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World journal of Gastroenterology 2009年第24期15卷 3065-3067页

作者： Sonja Gillen Helmut Friess jj?rg kleeff Department of Surgery Technische Universitt München

Iatrogenic perforation of esophageal cancer or cancer of the gastroesophageal(GE)junction is a serious complication that,in addition to short term morbidity and mortality,significantly compromises the success of any subsequent oncological ***,we present an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE *** surgical intervention included palliative resection and GE *** the case of iatrogenic tumor perforation, the primary goal should be adequate palliative(and not oncological)*** different approaches for iatrogenic perforation,*** versus endoscopic therapy are discussed.

关键词： Esophageal cancer Esophageal perforation Emergency surgery Stent therapy

Asymptomatic pancreatic lesions: New insights and clinical implications

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World journal of Gastroenterology 2012年第33期18卷 4474-4477页

作者： Martin Loos Christoph W Michalski jj?rg kleeff Department of Surgery Klinikum rechts der Isar Technische Universitt München 81675 München Germany

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI). Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: First: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?

关键词： Pancreatic cancer Early-stage pancreatic cancer Asymptomatic high-risk individuals Preinvasive pancreatic lesions Cystic pancreatic tumors Screening Computed tomography Magnetic resonance imaging Endoscopic ultrasound

Autoimmune pancreatitis associated with a large pancreatic pseudocyst

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World journal of Gastroenterology 2006年第36期12卷 5904-5906页

作者： Thilo Welsch jj?rg kleeff Irene Esposito Markus W Büchler Helmut Friess Department of Surgery University of Heidelberg Heidelberg Germany Department of Pathology University of Heidel-berg Heidelberg Germany

Pancreatic cystic lesions comprise various entities with different histopathological characteristics and their dif-ferential diagnosis is often a challenge for clinicians. Autoimmune pancreatitis (AIP) is usually not considered in the differential diagnosis of cystic lesions, but often mimics the morphological aspects of pancreatic neo-plasm. We report the case of a 64-year-old male patient with a cystic pancreatic head lesion (diameter 5 cm) and stenosis of the distal bile duct requiring repeated stent-ing. Because of the clinical presentation together with moderate elevation of serum CA19-9 and massive eleva-tion of cyst fluid CA19-9 (122.695 U/L; normal range: rgical procedures.

关键词： Pseudocyst Autoimmune pancreatitis Pancreatic cancer Tumor marker CEA CA19-9

Surgical approaches for resection of pancreatic cancer: an overview

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Hepatobiliary & Pancreatic Diseases International 2002年第1期1卷 118-125页

作者： Helmut Friess jj?rg kleeff Markus W Buchler Department of Visceral and Transplanlation Surgery University of Bern. Switzerland

Objective: To overview the different surgical approach-es for the resection of pancreatic cancer and our expe-rience with these ***: Surgical procedures including the Whipple re-section, pylorus-preserving resection, total and subto-tal panreatectomies, regional pancreatectomy and theextended lymph node resection were ***: Studies have shown that no operation seems toproduce significantly improved results in terms of sur-vival, mortality and resection rates compared to thestandard Whipple resection and ***: Despite the progress in the surgical treat-ment of pancreatic cancer, the overall prognosis afterresection remains unsatisfied. Surgery is likely to beoptional for the treatment of pancreatic cancer.

关键词： pancreatic cancer therapy surgery

Natural orifice transluminal endoscopic surgery in pancreatic diseases

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World journal of Gastroenterology 2010年第31期16卷 3859-3864页

作者： Sonja Gillen jj?rg kleeff Michael Kranzfelder Shailesh V Shrikhande Helmut Friess Hubertus Feussner Department of Surgery Tech-nische Universitt München Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery Tata Memorial Hospital

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has received considerable interest in recent years. Although minimal access surgery has increasingly replaced traditional open abdominal surgical approaches for a wide spectrum of indications, in pancreatic diseases its widespread use is limited to few indications because of the challenging and demanding nature of major pancreatic operations. Nonetheless, there have been attempts in animal models as well as in the clinical setting to perform diag- nostic and resectional NOTES for pancreatic diseases. Here, we review and comment upon the available data regarding currently analyzed and performed pancreatic NOTES procedures. Potential indications for NOTES include peritoneoscopy, cyst drainage, and necrosectomy, palliative procedures such as gastroenterostomy, as well as resections such as distal pancreatectomy or enucleation. These procedures have already been shown to be technically feasible in several studies in animal models and a few clinical trials. In conclusion, NOTES is a rapidly developing concept/technique that could potentially become an integral part of the armamentarium dealing with surgical approaches to pancreatic diseases.

