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Guzmán Y, Ríos J, Paredes J, Domínguez P, Maurel J, González-Abós C, Otero-Piñeiro A, Almenara R, Ladra M, Prada B, Pascual M, Guerrero MA, García-Granero Á, Fernández L, Ochogavia-Seguí A, Gamundi-Cuesta M, González-Argente FX, Pons LV, Centeno A, Arrayás Á, de Miguel A, Gil-Gómez E, Gómez B, Martínez JG, Lacy AM, de Lacy FB. Time Interval Between the End of Neoadjuvant Therapy and Elective Resection of Locally Advanced Rectal Cancer in the CRONOS Study. JAMA Surg 2023; 158:910-919. [PMID: 37436726 PMCID: PMC10339219 DOI: 10.1001/jamasurg.2023.2521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/28/2023] [Indexed: 07/13/2023]
Abstract
Importance The treatment for extraperitoneal locally advanced rectal cancer (LARC) is neoadjuvant therapy (NAT) followed by total mesorectal excision (TME). Robust evidence on the optimal time interval between NAT completion and surgery is lacking. Objective To assess the association of time interval between NAT completion and TME with short- and long-term outcomes. It was hypothesized that longer intervals increase the pathologic complete response (pCR) rate without increasing perioperative morbidity. Design, Setting, and Participants This cohort study included patients with LARC from 6 referral centers who completed NAT and underwent TME between January 2005 and December 2020. The cohort was divided into 3 groups depending on the time interval between NAT completion and surgery: short (≤8 weeks), intermediate (>8 and ≤12 weeks), and long (>12 weeks). The median follow-up duration was 33 months. Data analyses were conducted from May 1, 2021, to May 31, 2022. The inverse probability of treatment weighting method was used to homogenize the analysis groups. Exposure Long-course chemoradiotherapy or short-course radiotherapy with delayed surgery. Main outcome and Measures The primary outcome was pCR. Other histopathologic results, perioperative events, and survival outcomes constituted the secondary outcomes. Results Among the 1506 patients, 908 were male (60.3%), and the median (IQR) age was 68.8 (59.4-76.5) years. The short-, intermediate-, and long-interval groups included 511 patients (33.9%), 797 patients (52.9%), and 198 patients (13.1%), respectively. The overall pCR was 17.2% (259 of 1506 patients; 95% CI, 15.4%-19.2%). When compared with the intermediate-interval group, no association was observed between time intervals and pCR in short-interval (odds ratio [OR], 0.74; 95% CI, 0.55-1.01) and long-interval (OR, 1.07; 95% CI, 0.73-1.61) groups. The long-interval group was significantly associated with lower risk of bad response (tumor regression grade [TRG] 2-3; OR, 0.47; 95% CI, 0.24-0.91), systemic recurrence (hazard ratio, 0.59; 95% CI, 0.36-0.96), higher conversion risk (OR, 3.14; 95% CI, 1.62-6.07), minor postoperative complications (OR, 1.43; 95% CI, 1.04-1.97), and incomplete mesorectum (OR, 1.89; 95% CI, 1.02-3.50) when compared with the intermediate-interval group. Conclusions and Relevance Time intervals longer than 12 weeks were associated with improved TRG and systemic recurrence but may increase surgical complexity and minor morbidity.
