1
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Boeyer M, Tweedy N, Hoernschemeyer D, Wiesemann S. Central Airway Obstruction with Persistent Pulmonary Decline After Vertebral Body Tethering: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00007. [PMID: 37831807 DOI: 10.2106/jbjs.cc.23.00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
CASE An 11-year-old girl with pectus excavatum presented with an acute airway obstruction and persistent pulmonary compromise after vertebral body tethering (VBT). The anterior instrumentation was occluding her right basilar bronchus, resulting in hyperinflation. Removal of the instrumentation reversed the hyperinflation. CONCLUSION This case illustrates the difficulty of performing VBT in a small patient with severe scoliosis and significant asymmetric pectus excavatum. We recommend using low-profile instrumentation and ensuring the trajectory of the instrumentation is anterior to the rib head and parallel to the articular facets.
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Affiliation(s)
- Melanie Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Nicole Tweedy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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2
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Abstract
PURPOSE The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT. METHODS We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5 months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior-anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success. RESULTS The mean age at the time of instrumentation was 13.4 ± 1.3 years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification. CONCLUSIONS These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.
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Affiliation(s)
- Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA
- Missouri Orthopaedic Institute, Columbia, MO, USA
| | - Sophi Farid
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sebastian Wiesemann
- Division of Thoracic Surgery, Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Daniel G Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA.
- Missouri Orthopaedic Institute, Columbia, MO, USA.
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3
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Oladeji LO, Vivace B, Kelly S, Wiesemann S, DeFroda SF. The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation. Arthrosc Tech 2023; 12:e697-e702. [PMID: 37323796 PMCID: PMC10265522 DOI: 10.1016/j.eats.2023.01.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/18/2023] [Indexed: 06/17/2023] Open
Abstract
Bipolar "floating" clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.
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Affiliation(s)
- Lasun O. Oladeji
- Departments of Orthopaedic Surgery University of Missouri Columbia, Columbia, Missouri, U.S.A
| | - Bradley Vivace
- Departments of Orthopaedic Surgery University of Missouri Columbia, Columbia, Missouri, U.S.A
| | - Shayne Kelly
- Departments of Orthopaedic Surgery University of Missouri Columbia, Columbia, Missouri, U.S.A
| | - Sebastian Wiesemann
- Thoracic Surgery, University of Missouri Columbia, Columbia, Missouri, U.S.A
| | - Steven F. DeFroda
- Departments of Orthopaedic Surgery University of Missouri Columbia, Columbia, Missouri, U.S.A
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4
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Kang SA, Patel PK, Patil S, Bran-Acevedo A, Layfield L, Wiesemann S, Roland W. A Case of Spontaneous Pneumothorax due to Paragonimiasis in North America with Literature Review. IDCases 2023; 32:e01742. [PMID: 36968306 PMCID: PMC10034413 DOI: 10.1016/j.idcr.2023.e01742] [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] [Received: 02/15/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
The species, Paragonimus kellicotti , causes human paragonimiasis in North America. As a foodborne disease, human infection with P. kellicotti occurs after eating raw or undercooked crayfish containing metacercariae. Many risk factors have been described in the literature, including young adult age, male, alcohol consumption, outdoor activities involving rivers within Missouri, and ingesting raw or partially cooked crayfish. Here, we report a case of a 41-year-old male with a 5-year history of cough who presented with acute shortness of breath. Further workup showed mild eosinophilia and spontaneous pneumothorax. A definitive diagnosis was made with a lung biopsy, which showed P. kellicotti eggs. Further questioning revealed that the patient took a hunting and river rafting trip on a river in Missouri 5 years ago, though the history was negative for any crayfish consumption. Paragonimiasis should be considered in those with associated clinical features, including cough and eosinophilia, with a history of a river raft float trip in Missouri, even if the history is negative for crayfish ingestion or travel.
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Affiliation(s)
- Seung Ah Kang
- M4 Medical student, University of Missouri School of Medicine, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Parag Kumar Patel
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Sachin Patil
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
- Correspondence to: Division of Pulmonary, Critical Care and Environmental Medicine, USA.
| | - Andres Bran-Acevedo
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Lester Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Sebastian Wiesemann
- Department of Cardiothoracic Surgery, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - William Roland
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
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5
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Waldeck S, Mitschke J, Wiesemann S, Rassner M, Andrieux G, Deuter M, Mutter J, Lüchtenborg AM, Kottmann D, Titze L, Zeisel C, Jolic M, Philipp U, Lassmann S, Bronsert P, Greil C, Rawluk J, Becker H, Isbell L, Müller A, Doostkam S, Passlick B, Börries M, Duyster J, Wehrle J, Scherer F, von Bubnoff N. Early assessment of circulating tumor DNA after curative-intent resection predicts tumor recurrence in early-stage and locally advanced non-small-cell lung cancer. Mol Oncol 2021; 16:527-537. [PMID: 34653314 PMCID: PMC8763652 DOI: 10.1002/1878-0261.13116] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 06/14/2021] [Revised: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating tumor DNA (ctDNA) has demonstrated great potential as a noninvasive biomarker to assess minimal residual disease (MRD) and profile tumor genotypes in patients with non‐small‐cell lung cancer (NSCLC). However, little is known about its dynamics during and after tumor resection, or its potential for predicting clinical outcomes. Here, we applied a targeted‐capture high‐throughput sequencing approach to profile ctDNA at various disease milestones and assessed its predictive value in patients with early‐stage and locally advanced NSCLC. We prospectively enrolled 33 consecutive patients with stage IA to IIIB NSCLC undergoing curative‐intent tumor resection (median follow‐up: 26.2 months). From 21 patients, we serially collected 96 plasma samples before surgery, during surgery, 1–2 weeks postsurgery, and during follow‐up. Deep next‐generation sequencing using unique molecular identifiers was performed to identify and quantify tumor‐specific mutations in ctDNA. Twelve patients (57%) had detectable mutations in ctDNA before tumor resection. Both ctDNA detection rates and ctDNA concentrations were significantly higher in plasma obtained during surgery compared with presurgical specimens (57% versus 19% ctDNA detection rate, and 12.47 versus 6.64 ng·mL−1, respectively). Four patients (19%) remained ctDNA‐positive at 1–2 weeks after surgery, with all of them (100%) experiencing disease progression at later time points. In contrast, only 4 out of 12 ctDNA‐negative patients (33%) after surgery experienced relapse during follow‐up. Positive ctDNA in early postoperative plasma samples was associated with shorter progression‐free survival (P = 0.013) and overall survival (P = 0.004). Our findings suggest that, in early‐stage and locally advanced NSCLC, intraoperative plasma sampling results in high ctDNA detection rates and that ctDNA positivity early after resection identifies patients at risk for relapse.
