Ulrich Ronellenfitsch

• MD
• Professor (Assistant) at Universitätsmedizin Mannheim

Background Gastrointestinal (GI) cancers, particularly pancreatic cancer, are characterized by a dense stromal tumor microenvironment where cancer-associated fibroblasts (CAFs) predominate. CAFs comprise highly heterogeneous subpopulations with different functions, which can be both tumor-promoting and tumor-restraining. This systematic review and...

Background Title-abstract screening in the preparation of a systematic review is a time-consuming task. Modern techniques of natural language processing and machine learning might allow partly automatization of title-abstract screening. In particular, clear guidance on how to proceed with these techniques in practice is of high relevance. Methods...

Background Intra- and postoperative hemorrhage is a relevant problem in major abdominal surgery, leading to acute anemia and necessitating transfusion of packed red blood cells. It is estimated that in 30% of abdominal surgeries, intra- or postoperative transfusion is required. Transfusion potentially has detrimental health effects and poses a cons...

Importance The prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. From current evidence, it remains unclear to what extent preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy achieve better outcomes than surgery alone. Objective To assess the association of preo...

Introduction The occurrence of delayed gastric emptying (DGE) following pancreatoduodenectomy is of high clinical relevance. Despite the pivotal nature of this topic, the existing evidence is limited and often conflicting. This meta-analysis aims to assess the impact of various interventions, such as the type of surgical reconstruction (specificall...

TPS4184 Background: Despite recent advances, long-term survival of patients with locally advanced, operable esophagogastric adenocarcinoma (EGA) is below 50%. Immune checkpoint inhibitors in the neoadjuvant setting of this tumor type have lately been shown to increase pathological responses in all comers (IKF633/DANTE pII, KEYNOTE-585, Matterhorn),...

BACKGROUND At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Accordingly, better standardized m...

Background At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Therefore, better standardized met...

Introduction Perforated peptic ulcers are a life-threatening complication associated with high morbidity and mortality. Several treatment approaches are available. The aim of this network meta-analysis (NMA) is to compare surgical and alternative approaches for the treatment of perforated peptic ulcers regarding mortality and other patient-relevant...

TPS431 Background: The outcome of patients (pts) with adenocarcinomas of stomach and esophagogastric junction (GEJ) remains unsatisfactory (5-year survival rates of 24-84%), whereby surgical resection is considered as cornerstone of the curative treatment for pts with early stage esophageal adenocarcinoma (EGA), however, it is associated with morta...

BACKGROUND With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. OBJECTIVE This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing...

Background With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. Objective This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing...

Background Endoscopic approaches in the treatment of transmural esophageal defects, either after esophageal resection or due to perforation, have demonstrated convincing feasibility. Surgical options are limited and associated with high morbidity and mortality rates. Currently, internal endoscopic drainage with pigtail stents, self-expanding metal...

This meta-analysis examines the outcomes of patients undergoing surgery with vascular resection for retroperitoneal sarcoma. A systematic literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, identifying five comparative retrospective cohort studies published from 2015 to 20...

Background: The aim of this study was to analyze the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of "primary aortic" (aneurysm, aortic dissection, penetrating aortic ulcer (PAU)) and "secondary aortic" (iatrogenic, trauma, and aortoesophageal fistula) pathologies. Methods: Retrospective review of a cohort of...

BackgroundA hallmark of gastrointestinal cancer, especially pancreatic cancer, is the dense stromal tumor microenvironment in which cancer-associated fibroblasts (CAFs) represent the major stromal cell type. Preclinical studies have demonstrated that depletion of fibroblast activation protein (FAP)–positive CAFs results in increased survival. Objec...

The aim of the present study was to analyze the outcome of open surgical and endovascular interventions for the treatment of visceral aneurysms. A retrospective review of a cohort of visceral aneurysm patients treated at a single tertiary referral center was conducted. STROBE guidelines were followed. The primary endpoint was postoperative in-hospi...

Background In several settings in the treatment of gastrointestinal cancers, it is unclear if the addition of surgery to a multimodal treatment strategy, or in some circumstances its omission, lead to a better outcome for patients. In such situations of clinical equipoise, high-quality evidence from randomised-controlled trials is needed to decide...

The aim of this study was to analyse and compare the outcome of open surgery (OS) and endovascular repair (ER) for the treatment of visceral artery aneurysms (VAA). A systematic literature search was carried out. 25 comparative cohort studies with 4447 patients (2469 OS and 1978 ER) were included in the meta-analysis. Mortality (ER vs OS 1.8% vs 2....