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Affiliation(s)
- Yoelimar Guzmán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - José Ríos
- Department of Clinical Farmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Paredes
- General and Digestive Surgery Department, Colorectal Surgery Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain
| | - Paula Domínguez
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - Joan Maurel
- Medical Oncology Departments, Hospital Clínic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Carolina González-Abós
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - Ana Otero-Piñeiro
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - Raúl Almenara
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - María Ladra
- General and Digestive Surgery Department, Colorectal Surgery Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain
| | - Borja Prada
- General and Digestive Surgery Department, Colorectal Surgery Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain
| | - Marta Pascual
- General Surgery Department, Section of Colon and Rectal Surgery Unit, Hospital del Mar, Barcelona, Catalonia, Spain
| | - María Alejandra Guerrero
- General Surgery Department, Section of Colon and Rectal Surgery Unit, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Álvaro García-Granero
- Coloproctology Unit, Health Research Institute of the Balearic Islands, 3D-Reconstruction Unit and Simulation Center, Hospital Universitario Son Espases, Professor of Human Embriology and Anatomy Department, University of Islas Baleares, Palma de Mallorca, Spain
| | - Laura Fernández
- Coloproctology Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Aina Ochogavia-Seguí
- Coloproctology Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Lorenzo Viso Pons
- General and Digestive Surgery Department, Colorectal Surgery Unit, Consorci Sanitari Integral - Hospital General de l’Hospitalet, Barcelona, Catalonia, Spain
| | - Ana Centeno
- General and Digestive Surgery Department, Colorectal Surgery Unit, Consorci Sanitari Integral - Hospital General de l’Hospitalet, Barcelona, Catalonia, Spain
| | - Ángela Arrayás
- General and Digestive Surgery Department, Colorectal Surgery Unit, Consorci Sanitari Integral - Hospital General de l’Hospitalet, Barcelona, Catalonia, Spain
| | - Andrea de Miguel
- General and Digestive Surgery Department, Colorectal Surgery Unit, Consorci Sanitari Integral - Hospital General de l’Hospitalet, Barcelona, Catalonia, Spain
| | - Elena Gil-Gómez
- General and Digestive Surgery Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Beatriz Gómez
- General and Digestive Surgery Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José Gil Martínez
- General and Digestive Surgery Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Antonio M. Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
- Chief of Instituto Quirúrgico Lacy, Barcelona, Catalonia, Spain
- Clinica Rotger, Palma de Mallorca, Spain
- Hospital Ruber Internacional, Madrid, Spain
| | - F. Borja de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
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Garcia-Granero A, Jerí Mc-Farlane S, Gamundí Cuesta M, González-Argente FX. Application of 3D-reconstruction and artificial intelligence for complete mesocolic excision and D3 lymphadenectomy in colon cancer. Cir Esp 2023; 101:359-368. [PMID: 36709852 DOI: 10.1016/j.cireng.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 01/28/2023]
Abstract
Mathematical algorithms 3D-reconstruction techniques and artificial intelligence are a current line of innovation in colorectal surgical oncology. The objective of this study is to show the initial experience of a 3D image processing and reconstruction system to perform complete mesocolic excision and D3-lymphadenectomy in colon cancer. It is applied to a splenic flexure neoplasm and in a right colon cancer with suspected retroperitoneal infiltration. 3D image processing and reconstruction was employed to delimit 10 cm proximal and distal intestinal margins to the tumor and define its corresponding vascularization. In right colon cancer it showed position and exact dimensions of D3-lymphadenectomy area and possible retroperitoneal fascia infiltration. 3D image processing and reconstruction allows to obtain valuable information from computerized tomography scan. It could be employed during surgical strategy planification to improve oncological results and reduce intraoperative complications.
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Affiliation(s)
- Alvaro Garcia-Granero
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain; Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma, Illes Balears, Spain; Unidad de Reconstrucción-3D y Centro de Simulación, Hospital Universitario Son Espases, Palma, Illes Balears, Spain; Profesor Departamento de Anatomía y Embriología Humana, Universidad de Islas Baleares, Palma, Illes Balears, Spain; Coordinador Unidad de Anatomía Quirúrgica Aplicada, Universidad de Valencia, Valencia, Spain.
| | - Sebastían Jerí Mc-Farlane
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
| | - Margarita Gamundí Cuesta
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
| | - Francesc Xavier González-Argente
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
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Garcia-Granero A, Jerí Mc-Farlane S, Gamundí Cuesta M, González-Argente FX. Aplicación de reconstrucción 3D e inteligencia artificial a la escisión completa de mesocolon y linfadenectomía D3 en el cáncer de colon. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Alfonso-Garcia M, Garcia-Granero Á, Pineño Flores C, González-Argente FX. Emergency surgical strategy for incarcerated rectal prolapse. Cir Esp 2022; 100:645. [PMID: 35753573 DOI: 10.1016/j.cireng.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 06/15/2023]
Affiliation(s)
- María Alfonso-Garcia
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Álvaro Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Human Embryology and Anatomy Department, University of Illes Balears, Palma de Mallorca, Spain; Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain.
