Publications by authors named "Schadde E"
Background: Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR.
View Article and Find Full Text PDF(1) Background: Despite advances in surgical technique and systemic chemotherapy, some patients with multifocal, bilobar colorectal liver metastases (CRLM) remain unresectable. These patients may benefit from surgical debulking of liver tumors in combination with chemotherapy compared to chemotherapy alone. (2) Methods: A retrospective study including patients evaluated for curative intent resection of CRLM was performed.
View Article and Find Full Text PDFBackground: The purpose of this study was to compare 3-year overall survival after simultaneous portal (PVE) and hepatic vein (HVE) embolization versus PVE alone in patients undergoing liver resection for primary and secondary cancers of the liver.
Methods: In this multicentre retrospective study, all DRAGON 0 centres provided 3-year follow-up data for all patients who had PVE/HVE or PVE, and were included in DRAGON 0 between 2016 and 2019. Kaplan-Meier analysis was undertaken to assess 3-year overall and recurrence/progression-free survival.
Article Synopsis
- The study investigated whether volatile sedation with sevoflurane could protect organs in patients with severe COVID-19 lung injury experiencing a cytokine storm, particularly focusing on IL-6 levels.
- Conducted as a pilot trial in Switzerland, 60 patients requiring mechanical ventilation were randomly assigned to receive either sevoflurane or continuous intravenous sedation, with their outcomes analyzed at 28 days.
- Results showed no significant difference in primary outcomes such as mortality or persistent organ dysfunction between the two groups, but the sevoflurane group required fewer vasopressors and had higher reported acute kidney injury rates compared to controls.
Background: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA.
Methods: Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right.
Effect of Sarcopenia on the Increase in Liver Volume and Function After Portal Vein Embolization.
Cardiovasc Intervent Radiol
May 2024
Purpose: Sarcopenia is associated with a decreased kinetic growth rate (KGR) of the future liver remnant (FLR) after portal vein embolization (PVE). However, little is known on the increase in FLR function (FLRF) after PVE. This study evaluated the effect of sarcopenia on the functional growth rate (FGR) after PVE measured with hepatobiliary scintigraphy (HBS).
View Article and Find Full Text PDFArticle Synopsis
- - The study explores how liver growth behaves after a procedure called ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) by using MRI with a contrast agent (gadoxetic acid) to measure liver volume and function in Wistar rats.
- - Rats were divided into three groups: ALPPS, major liver resection (LR), and portal vein ligation (PVL), and their liver volume and function were tracked for five days post-surgery.
- - The results showed that liver function increased more than volume in the ALPPS and LR groups after the first day, with total liver function remaining well above 60% of pre-op values for ALPPS and PVL
Article Synopsis
- Resection is the only curative treatment for perihilar cholangiocarcinoma, but it carries high risks of complications and potential for disease recurrence, prompting the need to identify patients who may not benefit from surgery.
- This study analyzed data from 27 referral centers and developed a scoring system based on several clinical factors (e.g., ASA score, bilirubin levels, tumor size) to predict which patients fall into a "futile group," where surgical outcomes are unfavorable.
- The scoring system categorizes patients into low, intermediate, and high-risk classes, providing a useful tool to determine whether surgery or alternative treatments would be more appropriate based on preoperative assessments.
Background: Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone.
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- - Liver resections are vital for treating liver cancers, but many patients aren't resectable due to the risk of post-hepatectomy liver failure, as only about 70% of liver tissue can be safely removed.
- - Regenerative liver surgery techniques, like portal vein embolization (PVE) and the newer Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), have evolved to increase the amount of healthy liver left after surgery, improving resection rates.
- - Despite the promise of accelerated liver regeneration from methods like ALPPS, challenges remain, including a high mortality rate and the need for careful patient selection, prompting a plethora of modifications to enhance safety and effectiveness.
Article Synopsis
- Scientists wanted to create a clear definition for what "Textbook Outcome in Liver Surgery" (TOLS) means, which shows the best possible results after liver surgery.
