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Peter Kornprat

Publications and source records attributed to Peter Kornprat.

12 recordsLinked to original sources
PubMed2006

Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy.

BACKGROUND: Hepatic resection is generally accepted as the only potential for long-term survival in patients with colorectal metastases confined to the liver. Despite an unknown benefit, hepatic resection is playing an increasing role in patients with extensive disease. METHODS: A retrospective review of a prospectively maintained hepatobiliary surgical database was carried out. Outcome after hepatectomy for four or more colorectal hepatic metastases was reviewed. RESULTS: Between 1998 and 2002, out of a total of 584 patients, 98 (17%) with four or more colorectal hepatic metastases were resected. Actuarial 5-year survival was 33% for the entire group, with seven actual 5-year survivors. There were no perioperative deaths, and the perioperative morbidity was 28%. Positive margins and extrahepatic disease resection were independently associated with poor outcome. The median disease-free survival was 12 months, with no actuarial disease-free survivors at 5 years. Recurrence pattern, response to neoadjuvant chemotherapy, time to recurrence, and resection of recurrent disease were also associated with outcome. CONCLUSIONS: Long-term survival can be achieved after resection of multiple colorectal metastases; however, because most patients will experience recurrence of disease, effective adjuvant therapy and close follow-up is necessary.

Adult↗
PubMed2006

Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of bevacizumab: a matched case-control study.

BACKGROUND: Bevacizumab (bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor (VEGF). Perioperative bev is now commonly used in patients undergoing hepatic resection. Little is known, however, about the safety of perioperative bev use in the setting of hepatic resection. METHODS: Computerized pharmacy records were used to identify all patients who received bev between January 2004 and June 2005. Patients who underwent hepatectomy for colorectal metastases and received bev within 12 weeks of surgery were identified and compared with a group of matched historical controls. RESULTS: Thirty-two patients underwent hepatic resection of colorectal cancer metastases and received bev within the specified perioperative period. Sixteen patients received bev before surgery and 24 received bev after surgery. A subset of eight patients received bev both before and after surgery. The median time between bev administration and surgery was 6.9 weeks before (range, 3-15 weeks) and 7.4 weeks after (range, 5-15 weeks). Perioperative complications occurred in 13 patients (40.6%), two of which were considered major complications. There was no statistically significant difference in perioperative morbidity and severity of complications when compared with a set of matched controls. CONCLUSIONS: Clinical experience thus far does not indicate a statistically significantly increased risk of perioperative complications with the incorporation of bev into pre- and/or postoperative treatment paradigms. Given the long half-life of bev and the potential for anti-VEGF therapy to impede wound healing and/or liver regeneration, we continue to favor a window of 6 to 8 weeks between bev administration and surgery.

Adult↗
PubMed2006

Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy.

BACKGROUND AND AIMS: Laparoscopic surgery has become the treatment of choice for cholecystectomy. Many studies showed that while this approach benefits the patient, the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence. Robots have the potential to overcome these problems. To evaluate the efficiency and feasibility of robotically assisted surgery (RAC), we designed a prospective study to compare it with standard laparoscopic cholecystectomy (SLC). MATERIALS AND METHODS: Between 2001 and 2003, 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system. The feasibility, safety, and possible advantages were evaluated. To assess the efficacy, the total time in the operating room was divided into preoperative, operative, and postoperative time frames. RESULTS: For RAC in comparison with SLC, the preoperative phase including equipment setup was significantly longer. In the intraoperative phase, the cut-closure time and camera and trocar insertion times were significantly longer. It is interesting to note that the net dissection time for the cystic artery, duct, and the gall bladder was not different from SLC. CONCLUSIONS: The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity. There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore, presents no benefit in using the robot in laparoscopic cholecystectomy.

Adolescent↗
PubMed2005

Analysis of trefoil factor family protein 1 (TFF1, pS2) expression in chronic cholecystitis and gallbladder carcinoma.

Trefoil factor family protein 1 (TFF1, pS2) interacts with mucins to protect gastrointestinal epithelium against injury and contributes to mucosal repair by promoting epithelial cell migration and restitution. Moreover, TFF1 has antiproliferative and anti-apoptotic effects and promotes cell scattering and invasion. We investigated TFF1 expression in healthy and inflamed non-neoplastic gallbladder mucosa as well as in gallbladder carcinomas (n=57) and corresponding metastases (n=18), using a tissue microarray technique. TFF1 immunoreactivity was absent in healthy mucosa, focally observed in epithelium with inflammatory changes and present in 35% of primary and 24% of metastatic cancer tissues. Immunoreactivity significantly decreased with increasing tumour stage (P=0.009) and increasing tumour grade (P=0.001). Patients with TFF1 positive tumours showed a more favourable outcome compared to patients with TFF1 negative tumours in univariate analysis (P=0.006). However, multivariate analysis proved resection status and tumour grade as the only independent prognostic factors. In conclusion, TFF1 is expressed in inflamed non-neoplastic gallbladder epithelium and in low stage and low grade gallbladder carcinomas. Thus, TFF1 may be the missing link between gallstones, chronic cholecystitis and gallbladder cancer. Further studies are needed to evaluate whether TFF1 immunostaining can be used as a diagnostic tool to identify patients with a more favourable outcome.