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2022; 100:125-132. [PMID: 35221240 DOI: 10.1016/j.cireng.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
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6
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Pineño-Flores C, García-Granero Á, Segura-Sampedro JJ, Soldevila-Verdeguer C, Blasco-Serra A, González-Argente FX. Surgical anatomy applied to the international classification of the abdominal wall planes (ICAP) - a video vignette. Colorectal Dis 2021; 23:1007. [PMID: 33428319 DOI: 10.1111/codi.15529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Cristina Pineño-Flores
- Digestive Surgery Department, Hospital Universitario Son Espases, Palma de mallorca, España, Spain.,Malignant Peritoneal Disease Research Group, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Álvaro García-Granero
- Digestive Surgery Department, Hospital Universitario Son Espases, Palma de mallorca, España, Spain.,Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - Juan José Segura-Sampedro
- Digestive Surgery Department, Hospital Universitario Son Espases, Palma de mallorca, España, Spain.,Malignant Peritoneal Disease Research Group, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain.,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
| | - Carla Soldevila-Verdeguer
- Digestive Surgery Department, Hospital Universitario Son Espases, Palma de mallorca, España, Spain.,Malignant Peritoneal Disease Research Group, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Arantxa Blasco-Serra
- Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain.,University of Valencia, València, Spain
| | - Francesc Xavier González-Argente
- Digestive Surgery Department, Hospital Universitario Son Espases, Palma de mallorca, España, Spain.,Malignant Peritoneal Disease Research Group, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain.,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
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7
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2021; 100:S0009-739X(21)00029-4. [PMID: 33714556 DOI: 10.1016/j.ciresp.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
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Garcia-Granero A, Pellino G, Giner F, Frasson M, Fletcher-Sanfeliu D, Primo Romeguera V, Flor Lorente B, Gamundi M, Brogi L, Garcia-Calderón D, González-Argente FX, Garcia-Granero E. A video demonstration of three-dimensional imaging to assess the circumferential resection margin in locally advanced rectal cancer and recurrent rectal cancer - a video vignette. Colorectal Dis 2020; 22:2340-2341. [PMID: 32702181 DOI: 10.1111/codi.15281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023]
Affiliation(s)
- A Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - G Pellino
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - F Giner
- Department of Pathology, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - M Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - D Fletcher-Sanfeliu
- Cardiovascular Surgery Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - V Primo Romeguera
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - B Flor Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - M Gamundi
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - L Brogi
- 3D-Reconstruction Unit and Simulation Center, Hospital Universitario Son Espases, Mallorca, Spain
| | | | | | - E Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
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Segura-Sampedro JJ, Pineño-Flores C, Craus-Miguel A, Morales-Soriano R, González-Argente FX. New hemostatic device for grade IV-V liver injury in porcine model: a proof of concept. World J Emerg Surg 2019; 14:58. [PMID: 31889989 PMCID: PMC6916102 DOI: 10.1186/s13017-019-0277-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background The liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V). Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death. Methods We designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2). Results Both pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP. Conclusions We establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.
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Affiliation(s)
- Juan José Segura-Sampedro
- 1General & Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain.,3School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
| | - Cristina Pineño-Flores
- 1General & Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Andrea Craus-Miguel
- 1General & Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Rafael Morales-Soriano
- 1General & Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Francesc Xavier González-Argente
- 1General & Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain.,3School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
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Bonnin-Pascual J, Álvarez-Segurado C, Jiménez-Segovia M, Bianchi A, Bonnin-Pascual F, Molina-Romero FX, González-Argente FX. Aportaciones de la fluorescencia a la cirugía endocrina. Cir Esp 2018; 96:529-536. [DOI: 10.1016/j.ciresp.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
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