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  • Paul, Andreas  (9)
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  • 1
    Language: English
    In: The American Journal of Surgery, 2010, Vol.199(6), pp.776-781
    Description: The aim of this study was to compare the immediately postoperative and follow-up results of open and laparoscopic surgery of hepatic cysts in a tertiary hepatobiliary referral center. From March 1999 to February 2007, 59 patients underwent surgical treatment for nonparasitic liver cysts. Patients were assigned to the laparoscopic (n = 42) or open group (n = 17) for analysis. Three conversions to open procedures had to be performed in the laparoscopic group. One patient had to be reoperated because of a bile leakage in the laparoscopic group. Follow-up examination showed 2 recurrences in the laparoscopic and 3 in the open group. Three out of 17 patients in the open group had to be operated for incisional hernias. Time to previous activities was significantly shorter after laparoscopy. Laparoscopic treatment of symptomatic nonparasitic liver cysts is superior concerning short- and long-term results in a vast majority of cases.
    Keywords: Liver Cysts ; Laparoscopy ; Open Treatment ; Follow-Up ; Recurrence
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 2
    Language: English
    In: Journal of the American College of Surgeons, 2010, Vol.211(3), pp.S21-S21
    ISSN: 1072-7515
    E-ISSN: 1879-1190
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    Language: English
    In: Hepato-gastroenterology, 2010, Vol.57(104), pp.1337-40
    Description: Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Results for transplanted patients suffering from hilar cholangiocarcinoma were therefore compared to patients after hemihepatectomy. In a retrospective case-control study, seven patients transplanted for hilar cholangiocarcinoma were matched in terms of UICC stage with seven patients who underwent resection of the hilar bifurcation combined with a hemihepatectomy. Median survival was 22 months (range 1-55 months) for patients after liver resection and 64 months (range 1-138 months) for patients after liver transplantation. One and three year overall survival was 71% and 43% after liver resection versus 71% and 57% after liver transplantation. One patient from each group died within one month after surgery. Fatal cerebral bleeding and post-resection liver failure leading to multi-organ failure and sepsis were the causes of early mortality. Three patients are currently alive: one with 64 months after transplantation and two patients with 42 and 55 months after liver resection. Based on our findings and recently published promising results using liver transplantation for Klatskin tumor, it seems worthwhile to reconsider its potential use in the light of multimodal tumor treatment.
    Keywords: Hepatic Duct, Common ; Liver Transplantation ; Bile Duct Neoplasms -- Surgery ; Hepatectomy -- Methods ; Klatskin Tumor -- Surgery
    ISSN: 0172-6390
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 4
    Language: English
    In: The American surgeon, January 2013, Vol.79(1), pp.90-5
    Description: Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. Between April 1998 and January 2007, 96 patients with hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n = 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age (P = 0.048), pT status (P = 0.046), R class (P = 0.034), and adjuvant chemoradiation (P = 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older = 1:2 points; pT1:pT2 to 4 = 1:2 points; R0:R1/2 = 1:2 points; and chemoradiation yes:no = 1:2 points. The only model that reached statistical significance (P = 0.0332) described the following three groups: score 6 or less; score = 7; and score = 8. Median survival for score 6 or less, score = 7, and score = 8 was 26.5, 12, and 2.2 months, respectively (P = 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially improve patient selection for further postoperative oncologic treatment for Klatskin tumors.
