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1. Viscoelastic properties of colorectal liver metastases reflect tumour cell viability

Author

Skrip, Lisa-Marie, Moosburner, Simon, Tang, Peter, Guo, Jing, Görner, Steffen, Tzschätzsch, Heiko, Brüggemann, Kristin, Walter, Kilian Alexander, Hosse, Clarissa, Fehrenbach, Uli, Arnold, Alexander, Modest, Dominik, Krenzien, Felix, Schöning, Wenzel, Malinka, Thomas, Pratschke, Johann, Papke, Björn, Käs, Josef A., Sack, Ingolf, Sauer, Igor M., and Hillebrandt, Karl H.

Published
2024
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6. FOLFIRINOX or Gemcitabine-based Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Multi-institutional, Patient-Level, Meta-analysis and Systematic Review

Author

Eshmuminov, Dilmurodjon, Aminjonov, Botirjon, Palm, Russell F., Malleo, Giuseppe, Schmocker, Ryan K., Abdallah, Raëf, Yoo, Changhoon, Shaib, Walid L., Schneider, Marcel André, Rangelova, Elena, Choi, Yoo Jin, Kim, Hongbeom, Rose, J. Bart, Patel, Sameer, Wilson, Gregory C., Maloney, Sarah, Timmermann, Lea, Sahora, Klaus, Rössler, Fabian, Lopez-Lopez, Víctor, Boyer, Emanuel, Maggino, Laura, Malinka, Thomas, Park, Jeong Youp, Katz, Matthew H. G., Prakash, Laura, Ahmad, Syed A., Helton, Scott, Jang, Jin-Young, Hoffe, Sarah E., Salvia, Roberto, Taieb, Julien, He, Jin, Clavien, Pierre-Alain, Held, Ulrike, and Lehmann, Kuno

Published
2023
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14. ASO Visual Abstract: FOLFIRINOX or Gemcitabine Based Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Multi-Institutional, Patient-Level Meta-Analysis and Systematic Review

Author

Eshmuminov, Dilmurodjon, Aminjonov, Botirjon, Palm, Russell F., Malleo, Giuseppe, Schmocker, Ryan K., Abdallah, Raëf, Yoo, Changhoon, Shaib, Walid L., Schneider, Marcel André, Rangelova, Elena, Choi, Yoo Jin, Kim, Hongbeom, Rose, J. Bart, Patel, Sameer, Wilson, Gregory C., Maloney, Sarah, Timmermann, Lea, Sahora, Klaus, Rössler, Fabian, Lopez-Lopez, Víctor, Boyer, Emanuel, Maggino, Laura, Malinka, Thomas, Park, Jeong Youp, Katz, Matthew H. G., Prakash, Laura, Ahmad, Syed A., Helton, Scott, Jang, Jin-Young, Hoffe, Sarah E., Salvia, Roberto, Taieb, Julien, He, Jin, Clavien, Pierre-Alain, Held, Ulrike, and Lehmann, Kuno

Published
2023
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15. Clinical prognosticators and targets in the immune microenvironment of intrahepatic cholangiocarcinoma.

Author

Lozzi, Isis, Arnold, Alexander, Barone, Matthias, Johnson, Juliette Claire, Sinn, Bruno V, Eschrich, Johannes, Gebert, Pimrapat, Wang, Ruonan, Hu, Mengwen, Feldbrügge, Linda, Schirmeier, Anja, Reutzel-Selke, Anja, Malinka, Thomas, Krenzien, Felix, Schöning, Wenzel, Modest, Dominik P, Pratschke, Johann, Sauer, Igor M, and Felsenstein, Matthäus