Adenocarcinoma↗
PubMed2005

Enterolithiasis in jejunal diverticulosis, a rare cause of obstruction of the small intestine: a case report.

Jejunal diverticula are rare and usually asymptomatic; they occur twice as frequently in men. They are discovered incidentally during small-bowel enteroclysis, CT scan or laparotomy. Complications include diverticulitis, perforation, hemorrhage and enterolith formation. Intestinal obstruction due to enterolithiasis is uncommon. We present the association of enterolithiasis and jejunal diverticulosis causing obstruction of the small intestine in a 74-year-old female who was admitted for abdominal cramps, nausea and vomiting. On physical examination, there was discomfort on palpation of the upper abdomen. Laboratory tests revealed mild elevation of leucocytes and C-reactive protein. CT scan demonstrated dilatated loops of proximal jejunum with thickening of the wall, suggesting ingestion of a foreign body. Clinical and radiological findings did not indicate conservative therapy; our patient underwent minilaparotomy, and pronounced jejunal diverticulosis was identified. An enterotomy was performed and a cylindrical enterolith, 10cm long and 3cm in diameter, was removed. The operative and postoperative course was uneventful. Enterolithiasis must be considered as a potential source of intestinal obstruction. The differential diagnosis should take gallstone ileus and ingestion of a foreign body into consideration. Initial therapy is nonoperative; if this management fails, surgery is indicated.

Aged↗
PubMed2005

Congenital absence of the portal vein in an adult woman: a case report.

Congenital absence of the portal vein is a rare malformation. Mesenteric and splenic venous blood bypasses the liver and drains into the renal veins or directly into the inferior vena cava. The malformation occurs predominantly in females and children and is often associated with other anomalies such as hepatic tumors, cardiac malformations and skeletal abnormalities. We describe a 23-year-old female with congenital absence of the portal vein associated with variant origin of the hepatic artery from the superior mesenteric artery. Additional anomalies were not present. The patient is in good condition. Laboratory tests showed elevated total bilirubin; other liver parameters were within normal range. The absence of the portal vein was confirmed by MR angiography, which revealed that the upper part of the superior mesenteric vein and the splenic vein drained into the left renal vein. A liver biopsy showed no signs of cirrhosis. Yearly follow-up with laboratory tests and ultrasonography was recommended to our patient. According to the literature, the prognosis of this patient depends on the presence of cardiac defects and liver tumors. There is little information on the outcome of patients with congenital absence of the portal vein; only long-term follow-up investigations will provide answers to the numerous remaining questions.

Abdominal Pain↗
PubMed2005

Surgical therapy options in polycystic liver disease.

INTRODUCTION: Polycystic liver disease (PLD) is a rare affliction frequently observed in association with polycystic kidney disease. Only symptomatic patients require treatment, which can be conservative or surgical, i.e. laparoscopic or conventional. We report the results of our experience in the surgical management of polycystic liver disease. METHODS: Between 1994 and 2003, 19 patients (16 female, 3 male) were referred to our center for the management of PLD. Their median age was 50 years (range 33-72). All were symptomatic and their cysts had a median diameter of 11 cm (range 5-22). RESULTS: Laparoscopic management was undertaken in eight patients, with one conversion to open technique because of bleeding from a superficial hepatic vein. An open procedure was performed in 11 patients: one left hemihepatectomy, deroofing in two patients, segment resection 2/3 plus deroofing in six patients, and segment resection 5/6 plus deroofing in two patients. Four patients had complications: one case of biliary leakage was managed conservatively; two patients had pneumothorax caused by the cava catheter inserted for anesthesia, and one patient's abdominal drain tore off and had to be removed by relaparotomy on the fourth postoperative day. Median follow-up of all patients was 49 months (range 7-98). In one patient there was symptomatic recurrence with hepatomegaly and compression of the inferior vena cava 84 months after the first operation. CONCLUSIONS: Careful selection of patients and meticulous surgical technique are recommended in the management of PLD. The treatment of choice for symptomatic Gigot or Morino type 1 PLD is laparoscopic surgery, and for advanced stage PLD combined hepatic resection and cyst fenestration.

Adult↗
PubMed2004

Minimally invasive management of dysontogenetic hepatic cysts.

