Viszeralmedizin最新文献

{"title":"The Surgeon's Contribution to Image-Guided Oncology.","authors":"Christoph Benckert,&nbsp;Christiane Bruns","doi":"10.1159/000366458","DOIUrl":"https://doi.org/10.1159/000366458","url":null,"abstract":"<p><strong>Background: </strong>Advances in surgical and in imaging technology permit the performance of complex tumour resections in a safe and oncologically correct manner. To date, this has mainly implicated refined preoperative imaging methods, such as three-dimensional computer-assisted planning (3D-CASP). With the advent of modern hybrid operating rooms, intraoperative imaging has spread and various techniques of intraoperative image guidance have been developed.</p><p><strong>Methods: </strong>We review recent advances in intraoperative image guidance. We also delineate the role of intraoperative imaging techniques such as intraoperative ultrasound and computed tomography for real-time image guidance in laparoscopic liver surgery.</p><p><strong>Results: </strong>Our review shows that advances in intraoperative imaging accompany the increasing use of laparoscopic approaches in visceral surgery. For the liver surgeon working laparoscopically, the loss of tactile sensation and the complex three-dimensional anatomy of the human liver make 3D-imaging techniques and intraoperative image guidance indispensable. We describe the role of 3D-CASP in preoperative surgical planning in liver surgery.</p><p><strong>Conclusion: </strong>An innovative imaging strategy for identifying liver segments during laparoscopic liver surgery by applying a fluorescent imaging method is proposed.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"232-6"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34105296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-Guided Interventions in Oncology: A Look into the Future?","authors":"Jens Rickea,&nbsp;Joachim Mössnerb","doi":"10.1159/000366072","DOIUrl":"https://doi.org/10.1159/000366072","url":null,"abstract":"For many years, the diagnosis of metastasis in gastrointestinal tumours was deemed fatal for the patient. Nearly 40 years ago, there was an increasing number of reports according to which patients were surviving in the long term or healed after resection of solitary, small liver metastases. The accounts of experienced surgeons who actively worked during those days suggest the incredulity with which such reports were perceived by the oncology community. Since then, not only the readiness to perform an increasingly pervasive tumour resection of liver metastases but also the specific surgical technique for this has developed enormously. In the next step, it was mainly lung metastasis that could be removed, enabling to promise the patient an improved prognosis if the tumour biology was right. In parallel to this and dating back to the 1990s, locally ablative image-guided procedures such as radiofrequency ablation developed, minimizing the access and ablation trauma and permitting a lower strain for the patient. This made it possible to use such procedures even in patients with severe comorbidities. \u0000 \u0000A lot of time has passed since then. In addition to the perpetually progressing development of increasingly better imaging by means of computed tomography (CT), magnetic resonance imaging (MRI), or high-resolution ultrasound, as well as the introduction of increasingly perfect methods of celldestroying energy application (e.g. microwave, stereotactic radiation, image-guided brachytherapy), particularly new oncological concepts are becoming more and more interesting. The concept of ‘deepness of response’, where quick, intense reaction with clear tumour reduction under systemic therapy has a beneficial influence on survival, is of special importance for local ablation techniques. Why should the deepness of response, as it has been documented in detail for colorectal carcinoma in different studies, not also be valid for other solid tumours? Why would this deepness of response not be achievable much faster and more reliably by massive tumour-ablative measures than by systematic chemotherapy? Another phenomenon not yet understood in its complexity is that of ‘oligometastasis’. It is unclear at this time which biological markers or indicators describe patients profiting from locally or regionally ablative measures in spite of multiple metastases or various organ systems being affected. \u0000 \u0000This issue of VISZERALMEDIZIN does not try to give any definitive answers to the questions asked in this editorial – this is impossible at the current state of science. The contributions, and specifically the interdisciplinary discussion, however, clearly present the questions that we need to answer now and in the near future in order to achieve the next, truly great advance in improving survival in metastasis-forming gastrointestinal tumours. The questions that you will find in the articles together with some initial answers range from the ideal technique for microtherapeut","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"230"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Create Evidence for the Integration of Local and Locoregional Treatments in Future Oncological Treatment Concepts?","authors":"Florian Lordick, Jens Ricke, Konrad Mohnike, Ulrich Hacker","doi":"10.1159/000365313","DOIUrl":"10.1159/000365313","url":null,"abstract":"<p><strong>Background: </strong>While local treatment using more innovative technologies is increasingly applied in contemporary treatment of advanced cancer, its impact on outcomes is not well understood.