André L Mihaljevic

Technische Universität München, München, Bavaria, Germany

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Publications (27)48.13 Total impact

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    ABSTRACT: Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.
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    ABSTRACT: The benefit assessment of surgical procedures serves as the basis for the concept of evidence-based surgery. However, especially in the field of surgery, many interventions are lacking assessment in high-quality clinical trials. Therefore, a well-structured benefit assessment of surgical interventions in the future is imperative. Considering the different perspectives, e.g. of the patients, surgeons, industry or health care investors, the implications of the benefits and risks of a procedure can differ significantly. Researchers have to abide by different regulations, depending on the type of intervention being evaluated in a surgical trial. Furthermore, the benefit assessment of surgical procedures poses specific challenges, from the choice of a relevant endpoint to issues concerning the standardization of the interventions and the impact of learning curves. The IDEAL concept, which was established by a group of international experts in 2009, serves as a framework for the future development and assessment of innovations in the field of surgery. For example, the SDGC (Study Center of the German Society of Surgery) and CHIR-Net (Surgical Studies Network) indicate that such collaborations of clinicians and methodologists can lead to the creation of a qualified structure for the effective benefit assessment of surgical procedures. In the future, the aforementioned evidence gaps must be eliminated and innovations evaluated efficiently by the work of such networks.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 01/2015; DOI:10.1007/s00103-014-2113-2 · 1.01 Impact Factor
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    ABSTRACT: Continuous bleeding after using conventional hemostatic methods involving energy, sutures, or clips, is a serious and costly surgical complication. Many topical agents have been developed to promote intraoperative hemostasis, but improvement is needed in both decreasing time to hemostasis and increasing ease of use. Veriset™ hemostatic patch is CE-marked for controlling bleeding on the liver and in soft tissue. In the current study, we aimed to gather further evidence for the safety and effectiveness of Veriset™ hemostatic patch in soft tissue bleeding during a variety of surgical procedures. Thirty patients scheduled for nonemergency surgery, each with an intraoperative soft tissue bleeding site, were treated with Veriset™ hemostatic patch. Time to hemostasis was monitored, and adverse events were assessed during the 90 days after surgery. When Veriset™ hemostatic patch was used, hemostasis occurred within 5 minutes in 29/30 (96.7%) subjects and within 1 minute in 21/30 (70.0%) subjects. No device-related serious adverse events were recorded during the 30 days after surgery, and no reoperations for device-related bleeding complications were performed during the 5 days after surgery. Veriset™ hemostatic patch is a safe and effective hemostat for controlling soft tissue bleeding during a variety of surgical procedures.
    Medical Devices: Evidence and Research 01/2015; 8:167-74. DOI:10.2147/MDER.S79556
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    ABSTRACT: Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%). Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.
    PLoS ONE 01/2015; 10(3):e0121187. DOI:10.1371/journal.pone.0121187 · 3.53 Impact Factor
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    ABSTRACT: To determine whether circular plastic wound edge protectors (CWEPs) significantly reduce the rate of surgical site infections (SSIs) in comparison to standard surgical towels in patients undergoing laparotomy.
  • Der Chirurg 08/2014; 85(8):719-719. DOI:10.1007/s00104-014-2840-9 · 0.52 Impact Factor
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    ABSTRACT: Surgical treatment of incisional hernia includes implantation of a mesh. The use of synthetic grafts in contaminated fields results in an increased risk of infection. In these cases a potential advantage is described for biological repair material. Evidence for this problem is lacking; therefore, we initiated a survey among surgeons in Germany concerning this question.
