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Lluís N, Onoe S, Serradilla-Martín M, Achalandabaso M, Mizuno T, Jehaes F, Dasari BVM, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJH, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Detry O, Pozo CDD, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Yamaguchi J, Dokmak S, Prieto-Calvo M, D'Souza MA, Spiers HVM, van den Heuvel MC, Charco R, Lesurtel M, Ebata T, Ramia JM. Intraductal papillary neoplasms of the bile ducts: a comparative study of a rare disease in Europe and Nagoya, Japan. HPB (Oxford) 2024; 26:565-575. [PMID: 38307773 DOI: 10.1016/j.hpb.2024.01.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/27/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile ducts (IPNB) is a rare disease in Western countries. The aim of this study was to compare tumor characteristics, management strategies, and outcomes between Western and Eastern patients who underwent surgical resection for IPNB. METHODS A multi-institutional retrospective series of patients with IPNB undergoing surgery between January 2010 and December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), and at Nagoya University Hospital, Japan. RESULTS A total of 85 patients (51% male; median age 66 years) from 28 E-AHPBA centers were compared to 91 patients (64% male; median age 71 years) from Nagoya. Patients in Europe had more multiple lesions (23% vs 2%, P < .001), less invasive carcinoma (42% vs 85%, P < .001), and more intrahepatic tumors (52% vs 24%, P < .001) than in Nagoya. Patients in Europe experienced less 90-day grade >3 Clavien-Dindo complications (33% vs 68%, P < .001), but higher 90-day mortality rate (7.0% vs 0%, P = .03). R0 resections (81% vs 82%) were similar. Overall survival, excluding 90-day postoperative deaths, was similar in both regions. DISCUSSION Despite performing more extensive resections, the low perioperative mortality rate observed in Nagoya was probably influenced by a combination of patient-, tumor-, and surgery-related factors.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - François Jehaes
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V M Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sara Mambrilla-Herrero
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Frederik J H Hoogwater
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - María J Amaral
- General Surgery, Centro Hospitalar e Universitário de Coimbra, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bodil Andersson
- Department of Clinical Science Lund, Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Víctor López-López
- General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Olivier Detry
- Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Belgium
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, South Africa
| | | | | | - George N Tzimas
- HPB Surgery, Department of Surgery, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Safi Dokmak
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Melroy A D'Souza
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Harry V M Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Marius C van den Heuvel
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Mickaël Lesurtel
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - José M Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Alicante, Spain
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2
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Villodre C, Del Río-Martín J, Blanco-Fernández G, Cantalejo-Díaz M, Pardo F, Carbonell S, Muñoz-Forner E, Carabias A, Manuel-Vazquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kälviäinen-Mejia HK, Rotellar F, Garcés-Albir M, Latorre R, Longoria-Dubocq T, De Armas-Conde N, Serrablo A, Esteban Gordillo S, Sabater L, Serradilla-Martín M, Ramia JM. Textbook outcome in distal pancreatectomy: A multicenter study. Surgery 2024; 175:1134-1139. [PMID: 38071134 DOI: 10.1016/j.surg.2023.11.012] [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: 04/12/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. METHODS Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). RESULTS Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. CONCLUSION The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.
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Affiliation(s)
- Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Silvia Carbonell
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | | | | | | | | | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Raquel Latorre
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Alejandro Serrablo
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
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3
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Ramia JM, Alcázar-López CF, Villodre-Tudela C, Rubio-García JJ, Hernández B, Aparicio-López D, Serradilla-Martín M. Benchmark Outcomes for Distal Pancreatectomy: A Multicenter Prospective Snapshot Study (SPANDISPAN). J Am Coll Surg 2024:00019464-990000000-00958. [PMID: 38533997 DOI: 10.1097/xcs.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a one-country prospective study of distal pancreatectomies (DP) and determined BM. STUDY DESIGN Prospective, multicenter, observational snapshot study of DP carried out at Spanish HPB centers for a year (February 22-January 23). HPB centers were defined as high-volume if they performed > 10 DP per year. Inclusion criteria: any scheduled DP for any diagnosis and age > 18 years. The low-risk group was defined following the Durin et al. criteria and major complications as Clavien-Dindo ≥ III. RESULTS 313 patients from 42 centers and 46.6% from high-volume centers were included. Median DP by center was 7 (IQR: 5-10), median age was 65 years (IQR: 55-74), and 53.4% were female. The surgical approach was minimally invasive (MIS) in 69.3%. Major complications were 21.1%. Postoperative pancreatic fistula (POPF) grade B/C rate was 20.1%, and 90-day mortality was 1.6%. One hundred and forty-three were low-risk group patients (43.8%). Compared with previous BM data, an increasing MIS rate and fewer hospital stay was obtained. CONCLUSION We present the first determination of DP-BM in a prospective series, obtaining similar results to the previous ones, but our BM values include a shorter hospital stay and a higher percentage of MIS probably related to ERAS protocols and prospective data collection. BM is a multiparameter valuable tool for reporting outcomes, comparing centers, and identifying the points to improve surgical care.