</p><p><strong>Methods: </strong>We reviewed the literature using PubMed and major oncology congress websites, and report here about the understanding of oligometastatic disease, about the role of primary tumor resection in metastatic disease, and about the value of cytoreduction and tumor ablation.</p><p><strong>Results: </strong>The Achilless' heel of local treatment is the current lack of evidence of its efficacy. When considering how this lack of knowledge can be overcome, we arrive at three suggestions: First, adequately powered clinical trials must be performed to allow for the proper assessment of differences in survival outcomes. Second, the effect of local treatment on the biological evolution of the disease needs to be studied; analysis of circulating tumor DNA may help to assess these effects. Third and foremost, patient-reported outcomes like quality of life, symptom control, and satisfaction with treatment should define when to use and when to omit local treatment.</p><p><strong>Conclusions: </strong>Innovative trial designs in future oncology research will be required for assessing the true value of local and locoregional therapy.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"261-8"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Metastasis of Malignant Melanoma: Report of a Case and Review of Available Literature.","authors":"Nader El-Sourani,&nbsp;Achim Troja,&nbsp;Hans-Rudolph Raab,&nbsp;Dalibor Antolovic","doi":"10.1159/000364814","DOIUrl":"https://doi.org/10.1159/000364814","url":null,"abstract":"<p><strong>Background: </strong>Malignant melanoma is a tumor with common lymphogenic or hematogenic metastasis. Metastasis to the gastric mucosa is uncommon.</p><p><strong>Case report: </strong>We present the case of a 43-year-old female patient with metastases of a malignant melanoma to the lesser curvature of the stomach. The primary malignant melanoma of the right breast was resected 2 years previously.</p><p><strong>Conclusion: </strong>Metastases to the gastric mucosa are rarely seen. Esophagogastroduodenoscopy should be performed in symptomatic patients to rule out metastatic disease. When R0 resection can be achieved, it should be undertaken in order to increase the overall prognosis of the patient.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"273-5"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000364814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients.","authors":"Eligijus Poskus,&nbsp;Edvinas Kildusis,&nbsp;Edgaras Smolskas,&nbsp;Marijus Ambrazevicius,&nbsp;Kestutis Strupas","doi":"10.1159/000366218","DOIUrl":"https://doi.org/10.1159/000366218","url":null,"abstract":"<p><strong>Background: </strong>Closure of a loop ileostomy is a relatively simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce the number of complications, such as timing of closure or different surgical closure techniques, are investigated. The aim of this study was to evaluate the experience of the Abdominal Surgery Center at Vilnius University Hospital (VUH) 'Santariskiu klinikos' to review the complications after closure of loop ileostomy and to identify potential risk factors for postoperative complications.</p><p><strong>Methods: </strong>Data from 132 patients who underwent closure of loop ileostomy from 2003 to 2013 at the Abdominal Surgery Center of VUH were collected, including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of ileostomy, anastomotic technique, duration of the operation, postoperative complications, and hospital stay after surgery. The operations were performed by 15 surgeons with varying experience assisted by surgical residents. Experience in ileostomy closure was defined by the number of procedures performed.</p><p><strong>Results: </strong>Complications occurred in 24 patients (18.2%), with 20 of them having surgical complications: bowel obstruction (9 (6.8%)), wound infection (4 (3.0%)), peritonitis due to anastomotic leak (3 (2.3%)), intra-abdominal abscess (2 (1.5%)), anastomotic leak with enterocutaneous fistula (1 (0.76%)), and bleeding (1 (0.76%)). 4 patients had non-surgical complications: postoperative diarrhea (2 (1.5%)), urinary retention (1 (0.76%)), and deep vein thrombosis (1 (0.76%)). Most complications were classified as group II according to the Clavien-Dindo classification. 