[Abdominal organ transplantation in multimorbid patients].

Patients with an indication for transplantation of abdominal organs often suffer from terminal organ failure with a relevant number of comorbidities. This can be complicated by acute and underlying disease-related events or age-related comorbidities. The diagnostic assignment of symptoms is difficult and the available treatment options have to be adapted.

Liver Transplantation for Budd-Chiari Syndrome From Myeloproliferative Neoplasms - Management and Long-Term Results.

Myeloproliferative neoplasms can cause primary Budd-Chiari-Syndrome with acute or chronic liver failure necessitating liver transplantation. However, preventing the recurrence remains challenging and the need for post-transplant anticoagulant and cytoreductive treatment is not sufficiently clear. We analyzed the treatment regimens for all patients who presented to our department with PBCS from MPN between 2004 and 2021.

Rare tumours of the pancreas: monocentric study.

Purpose: The biology of rare pancreatic tumours, which differs from that of ductal pancreatic cancer, requires increased attention. Although the majority of rare pancreatic tumours are benign, it is difficult to decide whether an invasive component exists without complete removal of the lesion, despite considerable progress in diagnosis. We are investigating a large cohort of patients with histologically confirmed epithelial non-ductal non-neuroendocrine neoplasms of the pancreas.

Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy.

Purpose: This study was designed to elucidate the various new classifications and the use of LDLT and bridging therapy for HCC in this context beyond the Milan criteria (MC).

Methods: The clinical data of patients with HCC outside the MC who underwent LT at Jena University between January 2007 and August 2023 were retrospectively analysed. Eligible patients were classified according to various classification systems.

[Anastomotic techniques in minimally invasive hepatobiliopancreatic surgery].

The established anastomotic techniques conventionally used in open surgery are increasingly being implemented in a minimally invasive approach and further developed. The aim of all innovations is to carry out a safe anastomosis with a feasible minimally invasive technique; however, there is currently no broad consensus about the role of laparoscopic and robotic surgery in performing pancreatic anastomotic techniques. Pancreatic fistulas determine the morbidity following a minimally invasive resection.

Feasibility and Efficacy of Adjuvant Chemotherapy With Gemcitabine After Liver Transplantation for Perihilar Cholangiocarcinoma - A Multi-Center, Randomized, Controlled Trial (pro-duct001).

Background: Liver transplantation (LT) is considered a therapeutic option for unresectable perihilar cholangiocarcinoma (PHC) within defined criteria. It remains uncertain whether patients can safely receive adjuvant chemotherapy after LT.

Methods: We performed a prospective, multi-center, randomized, non-blinded two-arm trial (pro-duct001).

Impact of metabolic indices of F-fluorodeoxyglucose positron emission tomography/computed tomography on post transplantation recurrence of hepatocellular carcinoma.

Background: Tumor recurrence is the leading cause of death after liver transplantation in patients with hepatocellular carcinoma. There is an ongoing debate as to whether metabolic indices such as tumor to liver standardized uptake value ratio in F-fluorodeoxyglucose positron emission tomography/computed tomography of the primary tumor can identify patients outside the Milan criteria with as low recurrence rates as patients inside Milan and thus should be added to the established prognostic factors.

Methods: This retrospective study analyzes 103 consecutive patients who underwent F-fluorodeoxyglucose positron emission tomography/computed tomography before liver transplantation for hepatocellular carcinoma using data of clinical tumor registry.

Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors.

The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy.

Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure.

Purpose: Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy.

Methods: In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses.

Surgical treatment of liver metastases from non-colorectal non-neuroendocrine carcinomas.

Introduction: In the literature, results after surgical treatment of non-colorectal non-neuroendocrine liver metastases (NCNNLM) are reported that are often inferior to those from colorectal liver metastases. The selection of patients with favorable tumor biology is currently still a matter of discussion.

Materials/methods: The retrospective data analysis was based on data that were collected for the multicenter study "Role of surgical treatment for non-colorectal liver metastases" in county Thuringia.

[Minimally invasive liver surgery].

Minimally invasive liver surgery is safe and can be performed with results practically equal to those in open surgery. There are different techniques of parenchyma dissection and hemostasis available for the safe performance of minor and major resections, both laparoscopically and robotics based. Due to its technical options robotics-based surgery is a further development of laparoscopy.

[Surgical treatment of hepato-pancreatic metastases from renal cell carcinoma].

Background: The role of surgical treatment of hepato-pancreatic metastases from renal cell carcinoma is still under discussion.

Material And Methods: We report about 52 patients of whom 33 underwent surgery for liver metastases and 19 for pancreatic metastases from 1995 to 2018.

Results: The 5‑year survival rate of all patients with partial liver resection was statistically significantly lower (38%, median survival time 34 months) than with pancreas resection (69%, median survival time 69 months, p = 0.

[Living related liver transplantation].

Liver transplantation has become established as a standard procedure in the treatment of end-stage liver diseases. Despite intense efforts by all parties involved up to the amendment of the German Transplantation Act, the lack of suitable donor organs was still one of the limiting factors of this therapeutic procedure. One way out of this problem is to make so-called marginal organs usable, e.

Impact of successful local ablative bridging therapy prior to liver transplantation on long-term survival in patients with hepatocellular carcinoma in cirrhosis.

