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Influence of the body mass index on postoperative outcome and long-term survival after pancreatic resections in patients with underlying malignancy

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 201-210页

作者： Philippa Seika fritz klein Uwe Pelzer Johann Pratschke Marcus Bahra Thomas Malinka Department of Surgery Charite Campus Mitte and Charite Campus Virchow KlinikumCharité-Universitatsmedizin BerlinBerlinGermany Department of Hematology/Oncology/Tumorimmunology Campus Virchow KlinikumCharité-Universitatsmedizin BerlinBerlinGermany

Background:While the long-term survival rate among patients with pancreatic and periampullary carcinomas remains low,it can be influenced by various *** purpose of this retrospective study was to investigate the effects of body mass index(BMI)on postoperative complications and patient survival after pancreatic resections for underlying malignancy over a 20-year observation ***:We analyzed 1,384 patients,918 patients with pancreatic ductal adenocarcinoma(PDAC)(66.3%),229 patients with distal cholangiocarcinoma(16.5%),206 ampullary carcinoma patients(14.8%),and 31 duodenal carcinoma patients(2.2%).Patients were classified into four groups(group 130.0)according to their BMI(kg/m2).We analyzed differences in postoperative complications,postoperative length of hospital stays,reoperations,postoperative mortality and survival rate among the ***:Within a mean observation period of 687.7[2–8,500]days,735(53.1%)patients *** were important differences in postoperative complications(group 1,16.2%;group 2,20.3%;group 3,27.2%,group 4,41.6%)with the type of postoperative complications also varying between the *** 1-,5-,10-and 15-year survival rates were 66.4%,25.5%,17.9%,and 12.1%,respectively,with survival rates varying amongst the four ***:Patients with a BMI between 18.5 and 30 show better postoperative outcomes,regarding complications,hospitalization duration,and reoperation rates than underweight or obese ***-term survival depends strongly on postoperative complications while patients with a higher BMI show better long-term survival rates.

关键词： Pancreatic resection body mass index(BMI) outcome long-term survival

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An inflammatory subtype of pancreatic ductal adenocarcinoma is associated with poor prognosis and increased perioperative mortality

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Journal of Pancreatology 2019年第3期2卷 107-112页

作者： Benzing Christian klein fritz Pelzer Uwe Sinn Marianne Pratschke Johann Bahra Marcus Campus Charité-Mitte and Campus Virchow Klinikum Charité-Universitätsmedizin BerlinBerlinGermany Department of Hematology Oncology and Tumor ImmunologyCharité-Universitätsmedizin BerlinBerlinGermany

Pancreatic ductal adenocarcinoma(PDAC)is a malignancy characterized by an aggressive tumor *** present analysis seeks to identify and analyze a cohort that meets criteria for"inflammatory"PDAC(IPDAC).All patients who underwent a curative resection for PDAC at our institution between 1989 and 2015 were included in the retrospective *** with histological proven adenocarcinoma and elevated C-reactive protein(CRP)(≥6 mg/L)serum concentrations,but no other suspicion of infection were *** provide a matched control group with normal CRP serum levels from the same patient ***-six(6.8%)of 532 patients meet our criteria for an IPDAC group ***-hospital(30 days)mortality was 13.9%in the IPDAC group vs 0%in the control group(P=.020).Median follow-up was 183.8 months(standard deviation[SD]=53.3,range 14.3-285.4).Median overall survival was 8.5 months(SD=16.8,range 0.3-89.6)in the IPDAC group and 24.8 months(SD=19.4,range 0.7-80.4)in the control group(P=.002).Patients indicating an IPDAC in our cohort had a significantly and clinical meaningful decreased overall survival and a higher perioperative morbidity and mortality.

关键词： Cholangitis CRP Inflammatory carcinoma PDAC

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Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

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Hepatobiliary & Pancreatic Diseases International 2012年第1期11卷 89-95页

作者： fritz klein Marcus Bahra Matthias Glanemann Wladimir Faber Peter Warnick Andreas Andreou Safak Gül Dietmar Jacob Department of General Visceraland Transplantation SurgeryCharité-Campus VirchowUniversit tsmedizin Berlin Department of Visceral Vascularand Minimally Invasive SurgeryVivantes Klinikum Spandau

BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue *** 'gold standard' surgical technique for pancreaticoenteric anastomosis has been *** study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress ***:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric *** with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were *** groups were homogeneous for age,gender,and underlying *** morbidity,mortality,and preoperative and operative data were ***:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the *** age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative ***:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue *** our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomos

关键词： mattress sutures pancreaticoduodenectomy pancreaticogastrostomy pancreaticojejunostomy soft pancreatic tissue remnant

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Characterization of the Stem Cell Fraction in Pancreatobiliary Carcinomas: The Notch Signaling Pathway as a Potential Therapeutic Target

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Journal of Cancer Therapy 2018年第6期9卷 480-502页

作者： Elisabeth Seidel Cynthia de Carvalho Fischer Christopher Neumann Anja Reutzel-Selke Andreas Andreou Joseph Gassner Julia Gogolok Peter Tang Anja Schirmeier fritz klein Igor M. Sauer Johann Pratschke Marcus Bahra Rosa B. Schmuck Charité—Universitatsmedizin Berlin Corporate Member of Freie Universitat Berlin Humboldt-Universitatzu Berlin and Berlin Institute of Health Institute of Surgery Augustenburger Platz 1 Berlin Germany

Pancreatic adenocarcinoma (PDAC) and extrahepatic cholangiocarcinoma (ECC) are highly lethal malignancies with limited treatment options. Both a small subpopulation of cancer stem cells (CSC) and the deregulation of the notch pathway have been considered potential sources of tumor formation. In this study, flow cytometry (FCM) was conducted to identify the CSC population and Notch-associated proteins in ECC and PDAC cell lines. Additionally, the treatment effect of Gemcitabine and the specific notch-inhibitor DAPT on ECC and PDAC cell lines was evaluated. Our results show that the amount of SP cells in ECC cell lines is significantly higher than in PDAC cell lines, and that SP-ECC cells show a higher sensitivity to therapy. In conclusion, inhibition of Notch signaling with DAPT may be of therapeutic value in ECC, but seems to show no effect on more aggressive PDAC. As it could be essential for the improvement in outcomes of the ECC patients, other trials are needed to determine the role of further Notch components.

关键词： Notch Pathway Cancer Stem Cells Pancreatic Adenocarcinoma Extrahepatic Cholangiocarcinoma Targeted Therapy

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Test-retest reliability of the Mini Nutritional Assessment–Short Form(MNA-SF)in older patients undergoing cardiac rehabilitation

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Journal of Geriatric Cardiology 2020年第9期17卷 574-579页

作者： fritz Kather Miralem Hadzic Teresa Hehle Sarah Eichler Julia klein Heinz Völler Annett Salzwedel Department of Rehabilitation Medicine University of PotsdamFaculty of Health Sciences BrandenburgGermany Klinik am See Rehabilitation Center for Internal MedicineRüdersdorfGermany

Malnutrition is described as a state of insufficient intake of energy,protein and other nutrients leading to changes in body composition(weight loss,reduced fat-free mass)as well as adverse functional and clinical outcomes.[1]Depending on the assessments and definition used,the prevalence in older patients ranges between 12%in communitydwelling adults to 60%of patients in geriatric care facilities.[2–5]Older populations are at high risk of nutritional deficiencies because of risk factors such as multimorbidity,polypharmacy,cognitive and physical decline,poor appetite,depressive syndromes and socioeconomic changes.[4,6].

关键词： Cardiac rehabilitation Malnutrition Octogenarians Test-retest reliability

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