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Affiliation(s)
- Silvia Waldeck
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Mitschke
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Rassner
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geoffroy Andrieux
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Max Deuter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik Mutter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne-Marie Lüchtenborg
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Kottmann
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laurin Titze
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Zeisel
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martina Jolic
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Philipp
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Silke Lassmann
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Greil
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justyna Rawluk
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Isbell
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Müller
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Soroush Doostkam
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Börries
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Lübeck, Germany
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6
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Le UT, Bronsert P, Picardo F, Riethdorf S, Haager B, Rylski B, Czerny M, Beyersdorf F, Wiesemann S, Pantel K, Passlick B, Kaifi JT, Schmid S. Author Correction: Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases. Sci Rep 2020; 10:7633. [PMID: 32358537 PMCID: PMC7195361 DOI: 10.1038/s41598-020-64151-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Uyen-Thao Le
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Francesco Picardo
- Laboratory of Molecular Medicine and Biotechnology, Campus Bio-Medico University of Rome, Rome, Italy.,Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Haager
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jussuf Thomas Kaifi
- Section for Thoracic Surgery, Hugh E. Stephenson Jr., MD, Department of Surgery, Ellis Fischel Cancer Center, University of Missouri, Columbia, USA
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany. .,Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany. .,Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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7
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Palade E, Günter J, Gomez JMM, Wellner UF, Schmid S, Wiesemann S, Passlick B. Morbidity, mortality and long-term outcome of lung cancer resections performed in palliative intent. J Thorac Dis 2019; 11:4308-4318. [PMID: 31737316 DOI: 10.21037/jtd.2019.09.61] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgery is seldom used for palliation in advanced lung cancer and the published data on this issue are very limited. We aimed to assess the results of palliative lung resections and identify criteria to guide surgical therapy in this situation. Methods This is a retrospective single-institution analysis of patients with palliative intended lung cancer resection. Survival analysis was performed by Kaplan-Meier method, log-rank test and Cox proportional hazards regression at a statistical significance level of P=0.05. Results Forty-eight patients received palliative intended lung resections (31 lobectomies, 4 bilobectomies, 13 pneumonectomies) with acceptable rates of severe complications (Clavien-Dindo >IIIa 29%) and 30-day mortality (4%). The most frequent indications were infection and hemoptysis. The median survival for the entire group was 12 months (95% CI: 6.9-17.1 months). Due to unexpectedly favorable histopathologic tumor stage, a switch to curative treatment in 17 completely resected patients resulted in a 2-year survival rate of 46%. In a subgroup of 20 patients with favorable prognostic factors as identified by uni- and multivariable analysis, a median survival of 26 months was observed. Conclusions In well selected patients with lung cancer, resection in palliative intent can offer symptom relief and even a survival benefit with acceptable morbidity and low mortality. Prognostic factors were identified and can be used to guide operative treatment. Due to the low specificity of CT and FDG-PET/CT in the presence of inflammation or centrally located lung tumors, a large proportion of patients with lung resection in palliative intent experience a down-staging and frequently also a switch from palliative to curative treatment with additional survival benefit. Factors like expected complete resection, a squamous cell type and the ability to receive adjuvant therapy are useful to support the decision to perform palliative tumor resection.
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Affiliation(s)
- Emanuel Palade
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.,Department of Surgery, Medical University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jutta Günter
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Juan M M Gomez
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich F Wellner
- Department of Surgery, Medical University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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8
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Moneke I, Kaifi JT, Kloeser R, Samson P, Haager B, Wiesemann S, Diederichs S, Passlick B. Pulmonary metastasectomy for thyroid cancer as salvage therapy for radioactive iodine-refractory metastases. Eur J Cardiothorac Surg 2019; 53:625-630. [PMID: 29092022 DOI: 10.1093/ejcts/ezx367] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/09/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Distant metastasis arising from thyroid cancer is rare but has been associated with significantly reduced long-term survival, especially when refractory to radioactive iodine ablation. We provide one of the largest studies worldwide reporting the outcome after salvage pulmonary metastasectomy for this entity, aiming to identify prognostic factors and to analyse surgical indication. METHODS We retrospectively analysed the medical records of 43 patients who had undergone pulmonary metastasectomy for radioactive iodine-refractory thyroid cancer from 1985 to 2016. RESULTS The median follow-up period was 77 (95% confidence interval 41-113) months. Twenty-three (53%) patients were alive at the time of analysis. The majority of tumours were follicular thyroid cancer by histology, with 23% identified as Hurthle cell subtype. Five- and 10-year disease-specific (DS) survival was 84% and 59%, respectively. Thirty-one (72%) patients underwent R0-resection with a 5- and 10-year DS survival of 100% and 77%, respectively. This was significantly reduced to 62% and 22% (P = 0.013) in case of incomplete resection, respectively. Ten years after R0-metastasectomy, 17 (55%) patients were recurrence-free. Systematic mediastinal lymphadenectomy was performed in 16 (37%) patients and was associated with improved long-term DS survival (10 years 88% vs 46%, P = 0.034). Moreover, a reduction of > 80% in serum thyroglobulin levels post-metastasectomy correlates with better long-term DS survival (10 years 81% vs 36%, P = 0.007). CONCLUSIONS Pulmonary metastasectomy is associated with good survival for selected patients with radioactive iodine-refractory metastases of differentiated thyroid cancer, especially if R0-resection can be achieved. Moreover, it is worth considering whether a significant reduction of tumour load, as indicated by thyroglobulin serum levels, seems possible.
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Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Jussuf T Kaifi
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raphael Kloeser
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Samson
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Haager
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven Diederichs
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany.,Division of RNA Biology and Cancer, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Germany
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9
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Hechtner M, Eichler M, Wehler B, Buhl R, Sebastian M, Stratmann J, Schmidberger H, Gohrbandt B, Peuser J, Kortsik C, Nestle U, Wiesemann S, Wirtz H, Wehler T, Bals R, Blettner M, Singer S. Quality of Life in NSCLC Survivors - A Multicenter Cross-Sectional Study. J Thorac Oncol 2018; 14:420-435. [PMID: 30508641 DOI: 10.1016/j.jtho.2018.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 07/08/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea. METHODS Data from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age- and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales. RESULTS Six hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0-21.2 years). Compared to the age- and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p < 0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (β |19-31|, all p < 0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (β |8-12|, p < 0.01), respiratory comorbidity (β |4-5|, p < 0.01), and living on a disability pension (β |10-11|, p < 0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (β |10-20|, p < 0.001). Better QoL was also observed in patients with high income (β |10-14|, p < 0.01). CONCLUSIONS Lung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care.
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Affiliation(s)
- Marlene Hechtner
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Martin Eichler
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Germany; University Hospital Carl Gustav Carus Dresden, Germany
| | - Beatrice Wehler
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; Saarland University Medical Center, Homburg, Germany
| | - Roland Buhl
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Martin Sebastian
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Stratmann
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Heinz Schmidberger
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | - Ursula Nestle
- University Medical Center Freiburg, Albert-Ludwig-University, Freiburg Germany; Maria Hilf Hospital Moenchengladbach, Moenchengladbach, Germany
| | - Sebastian Wiesemann
- University Medical Center Freiburg, Albert-Ludwig-University, Freiburg Germany
| | - Hubert Wirtz
- Leipzig University Hospital, Leipzig University, Leipzig, Germany
| | - Thomas Wehler
- Saarland University Medical Center, Homburg, Germany
| | - Robert Bals
- Saarland University Medical Center, Homburg, Germany
| | - Maria Blettner
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Susanne Singer
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; University Cancer Center Mainz, Mainz, Germany
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10
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Schnell J, Beer M, Eggeling S, Gesierich W, Gottlieb J, Herth F, Hofmann HS, Jany B, Kreuter M, Ley-Zaporozhan J, Scheubel R, Walles T, Wiesemann S, Worth H, Stoelben E. Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline. Zentralbl Chir 2018; 143:S12-S43. [PMID: 30041262 DOI: 10.1055/a-0588-4444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery (DGT), in co-operation with the German Society for Pulmonology (DGP), the German Radiological Society (DRG) and the German Society of Internal Medicine (DGIM) has developed an S3 guideline on spontaneous pneumothorax and postinterventional pneumothorax moderated by the German Association of Scientific Medical Societies (AWMF). METHOD Based on the source guideline of the British Thoracic Society (BTS2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to GRADE (A: "we recommend"/"we do not recommend", B: "we suggest"/"we do not suggest") were determined in three consensus conferences by the nominal group process. RESULTS The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery (VATS). Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of postinterventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. DISCUSSION The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.