Background: It has been shown that local ablative procedures enable downsizing, reduce drop-out from the waiting list and improve prognosis after liver transplantation. It is still unclear whether a response to the local ablative therapy is due to a favorable tumor biology or if a real benefit in tumor stabilization exists, particularly in complete pathological response.

Method: Data of 163 HCC patients who underwent liver transplantation were extracted from our prospectively maintained registry.

Robotic hepatic surgery in malignancy: review of the current literature.

The use of minimally invasive liver surgery, such as laparoscopic and robotic surgery, is increasing worldwide. Robot-assisted laparoscopy is a new surgical technique that improves surgical handling. The advantage of this technique is improved dexterity, which leads to increased surgical precision and no tremor or fatigue.

[Biliary system : What does the surgeon want to know from the radiologist?].

Clinical/methodical Issue: Exact diagnostic procedures are prerequisite for surgical treatment of bile duct diseases.

Standard Radiological Methods: Magnetic resonance cholangiopancreatography may be supplemented by computed tomography (CT) for planning surgical interventions, for staging diagnostics in malignancies and for imaging the vascular anatomy in the upper abdomen.

Methodical Innovations: Statements from magnetic resonance cholangiopancreatography (MRCP) and CT may be supplemented via digital workup in selected cases of transplantation medicine and in liver surgery.

Morphologically 'invisible' proinsulin - secreting adenoma detected by Ga-68 Exendin-4 (GLP-1 Receptor) positron emission tomography/CT.

This case report of a young man suffering from recurring hypoglycaemia illustrates a rare condition of a neuroendocrine tumour, predominantly secreting proinsulin and invisible to conventional imaging approaches. Only a GLP-1 receptor PET/CT using Exendin-4 visualized the pancreatic lesion and enabled curative therapy, confirming the diagnostic value of this tracer for detection of neuroendocrine tumours. As only few publications on this topic are available, an overview of the available data is also given.

Analysis of prognostic factors after resection of solitary liver metastasis in colorectal cancer: a 22-year bicentre study.

Purpose: The investigation of the predictors of outcome after hepatic resection for solitary colorectal liver metastasis.

Methods: We recruited 350 patients with solitary colorectal liver metastasis at the University Hospitals of Jena and Magdeburg, who underwent curative liver resection between 1993 and 2014. All patients had follow-up until death or till summer 2016.

[Influence of bile duct anatomy on biliary complications in hepatic right lobe living donors].

Perioperative morbidity in the living donation of partial livers is mainly due to infections and biliary complications. Bile duct anatomy variants, in particular of the right system, are suspected to be causative. We investigated the influence of bile duct variants on the incidence of biliary donor complications in donations of the right liver lobe.

Validity of eleven prognostic scores with respect to intra- and extrahepatic recurrence of hepatocellular carcinoma after liver transplantation.

Introduction: Tumor recurrence is the most frequent cause of death after liver transplantation for hepatocellular carcinoma. We selected ten other prognostic classifications to evaluate their potential to predict the risk of recurrence after LT for HCC as compared to the Milan classification. All of the other scores have not been compared with one another in a single cohort.

Surgery for colorectal cancer in elderly patients: how can we improve outcome?

Purpose: Patients over 70 years of age are characterised by diminished long-term survival rates following resection of colorectal cancer (CRC) compared to younger patients. The aim of this study was to clarify whether reduced survival is a result of malignancy, comorbidities or the treatment received.

Methods: All patients with CRC, who were admitted to our institution over a period of 10 years, were selected from a prospectively maintained database.

ABO-Incompatible Living Donor Liver Transplantation in Focus of Antibody Rebound.

Background: Living donor liver transplantation (LDLT) is an option to expand the donor organ pool for patients with life-threatening diseases who cannot be supplied with a cadaver organ. Next to the donor risks, complications after ABO-incompatible LDLT (ABOi LDLT) in the recipient are subject to controversial discussion. Improvement in ABOi graft survival rates have been achieved with plasma treatment procedures (PTP) and immunosuppression but antibody-mediated rejection (AMR) and graft loss still occur.

Which factors affect the long-term survival of patients with hepatocellular carcinoma UICC stage IV?

Aim: In the 7th edition of the TNM classification, not only HCC with distant metastases but also those with regional lymph node metastases are classified as stage IV.

Materials And Methods, Results: From our prospectively recorded tumor registry, 138 patients (17 %) with HCC were in stage IV. Among those were 68 and 70, respectively, in stage IVA (regional lymph node metastases) and IVB (distant metastases).

[Vascular Problem Constellations and the Operational Tactical Approaches in Post-Mortem Liver Transplantations].

In liver transplantation, vascular problems may occur in the donor as well as in the recipient and during the donor operation as well as during the transplantation. They have a major influence on the outcome of the transplantation. In addition to anatomic variants, arteriosclerotic vascular diseases, complications from portal hypertension, vascular lesions from mistakes during the donor operation, complications from interventions and bridging procedures need to be identified and treated.

[Living Donor Liver Transplantation - Past and Present].

Since the first living donor liver transplantations at the end of the 1980s, this transplantation technique has developed as an established tool within the modern transplantation medicine. Especially in Asia, the majority of liver transplantation is performed through living donation, mainly for religious reasons. Liver grafts for adult recipients are mainly the right liver lobe of the donor, for paediatric recipients mainly the left lateral lobe.