Skip to main content
Erschienen in: Indian Journal of Surgical Oncology 4/2018

31.07.2018 | Original Article

Safety and Efficacy of Low-Dose Single-Agent Capecitabine in Inoperable Gallbladder Cancer with Jaundice Post-Single-System Single-Catheter External Biliary Drainage: a Pilot Study from a Highly Endemic Area

verfasst von: Ravi Gupta, Akshay Anand, Manoj Kumar, MLB Bhatt, Sudhir Singh, Abhinav Arun Sonkar

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Gallbladder cancer (CaGB) in the subcontinent belongs to low socioeconomic status, and at the time of diagnosis, a large number is unresectable or inoperable so the palliative treatment remains the only option. In the present study, attempt was made to see the effect and safety profile of single-agent oral capecitabine in inoperable CaGB in presence of low levels of jaundice post-single-catheter transhepatic external biliary drainage. In N = 35 of inoperable jaundiced CaGB, post-biliary drainage capecitabine in low dose was started when their total bilirubin levels fell to 10 mg% or below. Post-external drainage decreased bilirubin level to < 10 mg/dl within 1–4 weeks, mean 2.37 ± 0.80 weeks. Survival was 1–6 months, mean 3.26 ± 1.46 months. Catheter patency time was 1.92 ± 0.64 months (range 0–3 months). Young age, male sex, level of jaundice at presentation, and duration of decrease in jaundice after drainage were significantly associated with progressive disease course. Poor survival was significantly associated with progressive disease course, young age, and level of jaundice at admission. To the best of our knowledge, this is the first study to establish that single-agent capecitabine can be safely given in CaGB in presence of jaundice.
Literatur
1.
Zurück zum Zitat Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II et al (2001) Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin 51(6):349–364CrossRef Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II et al (2001) Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin 51(6):349–364CrossRef
2.
Zurück zum Zitat Murthy NS, Rajaram D, Gautam MS, Shivraj NS, Pruthvish S, George PS et al (2011) Trends in incidence of gallbladder cancer – Indian scenario. Gastrointestinal Cancer: Targets and Therapy 1:1–9 Murthy NS, Rajaram D, Gautam MS, Shivraj NS, Pruthvish S, George PS et al (2011) Trends in incidence of gallbladder cancer – Indian scenario. Gastrointestinal Cancer: Targets and Therapy 1:1–9
3.
Zurück zum Zitat Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH (1996) Long-term results after resection for gallbladder cancer Implications for staging and management. Ann Surg 224(5):639–646CrossRef Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH (1996) Long-term results after resection for gallbladder cancer Implications for staging and management. Ann Surg 224(5):639–646CrossRef
4.
Zurück zum Zitat Henson DE, Albores-Saavedra J, Corle D (1992) Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 70(6):1493–1497CrossRef Henson DE, Albores-Saavedra J, Corle D (1992) Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 70(6):1493–1497CrossRef
5.
Zurück zum Zitat Ong SL, Garcea G, Thomasset SC, Neal CP, Lloyd DM, Berry DP et al (2008) Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic Centre with review of the literature. HPB (Oxford) 10(6):446–458CrossRef Ong SL, Garcea G, Thomasset SC, Neal CP, Lloyd DM, Berry DP et al (2008) Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic Centre with review of the literature. HPB (Oxford) 10(6):446–458CrossRef
6.
Zurück zum Zitat Oertli D, Herzog U, Tondelli P (1993) Primary carcinoma of the gallbladder: operative experience during a 16 year period. Eur J Surg 159(8):415–420PubMed Oertli D, Herzog U, Tondelli P (1993) Primary carcinoma of the gallbladder: operative experience during a 16 year period. Eur J Surg 159(8):415–420PubMed
7.
Zurück zum Zitat Wade TP, Prasad CN, Virgo KS, Johnson FE (1997) Experience with distal bile duct cancers in U.S. veterans affairs hospitals: 1987-1991. J Surg Oncol 64(3):242–245CrossRef Wade TP, Prasad CN, Virgo KS, Johnson FE (1997) Experience with distal bile duct cancers in U.S. veterans affairs hospitals: 1987-1991. J Surg Oncol 64(3):242–245CrossRef
8.
Zurück zum Zitat de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM (1999) Biliary tract cancers. N Engl J Med 341(18):1368–1378CrossRef de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM (1999) Biliary tract cancers. N Engl J Med 341(18):1368–1378CrossRef
9.
Zurück zum Zitat Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y (2004) Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol 11(3):310–315CrossRef Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y (2004) Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol 11(3):310–315CrossRef
10.