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Affiliation(s)
- José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis
- ISABIAL, Alicante, Spain
- Miguel Hernández University, Alicante, Spain
| | | | - Celia Villodre-Tudela
- Department of Surgery, Hospital General Universitario Dr. Balmis
- ISABIAL, Alicante, Spain
- Miguel Hernández University, Alicante, Spain
| | - Juan J Rubio-García
- Department of Surgery, Hospital General Universitario Dr. Balmis
- ISABIAL, Alicante, Spain
| | - Belén Hernández
- Department of Surgery, Hospital General Universitario de Elda, Alicante, Spain
| | | | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, School of Medicine, University of Granada, Granada, Spain
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4
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Sánchez-Pérez B, Ramia JM. Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery? World J Gastrointest Oncol 2024; 16:255-258. [PMID: 38425397 PMCID: PMC10900164 DOI: 10.4251/wjgo.v16.i2.255] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022. Liver surgery is usually performed in oncological patients (liver metastasis, hepatocellular carcinoma, cholangiocarcinoma, etc.), but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined. Theoretical advantages of ERAS programs are: ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes; a better and faster postoperative recovery should let oncologic teams begin chemotherapeutic regimens on time; prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy. So, ERAS could be another way to improve our oncological results. We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.
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Affiliation(s)
- Belinda Sánchez-Pérez
- Department of General, Digestive and Transplantation Surgery, University Regional Hospital, Málaga 29010, Málaga, Spain
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante 03010, Spain
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5
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Alvarez XD, Fernando Alcázar C, Hernando Sanz A, Mora Oliver I, Granel L, Barreras JA, Calero A, Carbonell Morote S, Domingo C, Estevan R, Oliver I, López Andujar R, Sabater L, Compañ A, Ramia JM. Solid pseudopapillary neoplasms of the pancreas: Multicenter Vasepa study. Cir Esp 2024:S2173-5077(24)00047-4. [PMID: 38355041 DOI: 10.1016/j.cireng.2024.02.001] [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: 08/20/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Solid pseudopapillary tumors (SPT) of the pancreas are rare exocrine neoplasms of the pancreas. Correct preoperative diagnosis is not always feasible. The treatment of choice is surgical excision. These tumors have a good prognosis with a high disease-free survival rate. OBJECTIVE To describe the clinicopathological and radiological characteristics as well as short- and long-term follow-up results of patients who have undergone SPT resection. METHODS Multicenter retrospective observational study in patients with SPT who had undergone surgery from January 2000-January 2022. We have studied preoperative, intraoperative, and postoperative variables as well as the follow-up results (mean 28 months). RESULTS 20 patients with histological diagnosis of SPT in the surgical specimen were included. 90% were women; mean age was 33.5 years (13-67); 50% were asymptomatic. CT was the most used diagnostic test (90%). The most frequent location was body-tail (60%). Preoperative biopsy was performed in 13 patients (65%), which was correct in 8 patients. Surgeries performed: 7 distal pancreatectomies, 6 pancreaticoduodenectomies, 4 central pancreatectomies, 2 enucleations, and 1 total pancreatectomy. The R0 rate was 95%. Four patients presented major postoperative complications (Clavien-Dindo > II). Mean tumor size was 81 mm. Only one patient received adjuvant chemotherapy. With a mean follow-up of 28 months, 5-year disease-free survival was 95%. CONCLUSION SPT are large, usually located in the body-tail of the pancreas, and more frequent in women. The R0 rate obtained in our series is very high (95%). The oncological results are excellent.