    Keywords: Decision Support Techniques ; Hepatectomy ; Bile Duct Neoplasms -- Surgery ; Hepatic Duct, Common -- Surgery ; Klatskin Tumor -- Surgery
    ISSN: 00031348
    E-ISSN: 1555-9823
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  • 5
    In: Liver International, August 2010, Vol.30(7), pp.996-1002
    Description: To develop a clinical and prognostic scoring system predictive of survival after resection of intrahepatic cholangiocarcinomas (ICC). Two hundred and one consecutive ICC patients (83 from Essen, Germany, 54 from New York, USA and 64 from Chiba, Japan). The scoring systems were developed utilizing the data set from Essen University and then applied to the data sets from Mount Sinai Medical Center and Chiba University for validation. Eighteen potential prognostic factors were evaluated. Statistical analysis included multivariable regression analyses with the Cox proportional hazard model, power analysis, internal validation with structural equation modelling bootstrapping and external validation. The prognostic scoring model was based mainly in pathological and demographical variables, whereas the clinical scoring model was based mainly in radiological and demographical variables. Gender (=0.0086), UICC stage (=0.0140) and R‐class (=0.0016) were predictive of survival for the prognostic scoring model, while gender (=0.0023), CA 19‐9 levels (=0.0153) and macrovascular invasion (=0.0067) were predictive of survival for the clinical scoring model. Prognostic points were assigned as follows: female:male=1:2 points, UICC (I–II):UICC (III–IV)=1:2 points and R0:R1=1:2 points. Clinical points were allocated as follows: female:male=1:2 points, CA 19‐9 (〈100 U/ml):CA 19‐9 (≥100 U/ml)=1:2 points and no macrovascular invasion:macrovascular invasion=1:2 points. Prognostic groups with 3–4, 5 and 6 points (=0.000001) and clinical groups with 3–4 and 5–6 points (=0.0103) achieved statistically significant difference. We propose a clinical and prognostic scoring system predictive of long‐term survival after surgical resections for ICC.
    Keywords: Cholangiocarcinoma ; Cholangiocellular Carcinoma ; Primary Liver Tumours ; Surgical Therapy ; Survival Score ; Tumour Recurrence
    ISSN: 1478-3223
    E-ISSN: 1478-3231
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  • 6
    Language: English
    In: Digestive diseases and sciences, February 2009, Vol.54(2), pp.377-84
    Description: Living donor liver transplantation (LDLT) in cases of hepatocellular carcinoma (HCC) that do not fulfil accepted tumor criteria continues to be a matter of controversy. The aim of this study was to evaluate survival and prognostic factors associated with a liberal exclusionary policy. This is an analysis of data collected prospectively on 57 HCC patients who underwent LDLT at our institution between April 1998 and January 2007. Overall 3-year survival was 62%; this increased to 71% when 45-day mortality was excluded from the analysis. Age proved to be a predictor of survival irrespective of the 45-day mortality. In contrast, the Model for End stage Liver Disease (MELD) score predicted survival only when 45-day mortality was included in the analysis, while alpha fetoprotein (AFP) level predicted survival only when it was excluded. Significant cut-off values were patient age of over 60 years, MELD score above 22, and AFP level greater than 400 ng/ml. A scoring system was developed. Survival rate at 3 years--including 45-day mortality--was 72% for score =2 and 41% for score 〉2 (P = 0.0146). When 45-day mortality was excluded, the survival rate at 3 years was 90% for score =2 and 32% for score 〉2 (P = 0.00002). Our results could further enhance current guidelines on age, MELD score, and AFP level for patients with HCC being evaluated to undergo LDLT.
    Keywords: Living Donors ; Patient Selection ; Carcinoma, Hepatocellular -- Surgery ; Liver Neoplasms -- Surgery ; Liver Transplantation -- Mortality
    ISSN: 01632116
    E-ISSN: 1573-2568
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  • 7
    Language: English
    In: Digestive Diseases and Sciences, 2009, Vol.54(10), pp.2264-2273
    Description: The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma (HCC) in the setting of cirrhosis. A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection ( n  = 61), transarterial chemoembolization (TACE) ( n  = 64), or liver transplantation (LT) ( n  = 60). Long-term survival and survival according to the Milan criteria were the main outcomes measured. Median survival after resection, TACE, and LT was 11, 14, and 23 months, respectively. Five-year cumulative survival after resection, TACE, and LT was 23, 10, and 59%, respectively ( P  = 0.001). Five-year cumulative disease-free survival after resection and LT was 15% and 77%, respectively ( P  = 0.002). The presence of complications in the resection group ( P  = 0.004), MELD score ( P  = 0.0003), and maximum tumor diameter ( P  = 0.05) in the TACE group, and tumor grade ( P  = 0.01) and complications ( P  = 0.004) in the LT group were found to be independent predictors of survival. Five-year survival for patients within the Milan criteria after resection, TACE, and LT was 26, 37, and 66%, respectively. Five-year survival for patients outside the Milan criteria for patients undergoing LT was 53%. The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis, even for those beyond the Milan criteria. Considering the scarcity of available organs, liver resection remains the best alternative option. TACE remains a potential therapy in patients within the Milan criteria, where it may be more beneficial than resection.