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    ABSTRACT: Despite improvements in liver surgery over the past decades, hemostasis during hepatic resections remains challenging. This multicenter randomized study compares the hemostatic effect of a collagen hemostat vs. a carrier-bound fibrin sealant after hepatic resection. Patients scheduled for elective liver resection were randomized intraoperatively to receive either the collagen hemostat (COLL) or the carrier-bound fibrin sealant (CBFS) for secondary hemostasis. The primary endpoint was the proportion of patients with hemostasis after 3 min. Secondary parameters were the proportions of patients with hemostasis after 5 and 10 min, the total time to hemostasis, and the complication rates during a 3 months follow-up period. A total of 128 patients were included. In the COLL group, 53 out of 61 patients (86.9 %) achieved complete hemostasis within 3 min after application of the hemostat compared to 52 out of 65 patients (80.0 %) in the CBFS group. The 95 % confidence interval for this difference [-6.0 %, 19.8 %] does not include the lower noninferiority margin (-10 %). Thus, the COLL treatment can be regarded as noninferior to the comparator. The proportions of patients with hemostasis after 3, 5, and 10 min were not significantly different between the two study arms. Postoperative mortality and morbidity were similar in both treatment groups. The collagen hemostat is as effective as the carrier-bound fibrin sealant in obtaining secondary hemostasis during liver resection with a comparable complication rate.
    Langenbeck s Archives of Surgery 06/2014; 399(6). DOI:10.1007/s00423-014-1203-9 · 2.16 Impact Factor
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    ABSTRACT: Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gastric cancer by different levels of hospital care. Total of 8,601 patients with invasive gastric cancer documented between 1998 and 2012 by the Munich Cancer Registry were evaluated. Tumour and therapy characteristics and outcome were analysed in regard to five levels of hospital care: three levels were defined for general hospitals (level I-III), while university hospitals and speciality hospitals were grouped as separate classes. Survival was investigated using the Kaplan-Meier-method, computing relative survival, and by multivariate Cox proportional hazard regression. The average age differed between 66 years in university hospitals and 75 years in hospitals providing a basic level of care (level I). No survival differences were found for patients treated in different levels of hospital care in 75 % of the patient cohort, namely the M0 patients. A better survival could only be shown for patients with M1 at diagnosis when treated in a university or level III hospital compared to those treated in other hospitals. The outcome difference of M1 patients is most likely caused by selection effects concerning health status differences and not by processes of health care attributable to level of hospital care. Thus, this study demonstrates and confirms appropriate treatment and care of gastric cancer over all levels of hospital care.
    Journal of Cancer Research and Clinical Oncology 03/2014; DOI:10.1007/s00432-014-1632-4 · 3.01 Impact Factor
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    ABSTRACT: The purpose of this study was to report on the first experiences with freehand single-photon emission-computed tomography (freehand SPECT) in sentinel lymph node biopsy (SLNB) in patients with malignant melanoma. Freehand SPECT is a novel imaging modality combining gamma probes, surgical navigation systems, and emission tomography algorithms, designed to overcome some of the limitations of conventional gamma probes. In this study 20 patients with malignant melanoma underwent conventional planar scintigraphy prior to surgery. In the operating room, the number and location of separable SLNs were detected first by a pre-incisional scan with freehand SPECT to render a 3D-image of the target site and afterwards by a scan with a conventional gamma probe. After SLNB another scan was performed to document the removal of all targeted SLNs. Planar scintigraphy identified 40 SLNs in 26 nodal basins. Pre-incisional freehand SPECT mapped 38 of these nodes as well as one additional node in one patient (95.0% node based sensitivity). The results of freehand SPECT were identical to those of planar scintigraphy in 25 basins, while it missed one basin (96.2% basin based sensitivity). In comparison, the gamma probe failed to detect 7 nodes in 4 basins (82.5% node based sensitivity and 84.6% basin based sensitivity). After resection freehand SPECT detected 9 remaining radioactive spots, two of whichwere resected as they matched the position of SLNs detected on preoperative planar scintigraphy. Freehand SPECT provides a real-time, intraoperative 3D-image of the radioactive labelled SLNs, facilitating their detection and resection.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 09/2013; 40(1). DOI:10.1016/j.ejso.2013.09.005 · 2.89 Impact Factor
  • André L Mihaljevic, Helmut Friess, Christoph Schuhmacher
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    ABSTRACT: Following the first successful gastric resection for gastric cancer by Theodor Billroth in 1881 surgery has made tremendous progress leading to improved surgical mortality and morbidity. However, while treatment of early gastric cancer is frequently curative, 5-year survival rates for advanced gastric cancer remain dismal despite the application of perioperative multimodal treatment concepts. In this article we will outline key clinical trials that have lead to an improvement in treatment of gastric cancer patients with specific emphasis on the last 20 years. We will then outline recent concepts and key clinical trials that are currently being conducted in the field. Finally we will outline open questions that remain to be elucidated in the future. J. Surg. Oncol © 2012 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 03/2013; 107(3). DOI:10.1002/jso.23120 · 2.84 Impact Factor