To analyze the association of tumor volume with outcome after surgery for cervical paraganglioma. Materials and Methods: This retrospective study included consecutive patients undergoing surgery for cervical paraganglioma from 2009–2020. Outcomes were 30-day morbidity, mortality, cranial nerve injury, and stroke. Preoperative CT/MRI was used for tu...

BACKGROUND A hallmark of gastrointestinal cancer, especially pancreatic cancer, is the dense stromal tumor microenvironment in which cancer-associated fibroblasts (CAFs) represent the major stromal cell type. Preclinical studies have demonstrated that depletion of fibroblast activation protein (FAP)–positive CAFs results in increased survival. OBJ...

Background: The standard treatment of occlusive processes of the femoral artery bifurcation is thrombendarterectomy (TEA). Endovascular techniques (ENDO) have recently been put forward as a potential alternative. It is unclear so far which modality yields better outcomes with respect to long-term revascularization and periprocedural complications....

The oncological outcome of patients with locally advanced pancreatic cancer continues to be dismal. Abutment or invasion of visceral arteries, which constitutes irresectability according to the consensus of the International Association of Pancreatology and can be found in a considerable proportion of patients upon initial diagnosis, usually preclu...

Background Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. Methods A systematic literature search of the Pu...

The aim of the present study was to compare the open surgical and percutaneous access for thoracic/endovascular aortic repair (T/EVAR) regarding in-hospital and post-hospital minor-complications. Percutaneous (pEVAR) and cutdown (cEVAR) techniques for femoral vessel access for T/EVAR were compared regarding their minor complications. The basic popu...

Background: The aim of the study was to analyse the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of “primary aortic” (aneurysm, aortic dissection, penetrating aortic ulcer [PAU]) and “secondary aortic” (iatrogenic, trauma and aortoesophageal fistula) pathologies. Methods : Retrospective review of a cohort of pat...

Background The aim of the study was to analyse the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of “primary aortic” (aneurysm, aortic dissection, penetrating aortic ulcer [PAU]) and “secondary aortic” (iatrogenic, trauma and aortoesophageal fistula) pathologies. Methods Retrospective review of a cohort of patie...

Background Gastrointestinal stromal tumors (GIST) are rare abdominal tumors. Pretreatment biopsies may be used to diagnose a GIST and enable tailored treatment. Some experts are skeptical about biopsies because they fear tumor cell seeding. The objective of this study was to determine if pretreatment biopsy is associated with increased tumor recurr...

BACKGROUND Endovascular aortic repair (EVAR) is nowadays the standard procedure in treating patients diagnosed with abdominal pathologies with suitable anatomy. Open surgery remains an option mostly for patients not suitable for endovascular surgery. Colonic ischemia is an important and life-threatening postoperative complication of these procedure...

Background Endovascular aortic repair is considered the standard procedure in treating patients diagnosed with pathologies of the abdominal aorta with suitable anatomy. Open surgery remains an option mostly for patients not suitable for endovascular surgery. Colonic ischemia is an important and life-threatening postoperative complication of these p...

Background With the advances in multimodality treatment in recent years, an analysis of the outcome of vascular resections in surgery of cholangiocarcinoma is lacking. The aim of this meta-analysis was to summarize the currently available evidence on outcomes of patients undergoing arterial resection (AR) for the treatment of cholangiocarcinoma. M...

(1) Background: Numerous dissection instruments are available for liver resection. So far, there has been no evidence in favor of a specific dissection device effecting a reduction in postoperative mortality and morbidity or a reduction in intraoperative blood loss. The aim of the study was to evaluate the safety of liver resection with the 1318 nm...

BACKGROUND The lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas and a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy or chemoradiotherapy, which have become established treatments for car...

Background Lymph node yield is the number of lymph nodes retrieved during oncological resection and histopathologically identified in the resection specimen. It is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas, as well as a prognostic factor in these diseases. It remains un...

Surgical oncology is commonly regarded as the field of surgery dealing with cancer [...]

Objective To assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections. Methods and analysis A systematic search of randomised controlled trials compari...

Background In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinom...

Background: Tracheoesophageal fistulae (TEF) after oncologic resections and multimodal treatment are life-threatening and surgically challenging. Radiation and prior procedures hamper wound healing and lead to high complication rates. We present an interdisciplinary algorithm for the treatment of TEF derived from the therapy of consecutive patient...

In the framework of the German Interdisciplinary Sarcoma Group GISG-04/NOPASS trial, we evaluated soft tissue sarcoma samples taken before and after neoadjuvant pazopanib therapy using histopathology and next generation sequencing (NGS) to find potential predictive biomarkers. We also aimed to improve the genetically based sarcoma classification an...

BACKGROUND With the advances in multimodality treatment in the recent years, an analysis of the outcome of vascular resections in surgery of hilar cholangiocarcinoma is lacking. OBJECTIVE The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar c...