- They used a method called the Delphi process, where expert liver surgeons answered surveys, and they agreed on the definition only if 80% of them agreed on it.
- The final definition includes things like no serious incidents during surgery, no major problems after surgery, and a good recovery without re-hospitalization.
Article Synopsis
- The DRAGON 1 trial investigates the training, implementation, safety, and feasibility of a combined portal- and hepatic-vein embolization (PVE/HVE) approach to encourage liver growth in patients with borderline resectable colorectal cancer liver metastases.
- The study is a worldwide multicenter, single-arm trial, with primary endpoints focusing on the safety of the procedure and 90-day mortality, while secondary endpoints look at resection feasibility, liver function, and overall survival rates.
- The findings aim to standardize procedures for future trials and enhance understanding of the safety and effects of PVE/HVE on liver growth in this patient population.
Background: Allograft biopsy is the gold standard for diagnosing graft rejection following simultaneous pancreas and kidney (SPK) transplant. Intraperitoneal biopsies are technically challenging and can be burdensome to patients and the healthcare system. Donor-derived cell-free DNA (dd-cfDNA) is well-studied in kidney transplant recipients; however, it has not yet been studied in the SPK population.
View Article and Find Full Text PDFBackground: The number of laparoscopic liver resections is increasing worldwide, including in Switzerland. However, laparoscopy is mostly used for minor resections. Little is known about indications for and outcomes of major liver resections performed laparoscopically.
View Article and Find Full Text PDFGraft-versus-host disease (GVHD) is a rare complication after solid organ transplant. We present a case of GVHD after simultaneous pancreas kidney transplant. The patient was diagnosed with a cutaneous biopsy after developing the classic symptoms of maculopapular rash, diarrhea, and pancytopenia.
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- After portal vein embolization (PVE), a significant portion of patients (30%) experience failure in achieving successful liver resection, with malnutrition, particularly sarcopenia, identified as a modifiable risk factor that can impact outcomes.
- A retrospective study across eight centers reviewed 306 patients, revealing that those with sarcopenia had a 21% lower rate of resectability and a 23% reduced kinetic growth rate (KGR) post-PVE.
- The findings suggest that sarcopenia significantly affects both the likelihood of successful liver resection and the growth rate of the liver after PVE, emphasizing the importance of addressing nutritional status in patient management.
Aim: Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired.
Methods: Prospective single-institution clinical trial (clinicaltrials.
To repurpose therapeutics for fibrolamellar carcinoma (FLC), we developed and validated patient-derived xenografts (PDX) from surgical resections. Most agents used clinically and inhibitors of oncogenes overexpressed in FLC showed little efficacy on PDX. A high-throughput functional drug screen found primary and metastatic FLC were vulnerable to clinically available inhibitors of TOPO1 and HDAC and to napabucasin.
View Article and Find Full Text PDFBackground: Simultaneous portal vein embolization (PVE) and hepatic vein embolization (HVE) has been shown to be feasible, safe and lead to a faster growth of future liver remnant (FLR) than PVE alone. The objective of this study is to highlight different technical aspects as well as importance of embolization order.
Materials And Methods: Seven patients were treated with simultaneous PVE and HVE.
Background: COVID-19 epidemiologic studies comparing immunosuppressed and immunocompetent patients may provide insight into the impact of immunosuppressants on outcomes.
Methods: In this retrospective cohort study, we assembled kidney or kidney-pancreas transplant recipients who underwent transplant from January 1, 2010, to June 30, 2020, and kidney or kidney-pancreas waitlisted patients who were ever on the waitlist from January 1, 2019, to June 30, 2020. We identified laboratory-confirmed COVID-19 until January 31, 2021, and tracked its outcomes by leveraging informatics infrastructure developed for an outcomes research network.
Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.
Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement).
Colorectal liver metastases (CRLM) affect over 50 % of all patients with colorectal cancer, which is the second leading cause of cancer in the western world. Resection of CRLM may provide cure and improves survival over chemotherapy alone. However, resectability of CLRM has to be decided in multidisciplinary tumor boards and is based on oncological factors, technical factors and patient factors.
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