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Affiliation(s)
- Jost Schnell
- Lungenklinik Köln-Merheim, Lehrstuhl Thoraxchirurgie der Universität Witten-Herdecke
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm
| | | | | | - Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - Felix Herth
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik Universitätsklinikum Heidelberg
| | | | - Berthold Jany
- Medizinische Klinik - Schwerpunkt Pneumologie und Beatmungsmedizin, KWM Missioklinik Würzburg
| | - Michael Kreuter
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik Universitätsklinikum Heidelberg
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilans-Universität München
| | | | - Thorsten Walles
- Abteilung Thoraxchirurgie, Universitätsklinik für Herz- und Thoraxchirurgie Magdeburg
| | | | | | - Erich Stoelben
- Lungenklinik Köln-Merheim, Lehrstuhl Thoraxchirurgie der Universität Witten-Herdecke
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11
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Schnell J, Beer M, Eggeling S, Gesierich W, Gottlieb J, Herth FJF, Hofmann HS, Jany B, Kreuter M, Ley-Zaporozhan J, Scheubel R, Walles T, Wiesemann S, Worth H, Stoelben E. Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline. Respiration 2018; 97:370-402. [PMID: 30041191 DOI: 10.1159/000490179] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022] Open
Abstract
In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery, in co-operation with the German Society for Pulmonology, the German Radiological Society, and the German Society of Internal Medicine has developed an S3 guideline on spontaneous pneumothorax and post-interventional pneumothorax moderated by the German Association of Scientific Medical Societies. METHOD Based on the source guideline of the British Thoracic Society (2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to grade (A: "we recommend"/"we do not recommend," B: "we suggest"/"we do not suggest") were determined in 3 consensus conferences by the nominal group process. RESULTS The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery. Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences, and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of post-interventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. DISCUSSION The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.
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Affiliation(s)
- Jost Schnell
- Lungenklinik Köln-Merheim, Lehrstuhl Thoraxchirurgie der Universität Witten-Herdecke, Witten-Herdecke, Germany,
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Stephan Eggeling
- Klinik für Thoraxchirurgie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Gesierich
- Klinik für Pneumologie, Asklepios-Fachkliniken München Gauting, München Gauting, Germany
| | - Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Felix J F Herth
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Stefan Hofmann
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Berthold Jany
- Medizinische Klinik - Schwerpunkt Pneumologie und Beatmungsmedizin, KWM Missioklinik, Würzburg, Germany
| | - Michael Kreuter
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilans-Universität München, München, Germany
| | - Julia Ley-Zaporozhan
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert Scheubel
- Klinik für Thoraxchirurgie, Fachkliniken Wangen, Wangen, Germany
| | - Thorsten Walles
- Abteilung Thoraxchirurgie, Universitätsklinik für Herz- und Thoraxchirurgie Magdeburg, Magdeburg, Germany
| | - Sebastian Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Heinrich Worth
- Pneumologische und kardiologische Praxis Fürth, Fürth, Germany
| | - Erich Stoelben
- Lungenklinik Köln-Merheim, Lehrstuhl Thoraxchirurgie der Universität Witten-Herdecke, Witten-Herdecke, Germany
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12
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Fricke A, Bannasch H, Klein HF, Wiesemann S, Samson-Himmelstjerna P, Passlick B, Beyersdorf F, Hoeppner J, Penna V, Eisenhardt SU, Stark BG, Koulaxouzidis G. Pedicled and free flaps for intrathoracic fistula management. Eur J Cardiothorac Surg 2018; 52:1211-1217. [PMID: 29106507 DOI: 10.1093/ejcts/ezx216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/25/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Intrathoracic fistulae are among the potential sequelae of radiation therapy, empyema and abscess clearance and surgical tumour resections. Interdisciplinary plastic-reconstructive flap surgery is a helpful tool for the successful treatment of intrathoracic fistulae. METHODS From February 2006 to April 2016, 13 patients (3 females and 10 males) underwent flap surgery for bronchial (n = 5), tracheal (n = 2), oesophageal (n = 2), post-pneumonectomy bronchopleural fistula (n = 2), tracheo-oesophageal (n = 1), gastrobronchial (n = 1) and oesophagobronchial (n = 1) fistulae. Patient characteristics, identified pathogenic micro-organisms, treatment and decision criteria, long-term outcome and postoperative complications were evaluated by analysing patient charts and surgical reports. RESULTS The mean age of the 13 patients who underwent reconstructive surgery was 55.5 years (range: 42-66 years). The median follow-up time was 31.4 months (range: 2-96 months). American Society of Anaesthesiologists classification was II for 1 patient, III for 8 patients and IV for 4 patients. In total, 18 flaps were performed (7 latissimus dorsi pedicled flaps, 7 pectoralis major pedicled flaps, 2 rectus abdominis myocutaneous flaps, 1 free temporo-parietal fascia flap and 1 intercostal muscle flap). A second flap was indicated in 5 cases (38.5%) due to fistula recurrence; of these, 1 patient developed a bronchial fistula after successful reconstruction of a gastrobronchial fistula. Eight of the 13 patients (61.5%) were evaluated postoperatively at regular intervals for at least 1 year and showed no signs of fistula recurrence. CONCLUSIONS Our study showed that plastic-reconstructive flap surgery, although associated with significant morbidity and mortality, can be a life-saving tool for intrathoracic fistula reconstruction. Clinical Trial Registration DRKS00010447.
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Affiliation(s)
- Alba Fricke
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Henriette F Klein
- Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | | | | | - Bernward Passlick
- Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Jens Hoeppner
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Vincenzo Penna
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Björn G Stark
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Georgios Koulaxouzidis
- Department of Plastic and Hand Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
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13
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Le UT, Bronsert P, Picardo F, Riethdorf S, Haager B, Rylski B, Czerny M, Beyersdorf F, Wiesemann S, Pantel K, Passlick B, Kaifi JT, Schmid S. Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases. Sci Rep 2018; 8:8751. [PMID: 29884810 PMCID: PMC5993733 DOI: 10.1038/s41598-018-26410-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/09/2018] [Accepted: 05/10/2018] [Indexed: 01/15/2023] Open
Abstract
Circulating tumor cells (CTC) have been studied extensively in various tumor types and are a well-established prognosticator in colorectal cancer (CRC). This is the first study to isolate CTC directly from the tumor outflow in secondary lung tumors. For this purpose in 24 patients with CRC who underwent pulmonary metastasectomy in curative intent blood was drawn intraoperatively from the pulmonary vein (tumor outflow). In 22 samples CTC-enumeration was performed using CellSieve-microfilters and immunohistochemical- and Giemsa-staining. Additionally 10 blood samples were analyzed using the CellSearch-System. We could isolate more CTC in pulmonary venous blood (total 41, range 0-15) than in samples taken from the periphery at the same time (total 6, range 0-5, p = 0.09). Tumor positive lymph nodes correlated with presence of CTC in pulmonary venous blood as in all cases CTC were present (p = 0.006). Our findings suggest a tumor cell release from pulmonary metastases in CRC and a correlation of CTC isolated from the tumor outflow with established negative prognostic markers in metastasized CRC. The presented data warrant further investigations regarding the significance of local tumor compartments when analyzing circulating markers and the possibility of tumor cell shedding from secondary lung tumors.
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Affiliation(s)
- Uyen-Thao Le
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Francesco Picardo
- Laboratory of Molecular Medicine and Biotechnology, Campus Bio-Medico University of Rome, Rome, Italy
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Haager
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jussuf Thomas Kaifi
- Section for Thoracic Surgery, Hugh E. Stephenson Jr., MD, Department of Surgery, Ellis Fischel Cancer Center, University of Missouri, Columbia, USA
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.
- Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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14
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Eichler M, Hechtner M, Wehler B, Buhl R, Stratmann J, Sebastian M, Schmidberger H, Peuser J, Kortsik C, Nestle U, Wiesemann S, Wirtz H, Wehler T, Blettner M, Singer S. Psychological distress in lung cancer survivors at least 1 year after diagnosis-Results of a German multicenter cross-sectional study. Psychooncology 2018; 27:2002-2008. [PMID: 29761591 DOI: 10.1002/pon.4760] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/12/2018] [Accepted: 04/30/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Eichler
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marlene Hechtner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Beatrice Wehler
- Department of Radio-Oncology, University Hospital Saarland, Homburg, Germany.,Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Roland Buhl
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Jan Stratmann
- Medical Department II, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin Sebastian
- Medical Department II, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Heinz Schmidberger
- Department of Radio-Oncology, University Medical Center Mainz, Mainz, Germany
| | - Jessica Peuser
- Department of Pulmonology, Hildegardis Hospital, Mainz, Germany
| | | | - Ursula Nestle
- Department of Radiation Oncology, University Medical Center, Freiburg, Germany.,Department of Radiotherapy, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, University Medical Center, Freiburg, Germany
| | - Hubert Wirtz
- Department of Pneumology, University Medical Centre Leipzig, Leipzig, Germany
| | - Thomas Wehler
- Department of Internal Medicine V, University Hospital Saarland, Homburg, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
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15
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Haager B, Wiesemann S, Passlick B, Schmid S. Prognostic value of lymph node ratio after induction therapy in stage IIIA/N2 non-small cell lung cancer: a monocentric clinical study. J Thorac Dis 2018; 10:3225-3231. [PMID: 30069318 DOI: 10.21037/jtd.2018.05.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/18/2023]
Abstract
Background The optimal treatment modalities for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) are still a matter of debate. To provide best outcome and to avoid unnecessary treatment patient selection for surgical therapy is crucial. In addition to mediastinal downstaging the lymph node ratio (LNR) has been suggested as a prognosticator in this patient group. Methods We retrospectively reviewed clinical and histopathologic data of 78 patients with stage IIIA N2 NSCLC, who underwent induction therapy with two cycles of platinum-based chemotherapy for intended surgery at our clinic between 2009 and 2016. To evaluate the prognostic value of the LNR the cut off was set at 0.33 as reported in prior literature. Results The median follow-up time was 30.1 months. In multivariate analysis mediastinal down staging was associated with a longer overall survival (OS): 52.2 (range, 5.9-89.7) months for ypN0 versus 24.6 (4.4-84.2) months for ypN1/2 (HR, 2.76; 95% CI, 1.07-7.1, P=0.0348). LNR ≤0.33 was linked to a better OS of 39.3 (range, 5.9-89.7) months compared to 14.7 (range, 4.4-66.2) months for a LNR >0.33 in univariate analysis (P=0.037). In multivariate analysis a statistical trend could be observed (HR, 2.82; 95% CI, 0.98-8.14, P=0.1). In patients with persistent lymph node involvement the LNR could also identify a subgroup of patients with a favorable prognosis (30.1 vs. 14.7 months, P=0.145). Conclusions Mediastinal downstaging remains the best prognosticator in stage IIIA N2 NSCLC after induction therapy. However, using the LNR in patients with persistent mediastinal lymph node metastasis a subgroup with a favorable prognosis could be identified. The LNR could aid in finding the best treatment modalities for these patients.
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Affiliation(s)
- Benedikt Haager
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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16
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Grapatsas K, Kayser G, Passlick B, Wiesemann S. Pulmonary coin lesion mimicking lung cancer reveals an unexpected finding: Dirofilaria immitis. J Thorac Dis 2018; 10:3879-3882. [PMID: 30069389 DOI: 10.21037/jtd.2018.05.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Konstantinos Grapatsas
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Gian Kayser
- Institute of Surgical Pathology, Department of Pathology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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17
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Csanadi A, Oser A, Aumann K, Gumpp V, Rawluk J, Nestle U, Kayser C, Wiesemann S, Werner M, Kayser G. Overexpression of SLC1a5 in lymph node metastases outperforms assessment in the primary as a negative prognosticator in non-small cell lung cancer. Pathology 2018; 50:269-275. [PMID: 29455869 DOI: 10.1016/j.pathol.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/24/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 12/25/2022]
Abstract
Despite recent advances in therapeutic options, lung cancer is the leading cause of death among malignant diseases worldwide. Glutamine-dependence is an established attribute in cancer tissue with emerging importance as a diagnostic and therapeutic target. We analysed the expression of SLC1a5, a major glutamine transporter, in the primary tumour and corresponding nodal metastasis of non-small cell lung cancer (NSCLC) to investigate its biological impact. Expression of SLC1a5 was analysed by immunohistochemistry in 259 NSCLC and in 142 nodal metastases and correlated with clinicopathological parameters including overall survival. SLC1a5 expression in the primary tumour and in the corresponding lymph node metastasis revealed a positive correlation (p = 0.005). Moreover, overexpression of SLC1a5 was found to be an independent prognostic factor (p = 0.027) if assessed in lymph node metastases only. SLC1A5 expression was studied for the first time in both primary NSCLC and its corresponding nodal metastasis. Our results indicate that overexpression of SLC1a5 is associated with shorter overall survival. This proved to be an independent prognosticator if assessed in the lymph node metastases. Thus, diagnostics in lymph node metastasis provide superior prognostic information for SLC1a5 overexpression and may open target prediction for future therapeutic options.
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Affiliation(s)
- Agnes Csanadi
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Annika Oser
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Konrad Aumann
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Vera Gumpp
- Clinical Cancer Registry, Comprehensive Cancer Centre Freiburg, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Justyna Rawluk
- Faculty of Medicine, University of Freiburg, Germany; Department of Hematology and Oncology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Ursula Nestle
- Faculty of Medicine, University of Freiburg, Germany; Department of Radiation Oncology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Claudia Kayser
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Sebastian Wiesemann
- Faculty of Medicine, University of Freiburg, Germany; Department of Thoracic Surgery, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Martin Werner
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Gian Kayser
- Institute of Surgical Pathology, Medical Centre - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
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Simunovic F, Wittel U, Passlick B, Wiesemann S, Czerny M, Südkamp M, Stark GB, Bannasch H. [The use of Deep Inferior Epigastric Vessels to Revascularise Free Flaps for Reconstruction of Complex Oncosurgical Defects of the Thigh and the Abdomen]. HANDCHIR MIKROCHIR P 2018; 50:259-268. [PMID: 29341038 DOI: 10.1055/s-0043-124187] [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] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The resection of large soft-tissue sarcoma requires reconstruction with free flaps. The choice of recipient vessels is crucial for the success of surgery. PATIENTS We report four cases with large soft-tissue sarcomas with complex anatomical relationships: two tumors of the thigh surrounding the femoral neurovascular structures and two tumors of the abdomen with infiltration of the thorax and the abdomen. All cases received multimodal interdisciplinary treatment. The anterolateral thigh (ALT) flap and the latissimus dorsi (LD) flap were employed twice for defect coverage in this series. In all cases the deep inferior epigastric (DIE) vessels were transposed to the subcutaneous compartment and used as recipient vessels. RESULTS The mean duration of surgery was 694 ± 149 minutes. The mean weight of the tumor specimen was 3069 ± 1267 g. Three flaps healed primarily and one exhibited a minor necrosis, which was treated by excision and secondary suture. There were no cases of abdominal herniation due to the transposition of vessels. CONCLUSION Transposition of DIE-vessels to the subcutaneus compartment is a good alternative for free flap revascularisation in this patient group. In this position, the vessels are easily accessed and used for microsurgery. This technical modification increases the reconstructive possibilities in large and previously irradiated surgical defects.
