Publications (66)462.7 Total impact
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Article: Comparative evaluation of nine faecal immunochemical tests for the detection of colorectal cancer.
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ABSTRACT: Background. Faecal immunochemical tests (FITs) for haemoglobin are increasingly used for non-invasive screening for colorectal cancer (CRC) but large scale comparative studies of different FITs for detection of CRC, overall and by stage, are sparse. We aimed to determine and compare performance of different FITs for the detection of CRC, and to assess their stage-specific sensitivities. Material and methods. We assessed sensitivity, specificity and their corresponding 95% confidence intervals for six qualitative FITs among 74 CRC cases (59% stage I or II cancers) and 1480 controls free of colorectal neoplasm. Overall and stage-specific receiver operating characteristic curves were derived for three quantitative FITs. The areas under the curves (AUCs) were calculated and compared. Results. Pairs of overall sensitivity and specificity of the qualitative FITs ranged from 66% and 96% to 92% and 62%, respectively. For the three quantitative tests, AUCs ranged from 0.90 to 0.92, with sensitivities ranging from 80% to 87% at cut-offs yielding 90% specificity. AUCs ranged from 0.85 to 0.92, 0.94 to 0.96, and 0.86 to 0.93 for stage I, stage II and advanced stages (stage III and IV) cancers, respectively. At a specificity of 90%, the tests detected 65%-85% of stage I cancers. Conclusion. The diagnostic performance of FITs regarding detection of CRC is promising, even though the pre-defined cut-offs of some of the qualitative FITs need to be adjusted to limit false-positive rates in screening setting. At cut-off levels yielding 90% specificity, the quantitative tests detected the vast majority of CRCs, even at early stages.Acta oncologica (Stockholm, Sweden) 04/2013; · 2.27 Impact Factor -
Article: Colorectal cancers occurring after colonoscopy with polyp detection: Sites of polyps and sites of cancers.
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ABSTRACT: Colonoscopy with detection and removal of neoplasms strongly reduces risk of colorectal cancer. Nevertheless, colorectal cancers occur after colonoscopic polypectomy. We assessed agreement beyond chance of location of polyps detected at colonoscopy and of subsequent colorectal cancers to estimate the share of cancers that might be due to field effects or neoplasm recrudescence. In a population-based case-control study conducted in Germany (3,148 cases), detailed history and results of colonoscopies conducted within 10 years prior to cancer diagnosis were obtained by interview and from medical records. We determined the observed proportion of cancers for which a polyp had been detected at the same colorectal subsite at the preceding colonoscopy and compared it to the proportion expected by chance. 155 cases with physician validated polyp detection at the preceding colonoscopy were identified. Among 148 cases with cancer restricted to a single subsite, 43 (29.1%) had a polyp detected in the same colorectal subsite at the preceding colonoscopy. Agreement of location of cancer occurrence and preceding polyp detection would have been expected by chance for 27 cases, and agreement beyond chance was estimated to account for 16 cases (10.8%, 95% confidence interval 2.7-19.3%). Our study suggests that less than one out of 9 colorectal cancers occurring within 10 years after colonoscopy with polyp detection may be due to field effects or polyp recrudescence. © 2013 Wiley Periodicals, Inc.International Journal of Cancer 03/2013; · 5.44 Impact Factor -
Article: Role of colonoscopy and polyp characteristics in colorectal cancer after colonoscopic polyp detection: a population-based case-control study.