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Affiliation(s)
- Xiomara Duque Alvarez
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | | | - Ana Hernando Sanz
- Departamento de Cirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Isabel Mora Oliver
- Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Laura Granel
- Departamento de Cirugía, Hospital General Universitario de Castellón, Castellón, Spain
| | - José A Barreras
- Departamento de Cirugía, Hospital General Universitario de Elche, Elche, Spain
| | - Alicia Calero
- Departamento de Cirugía, Hospital General Universitario de Elche, Elche, Spain
| | | | - Carlos Domingo
- Departamento de Cirugía, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Rafael Estevan
- Departamento de Cirugía, Instituto Valenciano de Oncología, Valencia, Spain
| | - Israel Oliver
- Departamento de Cirugía, Hospital General Marina Baja Villajoyosa. Villajoyosa, Spain
| | - Rafael López Andujar
- Departamento de Cirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Sabater
- Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antonio Compañ
- Departamento de Cirugía, Hospital General Universitario San Juan, Alicante, Spain; Universidad Miguel Hernández, Campus Sant Joan Alicante, Spain
| | - José M Ramia
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; Universidad Miguel Hernández, Campus Sant Joan Alicante, Spain
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6
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Rojas-Holguín A, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Blanco-Fernández G. Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID). Surg Oncol 2024; 52:102039. [PMID: 38301449 DOI: 10.1016/j.suronc.2024.102039] [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: 12/12/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
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Affiliation(s)
- Adela Rojas-Holguín
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Constantino Fondevila-Campo
- Department of Surgery, Hospital Clinic, Barcelona, Spain; Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | - Héctor Marín-Ortega
- Department of Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro J Pérez-Alonso
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain; Department of Surgery, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain.
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Ramia JM, Villodre-Tudela C, Falgueras-Verdaguer L, Zambudio-Carroll N, Castell-Gómez JT, Carbonell-Morote S, Blas-Laina JL, Borrego-Estella V, Sánchez-Pérez B, Serradilla-Martín M. Textbook outcomes in the liver-first approach for colorectal liver metastases: prospective multicentre analysis. BJS Open 2024; 8:zrad123. [PMID: 38266122 PMCID: PMC10807998 DOI: 10.1093/bjsopen/zrad123] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/30/2023] [Accepted: 09/24/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed. METHODS A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June 2019 and August 2020 was performed. Two types of textbook outcome were measured: classic textbook outcome and liver-first-approach-specific textbook outcome (which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion). The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days. RESULTS A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8 per cent (107 patients) and 46 per cent (69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95 per cent c.i. 0.73 to 0.92); P = 0.001) and intraoperative blood loss (OR 0.99 (95 per cent c.i. 0.99 to 1.00); P = 0.007). Prolonged length of hospital stay (33 patients, 41 per cent), positive margins (31 patients, 39 per cent), perioperative transfusion (27 patients, 34 per cent), and no full treatment completion (18 patients, 23 per cent) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement. CONCLUSION Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases.
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Affiliation(s)
- José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Universidad Miguel Hernandez, Alicante, Spain
| | - Celia Villodre-Tudela
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | | | | | | | | | | | | | | | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
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8
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Sousa Da Silva RX, Breuer E, Shankar S, Kawakatsu S, Hołówko W, Santos Coelho J, Jeddou H, Sugiura T, Ghallab M, Da Silva D, Watanabe G, Botea F, Sakai N, Addeo P, Tzedakis S, Bartsch F, Balcer K, Lim C, Werey F, Lopez-Lopez V, Peralta Montero L, Sanchez Claria R, Leiting J, Vachharajani N, Hopping E, Torres OJM, Hirano S, Andel D, Hagendoorn J, Psica A, Ravaioli M, Ahn KS, Reese T, Montes LA, Gunasekaran G, Alcázar C, Lim JH, Haroon M, Lu Q, Castaldi A, Orimo T, Moeckli B, Abadía T, Ruffolo L, Dib Hasan J, Ratti F, Kauffmann EF, de Wilde RF, Polak WG, Boggi U, Aldrighetti L, McCormack L, Hernandez-Alejandro R, Serrablo A, Toso C, Taketomi A, Gugenheim J, Dong J, Hanif F, Park JS, Ramia JM, Schwartz M, Ramisch D, De Oliveira ML, Oldhafer KJ, Kang KJ, Cescon M, Lodge P, Rinkes IHMB, Noji T, Thomson JE, Goh SK, Chapman WC, Cleary SP, Pekolj J, Regimbeau JM, Scatton O, Truant S, Lang H, Fuks D, Bachellier P, Ohtsuka M, Popescu I, Hasegawa K, Lesurtel M, Adam R, Cherqui D, Uesaka K, Boudjema K, Pinto-Marques H, Grąt M, Petrowsky H, Ebata T, Prachalias A, Robles-Campos R, Clavien PA. Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers. Ann Surg 2023; 278:748-755. [PMID: 37465950 DOI: 10.1097/sla.0000000000006012] [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] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. BACKGROUND Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. METHODS A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. RESULTS Of 8044 patients, 2908 (36%) qualified as benchmark (low-risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI ® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1, 4-8 or H4-8) disclosed a higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow-up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. CONCLUSION These new benchmark cutoffs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation, or novel chemotherapy regimens.