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Affiliation(s)
- F Simunovic
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg
| | - U Wittel
- Klinik für Allgemein und Viszeralchirurgie, Universitätsklinikum Freiburg
| | - B Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg
| | - S Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg
| | - M Czerny
- Klinik für Herz und Gefäßchirurgie, Universitätsklinikum Freiburg
| | - M Südkamp
- Klinik für Herz und Gefäßchirurgie, Universitätsklinikum Freiburg
| | - G B Stark
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg
| | - H Bannasch
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg
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Gkika E, Beitinger S, Adebahr S, Schimek-Jasch T, Wiesemann S, Waller C, Grosu A, Nestle U, Kayser G. Prognostic significance of different immunohistochemical markers in small cell lung cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx090.011] [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: 11/14/2022] Open
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20
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Hechtner M, Eichler M, Wehler B, Buhl R, Stratmann J, Sebastian M, Schmidberger H, Gohrbandt B, Peuser J, Kortsik C, Nestle U, Wiesemann S, Wirtz H, Wehler T, Bals R, Blettner M, Singer S. Lebensqualität und psychosoziale Rehabilitation bei Lungenkrebsüberlebenden (LARIS) – eine multizentrische Studie. Pneumologie 2017. [DOI: 10.1055/s-0037-1598466] [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: 10/20/2022]
Affiliation(s)
- M Hechtner
- Institut für Medizinische Biometrie Epidemiologie und Informatik, Universitätsmedizin Mainz, Deutsches Konsortium für Translationale Krebsforschung (Dktk), Partnerstandort Mainz, Deutsches Krebsforschungszentrum Heidelberg
| | - M Eichler
- Institut für Medizinische Biometrie Epidemiologie und Informatik, Universitätsmedizin Mainz, Deutsches Konsortium für Translationale Krebsforschung (Dktk), Partnerstandort Mainz, Deutsches Krebsforschungszentrum Heidelberg
| | - B Wehler
- Klinik für Strahlentherapie und Radioonkologie & Innere Medizin V, Universitätsklinikum des Saarlandes; III. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
| | - R Buhl
- Schwerpunkt Pneumologie, III. Medizinische Klinik, Universitätsmedizin Mainz
| | - J Stratmann
- Med. Klinik II, Universitätsklinikum Frankfurt
| | - M Sebastian
- Med. Klinik II, Universitätsklinikum Frankfurt
| | - H Schmidberger
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie, Universitätsmedizin Mainz
| | - B Gohrbandt
- Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz
| | - J Peuser
- Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Katholisches Klinikum Mainz
| | - C Kortsik
- Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Katholisches Klinikum Mainz
| | - U Nestle
- Klinik für Strahlenheilkunde, Universiätsklinikum Freiburg
| | - S Wiesemann
- Klinik für Thoraxchirurgie, Universiätsklinikum Freiburg
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig AöR
| | - T Wehler
- Innere Medizin V, Universitätsklinikum des Saarlandes
| | - R Bals
- Innere Medizin V, Universitätsklinikum des Saarlandes
| | - M Blettner
- Institut für Medizinische Biometrie Epidemiologie und Informatik, Universitätsmedizin Mainz
| | - S Singer
- Institut für Medizinische Biometrie Epidemiologie und Informatik, Universitätsmedizin Mainz; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig
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21
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Kovaleva V, Geissler AL, Lutz L, Fritsch R, Makowiec F, Wiesemann S, Hopt UT, Passlick B, Werner M, Lassmann S. Spatio-temporal mutation profiles of case-matched colorectal carcinomas and their metastases reveal unique de novo mutations in metachronous lung metastases by targeted next generation sequencing. Mol Cancer 2016; 15:63. [PMID: 27756406 PMCID: PMC5069823 DOI: 10.1186/s12943-016-0549-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 07/05/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background Targeted next generation sequencing (tNGS) has become part of molecular pathology diagnostics for determining RAS mutation status in colorectal cancer (CRC) patients as predictive tool for decision on EGFR-targeted therapy. Here, we investigated mutation profiles of case-matched tissue specimens throughout the disease course of CRC, to further specify RAS-status dynamics and to identify de novo mutations associated with distant metastases. Methods Case-matched formalin-fixed and paraffin-embedded (FFPE) resection specimens (n = 70; primary tumours, synchronous and/or metachronous liver and/or lung metastases) of 14 CRC cases were subjected to microdissection of normal colonic epithelial, primary and metastatic tumour cells, their DNA extraction and an adapted library protocol for limited DNA using the 48 gene TruSeq Amplicon Cancer PanelTM, MiSeq sequencing and data analyses (Illumina). Results By tNGS primary tumours were RAS wildtype in 5/14 and mutated in 9/14 (8/9 KRAS exon 2; 1/9 NRAS Exon 3) of cases. RAS mutation status was maintained in case-matched metastases throughout the disease course, albeit with altered allele frequencies. Case-matched analyses further identified a maximum of three sequence variants (mainly in APC, KRAS, NRAS, TP53) shared by all tumour specimens throughout the disease course per individual case. In addition, further case-matched de novo mutations were detected in synchronous and/or metachronous liver and/or lung metastases (e.g. in APC, ATM, FBXW7, FGFR3, GNAQ, KIT, PIK3CA, PTEN, SMAD4, SMO, STK11, TP53, VHL). Moreover, several de novo mutations were more frequent in synchronous (e.g. ATM, KIT, PIK3CA, SMAD4) or metachronous (e.g. FBXW7, SMO, STK11) lung metastases. Finally, some de novo mutations occurred only in metachronous lung metastases (CDKN2A, FGFR2, GNAS, JAK3, SRC). Conclusion Together, this study employs an adapted FFPE-based tNGS approach to confirm conservation of RAS mutation status in primary and metastatic tissue specimens of CRC patients. Moreover, it identifies genes preferentially mutated de novo in late disease stages of metachronous CRC lung metastases, several of which might be actionable by targeted therapies. Electronic supplementary material The online version of this article (doi:10.1186/s12943-016-0549-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valentina Kovaleva
- Institute for Surgical Pathology, Medical Center-Faculty of Medicine, University of Freiburg, Breisacherstr. 115A, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna-Lena Geissler
- Institute for Surgical Pathology, Medical Center-Faculty of Medicine, University of Freiburg, Breisacherstr. 115A, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Lisa Lutz
- Institute for Surgical Pathology, Medical Center-Faculty of Medicine, University of Freiburg, Breisacherstr. 115A, 79106, Freiburg, Germany
| | - Ralph Fritsch
- Department of Medicine I, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Makowiec
- Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of General and Visceral Surgery, Medical Center- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Thoracic Surgery, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich T Hopt
- Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of General and Visceral Surgery, Medical Center- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Thoracic Surgery, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center-Faculty of Medicine, University of Freiburg, Breisacherstr. 115A, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Silke Lassmann
- Institute for Surgical Pathology, Medical Center-Faculty of Medicine, University of Freiburg, Breisacherstr. 115A, 79106, Freiburg, Germany. .,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Comprehensive Cancer Center Freiburg, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany.
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22
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Wiesemann S, Haager B, Passlick B. [Surgical Therapy of Acquired Unilateral Diaphragmatic Paralysis: Indication and Results]. Zentralbl Chir 2016; 141 Suppl 1:S43-9. [PMID: 27607888 DOI: 10.1055/s-0042-113192] [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: 10/21/2022]
Abstract
Unilateral elevation of the diaphragm may be due to various causes and requires further elucidation when the aetiology is unknown. Elevation of the diaphragm is often caused by diaphragmatic paralysis, either due to damage to the phrenic nerve or to the phrenic muscle. Patients typically complain of increased respiratory distress when lying down, bending or swimming. Basic diagnostic testing consists of a chest X-ray, as well as spirometry and computer tomography of the neck and chest. In many cases, no cause can be identified for the diaphragmatic paralysis. In symptomatic patients, diaphragm plication leads to fixation and thus to a reduction in the paradoxal respiratory movement of the paralysed diaphragm. In a large majority of studies, this results in significant and lasting improvement in vital capacity and respiratory distress. Spontaneous recovery of diaphragm paralysis is possible, even after several months, so a waiting period of at least 6 months should elapse before diaphragmatic plication is performed, if the clinical situation allows. The procedure can be performed minimally invasively, with low morbidity and mortality. When cutting the phrenic nerve, a nerve suture is recommended, if possible, or otherwise diaphragm plication during the procedure, especially in the case of pneumonectomy. This review provides an overview of the causes, pathophysiology, symptoms, diagnosis, therapy and results of diaphragmatic plication in acquired, unilateral diaphragmatic paralysis in adults, and suggests an algorithm for diagnostic testing and therapy.
