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Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers- Review

World Journal of Gastrointestinal Oncology 2016年第3期8卷 258-270页

作者： Hanno Riess Piet Habbel Anja Jühling Marianne Sinn uwe pelzer Department of Hematology Oncology and Tumor Immunology Charité University Medicine Berlin

Venous thromboembolism event(VTE) is a common and morbid complication in cancer patients. Patients with gastrointestinal cancers often suffer from symptomatic or incidental splanchnic vein thrombosis, impaired liver function and/or thrombocytopenia. These characteristics require a thorough risk/benefit evaluation for individual patients. Considering the risk factors for the development of VTE and bleeding events in addition to recent study results may be helpful for correct initiation of primary pharmacological prevention and treatment of cancer-associated thrombosis(CAT), preferably with low molecular weight heparins(LMWH). Whereas thromboprophylaxis is most often recommended in hospitalized surgical and non-surgical patients with malignancy, there is less agreement as to its duration. With regard to ambulatory cancer patients, the lack of robust data results in low grade recommendations against routine use of anticoagulant drugs. Anticoagulation with LMWH for the first months is the evidence-based treatment for acute CAT, but duration of secondary prevention and the drug of choice are unclear. Based on published guidelines and literature, this review will focus on prevention and treatment strategies of VTE in patients with gastrointestinal cancers.

关键词： Thromboembolism Gastrointestinal cancer Prophylaxis Treatment Anticoagulation

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Perioperative treatment options in resectable pancreatic cancer-how to improve long-term survival

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World Journal of Gastrointestinal Oncology 2016年第3期8卷 248-257页

作者： Marianne Sinn Marcus Bahra Timm Denecke Sue Travis uwe pelzer Hanno Riess Department of Medical Oncology and Haematology Charité-Universitatsmedizin Berlin Department of General Visceral and Transplantation SurgeryCharité-Universitatsmedizin Berlin Institute of Radiology Charité-Universitatsmedizin Berlin

Surgery remains the only chance of cure for pancreatic cancer, but only 15%-25% of patients present with resectable disease at the time of primary diagnosis. Important goals in clinical research must therefore be to allow early detection with suitable diagnostic procedures, to further broaden operation techniques and to determine the most effective perioperative treatment of either chemotherapy and/or radiation therapy. More extensive operations involving extended pancreatectomy, portal vein resection and pancreatic resection in resectable pancreatic cancer with limited liver metastasis, performed in specialized centers seem to be the surgical procedures with a possible impact on survival. After many years of stagnation in pharmacological clinical research on advanced pancreatic ductal adenocarcinomas(PDAC)- since the approval of gemcitabine in 1997- more effective cytotoxic substances(nab-paclitaxel) and combinations(FOLFIRINOX) are now available for perioperative treatment. Additionally, therapies with a broader mechanism of action are emerging(stroma depletion, immunotherapy, antiinflammation), raising hopes for more effective adjuvant and neoadjuvant treatment concepts, especially in the context of "borderline resectability". Only multidisciplinary approaches including radiology, surgery, medical and radiation oncology as the backbones of the treatment of potentially resectable PDAC may be able to further improve the rate of cure in the future.

关键词： Pancreatic cancer Perioperative treatment Perioperative radiology Chemotherapy

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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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