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ABSTRACT: Studies have identified characteristics of adenomas detected on colonoscopy to be predictive of adenoma recurrence. To assess the role of both colonoscopy-related factors and polyp characteristics on the risk for colorectal cancer after colonoscopic polyp detection. Population-based case-control study (3148 case participants and 3274 control participants). Rhine-Neckar region of Germany. Case and control participants with physician-validated detection of polyps (other than hyperplastic polyps) at a previous colonoscopy in the past 10 years. Detailed history and results of previous colonoscopies were obtained through interviews and medical records. Case and control participants were compared according to colonoscopy-related factors (incompleteness, poor bowel preparation, incomplete removal of all polyps, and no surveillance colonoscopy within 5 years) and polyp characteristics (≥ 1 cm, villous components or high-grade dysplasia, ≥ 3 polyps, and ≥ 1 proximal polyp). Odds ratios (ORs) and attributable fractions were derived by using multiple logistic regression and the Levin formula. 155 case participants and 260 control participants with physician-validated polyp detection in the past 10 years were identified. The following characteristics were significantly more common among case participants than among control participants: not all polyps completely removed (29.0% vs. 9.6%; OR, 3.73 [95% CI, 2.11 to 6.60]), no surveillance colonoscopy within 5 years (26.5% vs. 11.5%; OR, 2.96 [CI, 1.70 to 5.16]), and detection of 3 or more polyps (14.2% vs. 7.3%; OR, 2.21 [CI, 1.07 to 4.54]). Odds ratios ranged from 1.12 to 1.42 and CIs included 1.00 for all other variables. Overall, 41.1% and 21.7% of cancer cases were statistically attributable to colonoscopy-related factors and polyp characteristics, respectively. This was an observational study with potential for residual confounding and selection bias. Colonoscopy-related factors are more important than polyp characteristics for stratification of colorectal cancer risk after colonoscopic polyp detection in the community setting.Annals of internal medicine 08/2012; 157(4):225-32. · 16.73 Impact Factor -
Article: Risk of colorectal cancer after detection and removal of adenomas at colonoscopy: population-based case-control study.
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ABSTRACT: Empirical evidence for recommendations of surveillance intervals after detection and removal of adenomas at colonoscopy is still sparse and mostly based on observations of adenoma recurrence. We aimed to assess risk of colorectal cancer (CRC) according to time since polypectomy and factors that might be relevant for risk stratification. In a population-based case-control study conducted in Germany, detailed history and results of previous large-bowel endoscopies were obtained by interview and from medical records. Risk of CRC among participants with detection of at least one adenoma at a preceding colonoscopy compared with participants without previous large-bowel endoscopy was assessed according to time since polypectomy among 2,582 cases with CRC and 1,798 matched controls. Adjusted odds ratios (95% CIs) of CRC for participants with polypectomy less than 3, 3 to 5, and 6 to 10 years ago (using participants without previous endoscopy as reference group) were 0.2 (0.2 to 0.3), 0.4 (0.3 to 0.6), and 0.9 (0.5 to 1.5), respectively. Strong, significant risk reduction within 5 years was consistently seen for women and men, younger and older participants, patients with and without high-risk polyps (three or more polyps, at least one polyp ≥ 1 cm, at least one polyp with villous components), and those with and without polypectomy in the right colon. With adjusted odds ratios of 0.1 (0.1 to 0.2), 0.3 (0.2 to 0.5) and 0.4 (0.2 to 0.8) for patients with polypectomy less than 3, 3 to 5, and 6 to 10 years ago, risk reduction was particularly strong for left-sided CRC. Extension of surveillance intervals to 5 years should be considered, even after detection and removal of high-risk polyps.Journal of Clinical Oncology 07/2012; 30(24):2969-76. · 18.37 Impact Factor -
Article: Vascular clips versus ligatures in thyroid surgery-results of a multicenter randomized controlled trial (CLIVIT Trial).
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ABSTRACT: BACKGROUND: New techniques using vascular clips or ultrasonically activated shears have been suggested to shorten operation time without compromising safety. The objective of the CLIVIT Trial was to compare ligatures with vascular clips for hemostasis in elective benign thyroid surgery. METHODS: This multicenter, randomized, controlled, parallel group superiority trial was conducted in 13 German surgical centers. Patients scheduled for at least subtotal resection bilaterally were intraoperatively randomized. The primary endpoint was resection time. Secondary endpoints were the amount of postoperative bleeding, reoperation due to bleeding, wound infection, temporary (reversal within 12 months) and permanent (over 1 year) recurrent laryngeal nerve (RLN) paralysis, length of hospital stay, and safety. Registration: ISRCTN 96901396. RESULTS: Two hundred fifty patients were treated with ligatures and 241 with vascular clips. No differences in patients' baseline and surgical characteristics were observed. No difference was detected for mean resection time (clip 63.5 min ± 29.6, ligature 66.1 min ± 29.3, P = 0.258). Postoperative bleeding (mean 86 ml ± 93), reoperation due to bleeding (clips 4, ligature 2), wound infections (clips 4, ligature 4), postoperative hospital stay (mean 3.0 ± 1.9), and safety data also did not vary significantly. The rates of temporary and permanent RLN paralysis were 6.9 % (34/491) and 2.9 % (14/491), respectively. Not using a surgical drain (123 patients) was not associated with a higher rate of complications. CONCLUSION: Vascular clips did not reduce the resection time. However, a 2.9 % rate of permanent RLN paralysis is of concern. Drains in elective surgery may be of no benefit.Langenbeck s Archives of Surgery 06/2012; · 1.81 Impact Factor -
Article: Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583].
