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of General Surgery, Sisters of Charity Hospital, Linz, Austria
| | - T Jäger
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Y Kumata
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - R Fukushima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - T Inaba
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Yaguchi
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - M Horikawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - E Ogawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - T Katayama
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - P S Kumar
- ESI-PGIMSR and Medical College, Bangalore, India
| | - D Unal
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - C Caparlar
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - T Akkaya
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - U Mercan
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - H Kulacoglu
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | | | | | | | | | | | | | - K Fujino
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Mita
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - E Ohta
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Takahashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - M Hashimoto
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Nagayasu
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - R Murabayashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - H Asakawa
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Koizumi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - G Hayashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - H Ito
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - F Felberbauer
- Div. of General Surgery, Dpt. of Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - H El Komy
- Faculty of medicine, Alexandria, Egypt
| | | | - W Nabil
- Faculty of medicine, Alexandria, Egypt
| | - M Karam
- Faculty of medicine, Alexandria, Egypt
| | | | - N Chihara
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - H Suzuki
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - M Watanabe
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - E Uchida
- Department of Surgery, Nippon Medical School, Tokyo, Japan
| | - T Chen
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - H Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - N Bouchiba
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - T Elbakary
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - A Ramadan
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - M Elakkad
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - C Berney
- Bankstown-Lidcombe Hospital, University of NSW, Sydney, Australia
| | - V Vlasov
- Khmelnitskiy regional hospital, Khmelnitskiy, Ukraine
| | | | | | | | - N Asakage
- Department of Surgery, Tsudanuma Central General Hospital, Chiba, Japan
| | - P Molinari
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - E Contino
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - L Guzzetti
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Oggioni
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Sambuco
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Berselli
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - L Farassino
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - E Cocozza
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - A Crespi
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - A Ambrosoli
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - Y Zhao
- Department of vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Vanini R, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Tuveri M, Tuveri A, Nicolo E, Tomizawa K, Kuroyanagi H, Matoba S, Moriyama J, Toda S, Hanaoka Y, Fukui Y, Haruta S, Clara ES, Tang S, Tan WB, Wijerathne S, Hu J, Shabbir A, Lomanto D, Son G, Park S, Pietrantoni S, Pietrantoni C, Nishihara M, Takehara H, Nakagawa H, Kuniyoshi N, Aka H, Takushi Y, Miyahira T, Hanashiro N, Okushima N, Mayer F, Lechner M, Öfner D, Bittner R, Köhler G, Fortelny R, Köckerling F, Lim R, Berney C, Kato J, Iuamoto L, Meyer A, Floridi A, Bombelli E, Giuliani D, Galli I, Monti M, Longo A, Pisano G, Li J, Tian D. Topic: Inguinal Hernia - Tailored surgery. Hernia 2015; 19 Suppl 1:S287-92. [PMID: 26518825 DOI: 10.1007/bf03355373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - M Tuveri
- U.O. Chirurgia Generale, Ospedale N.S. di Bonaria, San Gavino Monreale, Italy
| | - A Tuveri
- U. O. Chirurgia Generale, CDC Sant'Elena, Quartu Sant Elena, Italy
| | - E Nicolo
- Dept. of General Surgery, Jefferson Hospital, Pittsburgh, USA
| | - K Tomizawa
- Toranomon Hospital Surgery, Tokyo, Japan
| | | | | | | | | | | | | | | | - E Sta Clara
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Tang
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W B Tan
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Wijerathne
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - G Son
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Park
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Pietrantoni
- General Surgery Department (Director: C. Pietrantoni), S.S. Filippo e Nicola Hospital, Avezzano, AQ, Italy
| | | | | | - H Takehara
- Heart-life Hospital, Nakagami-gun, Japan
| | - H Nakagawa
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - H Aka
- Heart-life Hospital, Nakagami-gun, Japan
| | - Y Takushi
- Heart-life Hospital, Nakagami-gun, Japan
| | - T Miyahira
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - N Okushima