Zurück zum Zitat Kapoor VK, Pradeep R, Haribhakti SP, Singh V, Sikora SS, Saxena R et al (1996) Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg 83(12):1709–1711CrossRef Kapoor VK, Pradeep R, Haribhakti SP, Singh V, Sikora SS, Saxena R et al (1996) Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg 83(12):1709–1711CrossRef
11.
Zurück zum Zitat Bismuth H, Castaing D, Traynor O (1988) Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg 12(1):39–47CrossRef Bismuth H, Castaing D, Traynor O (1988) Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg 12(1):39–47CrossRef
12.
Zurück zum Zitat Huibregtse K, Tytgat GN (1982) Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut 23(5):371–375CrossRef Huibregtse K, Tytgat GN (1982) Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut 23(5):371–375CrossRef
13.
Zurück zum Zitat Cotton PB (1984) Endoscopic methods for relief of malignant obstructive jaundice. World J Surg 8:854–861CrossRef Cotton PB (1984) Endoscopic methods for relief of malignant obstructive jaundice. World J Surg 8:854–861CrossRef
14.
Zurück zum Zitat Dowsett JF, Vaira D, Hatfield AR, Cairns SR, Polydorou A, Frost R et al (1989) Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 96(4):1180–1186CrossRef Dowsett JF, Vaira D, Hatfield AR, Cairns SR, Polydorou A, Frost R et al (1989) Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 96(4):1180–1186CrossRef
15.
Zurück zum Zitat Becker CD, Glättli A, Maibach R, Baer HU (1993) Percutaneous palliation of malignant obstructive jaundice with the Wallstent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction. J Vasc Interv Radiol 4(5):597–604CrossRef Becker CD, Glättli A, Maibach R, Baer HU (1993) Percutaneous palliation of malignant obstructive jaundice with the Wallstent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction. J Vasc Interv Radiol 4(5):597–604CrossRef
16.
Zurück zum Zitat Stoker J, Laméris JS, van Blankenstein M (1993) Percutaneous metallic self-expandable endoprostheses in malignant hilar biliary obstruction. Gastrointest Endosc 39(1):43–49CrossRef Stoker J, Laméris JS, van Blankenstein M (1993) Percutaneous metallic self-expandable endoprostheses in malignant hilar biliary obstruction. Gastrointest Endosc 39(1):43–49CrossRef
17.
Zurück zum Zitat Polydorou AA, Cairns SR, Dowsett JF, Hatfield AR, Salmon PR, Cotton PB et al (1991) Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut 32(6):685–689CrossRef Polydorou AA, Cairns SR, Dowsett JF, Hatfield AR, Salmon PR, Cotton PB et al (1991) Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut 32(6):685–689CrossRef
18.
Zurück zum Zitat De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C (2001) Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 53(6):547–553CrossRef De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C (2001) Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 53(6):547–553CrossRef
19.
Zurück zum Zitat Sherman S (2001) Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we place two? Gastrointest Endosc 53:681–684CrossRef Sherman S (2001) Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we place two? Gastrointest Endosc 53:681–684CrossRef
20.
Zurück zum Zitat Chang WH, Kortan P, Haber GB (1998) Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 47(5):354–362CrossRef Chang WH, Kortan P, Haber GB (1998) Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 47(5):354–362CrossRef
21.
Zurück zum Zitat American Society for Gastrointestinal Endoscopy (ASGE) meeting 1999 Orlando, Florida, USA. May 16-19. Abstracts. Mehta S et al. endoscopic single versus double (bilateral) wallstents for palliation of malignant bismuth type III/IV hilar strictures: comparison of clinical outcomes and costs (AB234). Gastrointest Endosc. 1999 Apr;49(4 Pt 2):AB49–256 American Society for Gastrointestinal Endoscopy (ASGE) meeting 1999 Orlando, Florida, USA. May 16-19. Abstracts. Mehta S et al. endoscopic single versus double (bilateral) wallstents for palliation of malignant bismuth type III/IV hilar strictures: comparison of clinical outcomes and costs (AB234). Gastrointest Endosc. 1999 Apr;49(4 Pt 2):AB49–256
22.
Zurück zum Zitat De Palma GD, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L et al (2003) Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc 58(1):50–53CrossRef De Palma GD, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L et al (2003) Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc 58(1):50–53CrossRef
23.
Zurück zum Zitat Müller BG, De Aretxabala X, González Domingo M (2014) A review of recent data in the treatment of gallbladder cancer: what we know, what we do, and what should be done. Am Soc Clin Oncol Educ Book 34:e165–e170CrossRef Müller BG, De Aretxabala X, González Domingo M (2014) A review of recent data in the treatment of gallbladder cancer: what we know, what we do, and what should be done. Am Soc Clin Oncol Educ Book 34:e165–e170CrossRef
24.