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ABSTRACT: BACKGROUND: The optimal strategy for abdominal wall closure has been an issue of ongoing debate. Available studies do not specifically enroll patients who undergo emergency laparotomy and thus do not consider the distinct biological characteristics of these patients. The present randomized controlled trial evaluates the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. Methods/design The CONTINT trial is a multicenter, open label, randomized controlled trial with a twogroup parallel design. Patients undergoing a primary emergency midline laparotomy are enrolled in the trial. The two most commonly applied strategies of abdominal wall closure after midline laparotomy are compared: the continuous, all-layer suture technique using slowly absorbable monofilament material (two Monoplus(R) loops) and the interrupted suture technique using rapidly absorbable braided material (Vicryl(R) sutures). The primary endpoint within the CONTINT trial is an incisional hernia within 12 months or a burst abdomen within 30 days after surgery. As reliable data on this primary endpoint is not available for patients undergoing emergency surgery, an adaptive interim analysis will be conducted after the inclusion of 80 patients, allowing early termination of the trial if necessary or modification of design characteristics such as recalculation of sample size. DISCUSSION: This is a randomized controlled multicenter trial with a two-group parallel design to assess the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. Trial registration NCT00544583.Trials 05/2012; 13(1):72. · 2.02 Impact Factor -
Article: To whom do the results of the multicenter, randomized, controlled INSECT trial (ISRCTN 24023541) apply?--assessment of external validity.
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ABSTRACT: A response to Seiler et al: Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 2009, 249(4):576-582. Existing evidence suggests that the transfer of results of randomized controlled trials into clinical practice may be limited. Potential reasons can be attributed to aspects of external validity. The aim of this study is to investigate issues related to the external validity of the INSECT trial. All participating surgical departments were categorized and the clinical and baseline characteristics of randomized patients were evaluated. In addition, demographic and clinical data of all screened and randomized patients at the Departments of Surgery in Heidelberg and Erlangen were analyzed. Twenty-five centers enrolled a total of 625 patients. These centers included eight primary, 11 secondary, and six tertiary care centers. The tertiary care centers enrolled the most patients (n = 237, 38%) followed by the primary care centers (n = 199, 32%) and the secondary care centers (n = 189 patients; 30%). The mean number and baseline data of randomized patients did not differ between the three types of care centers (p = 0.09). Overall, the treatment according to protocol was at least 92%. At the Department of Surgery, University of Heidelberg, 307 patients were screened and 60 out of 130 eligible patients were randomized. There were no differences in demographic and clinical baseline data between included and non-included patients. In Erlangen, 351 patients were screened and 57 out of 106 eligible patients randomized. Results of the INSECT trial are applicable to a broad spectrum of patients treated at different hospital levels.BMC Surgery 02/2012; 12:2. · 1.33 Impact Factor -
Article: Clustering in surgical trials--database of intracluster correlations.
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ABSTRACT: Randomised trials evaluation of surgical interventions are often designed and analysed as if the outcome of individual patients is independent of the surgeon providing the intervention. There is reason to expect outcomes for patients treated by the same surgeon tend to be more similar than those under the care of another surgeon due to previous experience, individual practice, training, and infrastructure. Such a phenomenon is referred to as the clustering effect and potentially impacts on the design and analysis adopted and thereby the required sample size. The aim of this work was to inform trial design by quantifying clustering effects (at both centre and surgeon level) for various outcomes using a database of surgical trials. Intracluster correlation coefficients (ICCs) were calculated for outcomes from a set of 10 multicentre surgical trials for a range of outcomes and different time points for clustering at both the centre and surgeon level. ICCs were calculated for 198 outcomes across the 10 trials at both centre and surgeon cluster levels. The number of cases varied from 138 to 1370 across the trials. The median (range) average cluster size was 32 (9 to 51) and 6 (3 to 30) for centre and surgeon levels respectively. ICC estimates varied substantially between outcome type though uncertainty around individual ICC estimates was substantial, which was reflected in generally wide confidence intervals. This database of surgical trials provides trialists with valuable information on how to design surgical trials. Our data suggests clustering of outcome is more of an issue than has been previously acknowledged. We anticipate that over time the addition of ICCs from further surgical trial datasets to our database will further inform the design of surgical trials.Trials 01/2012; 13:2. · 2.02 Impact Factor -
Article: Interval cancers after negative colonoscopy: population-based case-control study.
