Andrea Tannapfel

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany

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Publications (617)1617.85 Total impact

  • S R Benz · A Tannapfel · Y Tam · I Stricker
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    ABSTRACT: Background: Complete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer may be superior to standard hemicolectomy in terms of oncological results. This hypothesis is currently being investigated in a large multicentre trial conducted by the authors of this paper (Resektatstudie). Because CVL in right-sided hemicolectomy is technically rather demanding the incidence of central node involvement is of special interest. Therefore, during the single centre pilot phase of our multicentre trial we have analysed the incidence of central lymph node metastasis in CME specimens. Patients: In 51 patients with right-sided colon adenocarcinoma (cT1-3, cM0) an open CME with CVL was performed. In the fresh specimen the central four centimetres of the ileocolic vessels that would have been presumably left in place during a standard hemicolectomy were marked with a suture. The lymph nodes in this segment were separately analysed. Results: In the CME specimen the mean lymph node count was 52.6 (range: 27-171). 35.0 % (range: 13.1-65.6 %) of the nodes were located in the central 4 cm segment. The proportion of patients with positive nodes was 25.5 % (13/51). Of all nodes 1.97 % (53/2686) were metastatic. In 3/51 (5.8 %) patients the central nodes were involved. In one patient the central nodes were the only metastatic site. UICC stage was influenced in two of the three patients who had central involvement (stage migration: UICC IIB to IIIB, UICC IIIB to IIIC). Conclusion: CME with CVL in right-sided colon adenocarcinoma increases the probability of complete removal of the local lymph node drainage and thus local metastatic lymph nodes. Considering this result an improvement of long-term survival by the CME procedure seems conceivable but needs to be confirmed by the current multicentre trial.
    Zentralblatt fur Chirurgie, Supplement 08/2015; 140(4):449-453. DOI:10.1055/s-0034-1383133
  • M Neid · K Datta · S Stephan · I Khanna · L Shaw · M White · A Tannapfel · D Mukhopadhyay
    Zeitschrift für Gastroenterologie 08/2015; 41(08). DOI:10.1055/s-0035-1555187 · 1.67 Impact Factor
  • Zeitschrift für Gastroenterologie 08/2015; 41(08). DOI:10.1055/s-0035-1555422 · 1.67 Impact Factor
  • Stefan Benz · Yu Tam · Andrea Tannapfel · Ingo Stricker
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    ABSTRACT: Current evidence suggests that complete mesocolic excision (CME) for right-sided colon cancer could be beneficial in terms of long-term survival. However, CME is a considerably more complex operation than standard right hemicolectomy; this is especially true for the laparoscopic approach. Consequently, we have explored a new laparoscopic approach that provides surgical radicality at the mesenteric root on the one hand and maximum safety on the other hand. The key feature of the uncinate process first approach (UFA) is the commencement of the dissection at the fourth part of the duodenum using a medial to lateral approach, thus mobilizing the whole mesenteric root posteriorly before the central parts of the mesenteric vessels are accessed. Twenty-eight selected patients with right-sided colon cancer underwent surgery using the UFA and were compared with 51 patients who underwent an open CME procedure (CON). In 11/28 and 51/51 patients in the UFA and CON groups, respectively, a planimetric assessment of the specimen was performed. Surgical time was longer (144.8 vs. 202.5 min; p < 0.000) and postoperative stay shorter (8.0 vs. 10.5 days; p < 0.01) for the laparoscopic approach. The area of the resected mesentery (UFA, 15,097 mm(2); CON, 15,788 mm(2); p = 0.47) and the lymph node count (UFA, 59.0; CON, 51.0; p = 0.09) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative mortality (UFA, 0/28; CON, 1/51; p = 1.0). Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.