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Affiliation(s)
- Richard X Sousa Da Silva
- Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Eva Breuer
- Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Sadhana Shankar
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | - Shoji Kawakatsu
- Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University Warsaw, Warsaw, Poland
| | - João Santos Coelho
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Heithem Jeddou
- Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Mohammed Ghallab
- Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France
| | - Doris Da Silva
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris Cité, Clichy, France
| | - Genki Watanabe
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Florin Botea
- Department of Surgery and Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Nozomu Sakai
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospital, Strasbourg University, Strasbourg, France
| | - Stylianos Tzedakis
- Department of Hepatobiliary, Digestive and Endocrine Surgery, Cochin Hospital, Paris Cité University, Paris, France
| | - Fabian Bartsch
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany
| | - Kaja Balcer
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France
| | - Chetana Lim
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière, Sorbonne Université, Centre de Recherche de Saint-Antoine, Paris, France
| | - Fabien Werey
- Department of Oncology and Digestive Surgery, CHU Amiens-Picardie, Amiens, France
| | - Victor Lopez-Lopez
- Clinic and University Virgen de la Arrixaca Hospital, IMIB, Murcia, Spain
| | - Luciana Peralta Montero
- Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Sanchez Claria
- Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jennifer Leiting
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Neeta Vachharajani
- Department of Surgery, Section of Abdominal Organ Transplant, Washington University School of Medicine, St Louis, MO
| | - Eve Hopping
- Hepatobiliary Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide & Hepatobiliary Unit, Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Orlando J M Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Presidente Dutra Hospital, São Luiz, Brazil
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Daan Andel
- Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - Alicja Psica
- Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matteo Ravaioli
- Hepato-biliary surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keun Soon Ahn
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, Republic of Korea
| | - Tim Reese
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Leonardo A Montes
- General Surgery Department Liver, Pancreas and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Ganesh Gunasekaran
- Department of Surgery, Division of HPB Service, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cándido Alcázar
- Department of Surgery, HPB and Transplant Unit, General Universitary Hospital Alicante and Health and Biomedical Research Institute of Alicante, Alicante, Spain
| | - Jin Hong Lim
- Department of Surgery, Division of HBP Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Muhammad Haroon
- Department of HPB and Liver Transplant, Bahria International Hospital Orchard, Lahore, Pakistan
| | - Qian Lu
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Antonio Castaldi
- Department of Digestive Surgery and Liver Transplant Unit, University Côte d'Azur, CHU de Nice, Nice, France
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Beat Moeckli
- Division of Abdominal and Transplantation Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Teresa Abadía
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Ruffolo
- Department of HPB and Transplant Surgery, University of Rochester, Rochester, NY
| | - Josefina Dib Hasan
- Transplant Unit, Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| | - Francesca Ratti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | | | - Roeland F de Wilde
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wojciech G Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Lucas McCormack
- Transplant Unit, Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| | | | - Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Christian Toso
- Division of Abdominal and Transplantation Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Jean Gugenheim
- Department of Digestive Surgery and Liver Transplant Unit, University Côte d'Azur, CHU de Nice, Nice, France
| | - Jiahong Dong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Faisal Hanif
- Department of HPB and Liver Transplant, Bahria International Hospital Orchard, Lahore, Pakistan
| | - Joon Seong Park
- Department of Surgery, Division of HBP Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - José M Ramia
- Department of Surgery, HPB and Transplant Unit, General Universitary Hospital Alicante and Health and Biomedical Research Institute of Alicante, Alicante, Spain
| | - Myron Schwartz
- Department of Surgery, Division of HPB Service, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Diego Ramisch
- General Surgery Department Liver, Pancreas and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Michelle L De Oliveira
- Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Karl J Oldhafer
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Koo Jeong Kang
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, Republic of Korea
| | - Matteo Cescon
- Hepato-biliary surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Peter Lodge
- Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - John-Edwin Thomson
- Hepatobiliary Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide & Hepatobiliary Unit, Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Su Kah Goh
