Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

Postoperative pancreatic fistula: an international study group (ISGPF) definition.

Background. Postoperative pancreatic fistula (POPF) is still regarded as a major complication. The incidence of POPF varies greatly in different reports, depending on the definition applied at each surgical center. Our aim was to agree upon an objective and internationally accepted definition to allow comparison of different surgical experiences. Methods. An international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easyto-apply definition of POPF, graded primarily on clinical impact. Results. A POPF represents a failure of healing/sealing of a pancreatic-enteric anastomosis or a parenchymal leak not directly related to an anastomosis. An all-inclusive definition is a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity. Three different grades of POPF (grades A, B, C) are defined according to the clinical impact on the patient’s hospital course. Conclusions. The present definition and clinical grading of POPF should allow realistic comparisons of surgical experiences in the future when new techniques, new operations, or new pharmacologic agents that may impact surgical treatment of pancreatic disorders are addressed. (Surgery 2005;138:8-13.)

Special article Postoperative pancreatic fistula: An international study group (ISGPF) definition

Infectious Diseases Society of America.

The clinical successes in immunotherapy have been both astounding and at the same time unsatisfactory. Countless patients with varied tumor types have seen pronounced clinical response with immunotherapeutic intervention; however, many more patients have experienced minimal or no clinical benefit when provided the same treatment. As technology has advanced, so has the understanding of the complexity and diversity of the immune context of the tumor microenvironment and its influence on response to therapy. It has been possible to identify different subclasses of immune environment that have an influence on tumor initiation and response and therapy; by parsing the unique classes and subclasses of tumor immune microenvironment (TIME) that exist within a patient's tumor, the ability to predict and guide immunotherapeutic responsiveness will improve, and new therapeutic targets will be revealed.

Understanding the tumor immune microenvironment (TIME) for effective therapy.

The value of diagnostic laparoscopy to improve tumor staging in patients with pancreatic and periampullary cancer is still a matter of controversial discussion, especially with regard to whether diagnostic laparoscopy can identify patients in whom a laparotomy can be avoided due to metastases. To answer this question, all patients who underwent operations for pancreatic cancer (n = 97) or periampullary cancer (n = 30) between 11/1993 and 12/1995 were evaluated. Only 10% of the patients with periampullary/pancreatic cancer and 13% with pancreatic cancer could avoid laparotomy through diagnostic laparoscopy. Due to these low numbers, a diagnostic laparotomy cannot be recommended in general in patients with pancreatic and/or periampullary cancer on economic grounds and because of the risk of trocar metastases.

[Efficacy and economic aspects of preoperative diagnosis: laparoscopy is useful in only 13% of patients with pancreatic carcinoma].

With the introduction of University of Wisconsin (UW) solution in liver preservation, rinsing of the graft before reperfusion with either blood or synthetic solutions has become a standard procedure [1, 2]. Synthetic rinse solutions were developed not only to rinse out potassium and metabolites from the liver graft, but also to apply protective substances during the rinse-out phase [2–4]. In this study, we investigated the uptake of radiolabelled adenosine as an example of the uptake of low molecular protective substances during a rinse with a high viscosity solution at 4 °C.

Pharmacokinetics of rinse solutions at 4° celsius

991: Highly sensitive pancreatic cancer diagnosis by serum exosome stem cell and miRNA markers

Antibody-mediated rejection (ABMR) remains one of the most challenging issues after organ transplantation and particularly after kidney transplantation. Despite many progresses during the last decade, ABMR is still the main cause of kidney graft loss and this all over the post- transplant period. In this review, we describe the recent knowledge about molecular and cellular mechanisms involved in ABMR. We focused our report on the role of the complement pathway in the process of ABMR and we give some insights into the role of inflammatory cells, NK lymphocytes and the role of endothelial cells. We further describe the potential role of non-HLA antibodies, of which the importance has been increasingly emphasized in recent years. Overall, this report could be of interest for all physicians who are working in the field of organ transplantation or who are working in the field of immunology. It gives essential information to understand new diagnosis advances and further therapeutic approaches. Antibody-mediated rejection (ABMR) is the leading cause of graft failure ([1,2]). In contrast to T-cell mediated rejection usually sensitive to steroids, active ABMR remains a therapeutic challenge. ABMR diagnosis relies on the presence of renal injuries and donor-specific antibodies (DSA) (HLA and non HLA antibodies) with sometimes the evidence of interaction between DSA and graft endothelium. Regularly revised during expert conferences, ABMR definition is currently categorized as active or chronic active. [3] The emergence of validated molecular assays targeting a better phenotyping of ABMR and the recent advances regarding the detrimental effect of DSA directed against minor antigens open the way to a better assessment of the heterogeneity of ABMR. In this review, we will address new aspects of ABMR regarding its mechanisms, diagnosis and treatments. 

Unraveling complexity of antibody-mediated rejections, the mandatory way towards an accurate diagnosis and a personalized treatment.

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M.W. Büchler

Papers

[Efficacy and economic aspects of preoperative diagnosis: laparoscopy is useful in only 13% of patients with pancreatic carcinoma].

Pharmacokinetics of rinse solutions at 4° celsius

991: Highly sensitive pancreatic cancer diagnosis by serum exosome stem cell and miRNA markers

Unraveling complexity of antibody-mediated rejections, the mandatory way towards an accurate diagnosis and a personalized treatment.

Fast-Track verbessert die Ergebnisse nach Leberresektionen