2 patients died (1.5%). The anastomotic technique used did not affect the outcome. The experience of the surgeon as judged by the frequency of the procedure was the main factor affecting postoperative morbidity significantly (p = 0.03).</p><p><strong>Conclusion: </strong>Our study revealed that the rate of postoperative complications and a smooth postoperative course after the closure of ileostomy was influenced by surgical experience.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"276-80"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Endoscopic Treatment Options in Malignancies of the Biliopancreatic System.","authors":"Jürgen Feisthammel,&nbsp;Joachim Mössner,&nbsp;Albrecht Hoffmeister","doi":"10.1159/000366145","DOIUrl":"https://doi.org/10.1159/000366145","url":null,"abstract":"<p><p>In most of the cases, pancreatic cancer and malignancies of the bile tract can only be treated palliatively. Endoscopy offers several methods for effective control of the symptoms in those situations. In pancreatic cancer, stenting of bile ducts enables a control of jaundice most of the time. Stenting of an obstructed duodenum can relieve symptoms of gastric outlet obstruction without the need for major surgery. In biliary tract cancer, stenting of the bile ducts can provide effective drainage of the biliary system. Photodynamic therapy and radiofrequency ablation can sometimes be a valuable tool in symptom control. This review tries to provide an overview on endoscopic palliative treatment options in pancreatic cancer and biliary tract cancer. </p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"238-43"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34001795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending the Frontiers Beyond Thermal Ablation by Radiofrequency Ablation: SBRT, Brachytherapy, SIRT (Radioembolization).","authors":"Peter Hass,&nbsp;Konrad Mohnike","doi":"10.1159/000366088","DOIUrl":"https://doi.org/10.1159/000366088","url":null,"abstract":"<p><p>Metastatic spread of the primary is still defined as the systemic stage of disease in treatment guidelines for various solid tumors. This definition is the rationale for systemic therapy. Interestingly and despite the concept of systemic involvement, surgical resection as a local treatment has proven to yield long-term outcomes in a subset of patients with limited metastatic disease, supporting the concept of oligometastatic disease. Radiofrequency ablation has yielded favorable outcomes in patients with hepatocellular carcinoma and colorectal metastases, and some studies indicate its prognostic potential in combined treatments with systemic therapies. However, some significant technical limitations apply, such as size limitation, heat sink effects, and unpredictable heat distribution to adjacent risk structures. Interventional and non-invasive radiotherapeutic techniques may overcome these limitations, expanding the options for oligometastatic patients and cytoreductive concepts. Current data suggest very high local control rates even in large tumors at any given location in the human body. The article focusses on the characteristics and possibilities of stereotactic body radiation therapy, interstitial high-dose-rate brachytherapy, and Yttrium-90 radioembolization. In this article, we discuss the differences of the technical preferences as well as their impact on indications. Current data is presented and discussed with a focus on application in oligometastatic or cytoreductive concepts in different tumor biologies. </p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"245-52"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There Any Evidence for a Role of Local Treatment in Cholangiocarcinoma?","authors":"Arndt Vogel,&nbsp;Oliver Dudeck","doi":"10.1159/000365312","DOIUrl":"https://doi.org/10.1159/000365312","url":null,"abstract":"<p><strong>Background: </strong>Most cholangiocarcinomas (CCA) are locally advanced and unresectable at the time of diagnosis. Currently, chemotherapy combining gemcitabine with a platinum agent is the recommended first-line treatment regimen for advanced biliary tract cancer. However, median overall survival is only approximately 1 year. As the hepatic tumor burden is the limiting factor for the prognosis of these patients, local tumor control is essential.</p><p><strong>Methods: </strong>We present and discuss the current evidence for such therapy options for patients with CCA.</p><p><strong>Results: </strong>Local and locoregional therapies have been shown to be well tolerated and can contribute to tumor control in the context of a comprehensive oncologic treatment strategy, and may prolong survival of patients with advanced CCA. Unfortunately, only few high-quality clinical trials are available.