- Hepatobiliary Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide & Hepatobiliary Unit, Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - William C Chapman
- Department of Surgery, Section of Abdominal Organ Transplant, Washington University School of Medicine, St Louis, MO
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Juan Pekolj
- Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jean-Marc Regimbeau
- Department of Oncology and Digestive Surgery, CHU Amiens-Picardie, Amiens, France
| | - Olivier Scatton
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière, Sorbonne Université, Centre de Recherche de Saint-Antoine, Paris, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany
| | - David Fuks
- Department of Hepatobiliary, Digestive and Endocrine Surgery, Cochin Hospital, Paris Cité University, Paris, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospital, Strasbourg University, Strasbourg, France
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Irinel Popescu
- Department of Surgery and Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris Cité, Clichy, France
| | - René Adam
- Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France
| | - Hugo Pinto-Marques
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University Warsaw, Warsaw, Poland
| | - Henrik Petrowsky
- Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Tomoki Ebata
- Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Andreas Prachalias
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | | | - Pierre-Alain Clavien
- Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Ramia JM. How to select a journal for your research. World J Gastroenterol 2023; 29:3379-3384. [PMID: 37377587 PMCID: PMC10292146 DOI: 10.3748/wjg.v29.i21.3379] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/19/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
Publication in a peer-reviewed journal is the goal of any research project. One of the most important (and possibly the least understood) aspects of the publication process is the choice of a suitable journal that is likely to accept your work. Detailed information and tips and tricks to success are given in this editorial.
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Affiliation(s)
- José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante 03010, Spain
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Lluís N, Carbonell S, Villodre C, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F. Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes. Int J Surg 2023; 109:1603-1611. [PMID: 37060247 PMCID: PMC10389196 DOI: 10.1097/js9.0000000000000384] [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: 08/30/2022] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. METHODS Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. RESULTS The study included 2 645 patients with acute appendicitis [32 years (22-51), 44.3% women], 1 182 with acute cholecystitis [65 years (48-76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50-76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2-4); lap, 2 days (1-4); P <0.001], acute cholecystitis [open, 7 days (4-12); lap, 4 days (3-6); P <0.001], and gastrointestinal tract perforation [open, 11 days (7-17); lap, 6 days (5-8.5); P <0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P <0.001), acute cholecystitis (open, 41%; lap, 21.7%; P <0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P <0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P =0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P =0.013). CONCLUSIONS This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.
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Affiliation(s)
- Núria Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL
| | - Silvia Carbonell
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Celia Villodre
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Pedro Zapater
- Clinical Pharmacology
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Miguel Cantó
- Institute for Health and Biomedical Research of Alicante, ISABIAL
- Computing, BomhardIP, Alicante, Spain
| | - Luís Mena
- Clinical Documentation, Dr. Balmis General University Hospital
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - José M. Ramia
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Félix Lluís
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
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11
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Lluís N, Serradilla-Martín M, Achalandabaso M, Jehaes F, Dasari BV, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJ, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Alsammani M, Detry O, Domingo-del Pozo C, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Cauchy F, Prieto-Calvo M, D’Souza MA, Spiers HV, van den Heuvel MC, Charco R, Lesurtel M, Ramia JM. Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study). Int J Surg 2023; 109:760-771. [PMID: 36917142 PMCID: PMC10389541 DOI: 10.1097/js9.0000000000000280] [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: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND/PURPOSE Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. METHODS A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. RESULTS A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival. CONCLUSIONS Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - François Jehaes
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V.M. Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Ernesto Sparrelid
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Frederik J.H. Hoogwater
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria J. Amaral
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra
- Faculty of Medicine, University of Coimbra, Coimbra
| | - Bodil Andersson
- Department of Surgery, Lund University
- Skane University Hospital, Lund
| | - Frederik Berrevoet