关键词： Natural orifice transluminal endoscopic surgery Pancreatic disease Chronic pancreatitis Pancreatic resection Pancreatic drainage

Complexity of molecular alterations impacts pancreatic cancer prognosis

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World journal of Gastrointestinal Oncology 2013年第1期5卷 1-3页

作者： Ivonne Regel Bo Kong Philipp Bruns Christoph W Michalski jj?rg kleeff Department of Surgery Technische Universitt München

Individualized cancer treatment(*** therapy) based on molecular alterations has emerged as an important strategy to improve the current standardof-care chemotherapy.A large number of studies have demonstrated the importance of biomarkers not only in predicting prognosis but more importantly in predicting the response towards *** example,amplification or mutation status of the two biomarkers HER2(human epidermal growth factor 2) and BRCA(breast cancer) can be used to decide on a specific targeted therapy in breast ***,no biomarkers with a similar clinical impact have been identified in pancreatic ductal *** many genome-wide and proteome-based high-throughput studies have identified candidate genes or proteins as promising biomarkers,none of them were eventually transferred into the clinical ***,the most reliable markers for predicting prognosis are still the tumor stage and grade and biomarkers for therapy response remain *** reason lies in the lack of systemic approaches to analyze the complexity of dominating cancer pathways and the impact of such signal complexity on prognosis and therapy response.

关键词： Pancreatic cancer Diagnostic markers Biomarkers Targeted therapy Prognosis Pathways

Update on surgical treatment of pancreatic neuroendocrine neoplasms

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World journal of Gastroenterology 2014年第38期20卷 13893-13898页

作者： jan G D’Haese Chiara Tosolini Güralp O Ceyhan Bo Kong Irene Esposito Christoph W Michalski j?j?rg kleeff Department of Surgery Klinikum rechts der IsarTechnische Universit?t München Institute of Pathology Technische Universit?t München

Pancreatic neuroendocrine neoplasms(PNENs) are rare and account for only 2%-4% of all pancreatic neoplasms. All PNENs are potential(neurendocrine tumors PNETs) or overt(neuroendocrine carcinomas PNECs) malignant,but a subset of PNETs is low-risk. Even in case of low-risk PNETs surgical resection is frequently required to treat hormone-related symptoms and to obtain an appropriate pathological diagnosis. Low-risk PNETs in the body and the tail are ideal for minimallyinvasive approaches which should be tailored to the individual patient. Generally,surgeons must aim for parenchyma sparing in these cases. In high-risk and malignant PNENs,indications for tumor resection are much wider than for pancreatic adenocarcinoma,in many cases due to the relatively benign tumor biology. Thus,patients with locally advanced and metastatic PNETs may benefit from extensive resection. In experienced hands,even multi-organ resections are accomplished with acceptable perioperative morbidity and mortality rates and are associated with excellent long term survival. However,poorly differentiated neoplasms with high proliferation rates are associated with a dismal prognosis and may frequently only be treated with chemotherapy. The evidence on surgical treatment of PNENs stems from reviews of mostly singlecenter series and some analyses of nation-wide tumor registries. No randomized trial has been performed to compare surgical and non-surgical therapies in potentially resectable PNEN. Though such a trial would principally be desirable,ethical considerations and the heterogeneity of PNENs preclude realization of such a study. In the current review,we summarize recent advances in the surgical treatment of PNENs.