Subjects
BILIARY tract cancer, IMMUNE checkpoint inhibitors, T cells, PROGRAMMED death-ligand 1, PROGNOSIS
Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is a disease with poor prognosis and limited therapeutic options. We investigated the tumor immune microenvironment (TIME) to identify predictors of disease outcome and to explore targets for therapeutic modulation. Methods: Liver tissue samples were collected during 2008–2019 from patients (n = 139) diagnosed with ICC who underwent curative intent surgery without neoadjuvant chemotherapy. Samples from the discovery cohort (n = 86) were immunohistochemically analyzed on tissue microarrays (TMAs) for the expression of CD68, CD3, CD4, CD8, Foxp3, PD-L1, STAT1, and p-STAT1 in tumor core and stroma areas. Results were digitally analyzed using QuPath software and correlated with clinicopathological characteristics. For validation of TIME-related biomarkers, we performed multiplex imaging mass cytometry (IMC) in a validation cohort (n = 53). Results: CD68+ cells were the predominant immune cell type in the TIME of ICC. CD4+high T cell density correlated with better overall survival (OS). Prediction modeling together with validation cohort confirmed relevance of CD4+ cells, PD-L1 expression by immune cells in the stroma and N-stage on overall disease outcome. In turn, IMC analyses revealed that silent CD3+CD4+ clusters inversely impacted survival. Among annotated immune cell clusters, PD-L1 was most relevantly expressed by CD4+FoxP3+ cells. A subset of tumors with high density of immune cells ("hot" cluster) correlated with PD-L1 expression and could identify a group of candidates for immune checkpoint inhibition (ICI). Ultimately, higher levels of STAT1 expression were associated with higher lymphocyte infiltration and PD-L1 expression. Conclusions: These results highlight the importance of CD4+ T cells in immune response against ICC. Secondly, a subset of tumors with "hot" TIME represents potential candidates for ICI, while stimulation of STAT1 pathway could be a potential target to turn "cold" into "hot" TIME in ICC. TRANSLATIONAL RELEVANCE: The tumor immune microenvironment (TIME) plays a critical role in the immune response In many cancers, including intrahepatic cholangiocarcinoma (ICC). Molecular subtyping of the ICC microenvironment already revealed inter-tumoral heterogeneity with variant profiles of immune cell infiltrates. A recent study created an in-depth immune cell atlas of the TIME in biliary tract cancers and could demonstrate the relevance of specific immune cell subpopulations on patient outcome. We are able to provide a distinctive characterization of TIME, separating tumor epithelial- and stroma areas, in a large and representative ICC cohort using digitalized image analysis on tissue microarrays (TMA) as well as multiplex imaging mass cytometry (IMC). The study was designed for identification of immune cell prognosticators allocating institutional ICC patients into a discovery (2008–15) and a validation (2010–19) cohort. Immune cell subpopulations were correlated with clinicopathological characteristics and patient outcome. Our results highlight: i. The important role of CD4+ T cell infiltration in ICC patients; ii. ICC tumors with high density of immune cells associated with PD-L1 expression identifies a subset of patients with variant tumor biology; iii. Stimulation of STAT1 pathway may be a relevant target to turn "cold" into "hot" tumors. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Cytokine‐armed vaccinia virus promotes cytotoxicity toward pancreatic carcinoma cells via activation of human intermediary CD56dimCD16dim natural killer cells.

Author

Wang, Ruonan, Hu, Mengwen, Lozzi, Isis, Jin, Cao Zhong Jing, Ma, Dou, Splith, Katrin, Mengwasser, Jörg, Wolf, Vincent, Feldbrügge, Linda, Tang, Peter, Timmermann, Lea, Hillebrandt, Karl Herbert, Kirchner, Marieluise, Mertins, Philipp, Hilfenhaus, Georg, Neumann, Christopher Claudius Maximilian, Kammertoens, Thomas, Pratschke, Johann, Malinka, Thomas, and Sauer, Igor Maximillian