    Surgical Endoscopy 07/2015; DOI:10.1007/s00464-015-4417-1 · 3.31 Impact Factor
  • Zeitschrift für Gastroenterologie 07/2015; 53(7):668-723. DOI:10.1055/s-0035-1553193 · 1.67 Impact Factor
  • Johanna Munding · Andrea Tannapfel
    Gastroenterologie up2date 03/2015; 11(01):12-13. DOI:10.1055/s-0034-1391380
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    Gastroenterologie up2date 03/2015; 11(01):6-11. DOI:10.1055/s-0034-1391379
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    Orlin Belyaev · Johanna Munding · Andrea Tannapfel · Waldemar Uhl
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    ABSTRACT: In 2013, a 68-year-old male had a pancreaticoduodenectomy for pancreatic cancer. The pancreaticojejunostomy was sealed with cyanoacrylate (Dermabond) to prevent postoperative pancreatic fistula. Local recurrence of malignancy at the anastomosis was suspected 18 months later in PET/CT. Surgical revision was performed and anastomosis resected. However, histology showed no tumor recurrence, but strong inflammation and foreign-body reaction towards Dermabond. The sealant caused false-positive PET/CT findings, so its use in oncologic surgery should be abandoned.
    Journal of Gastrointestinal Surgery 03/2015; 19(5). DOI:10.1007/s11605-015-2780-9 · 2.39 Impact Factor
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    ABSTRACT: HintergrundDas Management von „kleinen Polypen“ im distalen Kolon und Rektum ist in den Fokus der Kosten-Nutzen-Analyse der Vorsorgekoloskopie geraten. So wird insbesondere im angloamerikanischen Sprachraum aktuell diskutiert, winzige (Die Amerikanische Gesellschaft für Gastroenterologische Endoskopie (ASGE) hat im Rahmen ihrer sog. Innovationsdiskussion („Preservation and Incorporation of Valuable Endoscopic Innovations [PIVI]“) diskutiert, Polypen unter 0,5 cm Durchmesser zwar zu entfernen, nicht jedoch histopathologisch zu untersuchen - um angeblich Kosten zu sparen (www. http://www.asge.org/publications/). In Computermodellrechnungen wurde ermittelt, dass durch das „Entfernen und Verwerfen“ pro Vorsorgekoloskopie 25 US-Dollar gespart werden könnten [1, 2].Nicht nur aus berufspolitischen Gründen wird die Diskussion auch in Deutschland geführt - und von einigen be ...
    Der Pathologe 03/2015; 36(2). DOI:10.1007/s00292-015-0003-5 · 0.64 Impact Factor
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    ABSTRACT: Background: IgG4-associated autoimmune diseases are systemic diseases affecting multiple organs of the body. Autoimmune pancreatitis, with a prevalence of 2.2 per 100 000 people, is one such disease. Because these multi-organ diseases present in highly variable ways, they were long thought just to affect individual organ systems. This only underscores the importance of familiarity with these diseases for routine clinical practice. Methods: This review is based on pertinent articles retrieved by a selective search in PubMed, and on the published conclusions of international consensus conferences. Results: The current scientific understanding of this group of diseases is based largely on case reports and small case series; there have not been any randomized controlled trials (RCTs) to date. Any organ system can be affected, including (for example) the biliary pathways, salivary glands, kidneys, lymph nodes, thyroid gland, and blood vessels. Macroscopically, these diseases cause diffuse organ swelling and the formation of pseudotumorous masses. Histopathologically, they are characterized by a lymphoplasmacytic infiltrate with IgG4-positive plasma cells, which leads via an autoimmune mechanism to the typical histologic findings-storiform fibrosis ("storiform" = whorled, like a straw mat) and obliterative, i.e., vessel-occluding, phlebitis. A mixed Th1 and Th2 immune response seems to play an important role in pathogenesis, while the role of IgG4 antibodies, which are not pathogenic in themselves, is still unclear. Glucocorticoid treatment leads to remission in 98% of cases and is usually continued for 12 months as maintenance therapy. Most patients undergo remission even if untreated. Steroid-resistant disease can be treated with immune modulators. Conclusion: IgG4-associated autoimmune diseases are becoming more common, but adequate, systematically obtained data are now available only from certain Asian countries. Interdisciplinary collaboration is a prerequisite to proper diagnosis and treatment. Treatment algorithms and RCTs are needed to point the way to organ-specific treatment in the future.