关键词： Surgery Laparoscopy Liver metastases Pancreatic neuroendocrine neoplasms Pancreatic neuroendocrine neoplasm

Tumor initiating cells in pancreatic cancer: A critical view

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World journal of Stem Cells 2009年第1期1卷 8-10页

作者： Christoph W Michalski jj?rg kleeff Department of Surgery Technische Universitt München Ismaningerstrasse22 81675 Munich Germany

Emerging evidence points to the existence of pan-creatic cancer stem cells (CSC) as the culprit in the initiation, maintenance, metastasis, and treatment resistance of pancreatic cancer. The existence of such a cell population would have an important im-pact on the design of novel therapies against this devastating disease. However, no in vivo validation or rebuttal of the pancreatic CSC hypothesis exists. Major backlashes in the discussion on CSC are firstly, the confusion between the terms CSC and cell of origin of pancreatic ductal adenocarcinoma (PDAC), secondly the ambiguity of the cell of origin itself and thirdly, the fact that the CSC hypothesis is based on cell sorting and xenografting experiments; the latter of which often precludes solid conclusions because of the lack of a natural microenvironment and differences in drug delivery. Nonetheless, recent studies in other cancers partially support the CSC hypothesis by demonstrating a link between epithelial-to-mesenchymal transdifferentiation/transition (EMT) and CSC properties. Such a link is again open to dispute as EMT is a reversible process which is highly dependent on major oncogenic pathways in PDAC [e.g. K-Ras, transforming growth factor-β (TGF-β)] rather than on presumed cancer stem cell pathways. Hence, the available evidence does not robustly support the CSC concept in PDAC and a thorough validation of this hypothesis in well-defined genetically engineered mouse models of pancreatic cancer is required.

关键词： Pancreatic cancer Cancer stem cell Tumor initiating cells Mouse models

Response evaluation following neoadjuvant treatment of pancreatic cancer patients

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World journal of Gastrointestinal Surgery 2013年第2期5卷 12-15页

作者： Chiara Tosolini Christoph W Michalski jj?rg kleeff Department of Surgery Technische Universit t München81675 MünchenGermany

Pancreatic ductal adenocarcinoma(PDAC) is one of the most aggressive human neoplastic entities,with a very poor prognosis characterized by a high mortality rate and short *** is due both to its aggressive biological behaviour and the high incidence of locally advanced stages at the time of the initial *** limits of resectability and the role of neoadjuvant(radio) chemotherapy for PDAC management are still unclear.A recently published article by Kats et al compared the radiological,surgical and histopathological results of 129 patients with borderline resectable tumors undergoing neoadjuvant treatment followed by *** post-neoadjuvant treatment imaging implied a low response rate,a high rate of complete resections was *** seems to confirm that,though radiology has made a significant progress in defining locally advanced PDAC,there is place for further *** particular,the differentiation between radiotherapy-induced scarring/fibrosis and cancer-associated desmoplasia remains a clinical/radiological *** selection of patients with occult systemic disease is possible with neoadjuvant treatment,downstaging does not seem to occur ***,development of novel,more aggressive(radio) chemotherapy regimens is required to improve prognosis of patients with locally unresectable but not systemically micro-metastasized tumors.

关键词： Pancreatic ductal adenocarcinoma Borderline resectable tumors Neoadjuvant chemotherapy

Pancreatic cancer surgery with vascular resection: current concepts and perspectives

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journal of Pancreatology 2019年第1期2卷 1-5页

作者： Artur Rebelo Christoph W.Michalski jörg Ukkat jöj?rg kleeff Department of Visceral Vascular and Endocrine SurgeryHalle University HospitalMartin-Luther-University Halle-WittenbergHalleGermany

Pancreatic cancer is a devastating disease and resection at an early disease stage is the best chance of cure. Less than 20% of all patients present with a resectable tumor, while another 20% to 30% have locally advanced pancreatic cancer and the majority of the patient suffer from metastatic disease. Recently, it has been recognized that there is a 4th group of patients with so-called borderline resectable disease. Here, the tumor approaches or infiltrates the vascular axis (superior mesenteric vein/portal vein and/or superior mesenteric/hepatic artery/celiac trunk). While a large number of tumors with suspected venous infiltration can be resected with concomitant venous resection and reconstruction, arterial infiltration has been considered a contraindication to resection. Neoadjuvant treatment with combination chemotherapy protocols with or without radiotherapy has allowed for higher resection rates even in patients with arterial invasion. Here, we review the contemporary literature on extensive pancreatic cancer surgery with vascular resection and reconstruction.

关键词： Borderline pancreatic cancer Celiac artery Hepatic artery Neoadjuvant chemotherapy Pancreatic cancer Portal vein Superior mesenteric artery Superior mesenteric vein Vascular resection