    Keywords: Hepatocellular carcinoma ; Liver resection ; Liver surgery ; Liver transplantation ; Transarterial chemoembolization ; Patient outcome ; Tumor recurrence ; Cirrhosis
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 8
    Language: English
    In: Journal of the American College of Surgeons, 2009, Vol.208(2), pp.218-228
    Description: Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver malignancy. Until now, outcomes and prognostic factors after liver resection for these tumors have not been well-documented. Between April 1998 and December 2006, a total of 158 patients underwent surgical exploration in our institution for intended liver resection of ICC. Prospectively collected data of patients undergoing liver resection (n = 83) were analyzed with regard to preoperative findings, operative details, perioperative morbidity and mortality, pathologic findings, outcomes measured by tumor recurrence and survival, and prognostic factors for outcomes. Tumors were solitary in 47 patients. R0 resections were achieved in 53 patients. Vascular infiltration and lymph node metastasis were detected in 41% and 34%, respectively. After resection, the calculated 1-, 3-, and 5-year-survival rates were 71%, 38%, and 21%, respectively, with corresponding rates of 83%, 50%, and 30% in R0 resections. For 14 variables evaluated, only gender (p = 0.008), Union Internationale Contre le Cancer stage (p = 0.014), and R classification (p = 0.001) showed predictive value in the multivariate Cox proportional hazard regression. Results presented outline that an R0 resection leads to substantially prolonged survival in ICC and represents the considerable input of the surgeon to the outcomes of these patients. Union Internationale Contre le Cancer stage remains an important factor.
    Keywords: Biliary Tract Surgical Procedures ; Bile Duct Neoplasms -- Surgery ; Bile Ducts, Intrahepatic -- Surgery ; Cholangiocarcinoma -- Surgery;
    ISSN: 1072-7515
    E-ISSN: 1879-1190
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  • 9
    Language: English
    In: Digestive Diseases and Sciences, 2009, Vol.54(2), pp.377-384
    Description: Background Living donor liver transplantation (LDLT) in cases of hepatocellular carcinoma (HCC) that do not fulfil accepted tumor criteria continues to be a matter of controversy. The aim of this study was to evaluate survival and prognostic factors associated with a liberal exclusionary policy. Material and Methods This is an analysis of data collected prospectively on 57 HCC patients who underwent LDLT at our institution between April 1998 and January 2007. Results Overall 3-year survival was 62%; this increased to 71% when 45-day mortality was excluded from the analysis. Age proved to be a predictor of survival irrespective of the 45-day mortality. In contrast, the Model for End stage Liver Disease (MELD) score predicted survival only when 45-day mortality was included in the analysis, while alpha fetoprotein (AFP) level predicted survival only when it was excluded. Significant cut-off values were patient age of over 60 years, MELD score above 22, and AFP level greater than 400 ng/ml. A scoring system was developed. Survival rate at 3 years—including 45-day mortality—was 72% for score =2 and 41% for score 〉2 ( P  = 0.0146). When 45-day mortality was excluded, the survival rate at 3 years was 90% for score =2 and 32% for score 〉2 ( P  = 0.00002). Conclusions Our results could further enhance current guidelines on age, MELD score, and AFP level for patients with HCC being evaluated to undergo LDLT.
    Keywords: Age ; Alpha fetoprotein ; MELD ; Milan criteria ; Mortality ; Prognostic score ; Survival ; UCSF criteria
    ISSN: 0163-2116
    E-ISSN: 1573-2568
    Source: Springer Science & Business Media B.V.
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