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    ABSTRACT: BACKGROUND: Bleeding during hepatic surgery is associated with prolonged hospitalization and increased morbidity and mortality. The Veriset™ haemostatic patch is a topical haemostat comprised of an absorbable backing made of oxidized cellulose and self-adhesive hydrogel components. It is designed to achieve haemostasis quickly and adhere to tissues without fixation. METHODS: A prospective, randomized, multicentre, single-blinded study (n = 50) was performed to compare the use of a Veriset™ haemostatic patch with a fibrin sealant patch (TachoSil® ) (control) in the management of diffuse bleeding after hepatic surgery. Patients were randomized following the confirmation of diffuse bleeding requiring the use of a topical haemostat. Time to haemostasis was assessed at preset intervals until haemostasis was achieved. RESULTS: Both groups were similar in comorbidities and procedural techniques. The median time to haemostasis in the group using the Veriset™ haemostatic patch was 1.0 min compared with 3.0 min in the control group (P < 0.001; 3-min minimum application time for the control patch). This result was independent of bleeding severity and surface area. Both products had similar safety profiles and no statistical differences were observed in the occurrence of adverse or device-related events. CONCLUSIONS: Regardless of bleeding severity or surface area, the Veriset™ haemostatic patch achieved haemostasis in this setting significantly faster than the control device in patients undergoing hepatic resection. It was safe and easy to handle in open hepatic surgery.
    HPB 12/2012; 15(7). DOI:10.1111/hpb.12009 · 2.05 Impact Factor
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    ABSTRACT: OBJECTIVES:: The objective of the HASTA trial was to compare hand suture versus stapling loop ileostomy closure in a randomized controlled trial. BACKGROUND:: Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy after low anterior resection. The best surgical technique for closure of loop ileostomy has not been defined yet. METHODS:: HASTA trial is a multicenter pragmatic randomized controlled surgical trial with 2 parallel groups to compare hand suture versus stapling for closure of loop ileostomy. The primary endpoint was the rate of bowel obstruction within 30 days after ileostomy closure. RESULTS:: A total of 337 randomized patients undergoing closure of loop ileostomy after low anterior resection because of rectal cancer in 27 centers were included. The overall rate of postoperative ileus after ileostomy closure was 13.4%. Seventeen of 165 (10.3%) patients in the stapler group and 27 of 163 (16.6%) in the hand suture group developed bowel obstruction within 30 days postoperatively [odds ratio (OR) = 1.72; 95% confidence interval (CI): 0.89-3.31 = 0.10]. Duration of surgical intervention was significantly shorter in the stapler group (15 minutes; P < 0.001). Multivariable analysis of potential risk factors did not reveal any significant correlation with development of postoperative ileus. Rate of anastomotic leakage (stapler: 3.0%, hand suture: 1.8%, P = 0.48) did not differ significantly as well as all other secondary endpoints. CONCLUSIONS:: Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time. Postoperative ileus after ileostomy reversal remains a relevant complication.
    Annals of surgery 11/2012; 256(5):828-836. DOI:10.1097/SLA.0b013e318272df97 · 7.19 Impact Factor
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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. DOI:10.1186/1745-6215-13-72 · 2.12 Impact Factor
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    ABSTRACT: Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010
    Trials 05/2012; 13(1):57. DOI:10.1186/1745-6215-13-57 · 2.12 Impact Factor
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    ABSTRACT: An important factor for successful therapy of poisoning with organophosphorus compounds (OP) is the rapid restoration of blocked respiratory muscle function. To achieve this goal, oximes are administered for reactivation of inhibited acetylcholinesterase (AChE). Unfortunately, clinically used oximes, e.g. obidoxime and pralidoxime, are of limited effectiveness in poisoning with different OP nerve agents requiring the search for alternative oximes, e.g. HI 6. In view of substantial species differences regarding reactivation properties of oximes, the effect of HI 6 was investigated with sarin, tabun and soman exposed human intercostal muscle. Muscle force production by indirect field stimulation and the activity of the human muscle AChE was assessed. 30 μM HI 6 resulted in an almost complete recovery of sarin blocked muscle force and in an increase of completely inhibited muscle AChE activity to approx. 30% of control. In soman or tabun exposed human intercostal muscle HI 6 (50 and 100 μM) had no effect on blocked muscle force or on inhibited human muscle AChE activity. In addition, HI 6 up to 1000 μM had no effect on soman blocked muscle force indicating that this oxime has no direct, pharmacological effect in human tissue. These results emphasize that sufficient reactivation of AChE is necessary for a beneficial therapeutic effect on nerve agent blocked neuromuscular transmission.