Subjects
KILLER cells, VACCINIA, CELL analysis, IMMUNE response, CYTOTOXINS
Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains a particularly aggressive disease with few effective treatments. The PDAC tumor immune microenvironment (TIME) is known to be immune suppressive. Oncolytic viruses can increase tumor immunogenicity via immunogenic cell death (ICD). We focused on tumor‐selective (vvDD) and cytokine‐armed Western‐reserve vaccinia viruses (vvDD‐IL2 and vvDD‐IL15) and infected carcinoma cell lines as well as patient‐derived primary PDAC cells. In co‐culture experiments, we investigated the cytotoxic response and the activation of human natural killer (NK). Infection and virus replication were assessed by measuring virus encoded YFP. We then analyzed intracellular signaling processes and oncolysis via in‐depth proteomic analysis, immunoblotting and TUNEL assay. Following the co‐culture of mock or virus infected carcinoma cell lines with allogenic PBMCs or NK cell lines, CD56+ NK cells were analyzed with respect to their activation, cytotoxicity and effector function. Both, dose‐ and time‐dependent release of danger signals following infection were measured. Viruses effectively entered PDAC cells, emitted YFP signals and resulted in concomitant oncolysis. The proteome showed reprogramming of normally active core signaling pathways in PDAC (e.g., MAPK–ERK signaling). Danger‐associated molecular patterns were released upon infection and stimulated co‐cultured NK cells for enhanced effector cytotoxicity. NK cell subtyping revealed enhanced numbers and activation of a rare CD56dimCD16dim population. Tumor cell killing was primarily triggered via Fas ligands rather than granule release, resulting in marked apoptosis. Overall, the cytokine‐armed vaccinia viruses induced NK cell activation and enhanced cytotoxicity toward human PDAC cells in vitro. We could show that cytokine‐armed virus targets the carcinoma cells and thus has great potential to modulate the TIME in PDAC. [ABSTRACT FROM AUTHOR]

Published
2025
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22. Cachexia-Affected Survival Based on Inflammatory Parameters Compared to Complex Conventional Nutritional Assessments in Patients with Pancreatic Cancer and Other Gastrointestinal Tumors—The CONKO 020 Investigation

Author

Meyer-Knees, Johanna W., primary, Falkenthal, Janina, additional, Geisel, Dominik, additional, Neumann, Christopher C. M., additional, Hilfenhaus, Georg, additional, Stephan, Lars U., additional, Schöning, Wenzel, additional, Malinka, Thomas, additional, Pratschke, Johann, additional, Stintzing, Sebastian, additional, and Pelzer, Uwe, additional

Published
2024
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26. Impact of complexity in minimally invasive liver surgery on enhanced recovery measures: prospective study

Author

Dahlke, Paul M, primary, Benzing, Christian, additional, Lurje, Georg, additional, Malinka, Thomas, additional, Raschzok, Nathanael, additional, Kamali, Can, additional, Gül-Klein, Safak, additional, Schöning, Wenzel, additional, Hillebrandt, Karl H, additional, Pratschke, Johann, additional, Neudecker, Jens, additional, and Krenzien, Felix, additional

Published
2024
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27. Correction: Felsenstein M. et al. Perineural Invasion in Pancreatic Ductal Adenocarcinoma (PDAC): A Saboteur of Curative Intended Therapies? J. Clin. Med. 2022, 11, 2367

Author

Felsenstein, Matthäus, primary, Lindhammer, Flora, additional, Feist, Mathilde, additional, Hillebrandt, Karl Herbert, additional, Timmermann, Lea, additional, Benzing, Christian, additional, Globke, Brigitta, additional, Zocholl, Dario, additional, Hu, Mengwen, additional, Fehrenbach, Uli, additional, Sinn, Bruno Valentin, additional, Pelzer, Uwe, additional, Sauer, Igor Maximillian, additional, Pratschke, Johann, additional, and Malinka, Thomas, additional

Published
2023
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31. Impact of Smoking, Body Weight, Diabetes, Hypertension and Kidney Dysfunction on Survival in Pancreatic Cancer Patients—A Single Center Analysis of 2323 Patients within the Last Decade