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ABSTRACT: The risk of colorectal cancer after a previous negative colonoscopy is very low. Nevertheless, interval cancers occur. We aimed to assess the characteristics and predictors of interval cancers after negative colonoscopy. A population-based case-control study was conducted in Southern Germany in 2003-7. Sociodemographic and tumour characteristics were compared among 78 patients with interval cancers occurring 1-10 years after a negative colonoscopy and 433 colorectal cancers detected at screening. In addition, the indication for the preceding negative colonoscopy and its completeness were compared between patients with interval cancers and 515 controls with a preceding negative colonoscopy. 56.4% of interval cancers occurred among women compared with 33.7% of cases detected by screening (p=0.0001). After adjustment for covariates, female sex (OR 2.28, 95% CI 1.35 to 3.83) and location in the caecum or ascending colon (OR 1.98, 95% CI 1.17 to 3.35) were independently associated with occurrence of interval cancers. The preceding negative colonoscopy was more commonly conducted because of a positive faecal occult blood test (26.0% vs 12.9%, p=0.009) and was more often incomplete (caecum not reached: 18.1% vs 6.7%, p=0.001) among interval cancer cases than among controls. Characteristics of the preceding negative colonoscopy strongly and independently associated with occurrence of interval cancers were follow-up of a positive faecal occult blood test among men (OR 5.49, 95% CI 2.10 to 14.35) and incompleteness among women (OR 4.38, 95% CI 1.69 to 11.30). The observed patterns suggest that a substantial proportion of interval cancers are due to neoplasms missed at colonoscopy and are potentially preventable by enhanced performance of colonoscopy.Gut 12/2011; 61(11):1576-82. · 10.11 Impact Factor -
Article: Evaluation of the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy-a controlled prospective multicentre trial: ISSAAC [NCT005725079].
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ABSTRACT: Different suture techniques and various suture materials are in use to close midline incisions after primary laparotomy. The ISSAAC study aimed to assess the safety and efficacy of the new ultra-long-term absorbable, elastic monofilament suture material MonoMax® for abdominal wall closure. This is a single-arm, multicentre prospective study that included 150 patients undergoing a primary elective midline incision. The control group consists of 141 patients from the INSECT study who received MonoPlus® or PDS® for abdominal wall closure. The incidences of burst abdomen and wound infection until the day of discharge were defined as the primary composite endpoints. The rate of incisional hernias 1 year after surgery, the length of postoperative hospital stay and safety parameters served as secondary endpoints. The study has been registered under www.clinicaltrials.gov [NCT005725079]. Eleven patients in the ISSAAC study [7.3%; 95% CI = (3.9; 13.1%)] experienced wound infection or burst abdomen until the day of discharge as compared to 16 [11.3%; 95% CI = (6.6; 17.8%)] patients in the INSECT control group (p = 0.31). The length of postoperative hospital stay was comparable in both study groups. One year after surgery, incisional hernias were observed in 21 ISSAAC patients (14.0%) in contrast to 30 hernias (21.3%) in the INSECT control group. The ultra-long-term absorbable, elastic monofilament suture material MonoMax® is safe and efficient for abdominal wall closure.Langenbeck s Archives of Surgery 12/2011; 397(3):363-71. · 1.81 Impact Factor -
Article: Clustering in surgical trials - database of intra-cluster correlations.
Trials 12/2011; 12 Suppl 1:A24. · 2.02 Impact Factor -
Article: Prevention of abdominal wound infection (PROUD trial, DRKS00000390): study protocol for a randomized controlled trial.