    Deutsches Ärzteblatt International 02/2015; 112(8):128-+. DOI:10.3238/arztebl.2015.0128 · 3.61 Impact Factor
  • Deutsches Ärzteblatt International 01/2015; 112(4):60-60. DOI:10.3238/arztebl.2015.0060b · 3.61 Impact Factor
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    ABSTRACT: Oncogenic Kras-activated robust Mek/Erk signals phosphorylate to the tuberous sclerosis complex (Tsc) and deactivates mammalian target of rapamycin (mTOR) suppression in pancreatic ductal adenocarcinoma (PDAC); however, Mek and mTOR inhibitors alone have demonstrated minimal clinical antitumor activity. We generated transgenic mouse models in which mTOR was hyperactivated either through the Kras/Mek/Erk cascade, by loss of Pten or through Tsc1 haploinsufficiency. Primary cancer cells were isolated from mouse tumours. Oncogenic signalling was assessed in vitro and in vivo, with and without single or multiple targeted molecule inhibition. Transcriptional profiling was used to identify biomarkers predictive of the underlying pathway alterations and of therapeutic response. Results from the preclinical models were confirmed on human material. Reduction of Tsc1 function facilitated activation of Kras/Mek/Erk-mediated mTOR signalling, which promoted the development of metastatic PDACs. Single inhibition of mTOR or Mek elicited strong feedback activation of Erk or Akt, respectively. Only dual inhibition of Mek and PI3K reduced mTOR activity and effectively induced cancer cell apoptosis. Analysis of downstream targets demonstrated that oncogenic activity of the Mek/Erk/Tsc/mTOR axis relied on Aldh1a3 function. Moreover, in clinical PDAC samples, ALDH1A3 specifically labelled an aggressive subtype. These results advance our understanding of Mek/Erk-driven mTOR activation and its downstream targets in PDAC, and provide a mechanistic rationale for effective therapeutic matching for Aldh1a3-positive PDACs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Gut 01/2015; DOI:10.1136/gutjnl-2014-307616 · 13.32 Impact Factor
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    ABSTRACT: Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is the most common soft-tissue sarcoma of late adult life. Further advances in genetic characterization are warranted. The aim of this study was to search for numerical and structural chromosomal anomalies in UPS. We investigated five sarcoma-specific chromosomal translocations, five oncogene amplifications as well as the numerical karyotype of 19 UPS samples and one UPS/MFH cell line (U2197) using FISH probes on interphase nuclei. Our results demonstrate that chromosomal translocations involving CHOP, SYT, EWS, FUS and FKHR genes are absent. Furthermore, amplification of ERBB2 (10.5%) and MDM2 (10.5%) was observed whereas the EGFR, C-MYC and N-MYC genes were not amplified. Interestingly, predominant aneuploidies were found in eight chromosomes. The data demonstrate rarity of sarcoma-specific chromosomal breaks and oncogene amplifications in UPS, yet polysomic chromosomes appear more characteristically in this condition. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    Anticancer research 12/2014; 34(12):7119-27. · 1.87 Impact Factor
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    ABSTRACT: Purpose: The aim of this study was to evaluate the prognostic value of MSI-H and p53 overexpression in metastatic colorectal cancer (mCRC) treated with oxaliplatin and fluoropyrimidine-based first line chemotherapy. Methods: Tumour samples were retrospectively obtained from 229 patients from a prospective randomised phase III trial of the AIO colorectal study group, comparing CAPOX and FUFOX in mCRC. Immunohistochemistry of p53 and MMR proteins as well as microsatellite analysis were performed. Results: The incidence of MSI-H and p53 overexpression was 7.9 % and 65.4 %, respectively. MSI-H status was not correlated with ORR, PFS and OS. We observed a trend to lower DCR for MSI-H tumours (65 % vs. 85 %, p = 0.055). p53 overexpression was not correlated with DCR, ORR and PFS. The median OS of patients with tumors with p53 overexpression was significantly longer compared to tumors withhout p53 overexpression (19.6 vs. 15.8 months; p = 0.05). The post-progression survival (PPS) of p53-positive patients undergoing 2nd and/or 3rd line chemotherapy with irinotecan and/or cetuximab was significantly longer compared to p53-negative patients. Conclusion: MSI-H tumours tend to have lower disease control rates when treated with an oxaliplatin/fluoropyrmidin combination. mCRC patients with p53 overexpression undergoing an irinotecan containing second- or third-line chemotherapy after oxaliplatin failure have a significantly longer post-progression survival compared to patients without p53 overexpression. To validate the clinical impact of p53 in patients with mCRC treated with irinotecan- and/or cetuximab further studies are needed. © Georg Thieme Verlag KG Stuttgart · New York.