Author

Neumann, Christopher C. M., primary, Schneider, François, additional, Hilfenhaus, Georg, additional, Vecchione, Loredana, additional, Benzing, Christian, additional, Ihlow, Jana, additional, Fehrenbach, Uli, additional, Malinka, Thomas, additional, Keilholz, Ulrich, additional, Stintzing, Sebastian, additional, and Pelzer, Uwe, additional

Published
2023
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33. FOLFIRINOX or Gemcitabine-based Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Multi-institutional, Patient-Level, Meta-analysis and Systematic Review

Author

Eshmuminov, Dilmurodjon; https://orcid.org/0000-0002-9575-7094, Aminjonov, Botirjon, Palm, Russell F, Malleo, Giuseppe, Schmocker, Ryan K, Abdallah, Raëf, Yoo, Changhoon, Shaib, Walid L, Schneider, Marcel Andre; https://orcid.org/0000-0002-6723-8879, Rangelova, Elena, Choi, Yoo Jin, Kim, Hongbeom, Rose, J Bart, Patel, Sameer, Wilson, Gregory C, Maloney, Sarah, Timmermann, Lea, Sahora, Klaus, Rössler, Fabian; https://orcid.org/0000-0002-2968-347X, Lopez-Lopez, Víctor, Boyer, Emanuel, Maggino, Laura, Malinka, Thomas, Park, Jeong Youp, Katz, Matthew H G, Prakash, Laura, Ahmad, Syed A, Clavien, Pierre-Alain; https://orcid.org/0000-0002-9916-7905, Held, Ulrike; https://orcid.org/0000-0003-3105-5840, Lehmann, Kuno; https://orcid.org/0000-0002-6177-9543, et al, Eshmuminov, Dilmurodjon; https://orcid.org/0000-0002-9575-7094, Aminjonov, Botirjon, Palm, Russell F, Malleo, Giuseppe, Schmocker, Ryan K, Abdallah, Raëf, Yoo, Changhoon, Shaib, Walid L, Schneider, Marcel Andre; https://orcid.org/0000-0002-6723-8879, Rangelova, Elena, Choi, Yoo Jin, Kim, Hongbeom, Rose, J Bart, Patel, Sameer, Wilson, Gregory C, Maloney, Sarah, Timmermann, Lea, Sahora, Klaus, Rössler, Fabian; https://orcid.org/0000-0002-2968-347X, Lopez-Lopez, Víctor, Boyer, Emanuel, Maggino, Laura, Malinka, Thomas, Park, Jeong Youp, Katz, Matthew H G, Prakash, Laura, Ahmad, Syed A, Clavien, Pierre-Alain; https://orcid.org/0000-0002-9916-7905, Held, Ulrike; https://orcid.org/0000-0003-3105-5840, Lehmann, Kuno; https://orcid.org/0000-0002-6177-9543, and et al