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Affiliation(s)
- S Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B Haager
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
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23
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Leskow P, Wiesemann S, Kurz P, Passlick B. Costales Hämangiom der vorderen Thoraxwand. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587487] [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: 10/21/2022]
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24
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Bunea A, Schiebahn D, Schanne D, Schimek-Jasch T, Gkika E, Wiesemann S, Rawluk J, Waller C, Grosu A, Nestle U. EP-1252: Oligometastatic NSCLC: long-term results show efficiency of radical approaches in selected patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32502-6] [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: 10/21/2022]
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25
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Günter J, Palade E, Elze M, Passlick B, Wiesemann S. Interdisziplinäres Hämoptysenmanagement. Pneumologie 2016. [DOI: 10.1055/s-0036-1572143] [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: 10/22/2022]
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26
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Haager B, Kayser G, Schmid S, Passlick B, Wiesemann S. Intrapulmonary Castleman's Disease Pretending to Be a Lung Cancer-Work Up of an Intrapulmonary Tumour. Ann Thorac Cardiovasc Surg 2015; 22:258-60. [PMID: 26581496 DOI: 10.5761/atcs.cr.15-00216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 24 year old male presented with a history of recurrent bronchopulmonal infections. Chest computed tomography was performed, revealing a right central mass. In the following bronchoscopy and ultrasound guided needle aspiration of the tumour no specific diagnosis could be obtained. Due to the central location of the tumour thoracotomy and middle lobe resection was performed. Histopathological analysis revealed an intrapulmonary, subpleural located Morbus Castleman of the hyaline-vascular type.Castleman's disease is a very rare disorder of the lymphatic tissue that is differentiated into two clinical subtypes. The localized type presents histologically almost always as the hyaline-vascular form. Findings have been reported in mediastinal lymph nodes, the abdomen and peripheral lymphnodes. Intrapulmonary development is very rare and only 9 cases have previously been described in literature.On the other hand the multicentric type accounts for approximately 10%-15% of cases and histologically usually presents as the plasma cell variant. It is accompanied by fatigue and general weakness and often requires systemic steroid or chemotherapy.The localized type develops less clinical symptoms and is curable by complete surgical resection.
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Affiliation(s)
- Benedikt Haager
- Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany
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27
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Schmid S, Kübler M, Korcan Ayata C, Lazar Z, Haager B, Hoßfeld M, Meyer A, Cicko S, Elze M, Wiesemann S, Zissel G, Passlick B, Idzko M. Altered purinergic signaling in the tumor associated immunologic microenvironment in metastasized non-small-cell lung cancer. Lung Cancer 2015; 90:516-21. [PMID: 26505137 DOI: 10.1016/j.lungcan.2015.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/13/2015] [Accepted: 10/04/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Purines are well-known as intracellular sources for energy but they also act as extracellular signaling molecules. In the recent years, there has been a growing interest in the therapeutic potential of purinergic signaling for cancer treatment. This is the first study to analyze lung purine levels and purinergic receptors in non-small-cell lung cancer (NSCLC) patients. MATERIALS AND METHODS In this prospective clinical trial we enrolled 26 patients with NSCLC and 21 patients with chronic obstructive pulmonary disease (COPD) without signs of malignancy. The purine concentrations were analyzed in bronchoalveolar lavage fluid (BALF) using fluorescent/luminescent assays. Expression of purinergic receptors and ectonucleotidases were analyzed using real time quantitative polymerase chain reaction (RT-qPCR). RESULTS Patients with NSCLC have significantly lower ATP and ADP concentrations in BALF than patients with COPD (p=0.006 and p=0.009). Expression of the ectonucleotidase CD39 is significantly higher in BAL cells from cancer patients compared to COPD (p=0.001) as well as in metastasized tumors compared to non-metastasized tumors (p=0.009). Receptor-analysis revealed a higher expression of P2X4 (p=0.03), P2X7 (p=0.001) and P2Y1 (p=0.003) in BAL cells of tumors with distant metastasis. CONCLUSION Our data suggests a role for CD39 in lung cancer tumor microenvironment, influencing tumor invasiveness and metastasization. Potentially the increased degradation of ATP and ADP leads to a subversion of their anti-neoplastic effects. Furthermore P2Y1, P2X4 and P2X7 receptors are upregulated in BAL cells in metastatic disease. Our findings might facilitate the identification of new therapeutic targets for cancer immunotherapy.
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Affiliation(s)
- Severin Schmid
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany.
| | - Markus Kübler
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany
| | - C Korcan Ayata
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
| | - Zsofia Lazar
- Semmelweis University, Department of Pneumology, Budapest, Hungary
| | - Benedikt Haager
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany
| | - Madelon Hoßfeld
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
| | - Anja Meyer
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
| | - Sanja Cicko
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
| | - Mirjam Elze
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany
| | - Sebastian Wiesemann
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany
| | - Gernot Zissel
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
| | - Bernward Passlick
- University Medical Center Freiburg, Department of Thoracic Surgery, Freiburg, Germany
| | - Marco Idzko
- University Medical Center Freiburg, Department of Pneumology, Freiburg, Germany
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Affiliation(s)
- S. Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - S. Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B. Haager
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B. Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
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29
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Samson PV, Wiesemann S, Osei-Agyemang T, Schmid S, Kaifi J, Passlick B. Radikale Pleurektomie mit Hypertherme intrathorakale Chemotherapie (HITHOC) als kombinierte Therapie bei malignen, epitheloiden Pleuramesotheliomen. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559957] [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: 10/23/2022]
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30
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Haager B, Kayser G, Schmid S, Passlick B, Wiesemann S. Die Zwiebelschale als seltene Differentialdiagnose eines zentralen Tumors. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559910] [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: 10/23/2022]
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31
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Palade E, Guenter J, Elze M, Wiesemann S, Passlick B. [Management of Hemoptysis: Results of an Algorithm-Based Interdisciplinary Treatment Scheme]. Zentralbl Chir 2015; 141:85-92. [PMID: 26135612 DOI: 10.1055/s-0035-1545877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hemoptysis is a worrying symptom for the majority of patients, is frequently a sign for a severe disease and can develop into a life-threatening situation. Various therapeutic methods and medical specialties can be involved in the management of these patients. Guidelines or evidence-based recommendations on this issue are not available. Based on our long-term experience and considering all established diagnostic and therapeutic means, we propose an algorithm to manage this condition. PATIENTS AND METHODS This is a retrospective analysis of a cohort from a single thoracic surgical institution. Data regarding the used diagnostic and therapeutic methods with focus on outcome parameters are presented. Based on our experience and the published data we discuss the proposed algorithm. RESULTS Between 01.2009 and 12.2013, 204 patients were hospitalised and treated for hemoptysis. Malignancies were the most frequent (50 %) cause of hemoptysis, followed by infectious/inflammatory diseases (25 %), cardiovascular disorders (6 %), rare (12 %) and unclear (7 %) circumstances. In 71 cases the bleeding stopped spontaneously, in 124 (61 %) one invasive measure (interventional bronchoscopy 43, bronchial artery embolisation 34 or operation 12) or a combination of methods (35 combinations of two or all three methods) were necessary to stop the hemoptysis. Six patients died without intervention. The bronchial artery embolisation showed a 79 % success rate and a morbidity of 11 %. Lung resections were performed in 30 cases (morbidity 43 %, mortality 0 %). The mortality directly due to massive hemoptysis was 4.5 %. CONCLUSIONS Even small hemoptysis can be the warning signal for serious conditions and immediate diagnostic evaluation and therapy, preferentially in an inpatient setting, is often mandatory. A prompt diagnostic bronchoscopy is advocated. The therapeutic method of first choice is non-surgical for the most cases (interventional bronchoscopy, bronchial artery embolisation). Lung resections retain an important role in the management of hemoptysis and are the only available therapy for some diseases. It is advisable to delay surgery until the bleeding is controlled and the patient is stabilised. Best results for managing hemoptysis can be achieved with a multidisciplinary approach (interventional bronchoscopy, angiology and thoracic surgery) in a high expertise centre.