- Heart-life Hospital, Nakagami-gun, Japan
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - R Bittner
- Winghofer Medicum Hernia Center, Rottenburg, Germany
| | - G Köhler
- Department Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, Berlin, Germany
| | - R Lim
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - C Berney
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - J Kato
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - L Iuamoto
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A Meyer
- Director of Abdominal Wall Repair Center, Samaritano Hospital, Sao Paulo, Brazil
| | - A Floridi
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - E Bombelli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - D Giuliani
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - I Galli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - M Monti
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - A Longo
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - G Pisano
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - J Li
- The 2nd Affiliated Hospital of Jilin University, Changchun, China
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Schöffmann T, Primavesi F, Stättner S, Klieser E, Öfner D, Hutter J. Fatal long-term consequence of an allegedly safe and promising procedure: case report of gallbladder cancer 22 years after extracorporeal shockwave lithotripsy for gallstones. Eur Surg 2015. [DOI: 10.1007/s10353-015-0370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Dinnewitzer A, Nawara C, Augschöll C, Neureiter D, Hitzl W, Öfner D, Jäger T. The impact of advanced age on short- and long-term results after surgery for colorectal cancer. Eur Surg 2015. [DOI: 10.1007/s10353-015-0355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Lechner MN, Jäger T, Buchner S, Köhler G, Öfner D, Mayer F. Rail or roll: a new, convenient and safe way to position self-gripping meshes in open inguinal hernia repair. Hernia 2015; 20:417-22. [PMID: 25989726 DOI: 10.1007/s10029-015-1389-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 04/19/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE In open inguinal hernia repair self-gripping meshes are currently commonly employed. Assumed benefits are saving of time, ease of handling and omission of fixation. Self-gripping meshes are, however, not as easy to handle and position as commonly stated. We describe a newly developed way of intra-operative mesh preparation and implantation and compare it to the conventional technique of insertion of self-gripping meshes. METHODS A two-armed, randomized trial with 64 patients was performed. For implantation of the self-gripping, light weight and partially absorbable mesh we used either a newly described rolling technique (group 1: n = 32) or the conventional way of insertion (group 2: n = 32). Primary endpoints of the study were feasibility with regard to actual implantation time and surgeons' satisfaction with the methods. Secondary endpoints were total operating time, length of hospital stay, postoperative pain, duration of pain medication intake and postoperative morbidity. In addition all patients were prospectively followed up according to the Hernia Med® registry's standards. RESULTS Implantation time (seconds) 140 ± 74 vs. 187 ± 84, p = 0.008, duration of pain medication intake (days) 3.6 ± 2.8 vs. 4.8 ± 2.6; p = 0.046 and postoperative morbidity 2 (6%) vs. 8 (25%) was significantly beneficial in group 1 (rolling technique) compared to group 2 (conventional method). Blinded questionnaire revealed that rolling the mesh is generally easier with less repositioning maneuvers than conventional placement. Neither overall procedure time, length of stay nor postoperative pain scores differed significantly between groups. CONCLUSION The newly introduced rolling technique for the actual placement of self-gripping meshes in open inguinal hernia repair is technically less demanding and therefore significantly faster when compared to the conventional way of insertion of the same product. In addition the rolling technique has shown to be safe for the patients and to also provide higher surgeons' satisfaction.
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Affiliation(s)
- M N Lechner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - T Jäger
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - S Buchner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Köhler
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Öfner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria.
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20
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Mayer F, Lechner M, Adolf D, Öfner D, Köhler G, Fortelny R, Bittner R, Köckerling F. Is the age of >65 years a risk factor for endoscopic treatment of primary inguinal hernia? Analysis of 24,571 patients from the Herniamed Registry. Surg Endosc 2015; 30:296-306. [PMID: 25899813 PMCID: PMC4710662 DOI: 10.1007/s00464-015-4209-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
Introduction
Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit. Methods In the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis. Results Unadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60 %; p = 0,010), postoperative surgical (2.72 vs 4.59 %; p < 0.001) and postoperative general complications (0.85 vs 1.98 %; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37 %; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years. Conclusion The higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years.