Abstract

BACKGROUND Pancreatic cancer often presents as locally advanced (LAPC) or borderline resectable (BRPC). Neoadjuvant systemic therapy is recommended as initial treatment. It is currently unclear what chemotherapy should be preferred for patients with BRPC or LAPC. METHODS We performed a systematic review and multi-institutional meta-analysis of patient-level data regarding the use of initial systemic therapy for BRPC and LAPC. Outcomes were reported separately for tumor entity and by chemotherapy regimen including FOLFIRINOX (FIO) or gemcitabine-based. RESULTS A total of 23 studies comprising 2930 patients were analyzed for overall survival (OS) calculated from the beginning of systemic treatment. OS for patients with BRPC was 22.0 months with FIO, 16.9 months with gemcitabine/nab-paclitaxel (Gem/nab), 21.6 months with gemcitabine/cisplatin or oxaliplatin or docetaxel or capecitabine (GemX), and 10 months with gemcitabine monotherapy (Gem-mono) (p < 0.0001). In patients with LAPC, OS also was higher with FIO (17.1 months) compared with Gem/nab (12.5 months), GemX (12.3 months), and Gem-mono (9.4 months; p < 0.0001). This difference was driven by the patients who did not undergo surgery, where FIO was superior to other regimens. The resection rates for patients with BRPC were 0.55 for gemcitabine-based chemotherapy and 0.53 with FIO. In patients with LAPC, resection rates were 0.19 with Gemcitabine and 0.28 with FIO. In resected patients, OS for patients with BRPC was 32.9 months with FIO and not different compared to Gem/nab, (28.6 months, p = 0.285), GemX (38.8 months, p = 0.1), or Gem-mono (23.1 months, p = 0.083). A similar trend was observed in resected patients converted from LAPC. CONCLUSIONS In patients with BRPC or LAPC, primary treatment with FOLFIRINOX compared with Gemcitabine-based chemotherapy appears to provide a survival benefit for patients that are ultimately unresectable. For patients that undergo surgical resection, outcomes are similar between GEM

Published
2023

34. Initial learning curves of laparoscopic and robotic distal pancreatectomy compared with open distal pancreatectomy: multicentre analysis

Author

Nickel, Felix, primary, Distler, Marius, additional, Limen, Eldridge F, additional, Wise, Philipp A, additional, Kowalewski, Karl-Friedrich, additional, Tritarelli, Patricia M, additional, Perez, Daniel, additional, Izbicki, Jakob R, additional, Kersebaum, Jan-Niclas, additional, Egberts, Jan-Hendrik, additional, Becker, Thomas, additional, Timmermann, Lea, additional, Malinka, Thomas, additional, Bahra, Marcus, additional, Pratschke, Johann, additional, Müller-Stich, Beat P, additional, Weitz, Jürgen, additional, and Hackert, Thilo, additional

Published
2023
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36. Robotic Liver Surgery: Technical Advantages Over Laparoscopic Technique Based on Parameters of Surgical Complexity and Perioperative Outcomes

Author

Nevermann, Nora, primary, Feldbrügge, Linda, additional, Krenzien, Felix, additional, Ortiz Galindo, Santiago, additional, Knitter, Sebastian, additional, Haber, Philipp, additional, Malinka, Thomas, additional, Lurje, Georg, additional, Schöning, Wenzel, additional, Schmelzle, Moritz, additional, and Pratschke, Johann, additional

Published
2023
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37. Inhibition of Vascular Endothelial Growth Factor Protects against the Development of Oxaliplatin-Induced Sinusoidal Obstruction Syndrome in Wild-Type but Not in CD39-Null Mice

Author

Knitter, Sebastian, primary, Duwe, Gregor, additional, Beierle, Anika Sophie, additional, Pesthy, Sina, additional, Ritschl, Paul Viktor, additional, Hillebrandt, Karl Herbert, additional, Arnold, Alexander, additional, Malinka, Thomas, additional, Modest, Dominik Paul, additional, Bahra, Marcus, additional, Pratschke, Johann, additional, Sauer, Igor Maximilian, additional, Schmelzle, Moritz, additional, and Andreou, Andreas, additional

Published
2022
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39. Gallengangsverletzung im Rahmen der laparoskopischen Cholezystektomie

Author

Nevermann, Nora, Schöning, Wenzel, Malinka, Thomas, Fehrenbach, Uli, Müller, Tobias, Pratschke, Johann, and Schmelzle, Moritz