    Zeitschrift für Gastroenterologie 12/2014; 52(12):1394-1401. DOI:10.1055/s-0034-1366781 · 1.67 Impact Factor
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    ABSTRACT: The TNM classification is used to assess cancers of the oral cavity, and advancements in imaging techniques have revealed clear variations in tumor volume at presentation. This study therefore aimed to clarify whether preoperative imaging, with exact measurements of the tumor, could affect post-surgery survival after controlling for demographic, clinical, and tumor characteristics. We included 437 patients with histologically confirmed, stage T1-4, N1-3, M0, invasive squamous cell carcinoma of the tongue. Participants were assessed for recurrence every 3 months for the first 2 years, every 6 months for another 2 years, and annually thereafter; routine computed tomography was performed annually. Associations were determined using the Kaplan-Meier estimator, univariate log-rank test, and Cox proportional hazards regression models. The mean survival of all patients was 68.1 ± 48.2 months. The 2- and 5-year overall survival rates were 82.2 and 66.7 %, respectively. The mean primary tumor volume was 7.14 cm(3) with a range of 1.3-24.21 cm(3). The ROC curve and Youden Index analysis revealed that the optimal cutoff volume was between ≤5.9 and ≤18.3 cm(3) for three different volume groups (p < 0.0001). Large tumor volume was associated with a significantly poorer overall survival (p < 0.0001). Tumor volume was significantly associated with the overall survival of patients. This has both prognostic and reconstructive implications that will affect health-related quality of life. In addition, this will inform surgical planning and the allocation of resources.
    Journal of Cancer Research and Clinical Oncology 11/2014; 141(6). DOI:10.1007/s00432-014-1881-2 · 3.01 Impact Factor
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    European Urology Supplements 11/2014; 13(5). DOI:10.1016/S1569-9056(14)61324-5 · 3.37 Impact Factor
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    ABSTRACT: Lynch syndrome is the most frequent hereditary cancer syndrome, accounting for approximately 3-5 % of all colorectal cancers. In addition, it is the most frequent predisposing hereditary cause of endometrial cancer and is also associated with gastric cancer, ovarian cancer, cancer of the urinary tract as well as several other cancers. In clinical practise Lynch syndrome is frequently not detected and many clinicians admit uncertainties regarding diagnostic procedures. Also, counselling of patients is considered difficult regarding therapeutic - especially prophylactic surgical and chemopreventive options and recommendations. Based on a review of available literature we discuss optimized strategies for improved detection of suspected Lynch syndrome patients. The aim of this review is to establish a clinical algorithm of how to proceed on a diagnostic level and to discuss surgical options at the time of a colorectal cancer. In order to identify patients with Lynch syndrome, family history should be ascertained and evaluated in regards to fulfilment of the Amsterdam-II- and/or the revised Bethesda criteria. Subsequently immunohistochemical staining for the mismatch-repair-genes, BRAF testing for MLH1 loss of expression, as well as testing for microsatellite instability in some, followed by genetic counselling and mutation analysis when indicated, is recommended. Pathological identification of suspected Lynch syndrome is readily feasible and straightforward. However, the need of performing these analyses in the tumor biopsy at the time of (gastroenterological) diagnosis of CRC neoplasia is essential, in order to offer patients the option of a prophylactically extended surgery and - as recommended in the German S3 guidelines - to discuss the option of a merely prophylactical hysterectomy and oophorectomy (if postmenopausal) in women. Close cooperation between gastroenterologists, pathologists and surgeons is warranted, so that patients may benefit from options of extended or prophylactically extended surgery at the time of diagnosis of a colorectal primary. Patients nowadays must be involved in informed decision-making regarding prophylactic or extended prophylactic surgery at the time of a colorectal primary. To date, however, limitations in daily clinical practise, the failure to assess family history and the lack of awareness of this important hereditary syndrome is the major asset leading to severe underdiagnosis and putting to risk the indexpatients themselves and their families to (metachronous) CRC and the associated extracolonic cancers. If at all tumors of patients fulfilling Bethesda criteria will be analysed for MSI in the surgical specimen and therefore Lynch syndrome patients are not given the opportunity to opt for extended surgery. In clinical experience the postoperative MSI-analysis is inconsistently performed - even if the Bethesda criteria are fulfilled - and in case of suspected Lynch syndrome genetically counselling is not consistently recommended. Therefore affected cancer patients are left unaware of their increased genetic risk and in average 3 high-risk gene carriers per family miss the opportunity to actively engage in the recommended screening program.