    Toxicology Letters 09/2011; 206(1):72-6. DOI:10.1016/j.toxlet.2011.07.016 · 3.36 Impact Factor
  • André L. Mihaljevic, Helmut Friess
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    ABSTRACT: ZusammenfassungBei zystischen Raumforderungen ist aufgrund der weiten Spanne an möglichen Differentialdiagnosen mit sehr unterschiedlichen Prognosen eine fundierte Diagnostik angezeigt. Selbst dann kann nicht immer präoperativ eine sichere Diagnose gestellt werden, da viele zystische Raumforderungen nur durch eine feingewebliche pathologische Untersuchung eines Operationspräparates sicher diagnostiziert werden können, sodass präoperativ Unsicherheiten verbleiben. Die einzelnen Krankheitsbilder verlangen oftmals nach einer individualisierten chirurgischen Intervention, die der Prognose, der Pathologie, den Komorbiditäten und der Ausdehnung der Erkrankung Rechnung tragen muss. Hierbei kommt das gesamte Spektrum der Pankreaschirurgie zur Anwendung, wodurch sich die Notwendigkeit ergibt, solche Patienten in einem Pankreaszentrum mit entsprechender diagnostischer, konservativer und chirurgischer Expertise zu behandeln. Nach einer Darstellung des präoperativen klinischen Vorgehens sowie der Indikationen für einzelne Operationsverfahren werden diese individualisierten chirurgischen Interventionen im Anschluss kurz dargestellt.
    Viszeralmedizin / Visceral Medicine 01/2011; 27:214-224. DOI:10.1159/000329567 · 0.10 Impact Factor
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    ABSTRACT: The purpose of this review is to highlight the molecular mechanisms leading to the development and progression of pancreatic ductal adenocarcinoma (PDAC) with particular emphasis on tumor cell proliferation, local invasion, and metastasis. Recent advances in the field of PDAC biology have shed light on the molecular events that trigger PDAC initiation and maintenance. It is now clear that apart from the genetic alterations within the tumor cells, interactions of the tumor with its environment are necessary for proliferation and invasion. Interestingly, a number of developmental signaling pathways are reactivated in PDAC. Progress has also been made in the understanding of the molecular events that govern the process of metastasis. Although our understanding of the mechanisms underlying PDAC pathobiology are more advanced than ever, little progress has been made in the clinical treatment of PDAC, and successful bench-to-bedside transfer of knowledge to boost new treatment options is still unsatisfying.