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Affiliation(s)
- F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - R Bittner
- Hernia Center, Winghofer Medicum, Rottenburg am Neckar, Germany
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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21
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Schweigert M, Giraldo Ospina C, Solymosi N, Karmy-Jones R, Dubecz A, Jiménez Fernández M, Öfner D, Stein HJ. Emergent pneumonectomy for lung gangrene – does the outcome warrant the procedure? Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Augschöll C, Nawara C, Lechner M, Mayer F, Reich-Weinberger S, Jäger T, Öfner D. Pyoderma gangrenosum after ventral hernia repair: a pitfall and how to avoid it. Eur Surg 2013. [DOI: 10.1007/s10353-013-0234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Nawara C, Augschöll C, Hutter J, Öfner D, Primavesi F. GIST des Ösophagus im linken tracheobronchialen Winkel: Resektion mittels rechtsthorakaler VATS. Zentralbl Chir 2013; 138:499-501. [DOI: 10.1055/s-0033-1350904] [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: 10/26/2022]
Affiliation(s)
- C. Nawara
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Österreich
| | - C. Augschöll
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Österreich
| | - J. Hutter
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Österreich
| | - D. Öfner
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Österreich
| | - F. Primavesi
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Österreich
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24
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Affiliation(s)
- F Primavesi
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Österrreich
| | - J Holzinger
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Österrreich
| | - D Öfner
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Österrreich
| | - J Hutter
- Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Österrreich
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25
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Spizzo G, Öfner D, de Vries A, Lukas P, Steger G, Pluschnig U, Zacherl J, Widder J, Zabernigg A, Gastl G, Mühlmann G. Preoperative chemotherapy with cisplatin and docetaxel followed by surgery and clip-oriented postoperative chemoradiation in patients with localized gastric or gastroesophageal junction adenocarcinoma: results from a phase II feasibility study. Ann Surg Oncol 2010; 18:677-83. [PMID: 21063792 DOI: 10.1245/s10434-010-1388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND We conducted a phase II feasibility study using preoperative chemotherapy with cisplatin and docetaxel followed by surgical resection and postoperative chemoradiation in patients with gastric or gastroesophageal cancer. METHODS Preoperative chemotherapy (two or three cycles) consisted of 50 mg/m(2) docetaxel and 50 mg/m(2) cisplatin. Surgical resection was planned 4 weeks after the last chemotherapy cycle. Patients underwent postsurgical chemoradiation, receiving a total dose of 39.6 Gy and 5-fluorouracil (5-FU) continuous infusion (350 mg/m(2)/day). The primary end-points were feasibility, overall response rate and R0 resectability rate after preoperative chemotherapy. The secondary end-points were tolerability, treatment-associated complications, disease-free survival and overall survival. RESULTS Between 2002 and 2004, 15 patients were enrolled in this study. After neoadjuvant treatment, two patients (13%) experienced progressive disease, four patients (27%) showed partial remission and nine patients (60%) showed stable disease. In 11 patients (73%) R0 resectability could be achieved. Six of these patients (54%) were able to undergo postoperative chemoradiation. Notably, five (83%) of these patients were disease free and alive at median follow-up of 72 months. Chemotherapy-associated neutropaenia and neutropaenic fever, anastomotic dehiscence, pulmonary embolism and acute pancreatitis were observed. CONCLUSIONS The combination of preoperative chemotherapy and postoperative chemoradiation is feasible in a significant subset of gastric cancer patients.
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Affiliation(s)
- G Spizzo
- Division of Haematology and Oncology, Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria
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26
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Eisterer WM, De Vries A, Spechtenhauser B, Kendler D, Königsrainer A, Nehoda H, Lukas P, Wöll E, Öfner D. Triple induction chemotherapy and chemoradiotherapy in locally advanced esophageal cancer: Final results of a multicenter phase II trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4568] [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: 11/20/2022] Open
Abstract
4568 Background: Surgery is the standard treatment for patients with resectable esophageal carcinoma, but 5-year survival rates rarely exceed 20%. Neoadjuvant chemoradiotherapy (CRT) may lead to downstaging of the tumor and thus improve the possibility of complete oncologic resection. Docetaxel (Dx) showed considerable activity in combination with hyperfractionated radiotherapy and only moderate toxicity. We evaluated a triple neoadjuvant regime including Dx in patients with locally advanced esophageal adenocarcinoma (AC) or squamos cell carcinoma (SCC). Methods: 24 patients (pts) with AC (n=8) or SCC (n=16) medically fit, no prior therapy, ECOG-performance status = 2 were included. Pts received 2 cycles of cisplatin (Cis) 15mg/ms2 d1–5, 5-fluorouracil (5-FU) 750mg/m2 continuous infusion (CI) d1–5, and Dx 75mg/m2 d1 repeated every 29 days followed by radiotherapy (RT) 39.6 Gy total dose (daily fraction 1.8Gy) concomitant to Dx 15mg/m2 on days 1, 8, 15, 22 and 5-FU 300mg/m2 CI on the days of RT followed by resection or definitive RT up to 59.6 Gy in case of inoperability. Results: See table . Grade 3/4 toxicity (n/%): neutropenia 10/43%, diarrhea 4/18%, alopecia 2/9%; deep vein thrombosis 1/5%, blurred vision 1/5%, fever 1/5%, pulmonary embolus 1/5%, arterial hypertension 1/5%. 1 pt died 39 days post resection due to fatal anastomical bleeding. 6/16 operated pts (37%) showed morbidity (anastomical stenosis/insufficiency, fistula, nervus recurrens palsy). 4/22 pts (18%) died 7- 25 months after therapy due to metastatic disease. At a median follow-up of 12 months 18 pts (82%) are alive, median survival has not been reached yet. Conclusions: Triple induction CT and CRT with Dx, Cis, and 5-FU is safe, feasible, and effective with CPR in 31%, downstaging in 81% and R0-resection in 100% of pts. Main toxicities are neutropenia (43%) and postoperative morbidity (37%). A follow-up phase II trial of triple induction therapy in combination with an EGFR-directed antibody is planned. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- W. M. Eisterer