- Department of General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, Besancon
| | - Víctor López-López
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Murcia
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F. Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B. Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, Bloemfontein
| | - Donzília Sousa-Silva
- Department of Surgery, HEBIPA – Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Enrique Toledo-Martínez
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - George N. Tzimas
- Hepatobiliary Surgery Department, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- Department of HPB Surgery, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao
| | - Melroy A. D’Souza
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Harry V.M. Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Marius C. van den Heuvel
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - José M. Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
- Miguel Hernández University, Alicante
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Jaén-Torrejimeno I, Ramia JM, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Textbook outcome in the surgical treatment of liver hydatid cyst. Surgery 2023; 173:429-434. [PMID: 36334979 DOI: 10.1016/j.surg.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Textbook outcome is a composite measure used in surgery to define the ideal postoperative period and to assess the quality of care. The aim of this study was to analyze the incidence of textbook outcome and the factors independently associated with its achievement following surgical treatment of liver hydatid cysts. METHODS Retrospective cohort study of patients operated on for liver hydatid cysts between January 2006 and December 2021. Textbook outcome was achieved when all the following criteria were fulfilled: no mortality within 90 days, no major complications within 90 days, no hospital readmission within 90 days, and no prolonged hospital stay. Univariable and multivariable analyses were performed to identify factors associated with textbook outcome. RESULTS During the study period, 296 patients underwent surgery. Textbook outcome was recorded in 65.9% (195/296). Female gender (odds ratio 2.02; P = .010), noncomplicated cyst (odds ratio 3.97, P < .001), and radical surgery (odds ratio 2.26, P = .003) were the variables associated with a higher probability of achieving textbook outcome. CONCLUSION Textbook outcome may be a useful measure to assess the variations in surgical management between different centers, and to improve quality of care after liver hydatid cysts resection.
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Affiliation(s)
| | - José M Ramia
- Department of Surgery, Hospital Universitario de Alicante, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain; Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain; Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud
| | - Noelia De-Armas-Conde
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud; Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain.
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Ramia JM, Cabello A, Garijo J, Hernandez-Salvan J, Herrero B, Jover JM, Vaquero MA, Unda A, Jimenez A, Martinez-Meco L, Nicolas S, Sanchez-Cabezudo F, Alvarez E, Torres J. Benefica chirurgia. A global surgery project focusing on hernia surgery. Surgeon 2022; 20:309-313. [PMID: 34483056 DOI: 10.1016/j.surge.2021.08.002] [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: 05/27/2021] [Revised: 06/19/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital Universitario de Alicante, ISABIAL, Alicante, Spain.
| | - A Cabello
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - J Garijo
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Hernandez-Salvan
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - B Herrero
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - J M Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Spain
| | - M A Vaquero
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Unda
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - A Jimenez
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - Laura Martinez-Meco
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - S Nicolas
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - F Sanchez-Cabezudo
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain
| | - E Alvarez
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Torres
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain; President of Benefica Chirugia, Spain
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Llopis-Torremocha C, Rodríguez-Laiz G, Sevila-Micó S, Campo-Betancourth CF, Ramia JM. Retroperitoneal calcifying fibrous tumor involving the inferior vena cava. Cir Esp 2022; 100:595-597. [PMID: 35697240 DOI: 10.1016/j.cireng.2022.06.020] [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: 03/02/2021] [Accepted: 08/02/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Clara Llopis-Torremocha
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain.
| | - Gonzalo Rodríguez-Laiz
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Sevila-Micó
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
| | - Carlos Felipe Campo-Betancourth
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
| | - José M Ramia
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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15
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Lluís N, Parra J, Villodre C, Zapater P, Jalali A, Cantó M, Mena L, Ramia JM, Lluís F. Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide. Int J Surg 2022; 104:106741. [PMID: 35772594 DOI: 10.1016/j.ijsu.2022.106741] [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: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.