Zurück zum Zitat Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA et al (2004) Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer 101(3):578–586CrossRef Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA et al (2004) Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer 101(3):578–586CrossRef
25.
Zurück zum Zitat Twelves C, Glynne-Jones R, Cassidy J, Schüller J, Goggin T, Roos B et al (1999) Effect of hepatic dysfunction due to liver metastases on the pharmacokinetics of capecitabine and its metabolites. Clin Cancer Res 5(7):1696–1702PubMed Twelves C, Glynne-Jones R, Cassidy J, Schüller J, Goggin T, Roos B et al (1999) Effect of hepatic dysfunction due to liver metastases on the pharmacokinetics of capecitabine and its metabolites. Clin Cancer Res 5(7):1696–1702PubMed
26.
Zurück zum Zitat Superfin D, Iannucci AA, Davies AM (2007) Commentary: oncologic drugs in patients with organ dysfunction: a summary. Oncologist 12(9):1070–1083CrossRef Superfin D, Iannucci AA, Davies AM (2007) Commentary: oncologic drugs in patients with organ dysfunction: a summary. Oncologist 12(9):1070–1083CrossRef
27.
Zurück zum Zitat Lee JJ, Han JY, Lee DH, Kim HY, Chun JH, Lee HG et al (2006) A phase II trial of docetaxel plus capecitabine in patients with previously treated non-small cell lung cancer. Jpn J Clin Oncol 36(12):761–767CrossRef Lee JJ, Han JY, Lee DH, Kim HY, Chun JH, Lee HG et al (2006) A phase II trial of docetaxel plus capecitabine in patients with previously treated non-small cell lung cancer. Jpn J Clin Oncol 36(12):761–767CrossRef
28.
Zurück zum Zitat Han JY, Lee DH, Kim HY, Hong EK, Yoon SM, Chun JH et al (2003) A phase II study of weekly docetaxel plus capecitabine for patients with advanced non-small cell lung carcinoma. Cancer 98(9):1918–1924CrossRef Han JY, Lee DH, Kim HY, Hong EK, Yoon SM, Chun JH et al (2003) A phase II study of weekly docetaxel plus capecitabine for patients with advanced non-small cell lung carcinoma. Cancer 98(9):1918–1924CrossRef
29.
Zurück zum Zitat Kumaran V, Gulati S, Paul B, Pande K, Sahni P, Chattopadhyay K (2002) The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder. Eur Radiol 12(8):1993–1999CrossRef Kumaran V, Gulati S, Paul B, Pande K, Sahni P, Chattopadhyay K (2002) The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder. Eur Radiol 12(8):1993–1999CrossRef
30.
Zurück zum Zitat Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E et al (2005) Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol 23(10):2332–2338CrossRef Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E et al (2005) Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol 23(10):2332–2338CrossRef
31.
Zurück zum Zitat Cho JY, Paik YH, Chang YS, Lee SJ, Lee DK, Song SY et al (2005) Capecitabine combined with gemcitabine (CapGem) as first-line treatment in patients with advanced/metastatic biliary tract carcinoma. Cancer 104(12):2753–2758CrossRef Cho JY, Paik YH, Chang YS, Lee SJ, Lee DK, Song SY et al (2005) Capecitabine combined with gemcitabine (CapGem) as first-line treatment in patients with advanced/metastatic biliary tract carcinoma. Cancer 104(12):2753–2758CrossRef
32.
Zurück zum Zitat Chowdhury Q, Reza S, Hai M, Shahid S. Capecitabine therapy in advanced gall bladder cancer: A phase II study. J Clin Oncol (Meeting Abstracts) June 2006 vol. 24 no. 18 suppl 14153 Chowdhury Q, Reza S, Hai M, Shahid S. Capecitabine therapy in advanced gall bladder cancer: A phase II study. J Clin Oncol (Meeting Abstracts) June 2006 vol. 24 no. 18 suppl 14153
34.
Zurück zum Zitat Joerger M, Huitema AD, Koeberle D, Rosing H, Beijnen JH, Hitz F et al (2014) Safety and pharmacology of gemcitabine and capecitabine in patients with advanced pancreatico-biliary cancer and hepatic dysfunction. Cancer Chemother Pharmacol 73(1):113–124CrossRef Joerger M, Huitema AD, Koeberle D, Rosing H, Beijnen JH, Hitz F et al (2014) Safety and pharmacology of gemcitabine and capecitabine in patients with advanced pancreatico-biliary cancer and hepatic dysfunction. Cancer Chemother Pharmacol 73(1):113–124CrossRef
35.