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Affiliation(s)
- E Palade
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J Guenter
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Deutschland
| | - M Elze
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Deutschland
| | - S Wiesemann
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B Passlick
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Deutschland
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Csanadi A, Kayser C, Donauer M, Gumpp V, Aumann K, Rawluk J, Prasse A, zur Hausen A, Wiesemann S, Werner M, Kayser G. Prognostic Value of Malic Enzyme and ATP-Citrate Lyase in Non-Small Cell Lung Cancer of the Young and the Elderly. PLoS One 2015; 10:e0126357. [PMID: 25962060 PMCID: PMC4427316 DOI: 10.1371/journal.pone.0126357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/01/2015] [Indexed: 01/29/2023] Open
Abstract
Background Lung cancer is the leading cause of death among malignancies worldwide. Understanding its biology is therefore of pivotal importance to improve patient’s prognosis. In contrast to non-neoplastic tissues, cancer cells utilize glucose mainly for production of basic cellular modules ‘(i.e. nucleotides, aminoacids, fatty acids). In cancer, Malic enzyme (ME) and ATP-citrate lyase (ACLY) are key enzymes linking aerobic glycolysis and fatty acid synthesis and may therefore be of biological and prognostic significance in non-small cell lung cancer (NSCLC). Material and Methods ME and ACLY expression was analyzed in 258 NSCLC in correlation with clinico-pathological parameters including patient’s survival. Results Though, overall expression of both enzymes correlated positively, ACLY was associated with local tumor stage, whereas ME correlated with occurrence of mediastinal lymph node metastases. Young patients overexpressing ACLY and/or ME had a significantly longer overall survival. This proved to be an independent prognostic factor. This contrasts older NSCLC patients, in whom overexpression of ACLY and/or ME appears to predict the opposite. Conclusion In NSCLC, ME and ACLY show different enzyme expressions relating to local and mediastinal spread. Most important, we detected an inverse prognostic impact of ACLY and/or ME overexpression in young and elderly patients. It can therefore be expected, that treatment of NSCLC especially, if targeting metabolic pathways, requires different strategies in different age groups.
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Affiliation(s)
- Agnes Csanadi
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
| | - Claudia Kayser
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
| | - Marcel Donauer
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
| | - Vera Gumpp
- Clinical Cancer Registry, Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany
| | - Konrad Aumann
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
| | - Justyna Rawluk
- Department of Hematology and Oncology, University Medical Center Freiburg, Hugstetter Strassse 55, D-79106 Freiburg, Germany
| | - Antje Prasse
- Department of Pneumonology, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625 Hannover, Germany
| | - Axel zur Hausen
- Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany
| | - Martin Werner
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
| | - Gian Kayser
- Department of Pathology, Institute of Surgical Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, D-79106 Freiburg, Germany
- * E-mail:
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Schmid S, Csanadi A, Kaifi JT, Kübler M, Haager B, Kayser G, Passlick B, Wiesemann S. Prognostic factors in solitary fibrous tumors of the pleura. J Surg Res 2015; 195:580-7. [DOI: 10.1016/j.jss.2015.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
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Brühl F, Csanadi A, Kayser C, Wiesemann S, Rawluk J, Werner M, Kayser G. PD1/PD-L1 Expression in Nsclc Differs According to Localisation, Grading and Subtype. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv043.07] [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: 11/14/2022] Open
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Schmid S, Csanadi A, Wiesemann S, Passlick B. Proliferationsmarker und Langzeitüberleben bei solitär fibrösen Tumoren der Pleura. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389356] [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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Schmid S, Elze M, Haager B, Wiesemann S, Zissel G, Passlick B. CC Chemokin Ligand 18 in bronchoalveolärer Lavage korreliert mit der Tumorgröße bei nicht-kleinzelligen Lungenkarzinomen. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389273] [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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Wiesemann S, Passlick B. Zystischer Zwerchfelltumor mit Einblutung – ein inspirierender Befund. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389297] [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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Palade E, Guenter J, Kirschbaum A, Wiesemann S, Passlick B. [Postoperative pain in the acute phase after surgery: VATS lobectomy vs. open lung resection - results of a prospective randomised trial]. Zentralbl Chir 2014; 139 Suppl 1:S59-66. [PMID: 25264726 DOI: 10.1055/s-0034-1368594] [Citation(s) in RCA: 10] [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: 10/24/2022]
Abstract
INTRODUCTION Minimally invasive procedures, e.g. video-assisted thoracoscopic lobectomy, are less traumatic and thus one may expect a lower level of postoperative pain compared to open procedures. This assumption is supported by several studies/metaanalyses. However, confirmation by larger prospective randomised studies is lacking. In the present study we analysed 2 groups of patients with lobectomy for early-stage lung cancer performed by VATS or by antero-lateral thoracotomy. MATERIAL AND METHODS 66 patients with early-stage NSC lung cancer were randomised to VATS lobectomy (A) or open resection (B). Two patients from A were excluded. The 2 groups were equally large (n = 32). All patients received the same analgetic therapy regime during and after surgery. We defined the early postoperative period as the first 10 days after operation and evaluated the intensity of pain (assessed by NAS) and the medication. Data acquisition was performed until discharge or the 10th postoperative day. RESULTS 21 values for mean NAS were calculated for both groups and each situation (at rest or under movement). For 8 a significant difference resulted in favour of VATS. In open thoracotomy the postoperative pain level was acceptable (NAS < 4) due to our well established pain control management. Also, 3 categories of patients with a very low pain profile were defined: patients with NAS not over 4 at any point, patients without any pain (NAS = 0) after a certain point or patients discharged without any pain. The VATS procedure showed a higher proportion of patients in all 3 categories: 17 in A vs. 7 in B had a max. NAS of 4 during the course; 20 vs. 11 were free of pain at certain times and 22 vs. 12 were discharged without pain. For both groups a painless postoperative course was achieved on day 6 (range, 4-10 days for A/3-10 for B). The medication was adjusted according to intensity. A difference was seen in favour of VATS for Sufentanil + Ropivacain via PDK and for Piritramid i. v. CONCLUSIONS Regardless of procedure (VATS vs. open) pain control can be achieved with an adequate analgetic regime. For VATS during the first days a lower amount of medication is required. The VATS group showed a higher proportion of patients with very low postoperative pain profile: patients with pain score always under 4 and patients without pain at certain points before the 10th postoperative day or at discharge.
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Affiliation(s)
- E Palade
- Klinik für Chirurgie, UKSH Campus Lübeck, Deutschland
| | - J Guenter
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | | | - S Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
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Abstract
BACKGROUND Induction chemotherapy followed by surgical resection has been a treatment option for stage IIIA3 N2 non-small cell lung cancer since publication of some small randomised trials during the 1990s. Later on other studies suggested a poor prognosis in cases of persistent N2 disease, so surgical treatment for these patients was not recommended. This study analyses the outcome of patients with persisting N2 disease and tries to identify prognostic parameters within that group of patients. METHODS We conducted a retrospective cohort study with 50 patients after induction therapy for stage IIIA N2 NSCLC. We analysed the influence of the postoperative lymph node involvement as well as the number of involved lymph nodes on the overall survival. RESULTS 50 patients with potentially resectable stage IIIA N2 were included in the analysis. In 25 cases (50 %) a persisting N2 remained after induction therapy with cisplatin/gemcitabine, 11 patients had a mediastinal downstaging. 14 patients did not qualify for surgery because of disease progression or comorbidities. The resection consisted in 29 cases of a lobectomy or bilobectomy; two times pneumonectomy was necessary and 4 segmentectomies and one atypical resection were performed. The median survival of patients with persisting N2 (ypN2) was 14.6 months, if mediastinal downstaging was achieved (ypN0/1) it was 22.3 months (p = 0.172). The number of involved mediastinal lymph nodes was a significant prognostic factor. If less than 6 lymph nodes were involved the mean survival was 17.5 months, while it was 8.6 months in patients with more than 6 involved lymph nodes (p < 0.01). CONCLUSIONS The median survival for patients with persisting N2 disease is less favourable compared to patients with mediastinal downstaging. However, the long-term survival for patients with less than 6 involved lymph nodes is 17.5 months. Therefore surgical resection for these patients seems to be justified. After induction therapy a rigorous restaging should be performed to rule out persisting multilevel N2 disease.