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ABSTRACT: Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n=750 is sufficient to ensure alpha=5% and power=80%, an interim analysis will be carried out after data of 375 patients are available. The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390).Trials 11/2011; 12:245. · 2.02 Impact Factor -
Article: Long-term risk of colorectal cancer after negative colonoscopy.
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ABSTRACT: Colonoscopy is thought to be a powerful and cost-effective tool to reduce colorectal cancer (CRC) incidence and mortality. Empirical evidence for overall and risk group-specific definition of screening intervals is sparse. We aimed to assess the risk of CRC according to time since negative colonoscopy, overall, and by sex, smoking, and family history of CRC, in a large population-based case-control study. In all, 1,945 patients with CRC and 2,399 population controls were recruited in 22 hospitals and through population registers in the Rhine-Neckar region of Germany from 2003 to 2007. Data on history of colonoscopy and important covariates were obtained by personal interviews and from medical records. Compared with people who had never undergone colonoscopy, people with a previous negative colonoscopy had a strongly reduced risk of CRC. Adjusted odds ratios for time windows of 1 to 2, 3 to 4, 5 to 9, 10 to 19, and 20+ years after negative colonoscopy were 0.14 (95% CI, 0.10 to 0.20), 0.12 (95% CI, 0.08 to 0.19), 0.26 (95% CI, 0.18 to 0.39), 0.28 (95% CI, 0.17 to 0.45), and 0.40 (95% CI, 0.24 to 0.66), respectively. Low risks even beyond 10 years after negative colonoscopy were observed for both left- and right-sided CRC and in all risk groups assessed except current smokers, who had a risk similar to that of never smokers with no previous colonoscopy 10 or more years after a negative colonoscopy. These results support suggestions that screening intervals for CRC screening by colonoscopy could be longer than the commonly recommended 10 years in most cases, perhaps even among men and people with a family history of CRC, but probably not among current smokers.Journal of Clinical Oncology 08/2011; 29(28):3761-7. · 18.37 Impact Factor -
Article: LigaSure Impact™ versus conventional dissection technique in pylorus-preserving pancreatoduodenectomy in clinical suspicion of cancerous tumours on the head of the pancreas: study protocol for a randomised controlled trial.
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ABSTRACT: BACKGROUND: The pp-Whipple procedure requires extensive preparation. The conventional preparation technique is done with scissors for dissection and ligatures, and with clips and sutures for hemostasis. This procedure is very time-consuming and requires numerous changes of instruments. The LigaSure™ device allows dissection and hemostasis for preparation with one instrument. Up to now there has been no comparison of the two techniques with regard to operating time and the patients' outcome. It is still unclear which technique has the optimal benefit/risk ratio for the patient. METHODS/DESIGN: A single-center, randomized, single-blinded, controlled superiority trial to compare two different techniques for dissection in a pp-Whipple procedure. 102 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective pp-Whipple procedure who signed the informed consent will be included. The primary endpoint is the operating time of the randomized technique. Control Intervention: Conventional dissection technique; experimental intervention: LigaSureTM dissection technique. Duration of study: Approximately 15 months; follow up time: 3 years. The trial is registered at German ClinicalTrials Register (DRKS00000166).Trials 06/2011; 12:162. · 2.02 Impact Factor -
Article: Letter to the Editor.
Annals of surgery 06/2011; · 7.90 Impact Factor -
Article: Ranking of patient and surgeons' perspectives for endpoints in randomized controlled trials--lessons learned from the POVATI trial [ISRCTN 60734227].