BACKGROUND: Liver cysts occur with a prevalence of 4%-7% in the general population. Laparoscopic surgery is effective for solitary cysts and in selected patients with polycystic liver disease (PLD). We present our experience in the laparoscopic management of dysontogenetic cysts. PATIENTS AND METHODS: Between 1994 and 2002, 36 patients were referred to our centre for the management of dysontogenetic cystic liver disease. Management was laparoscopic in 16 cases. Indications were solitary giant cysts (n=9) and PLD (n=7). RESULTS: Laparoscopic procedures were completed in 15 patients. Mean operating time was 90 min. There were no deaths. In one case there was an intraoperative complication: bleeding from a superficial hepatic vein necessitated conversion to an open procedure. There were two postoperative complications: one patient with biliary leakage, which was managed conservatively, and one patient with a pneumothorax caused by the cava catheter installed for anaesthesia. Median follow-up was 36 months. There was no symptomatic recurrence. CONCLUSION: Laparoscopy can be recommended as the procedure of choice for symptomatic solitary giant cysts and PLD Gigot type I.

Adult↗
PubMed2003

[Endoscopic palliation of malignant gastric outlet obstruction by self-expanding metal stents].

INTRODUCTION: Malignant gastric outlet stenosis is caused by tumour obstruction and restricts the oral intake of food, resulting in a seriously reduced quality of life. Endoscopic implantation of self expanding metal stents (SEMS) can clear stenosis in the GI-tract and reestablish and preserve the passage in the GI-tract. PATIENTS AND METHODS: Between October 2001 and April 2003 seven patients with malignant gastric outlet stenosis have been treated by the implantation of SEMS. Four patients had malignant stenosis in the upper duodenum or gastric antrum, two patients had stenosis because of tumour recurrence in the efferent loop of the jejunum after gastric resection because of gastric carcinoma and one patient had an obstruction 20 cm distal of the oesophagus after gastrectomy because of gastric cancer. RESULTS: In all patients obstruction was cleared by the implantation of SEMS, and oral intake of food was possible in all patients after two days. No serious complications occurred during or after stent implantation. CONCLUSION: Stent implantation for the treatment of malignant gastric outlet stenosis is a cost effective procedure, associated with low risk and low stress for the patient, and provides excellent palliation of symptoms in patients with malignant gastric outlet stenosis.

Aged↗
PubMedDate not supplied

Accuracy of preoperative routine MRI for hepatic lesion detection.

BACKGROUND: The outcome of liver resections depends on complete removal of all detectable foci. Our aim was to determine the value of preoperative routine magnetic resonance imaging (MRI) for complete detection of hepatic lesions. METHODS: We compared 271 lesions seen on MRI in 182 patients to intraoperative findings (including intraoperative ultrasonography) and histology. RESULTS: The overall rate of lesions was 7% each for segments 2 and 3, as compared to 14-17% each for segments 5, 6, 7, and 8. Twenty-three additional lesions were found intraoperatively, two thirds of them in the left lobe (mean size: 1.4 cm; mean total number of lesions in those patients: 2.2). In segments 2 and 3, the relative frequency for intraoperative diagnosis of additional lesions was 17% and 20%, respectively. On the other hand, most of the 15 MRI lesions not verified intra- or postoperatively had been described in the right hepatic lobe (maximum: segment 6). CONCLUSION: MRI provided reliable preoperative lesion detection. Special attention should be paid to segments 2 and 3, which showed a lower total number of lesions but an elevated relative frequency of intraoperatively detected additional foci.

Humans↗
PubMedDate not supplied

Is intraoperative ultrasonography during partial hepatectomy still necessary in the age of magnetic resonance imaging?

BACKGROUND/AIMS: The aim of our study was to determine if intraoperative ultrasonography is still necessary in the time of magnetic resonance imaging. METHODOLOGY: Our prospective study comprised 122 patients (82% with malignant tumors) undergoing partial hepatectomy with preoperative magnetic resonance imaging, done at the same institution using a standardized liver protocol as well as intraoperative ultrasonography performed in a systematic fashion. RESULTS: Seventeen additional malignant lesions in 16/122 patients (13.1%) were found intraoperatively [7 visible, 2 palpable, 8 (6.6%) diagnosed by intraoperative ultrasonography only; mean size: 1.5 cm; left:right lobe = 11:6]. This caused a change in surgical strategy in 14 patients (11.5%), including 6 patients (4.9%) with lesions seen on intraoperative ultrasonography only. The average total number of lesions in those patients was 3.4. Ten lesions (7 benign, 3 malignant) described on magnetic resonance imaging were not found on intraoperative ultrasonography, but no unnecessary operations resulted from this. In one patient additional micrometastases seen neither on magnetic resonance imaging nor on intraoperative ultrasonography were found histologically. CONCLUSIONS: Intraoperative ultrasonography is still worthwhile as it remains unsurpassed in the ultimate determination of the number of lesions, tumor extension and anatomical resolution. However, in the course of time its benefits may decrease further due to ongoing improvement of preoperative imaging.

Hepatectomy↗