Zurück zum Zitat Borner MM, Dietrich D, Stupp R, Morant R, Honegger H, Wernli M et al (2002) Phase II study of capecitabine and oxaliplatin in first- and second-line treatment of advanced or metastatic colorectal cancer. J Clin Oncol 20(7):1759–1766CrossRef Borner MM, Dietrich D, Stupp R, Morant R, Honegger H, Wernli M et al (2002) Phase II study of capecitabine and oxaliplatin in first- and second-line treatment of advanced or metastatic colorectal cancer. J Clin Oncol 20(7):1759–1766CrossRef
36.
Zurück zum Zitat Covey AM, Brown KT (2006) Palliative percutaneous drainage in malignant biliary obstruction. Part 1: indications and preprocedure evaluation. J Support Oncol 4(6):269–273PubMed Covey AM, Brown KT (2006) Palliative percutaneous drainage in malignant biliary obstruction. Part 1: indications and preprocedure evaluation. J Support Oncol 4(6):269–273PubMed
37.
Zurück zum Zitat van Delden OM, Laméris JS (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18(3):448–456CrossRef van Delden OM, Laméris JS (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18(3):448–456CrossRef
38.
Zurück zum Zitat Robson PC, Heffernan N, Gonen M, Thornton R, Brody LA, Holmes R et al (2010) Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 17(9):2303–2311CrossRef Robson PC, Heffernan N, Gonen M, Thornton R, Brody LA, Holmes R et al (2010) Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 17(9):2303–2311CrossRef
39.
Zurück zum Zitat Tapping CR, Byass OR, Cast JE (2011) Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score. Eur Radiol 21(9):1948–1955CrossRef Tapping CR, Byass OR, Cast JE (2011) Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score. Eur Radiol 21(9):1948–1955CrossRef
40.
Zurück zum Zitat Roth LJ, Pugh EJ (1999) The role of endoscopic biliary stents in palliative care. Palliat Med 13(1):63–68CrossRef Roth LJ, Pugh EJ (1999) The role of endoscopic biliary stents in palliative care. Palliat Med 13(1):63–68CrossRef
41.
Zurück zum Zitat De Palma GD, Masone S, Rega M, Simeoli I, Salvatori F, Siciliano S et al (2007) Endoscopic approach to malignant strictures at the hepatic hilum. World J Gastroenterol 13(30):4042–4045CrossRef De Palma GD, Masone S, Rega M, Simeoli I, Salvatori F, Siciliano S et al (2007) Endoscopic approach to malignant strictures at the hepatic hilum. World J Gastroenterol 13(30):4042–4045CrossRef
42.
Zurück zum Zitat Freeman ML, Overby C (2003) Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 58(1):41–49CrossRef Freeman ML, Overby C (2003) Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 58(1):41–49CrossRef
43.
Zurück zum Zitat Indar AA, Lobo DN, Gilliam AD, Gregson R, Davidson I, Whittaker S et al (2003) Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol 15(8):915–919CrossRef Indar AA, Lobo DN, Gilliam AD, Gregson R, Davidson I, Whittaker S et al (2003) Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol 15(8):915–919CrossRef
44.
Zurück zum Zitat Born P, Rösch T, Triptrap A, Frimberger E, Allescher HD, Ott R et al (1998) Long-term results of percutaneous transhepatic biliary drainage for benign and malignant bile duct strictures. Scand J Gastroenterol 33(5):544–549CrossRef Born P, Rösch T, Triptrap A, Frimberger E, Allescher HD, Ott R et al (1998) Long-term results of percutaneous transhepatic biliary drainage for benign and malignant bile duct strictures. Scand J Gastroenterol 33(5):544–549CrossRef
Metadaten
Titel
Safety and Efficacy of Low-Dose Single-Agent Capecitabine in Inoperable Gallbladder Cancer with Jaundice Post-Single-System Single-Catheter External Biliary Drainage: a Pilot Study from a Highly Endemic Area
verfasst von
Ravi Gupta
Akshay Anand
Manoj Kumar
MLB Bhatt
Sudhir Singh
Abhinav Arun Sonkar
Publikationsdatum
31.07.2018
Verlag
Springer India
Erschienen in
Indian Journal of Surgical Oncology / Ausgabe 4/2018
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-018-0798-7

Weitere Artikel der Ausgabe 4/2018

Indian Journal of Surgical Oncology 4/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.