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ABSTRACT: Surgical trials focus mainly on mortality and morbidity rates, which may be not the most important endpoints from the patient's perspective. Evaluation of expectations and needs of patients enrolled in clinical trials can be analyzed using a procedure called ranking. Within the Postsurgical Pain Outcome of Vertical and Transverse Abdominal Incision randomized trial (POVATI), the perspectives of participating patients and surgeons were assessed as well as the influence of the surgical intervention on patients' needs. All included patients of the POVATI trial were asked preoperatively and postoperatively to rank predetermined outcome variables concerning the upcoming surgical procedure (e.g., pain, complication, cosmetic result) hierarchically according to their importance. Preoperatively, the surgeons were asked to do the same. One hundred eighty two out of 200 randomized patients (71 females, 111 males; mean age 59 years) returned the ranking questionnaire preoperatively and 152 patients (67 females, 85 males; mean age 60 years) on the day of discharge. There were no differences between the two groups with respect to the distribution of ranking variables (p > 0.05). Thirty-five surgeons (7 residents, 6 fellows, and 22 consultants) completed the same ranking questionnaire. The order of the four most important ranking variables for both patients and surgeons were death, avoiding of postoperative complications, avoiding of intraoperative complications, and pain. Surgeons ranked the variable "cosmetic result" significantly as more important compared to patients (p = 0.034, Fisher's exact test). Patients and surgeons did not differ in ranking predetermined outcomes in the POVATI trial. Only the variable "cosmetic result" is significantly more important from the surgeon's than from the patient's perspective. Ranking of outcomes might be a beneficial tool and can be a proper addition to RCTs.Langenbeck s Archives of Surgery 05/2011; 396(7):1061-6. · 1.81 Impact Factor -
Article: Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial.
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ABSTRACT: The ideal closure technique of the pancreas after distal pancreatectomy is unknown. We postulated that standardised closure with a stapler device would prevent pancreatic fistula more effectively than would a hand-sewn closure of the remnant. This multicentre, randomised, controlled, parallel group-sequential superiority trial was done in 21 European hospitals. Patients with diseases of the pancreatic body and tail undergoing distal pancreatectomy were eligible and were randomly assigned by central randomisation before operation to either stapler or hand-sewn closure of the pancreatic remnant. Surgical performance was assessed with intraoperative photo documentation. The primary endpoint was the combination of pancreatic fistula and death until postoperative day 7. Patients and outcome assessors were masked to group assignment. Interim and final analysis were by intention to treat in all patients in whom a left resection was done. This trial is registered, ISRCTN18452029. Between Nov 16, 2006, and July 3, 2009, 450 patients were randomly assigned to treatment groups (221 stapler; 229 hand-sewn closure), of whom 352 patients (177 stapler, 175 hand-sewn closure) were analysed. Pancreatic fistula rate or mortality did not differ between stapler (56 [32%] of 177) and hand-sewn closure (49 [28%] of 175; OR 0·84, 95% CI 0·53–1·33; p=0·56). One patient died within the fi rst 7 days after surgery in the hand-sewn group; no deaths occurred in the stapler group. Serious adverse events did not differ between groups. Stapler closure did not reduce the rate of pancreatic fistula compared with hand-sewn closure for distal pancreatectomy. New strategies, including innovative surgical techniques, need to be identified to reduce this adverse outcome. German Federal Ministry of Education and Research.The Lancet 04/2011; 377(9776):1514-22. · 38.28 Impact Factor -
Article: Rupture without warning.
The Lancet 03/2011; 377(9769):966. · 38.28 Impact Factor -
Article: Antireflux jejunoplasty for recurrent cholangitis.
Journal of the American College of Surgeons 03/2011; 212(5):e28-32. · 4.55 Impact Factor -
Article: Erratum to: Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence.
Langenbeck s Archives of Surgery 03/2011; · 1.81 Impact Factor
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- Trials (10)
- Langenbeck s Archives of Surgery (7)
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- BMC Surgery (5)
- The Lancet (5)
Institutions
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2007–2013
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Deutsches Krebsforschungszentrum
- Division of Clinical Epidemiology and Aging Research
Heidelberg, Baden-Wuerttemberg, Germany
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2011–2012
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University of Aberdeen
- Health Services Research Unit
Aberdeen, SCT, United Kingdom -
Ludwig-Maximilian-University of Munich
- Department of Surgery
München, Bavaria, Germany
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2003–2012
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Universität Heidelberg
- • Department of General, Visceral and Transplantation Surgery
- • Institute of Pathology (Mannheim)
- • Institute of Medical Biometry and Informatics
Heidelberg, Baden-Wuerttemberg, Germany
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2009
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University of Oxford
Oxford, ENG, United Kingdom -
McGill University Health Centre
Montréal, Quebec, Canada -
McGill University
- Department of Surgery
Montréal, Quebec, Canada
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2005
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Universität Köln
- Faculty of Medicine
Köln, North Rhine-Westphalia, Germany
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