    Langenbeck s Archives of Surgery 03/2010; 395(4):295-308. DOI:10.1007/s00423-010-0622-5 · 2.16 Impact Factor
  • A. L. Mihaljevic, I. Esposito, H. Friess, J. Kleeff
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    ABSTRACT: BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP) represent frequent, and devastating diseases of the pancreas. Although the treatment for both conditions has improved over the past decades, overall prognosis remains poor necessitating the development of new treatment options, which in turn requires a deeper understanding of the underlying pathophysiology including genetic, molecular, and histopathologic changes occurring in both diseases. METHODS: Review of the literature. RESULTS: Significant progress has been made in the field of pancreatic research deepening our understanding of PDAC and CP development and maintenance. The landmark findings will be outlined in this article drawing attention to the common pathologic pathways of both diseases. On a histopathologic level, PDAC development from precursor lesions has been described in detail. Furthermore, genetic changes during PDAC initiation and maintenance have recently been discovered. However, the exact role of many molecular alterations found in PDAC remains unclear. In CP, new concepts have changed our understanding of the disease and the finding and characterization of pancreatic stellate cells have given us a better understanding of the mechanism of pancreatic fibrosis, a hallmark of CP. CONCLUSIONS: Our growing knowledge of the underlying molecular and histopathologic changes occurring in PDAC as well as CP has given us an unprecedented insight into the causes and mechanisms of PDAC and CP development. GRUNDLAGEN: Das duktale Adenokarzinom des Pankreas sowie die chronische Pankreatitis stellen zwei häufige und schwerwiegende Erkrankungen der Bauchspeicheldrüse dar. Auch wenn sich die Behandlung dieser Erkrankungen in den letzten Jahrzehnten deutlich verbessert hat, bleibt doch die Prognose in beiden Fällen schlecht, so dass die Entwicklung neuer Behandlungsoptionen notwendig erscheint. Dies wiederum setzt ein tieferes Verständnis der zu Grunde liegende Pathophysiologie, einschließlich der molekularen, genetischen und histopathologischen Veränderungen, voraus. METHODIK: Übersichtsarbeit auf der Grundlage einer selektiven Literaturausarbeitung. ERGEBNISSE: Wesentliche Fortschritte im Bereich der Pankreasforschung haben unser Verständnis des duktalen Adenokarzinoms sowie der chronischen Pankreatitis vertieft. Die grundlegenden Erkenntnisse werden in diesem Artikel skizziert werden, mit besonderem Fokus auf den gemeinsamen pathophysiologischen Grundlagen beider Erkrankungen. Die Entwicklung des duktalen Adenokarzinoms aus Vorläuferläsionen ist in der Zwischenzeit im Detail beschrieben. Des Weiteren sind grundlegende genetische Veränderungen der Entwicklung und Ausbreitung des PDAC identifiziert worden. Viele molekulare Veränderungen sind jedoch in ihrer Bedeutung nicht genau bekannt oder noch nicht ausreichend untersucht worden. In der chronischen Pankreatitis haben neue Konzepte unser Verständnis der Erkrankung grundlegend verändert. Die Entdeckung und Charakterisierung von pankreatischen Sternzellen hat zu einem besseren Verständnis der Genese der Pankreasfibrose, eines der wesentlichen Charakteristika der chronischen Pankreatitis, beigetragen. SCHLUSSFOLGERUNGEN: Unser wachsendes Wissen über die molekularen und histopathologischen Grundlagen des Pankreaskarzinoms sowie der chronischen Pankreatitis haben uns einen nie dagewesenen Einblick in die Entstehung dieser Erkrankungen ermöglicht. KeywordsPancreatic cancer-Chronic pancreatitis-Pathogenesis-Genetic alterations-Pancreatic stellate cells-Desmoplasia-Signaling pathways-Histopathology SchlüsselwörterPankreaskarzinom-Chronische Pankreatitis-Pathogenese-Genetische Veränderungen-Pankreatische Sternzellen-Desmoplasie-Signalkaskaden-Histopathologie
    European Surgery 12/2009; 41(6):250-267. DOI:10.1007/s10353-009-0496-3 · 0.26 Impact Factor
  • André L Mihaljevic, Jörg Kleeff, Helmut Friess
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    ABSTRACT: The purpose of this paper is to illuminate the origin and current results of the duodenum-preserving pancreatic head resection (DPPHR) developed by Beger in the 1970s, as well as its simplified Berne modification, for patients suffering from chronic pancreatitis (CP). Indications for the procedures and their results are presented on the basis of available data. A selected review was made of the available data on the DPPHR developed by Beger and its modifications. The organ-sparing DPPHR developed by Beger, and its modifications, provide better pain relief, better preservation of exocrine and endocrine pancreatic function, and a superior quality of life compared with the more radical pancreaticoduodenectomy (PD, with or without pylorus-preservation), once the standard treatment for patients with CP. Recently published data on the long-term follow-up of studies comparing PD to DPPHR indicate that the initial benefits of DPPHR over PD might be less pronounced in the long-run. The organ-preserving DPPHR developed by Beger, and its modifications, have become established and well-evaluated surgical treatment options for patients with CP.
    Journal of Hepato-Biliary-Pancreatic Sciences 10/2009; 17(6):735-44. DOI:10.1007/s00534-009-0179-2 · 2.31 Impact Factor