Introduction: Pancreatic cancer continues to have a poor outcome. Many patients are diagnosed with advanced disease, and in a considerable proportion, abutment or invasion of visceral arteries is present. Moreover, some patients have anatomical variations or stenosis of major visceral arteries requiring arterial reconstruction upon pancreatic cance...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To compare and rank preoperative chemoradiotherapy and chemotherapy treatment modalities for patients with resectable adenocarcinoma of the esophagus and esophagogastric junction, in terms of overall survival and other patient-relevant outcomes, by...

Palliative care comprehends a crucial interdisciplinary approach for affected patients. Control of local tumor growth and cancer-related symptoms, improved survival and quality life are the most relevant goals within palliative therapy. Surgery can contribute to palliative care addressing all three above-mentioned issues. This review article, based...

Background: The lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas and a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy or chemoradiotherapy, which have become established treatments for ca...

Pancreatic cancer is one of the most lethal gastrointestinal tumor entities. Surgery is the only chance for cure; however, only a minority of patients can be offered this option. Due to the anatomic location of the gland, tumor-related problems and complications affecting the surrounding structures are common, leading to bile and gastric outlet obs...

Zusammenfassung Zusammenfassung In der Patientenversorgung tätige Mitarbeiter erleben häufig einen Konflikt zwischen dem systemimmanent vorgegebenen Ziel einer möglichst wirtschaftlichen Behandlung und der berufsethisch geprägten Bestrebung, ein aus Sicht des Patienten möglichst gutes Behandlungsergebnis zu erreichen. Dieser Konflikt kann durch de...

Surgeons are frequently confronted with the treatment of retroperitoneal masses. The respective tumor entities comprise sarcoma, adrenal carcinoma, hormonally active and inactive benign adrenal tumours, adrenal metastasis, extragonadal manifestations of germ cell tumours, lymphoma and lymphatic metastases of extra-retroperitoneal primaries. This re...

Upper gastrointestinal carcinomas comprise squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the esophagus, as well as gastric AC [...]

Objective: With the advances in multimodality treatment in the recent years, an analysis of the outcome of vascular resections in surgery of hilar cholangiocarcinoma is lacking. The aim of this meta-analysis was to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangioca...

Objective Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery. Methods A systematic literature search was carried out from January 2011 until January 20...

Background Despite obvious advances over the last decades, locally advanced adenocarcinomas of the gastroesophageal junction (GEJ) still carry a dismal prognosis with overall 5-year survival rates of less than 50% even when using modern optimized treatment protocols such as perioperative chemotherapy based on the FLOT regimen or radiochemotherapy....

Background: The aim of this study was to evaluate postoperative morbidity, mortality, and failure to rescue following complications after radical resection for gastric cancer. Methods: A retrospective analysis of the surgical database of patients with gastroesophageal malignancies at our institution was performed. All consecutive patients underg...

Background The purpose of this study was to investigate clinical features, prognostic factors, and overall survival (OS) in surgical patients with gastric remnant cancer (GRC).MethodsA retrospective analysis of patients with gastrectomy for pT1–4 gastric cancer between October 1972 and February 2014 at our institution was performed. Clinical charac...

Bedingt durch einen technischen Fehler fehlen in der ursprünglichen Publikation alle Koautoren. Neben dem Erstautor, Herrn Dr. S. Seyfried, sind Axel Drazyk, Geogi Vassilev, Christian Galata, Andreas Gerken, Ioannis Karampinis, Christoph Reißfelder, Ulrich Ronellenfitsch und Mirko Otto weitere …

4533 Background: Disease-free survival (DFS) is an appealing surrogate endpoint for overall survival (OS) in trials on neoadjuvant or adjuvant cancer therapy, because it is available faster and with less follow-up effort. The aim of this study was to assess if DFS can be a valid surrogate endpoint for OS when comparing neoadjuvant treatment followe...

(1) Background: Oncological gastrectomy requires complex multidisciplinary management. Clinical pathways (CPs) can potentially facilitate this task, but evidence related to their use in managing oncological gastrectomy is limited. This study evaluated the effect of a CP for oncological gastrectomy on process and outcome quality. (2) Methods: Consec...

Purpose Based on results from randomized controlled trials, there is an increasing discussion if antibiotic treatment is an equivalent therapeutic approach to appendectomy in uncomplicated acute appendicitis. This observational prospective study evaluates its feasibility, safety, and effectiveness in clinical practice. Methods The study included a...

Background: Pancreatic surgery demands complex multidisciplinary management. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated the effect of CPs on quality of care for pancreatoduodenectomy. Methods: Data of all consecutive patients who underwent pancr...