    Zentralblatt fur Chirurgie, Supplement 11/2014; DOI:10.1055/s-0034-1368480
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    ABSTRACT: Background & Aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in combination with cytopathology is the optimal method for diagnosis and staging of pancreatic ductal adenocarcinoma (PDAC) and other pancreatic lesions. Its clinical utility, however, can be limited by high rates of indeterminate or false negative results. We aimed to develop and validate a microRNA (miRNA)-based test to improve preoperative detection of PDAC. Methods Levels of miRNAs were analyzed in a central clinical laboratory by relative quantitative PCR in 95 formalin-fixed, paraffin-embedded (FFPE) specimens and 228 samples collected by EUS-FNA during routine evaluations of patients with solid pancreatic masses at 4 institutions in the United States, 1 in Canada, and 1 in Poland. Results We developed a 5-miRNA expression classifier, consisting of MIR24, MIR130B, MIR135B, MIR148A, and MIR196, that could identify PDAC in well-characterized FFPE specimens. Detection of PDAC in EUS-FNA samples increased from 78.8% by cytology analysis alone (95% confidence interval [CI], 72.2%–84.5%) to 90.8% when combined with miRNA analysis (95% CI, 85.6%–94.5%). The miRNA classifier correctly identified 22 additional true PDAC cases among 39 samples initially classified as benign, indeterminate, or non-diagnostic by cytology. Cytology and miRNA test results were each significantly associated with PDAC (P<.001), with positive predictive values >99% (95% CI, 96%–100%). Conclusions We developed and validated a 5 miRNA classifier that can accurately predict which preoperative pancreatic EUS-FNA specimens contain PDAC. This test might aid in the diagnosis of pancreatic cancer by reducing the number of FNAs without a definitive adenocarcinoma diagnosis, thereby reducing the number of repeat EUS-FNA procedures.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2014; 12(10). DOI:10.1016/j.cgh.2014.02.038 · 6.53 Impact Factor

Publication Stats

8k Citations
1,617.85 Total Impact Points

Institutions

  • 2006–2015
    • Ruhr-Universität Bochum
      • Institute of Pathology
      Bochum, North Rhine-Westphalia, Germany
    • Klinikum Bayreuth GmbH
      Bayreuth, Bavaria, Germany
  • 2008–2013
    • Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil
      Bochum, North Rhine-Westphalia, Germany
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 2011
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2010
    • Sana Klinikum Remscheid GmbH
      Remscheid, North Rhine-Westphalia, Germany
  • 2008–2010
    • St. Josef-Hospital
      Bonn, North Rhine-Westphalia, Germany
  • 1997–2009
    • University of Leipzig
      • Institute of Pathology
      Leipzig, Saxony, Germany
  • 2004–2005
    • HELIOS Klinik Zwenkau
      Zwenkau, Saxony, Germany
  • 2001–2004
    • Institut für Pathologie und Molekularpathologie
      Gelsenkirchen, North Rhine-Westphalia, Germany
    • Klinikum Augsburg
      Augsberg, Bavaria, Germany
  • 2002
    • Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.
      Leipzig, Saxony, Germany
  • 1992–2001
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
  • 2000
    • Universitätsklinikum Erlangen
      • Department of Surgery
      Erlangen, Bavaria, Germany
  • 1995–1996
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Surgery
      Erlangen, Bavaria, Germany