</p><p><strong>Conclusion: </strong>Randomized prospective clinical trials enrolling larger numbers of patients need to be carried out to elucidate the precise value of these treatments alone as well as in combination with systemic chemotherapy.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"254-60"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000365312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Image-Guided Oncology and Local Tumor Treatments.","authors":"Jens Ricke,&nbsp;Christiane Bruns,&nbsp;Christoph Dietrich,&nbsp;Maciej Pech,&nbsp;Peter Wust","doi":"10.1159/000366075","DOIUrl":"https://doi.org/10.1159/000366075","url":null,"abstract":"Pech: There are indeed distinct limitations of thermal ablation such as radiofrequency ablation (RFA), despite RFA being the most frequently used local ablation tool available. However, in many cases anatomical locations with adjacent thermosensitive structures or the size of a specific lesion represent strong limitations in daily routine, requiring more efforts in the development of non-thermal ablation techniques. Ultimately, the toolbox enabling minimally traumatic local treatments will be decisive for patient outcome – in a patient selection beyond what is considered suitable for local approaches today. However, even today the combination of thermal ablation, resection, and radiation allows extensive macroscopic tumor cell count reduction in almost all patients considered ‘oligometastatic’. Local tumor ablation may strongly improve the outcome of systemic chemotherapies or targeted treatments. According to the Goldie-Coldman hypothesis from the 1970s (!), extensive local treatment (with reasonable interventional risk) reduces the mathematical probability of a chemotherapy-resistant clonal selection. Hence, local tumor ablation or local treatment in general promotes an optimal environment for simultaneous chemotherapy – it may even help to suppress resistant clones if used in between chemotherapy cycles (in biologically suitable candidates!). In the CELIM study [1], patients resected R0 or ablated completely after downstaging had almost twofold survival rates as compared to R1-resected patients. Maybe there is a selection bias in that study; however, would this result not best be explained by clonal selection pressure through complete resection? Question 2: Local tumor ablation in combination with chemotherapy would undoubtedly result in the best imaginable ‘deepness of response’. If deepness of response truly works, such as proven for colorectal metastases [2], what would you recommend to your patients if the procedural risk is low with minimally invasive ablation?","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 4","pages":"269-72"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malabsorption as a Therapeutic Approach in Bariatric Surgery.","authors":"Adrian T Billeter,&nbsp;Lars Fischer,&nbsp;Anna-Laura Wekerle,&nbsp;Jonas Senft,&nbsp;Beat Müller-Stich","doi":"10.1159/000363480","DOIUrl":"https://doi.org/10.1159/000363480","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of obese patients will lead to a more frequent use of bariatric procedures in the future. Compared to conservative medical therapy, bariatric procedures achieve greater weight loss and superior control of comorbidities, resulting in improved overall mortality.</p><p><strong>Methods: </strong>A search for current literature regarding mechanisms, indications, and outcomes of bariatric surgery was performed.</p><p><strong>Results: </strong>In order to care for patients after bariatric surgery properly, it is important to understand its mechanisms of action and effects on gastrointestinal physiology. Recent investigations indicate that the beneficial effects of bariatric procedures are much more complex than simply limiting food intake or an associated malabsorption. Changes in gastrointestinal hormone secretion, energy expenditure, intestinal bacterial colonization, bile acid metabolism, and epigenetic modifications resulting in altered gene expression are likely responsible for the majority of the beneficial effects of bariatric surgery. Malabsorptive bariatric procedures divert the flow of bile and pancreatic enzymes from food and therefore limit the digestion and absorption of nutrients, resulting in reduced calorie intake and subsequent weight loss. Essential micronutrients such as vitamins and trace elements are also absorbed to a lesser extent, potentially leading to severe side effects.</p><p><strong>Conclusion: </strong>To prevent malnutrition, dietary supplementation and regular control of micronutrient levels are mandatory for patients undergoing malabsorptive bariatric procedures, in whom the fat-soluble vitamins A and D are commonly deficient.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 3","pages":"198-204"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34001793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}