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - A. De Vries
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - B. Spechtenhauser
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - D. Kendler
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - A. Königsrainer
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - H. Nehoda
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - P. Lukas
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - E. Wöll
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
| | - D. Öfner
- Medical University Innsbruck, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; General Hospital Kufstein, Kufstein, Austria; Public General Hospital St. Vinzenz, Zams, Austria
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Öfner D, de Vries A, Thaler J, Eisterer W, Greil R, Lukas P, Rabl H, Samonigg H, Kapp K, Gnant M. Preoperative oxaliplatin (O), capecitabine (X), and external beam radiotherapy (RT) in patients (pts) with newly diagnosed, primary operable, locally advanced rectal cancer (LARC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14527] [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: 11/20/2022] Open
Abstract
14527 Background: Local recurrence after surgery is a cause of treatment failure and relapse in pts with LARC. Preoperative RT decreases local recurrence but not distant spread. X and O are both highly active chemotherapies for advanced colorectal cancer, particularly in combination, and both are radiosensitizers. Therefore, the addition of X and O to preoperative RT should improve efficacy in terms of local control and prevention of metastases. Methods: This study investigated the efficacy (rate of downstaging) and safety of preoperative chemoradiation in pts with LARC (of lower and middle rectum), T3NxM0 staged by MRT. RT was administered for 5 weeks, 5 days/week, 1.8 Gy/fraction, total dose 45 Gy, 3D conformation technique, in combination with O 50 mg/m2 intravenously on days 1, 8, 15, and 22, and oral X 825 mg/m2 twice a day on RT-days during weeks 1–4. Surgery was performed 14–28 days after completion of RT. Results: 59 pts were enrolled (19 female, 40 male); median age 61 years (range 34–76), 100% of pts are evaluable for efficacy and toxicity. 41 patients had comorbidities: 16 cardiac, 3 hepatic, 6 diabetes, 1 neurological/psychological, 49 others. Tumor downstaging was observed in 53% of pts (23 T2, 2 T1, 6 T0). 5 pts withdrew because of adverse events. 28 pts (47%) experienced grade 1 neurotoxicity and 5 pts (8%) had grade 2 neurotoxicity. The most frequent grade 3/4 NCI-CTC adverse event was diarrhea: 5/59 pts (8%). Total O and X doses received were 90% and 93% of the planned doses, respectively. The main reason for chemotherapy dose reduction was diarrhea occurring during the 3rd-4th week of treatment. Per-protocol therapy was terminated for 8 pts due to interruption of RT for more than 3 days or adverse events such as diarrhea and nausea (total dose received 25.2–34.2 Gy). Conclusions: These results demonstrate that preoperative O and X in combination with RT is feasible in pts with LARC, and comparable with 5-FU. As expected, the only clinically relevant toxicity was diarrhea, and dose intensity of both chemotherapeutic agents and RT was high. [Table: see text]
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Affiliation(s)
- D. Öfner
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - A. de Vries
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - J. Thaler
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - W. Eisterer
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - R. Greil
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - P. Lukas
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - H. Rabl
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - H. Samonigg
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - K. Kapp
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
| | - M. Gnant
- Medical University Innsbruck, Innsbruck, Austria; LKH Feldkirch, Feldkirch, Austria; Klinikum Kreuzschwestern Wels, Wels, Austria; Salzburger Landeskliniken, St. Johanns-Spital, Salzburg, Austria; LKH Leoben, Leoben, Austria; Medical University of Graz, Graz, Austria; University Hospital of Surgery, Vienna, Austria; ABCSG 95 Investigators
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DeVries A, Griebel J, Kremser C, Hoflehner J, Öfner D, Debbage P, Lukas P. In vivo monitoring of tumor microcirculation changes during radiotherapy in patients with rectal carcinomas: preliminary results and possible implications for therapy. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Piffkò J, Bànkfalvi A, Öfner D, Joos U, Böcker W, Schmid KW. The effect of wet autoclave pretreatment on silver staining of nucleolar-organizer-region-associated proteins (AgNORs) in archival oral squamous cell carcinomas. J Cancer Res Clin Oncol 1995. [DOI: 10.1007/bf02572121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schmid T, Oberhuber G, Thaler W, Klima G, Öfner D, Margreiter R. Experimentelle Untersuchungen zur Abstoßungsdiagnostik nach allogener Dünndarmtransplantation. Eur Surg 1993. [DOI: 10.1007/bf02602214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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