Introduction: Disease-free survival (DFS) is increasingly being used as surrogate end-point for overall survival (OS) in cancer trials. So far, there has been no validation of the surrogacy of DFS for OS for neoadjuvant treatment of gastroesophageal adenocarcinoma. Methods: The study uses individual patient data (IPD) from eight randomised contr...

Purpose Pancreatic surgery demands complex multidisciplinary management, which is often cumbersome to implement. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated if CPs are a suitable tool for process standardization in order to improve process and outco...

Zusammenfassung Die für eine aus Sicht von Patienten, Arzt und Krankenhausträger erfolgreiche stationäre Behandlung erforderlichen Schritte sind vielschichtig und müssen sinnvoll miteinander verzahnt werden. Dies trifft in besonderem Maße für operativ tätige Fächer zu. Zur Koordination dieser Schritte, die mit der Planung der stationären Aufnahme b...

The outcome of high-risk soft tissue sarcoma (STS) is poor with radical surgery being the only potentially curative modality. Pazopanib is a multikinase inhibitor approved for the treatment of metastatic STS. Herein, in terms of the German Interdisciplinary Sarcoma Group (GISG-04/NOPASS) trial, we evaluate the potential role of kinetic analysis of...

Objective To explore effects of the implementation of clinical pathways (CPs) on hierarchical structures within a surgical department. Summary of background data CPs are care plans stipulating diagnostic and therapeutic measures along a time axis for a given condition or procedure. They are widely used in surgery. There is limited evidence to what...

Background Preoperative devascularization might improve local control and thus the outcome of patients with soft tissue sarcoma (STS). The multikinase inhibitor pazopanib has antiangiogenic effects and is approved for treating metastatic STS. We conducted a trial of preoperative pazopanib therapy in high-risk STS. Methods This single-arm, phase II...

Background: The principles of surgery for primary gastrointestinal stromal tumor (GIST) are resection with clear margins without lymphadenectomy, thus enabling organ-preserving resection in many cases. Tumor rupture needs to be avoided, because it entails peritoneal sarcomatosis. Given these preconditions, there is a rationale for laparoscopic res...

Objective: The objective of this study was to analyze the impact of completion digital subtraction angiography (cDSA) after carotid endarterectomy (CEA) on technical and early clinical results. Methods: This retrospective study included consecutive patients undergoing CEA from January 2011 to January 2015. Routine cDSA was performed in all patie...

Introduction: Survival in gastric cancer is often limited by peritoneal carcinomatosis, which supposedly develops from serosal tumor infiltration or tumor cell spread during gastrectomy with lymphadenectomy. To eliminate peritoneal tumor cells, extensive intraperitoneal lavage (EIPL) has been suggested. Impressive results have been achieved in Jap...

Background The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a cla...

After the introduction of endovascular aortic aneurysm repair (EVAR) in the 1990s, the treatment of abdominal aortic aneurysms (AAA) has gradually shifted from open repair (OR) to EVAR. Given its reduced invasiveness with the avoidance of laparotomy and general anesthesia, shorter operation times, less blood loss and lower postoperative pain levels...

Introduction: Neovascularisation is a critical step in the progression of malignant tumors. Circulating endothelial progenitor cells (cEPC) have been proposed as surrogate markers of vasculogenesis in malignancies. In this project, we studied the impact of tumor-specific therapy on cEPC and associated angiogenic factors in patients with soft tissu...

Purpose: Optimal perfusion of the gastric conduit during esophagectomy is elementary for the anastomotic healing since poor perfusion has been associated with increased morbidity due to anastomotic leaks. Until recently surgical experience was the main tool to assess the perfusion of the anastomosis. We hypothesized that anastomoses located in the...

The article “Imaging therapy response of gastrointestinal stromal tumors (GIST) with FDG PET, CT and MRI: a systematic review”, written by Antonia Dimitrakopoulou-Strauss, Ulrich Ronellenfitsch, Caixia Cheng, Leyun Pan, Christos Sachpekidis, Peter Hohenberger, and Thomas Henzler, was originally published Online First without open access. After publ...

Objective: Retroperitoneal sarcomas (RPSs) are rare cancers with some variability in clinical and histopathological presentation. In Germany, general treatment strategies of retroperitoneal sarcoma are unknown since centralized registries do not exist. The objective of this survey was to access the medical care of RPS patients in Germany. Methods...

Background In the last decades clinical pathways (CPs) have been proven to be an effective tool for process management. The CPs can be defined as multidisciplinary, timely structured treatment plans for a given diagnosis or procedure, which transfer national and international guidelines as well as evidence from other sources into local structures....