Abstract

Hintergrund: Gallengangsverletzungen im Rahmen einer laparoskopischen Cholezystektomie stellen eine seltene, aber gravierende Komplikation dar. Klassifikation und Diagnostik: Gallengangsverletzungen können anhand ihrer Lokalisation, des Verletzungsmusters und einer möglichen vaskulären Begleitverletzung klassifiziert werden. Es bestehen mehrere Klassifikationen, wobei die in Deutschland weit verbreitete Neuhaus-Klassifikation eine klinisch-orientierte Einteilung von Gallengangsverletzungen erlaubt. Der diagnostische Algorithmus richtet sich nach der Frage, ob die Verletzung über eine Galleleckage oder eine Gallengangsokklusion diagnostiziert wird und zusätzlich eine Durchblutungsstörung der Leber vorliegt. Der differenzierte Einsatz laborchemischer, bildmorphologischer, endoskopischer und interventioneller Methoden erlaubt neben der Klassifikation auch die Therapieplanung. Therapie: Gut die Hälfte aller Gallengangsverletzungen können endoskopisch-interventionell therapiert werden. Mit zunehmender Größe des Defekts, bei kompletter Okklusion des Gallengangs oder bei relevanten Durchblutungsstörungen der Leber steigt allerdings die Wahrscheinlichkeit für die Notwendigkeit eines operativen Vorgehens. Intraoperativ muss zwischen einer Versorgung mittels Naht und Schienung und einer Rekonstruktion der Gallenwege mittels Patch-Plastik oder biliodigestiver Anastomose unterschieden werden. Insbesondere bei Durchblutungsstörungen kann eine Leberteilresektion oder Lebertransplantation notwendig werden. Für den Therapieerfolg ist neben einer entsprechenden Erfahrung eine gute Kommunikation und interdisziplinäre Zusammenarbeit der Endoskopie, der interventionellen Radiologie und der Chirurgie entscheidend. Insofern ist eine schnellstmögliche Kontaktaufnahme mit einem spezialisierten Zentrum für Leber- und Transplantationschirurgie angeraten.

Published
2024
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41. Dual Targeting of the EGFR/HER2 Pathway in Combination with Systemic Chemotherapy in Refractory Pancreatic Cancer—The CONKO-008 Phase I Investigation

Author

Striefler, Jana K., primary, Stieler, Jens M., additional, Neumann, Christopher C. M., additional, Geisel, Dominik, additional, Ghadjar, Pirus, additional, Sinn, Marianne, additional, Malinka, Thomas, additional, Pratschke, Johann, additional, Stintzing, Sebastian, additional, Oettle, Helmut, additional, Riess, Hanno, additional, and Pelzer, Uwe, additional

Published
2022
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43. Perineural Invasion in Pancreatic Ductal Adenocarcinoma (PDAC): A Saboteur of Curative Intended Therapies?

Author

Felsenstein, Matthäus, Lindhammer, Flora, Feist, Mathilde, Hillebrandt, Karl Herbert, Timmermann, Lea, Benzing, Christian, Globke, Brigitta, Zocholl, Dario, Hu, Mengwen, Fehrenbach, Uli, Sinn, Bruno Valentin, Pelzer, Uwe, Sauer, Igor Maximillian, Pratschke, Johann, and Malinka, Thomas

Subjects
pancreatic ductal adenocarcinoma, risk stratification, perineural invasion, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

(1) Background: Perineural invasion (PNI) is a common characteristic of pancreatic ductal adenocarcinoma (PDAC) and is present in most resection margins. We hypothesized that curative pancreatic tumor resection with long-term survival could only be achieved in PNI-negative patients. (2) Material and Methods: A retrospective investigation of PDAC patients who underwent curative-intended surgery during the period 2008 to 2019 was performed at our institution. (3) Results: We identified 571 of 660 (86.5%) resected patients with well-annotated reports and complete datasets. Of those, 531 patients (93%) exhibited tumors with perineural invasion (Pn1), while 40 (7%) were negative for PNI (Pn0). The majority of patients in the Pn1 group presented advanced tumor stage and positive lymph node infiltration. Patients in the Pn0 group showed an improved disease-free and long-term survival compared to the Pn1 group (p < 0.001). Subgroup analysis of all R0-resected patients indicated improved long-term survival and disease-free survival of R0 Pn0 patients when compared to R0 Pn1 patients (p < 0.001). (4) Conclusion: Our study confirmed that Pn0 improves the long-term survival of PDAC-resected cancer patients. Furthermore, PNI significantly challenges the long-term survival of formally curative (R0) resected patients. We provide new insights into the dynamics of PNI in pancreatic cancer patients which are needed to define subgroups of patients for risk stratification and multimodal treatment strategies.