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Affiliation(s)
- B Haager
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - T Osei-Agyemang
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - B Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - S Wiesemann
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
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Haager B, Wiesemann S, Osei-Agyemang T, Passlick B. Gibt es eine Indikation zur Resektion bei persistierendem N2 nach neoadjuvanter Chemotherapie? Pneumologie 2014. [DOI: 10.1055/s-0034-1367766] [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: 10/25/2022]
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Palade E, Passlick B, Osei-Agyemang T, Günter J, Wiesemann S. Video-assisted vs open mediastinal lymphadenectomy for Stage I non-small-cell lung cancer: results of a prospective randomized trial. Eur J Cardiothorac Surg 2013; 44:244-9; discussion 249. [PMID: 23295451 DOI: 10.1093/ejcts/ezs668] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Since the introduction of video-assisted lobectomy for non-small-cell lung cancer (NSCLC) into clinical practice, it has been discussed controversially whether mediastinal lymphadenectomy can be performed as effectively as an open procedure via thoracotomy. Therefore, we address this issue in a prospective randomized trial conducted in our institution. METHODS In total, 66 patients with completely staged clinical Stage I NSCLC were included and randomized either into a video-assisted group (n = 34) or into the conventional lobectomy group (n = 32). The video-assisted thoracoscopic (VATS) lobectomy was performed by using a 4- to 5-cm utility incision in the fourth or fifth intercostal space and two additional 10-mm ports without rib spreading. The conventional lobectomy was done via an anterolateral thoracotomy. Lymph nodes were classified according to the International Association for the Study of Lung Cancer classification; for right-sided tumours, lymph nodes number 2R, 4R, 7, 8, 9, 10, 11 and 12 were dissected, and for left-sided tumours, lymph nodes number 5, 6, 7, 8, 9, 10, 11 and 12. For the subsequent analyses, lymph nodes were grouped into different zones consisting of Zone 1 (2R and 4R), Zone 2 (7), Zone 3 (8R and 9R), Zone 4 (10R, 11 R and 12R), Zone 5 (4 L), Zone 6 (5 and 6), Zone 7 (8L and 9L) and Zone 8 (10 L, 11 L and 12L). RESULTS Both groups were comparable with respect to different clinical pathological parameters (age, tumour size and comorbidity). In the video-assisted group, 2 patients were excluded due to conversion to an open thoracotomy. The number of mediastinal lymph nodes removed was as follows: VATS (right side) 24.0 lymph nodes/patient, open right-sided 25.2 lymph nodes/patient, VATS (left side) 25.1 lymph nodes/patient and open left-sided 21.1 lymph nodes/patient. With respect to the zones mentioned above, we found the following results: VATS vs open (mean number of lymph nodes/patient): Zone 1: 9 vs 8.5; Zone 2: 6.3 vs 5.6; Zone 3: 2.4 vs 3.2; Zone 4: 6.5 vs 6.9; Zone 5: 0 vs 0.5; Zone 6: 3.2 vs 3.7; Zone 7: 4.6 vs 3.2 and Zone 8: 10.5 vs 8.9. There were no statistically significant differences between the procedures, either with respect to the overall number of lymph nodes or with respect to the number of lymph nodes in each zone. CONCLUSIONS Mediastinal lymph node dissection can be performed as effectively by the video-assisted approach as by the open thoracotomy approach. Furthermore, the video-assisted approach allows a better visualization of different lymph node zones.
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Affiliation(s)
- Emanuel Palade
- Department of Thoracic Surgery, Medical Center Freiburg, Freiburg, Germany.
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Wiesemann S, Stremmel C, Passlick B. Perioperative antithrombozytäre Therapie bei thoraxchirurgischen Eingriffen und kardiovaskulärer Vorerkrankung -Eine Umfrage an deutschen Kliniken. Pneumologie 2011. [DOI: 10.1055/s-0031-1271988] [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: 10/18/2022]
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Pache G, Schäfer C, Wiesemann S, Springer E, Liebau M, Reinhardt HC, August C, Pavenstädt H, Bek MJ. Upregulation of Id-1 via BMP-2 receptors induces reactive oxygen species in podocytes. Am J Physiol Renal Physiol 2006; 291:F654-62. [PMID: 16622178 DOI: 10.1152/ajprenal.00214.2004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bone morphogenetic proteins (BMPs) are secreted signaling molecules, which play a major role in kidney development and disease. Here, we show the existence of mRNA for BMP-2 and for the BMP receptors BMPR1A, BMPR1B, BMPRII, ACVR1A, ACVR2, and ACVR2B in differentiated mouse podocytes and the protein expression of BMPR1A in human glomerular podocytes. BMP-2 dose dependently increases the free cytosolic Ca(2+) concentration in podocytes proving the existence of a functional receptor in these cells. Recent data indicate that in a myoblastic cell line and in a breast cancer cell line, BMP-2 increases the expression of Id-1, a negative regulator of basic helix-loop-helix transcription factors, but the role of BMP-2 stimulated Id-1 expression in the kidney has not been further characterized. Here, we show that BMP-2 increases the expression of Id-1 in differentiated podocytes. To investigate a role of Id-1 for podocyte function, overexpression of Id-1 was induced in differentiated mouse podocytes. Id-1-overexpressing podocytes show an increased NADPH-dependent production of reactive oxygen species (ROS). This effect can be evoked by BMP-2 and can be antagonized by anti-Id-1 antisense oligonucleotides. The data indicate that BMP-2 may, via an increased expression of Id-1 and an increased generation of ROS, contribute to important cellular functions in podocytes. ROS supposedly play a major role in cell adhesion, cell injury, ion transport, fibrogenesis, angiogenesis and are involved in the pathogenesis of membranous nephropathy.
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Affiliation(s)
- Gregor Pache
- Department of Medicine, Division of Nephrology and General Medicine, University Clinic of Freiburg, Freiburg, Germany
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Mellins RB, Evans D, Clark N, Zimmerman B, Wiesemann S. Developing and communicating a long-term treatment plan for asthma. Am Fam Physician 2000; 61:2419-28, 2433-4. [PMID: 10794583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The treatment of asthma, according to current guidelines, requires complex treatment regimens that change as clinical conditions improve or deteriorate. We have developed a practical way to communicate long-term treatment plans in chart form in the primary care setting that is easy for patients to follow and use. The chart has been an important element in two interventions that have resulted in positive changes in health behavior and health outcomes in children with asthma. The plan provides recommendations for patients and families to make adjustments in medication based on changes in symptoms or peak expiratory air flow, or both, that are consistent with the Asthma Guidelines Expert Panel Report 2, 1997. The plan also indicates when the number and dosage of drugs should be increased or decreased and when emergency care should be sought, consistent with the Asthma Guidelines. By placing considerable control in the family's hands and by clearly delineating the conditions under which medicines can be reduced or discontinued, the physician provides incentives for families to adhere to the long-term treatment plan for asthma.
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Affiliation(s)
- R B Mellins
- Pediatric Pulmonary Division, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Evans D, Mellins R, Lobach K, Ramos-Bonoan C, Pinkett-Heller M, Wiesemann S, Klein I, Donahue C, Burke D, Levison M, Levin B, Zimmerman B, Clark N. Improving care for minority children with asthma: professional education in public health clinics. Pediatrics 1997; 99:157-64. [PMID: 9024439 DOI: 10.1542/peds.99.2.157] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children. Although effective preventive therapy is available, many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care. To see if access, continuity, and quality of care could be improved in pediatric clinics serving low-income children in New York City, we trained staff in New York City Bureau of Child Health clinics to provide continuing, preventive care for asthma. METHODS We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics. Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management. The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change. We hypothesized that after the intervention, clinics that received the intervention would, compared with control clinics, have increased numbers of children with asthma receiving continuing care in the clinics and increased staff use of new pharmacologic and educational treatment methods. RESULTS In both the first and second follow-up years, the intervention clinics had greater positive changes than control clinics on measures of access, continuity, and quality of care. For second year follow-up data these include: for access, greater rate of new asthma patients (40/1000 vs 16/1000; P < .01); for continuity, greater percentage of asthma patients returning for treatment 2 years in a row (42% vs 12%; P < .001) and greater annual frequency of scheduled visits for asthma per patient (1.85 vs .88; P < .001); and for quality, greater percentage of patients receiving inhaled beta agonists (52% vs 15%; P < .001) and inhaled antiinflammatory drugs (25% vs 2%; P < .001), and greater percentages of parents who reported receiving patient education on 12 topics from Bureau of Child Health physicians (71% vs 58%; P < .01) and nurses (61% vs 44%; P < .05). CONCLUSION We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.
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Affiliation(s)
- D Evans
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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