Published
2022

45. Additional file 1 of The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study

Author

Hillebrandt, Karl H., Moosburner, Simon, Winter, Axel, Nevermann, Nora, Raschzok, Nathanael, Malinka, Thomas, Sauer, Igor M., Schmelzle, Moritz, Pratschke, Johann, and Chopra, Sascha

Abstract

Additional file 1: Figure S1. Englisch translation of digital quality management document. QM documents are prospectively collected on the day of discharge and validated daily by a group of senior consultant surgeons. It includes the indication for surgical treatment (blue), complications which occurred during the inpatient stay (red) and the necessary procedure for complication management (green). Complications are classified either as medical or organizational. Medical complications are further classified into renal, post pancreatic surgery, central nervous system, post vascular surgery, cardiovascular, systemic, or surgical site infections, bleeding, post organ transplantation, pulmonary, gastrointestinal, and hepatobiliary complications. Finally, complications are classified according to Clavien-Dindo.

Published
2022
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46. Complexity-Adjusted Learning Curves for Robotic and Laparoscopic Liver Resection

Author

Krenzien, Felix, Benzing, Christian, Feldbrügge, Linda, Ortiz Galindo, Santiago Andres, Hillebrandt, Karl, Raschzok, Nathanael, Nevermann, Nora, Haber, Philipp, Malinka, Thomas, Schöning, Wenzel, Pratschke, Johann, and Schmelzle, Moritz

Subjects
laparoscopic liver resection (LLR), Minimally invasive liver surgery (MILS), learning curves, robotic liver resection (RLR), 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Background: Minimally invasive liver surgery (MILS) has a high variance in the type of resection and complexity, which has been underestimated in learning curve studies in the past. The aim of this work was to evaluate complexity-adjusted learning curves over time for laparoscopic liver resection (LLR) and robotic liver resection (RLR). Methods: Cumulative sum analysis (CUSUM) and complexity adjustment were performed using the Iwate score for LLR and RLR (n = 647). Lowest point of smoothed data was used to capture the cutoff of the increase in complexity. Data were collected retrospectively at the Department of Surgery of the Charité-Universitätsmedizin Berlin. Results: A total of 132 RLR and 514 LLR were performed. According to the complexity-adjusted CUSUM analysis, the initial learning phase was reached after 117 for LLR and 93 procedures for RLR, respectively. With increasing experience, the rate of (extended) right hemihepatectomy multiplied from 8.4% to 18.9% for LLR (P = 0.031) and from 21.6% to 58.3% for RLR (P < 0.001). Complication rates remained comparable between both episodes for LLR and RLR (T1 vs T2, P > 0.05). The complexity-adjusted CUSUM analysis demonstrated for blood transfusion, conversion, and operative time an increase during the learning phase (T1), while a steady state was reached in the following (T2). Conclusions: The learning phase for MILS after adjusting for complexity is about 4 times longer than assumed in previous studies, which should urge caution.

Published
2022
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50. Perioperative Risk Assessment in Pancreatic Surgery Using Machine Learning

Author

Pfitzner, Bjarne, primary, Chromik, Jonas, additional, Brabender, Rachel, additional, Fischer, Eric, additional, Kromer, Alexander, additional, Winter, Axel, additional, Moosburner, Simon, additional, Sauer, Igor M., additional, Malinka, Thomas, additional, Pratschke, Johann, additional, Arnrich, Bert, additional, and Maurer, Max M., additional

Published
2021
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