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Affiliation(s)
- N Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - J Parra
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - C Villodre
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - A Jalali
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Manuel-Vázquez A, Latorre-Fragua R, Alcázar C, Requena PM, de la Plaza R, Blanco Fernández G, Serradilla-Martín M, Ramia JM. Reaching a consensus on the definition of "difficult" cholecystectomy among Spanish experts. A Delphi project. A qualitative study. Int J Surg 2022; 102:106649. [PMID: 35525412 DOI: 10.1016/j.ijsu.2022.106649] [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: 12/07/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Being able to predict preoperatively the difficulty of a cholecystectomy can increase safety and improve results. However, there is a need to reach a consensus on the definition of a cholecystectomy as "difficult". The aim of this study is to achieve a national expert consensus on this issue. METHODS A two-round Delphi study was performed. Based on the previous literature, history of biliary pathology, preoperative clinical, analytical, and radiological data, and intraoperative findings were selected as variables of interest and rated on a Likert scale. Inter-rater agreement was defined as "unanimous" when 100% of the participants gave an item the same rating on the Likert scale; as "consensus" when ≥80% agreed; as "majority" when the agreement was ≥70%. The delta of change between the two rounds was calculated. RESULTS After the two rounds, the criteria that reached "consensus" were bile duct injury (96.77%), non-evident anatomy (93.55%), Mirizzi syndrome (93.55%), severe inflammation of Calot's triangle (90.32%), conversion to laparotomy (87.10%), time since last acute cholecystitis (83.87%), scleroatrophic gallbladder (80.65%) and pericholecystic abscess (80.65%). CONCLUSION The ability to predict difficulty in cholecystectomy offers important advantages in terms of surgical safety. As a preliminary step, the items that define a surgical procedure as difficult should be established. Standardization of the criteria can provide scores to predict difficulty both preoperatively and intraoperatively, and thus allow the comparison of groups of similar difficulty.
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Affiliation(s)
| | | | | | | | | | | | | | - J M Ramia
- Hospital General Universitario de Alicante, Spain
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17
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Rodríguez-Laiz G, Melgar P, Bolufer S, Navarro Martínez J, Ramia JM. Liver and lung hydatid cysts with transdiaphragmatic rupture treated by radical surgery. Ann R Coll Surg Engl 2022; 104:e125-e127. [PMID: 34931529 DOI: 10.1308/rcsann.2021.0183] [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] [Indexed: 02/05/2023] Open
Abstract
Hydatidosis is a parasitic disease caused by Echinococcus granulosus, a tapeworm that is endemic in certain parts of the world. We present a case of hepatopulmonary hydatidosis with diaphragm involvement and close contact with the suprahepatic inferior vena cava treated with radical surgery. We discuss therapeutical surgical options (approach and type of surgery).
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Affiliation(s)
- G Rodríguez-Laiz
- Hospital General Universitario de Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain
| | - P Melgar
- Hospital General Universitario de Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain
| | - S Bolufer
- Hospital General Universitario de Alicante, Spain
| | | | - J M Ramia
- Hospital General Universitario de Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain
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Llopis Torremocha C, Rodríguez Laiz G, Alcázar C, Lluis F, Ramia JM. Metastatic choriocarcinoma involving the duodenum. Gastroenterol Hepatol 2022; 45 Suppl 1:43-44. [PMID: 33545246 DOI: 10.1016/j.gastrohep.2020.11.019] [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] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Clara Llopis Torremocha
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Gonzalo Rodríguez Laiz
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España.
| | - Cándido Alcázar
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - Félix Lluis
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - José M Ramia
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
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Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
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Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Blanco-Fernández G, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Rojas-Holguín A. Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID). Eur J Surg Oncol 2022; 48:133-141. [PMID: 34417061 DOI: 10.1016/j.ejso.2021.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/01/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain.
| | | | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- Department of Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitariode Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
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Llopis-Torremocha C, Rodríguez-Laiz G, Sevila-Micó S, Campo-Betancourth CF, Ramia JM. Retroperitoneal calcifying fibrous tumor involving the inferior vena cava. Cir Esp 2021; 100:S0009-739X(21)00248-7. [PMID: 34493376 DOI: 10.1016/j.ciresp.2021.08.001] [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] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/31/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Clara Llopis-Torremocha
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital General Universitario de Alicante, Alicante, España.
| | - Gonzalo Rodríguez-Laiz
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Silvia Sevila-Micó
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital General Universitario de Alicante, Alicante, España
| | - Carlos Felipe Campo-Betancourth
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital General Universitario de Alicante, Alicante, España
| | - José M Ramia
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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22
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Gemio del Rey IA, López Marcano AJ, Medina Velasco AA, de la Plaza Llamas R, Ramia JM. Giant ischiorectal lipoma as a cause of anal pain, fecal incontinence and dyspareunia. An exceptional association. Rev Argent Cir 2021. [DOI: 10.25132/raac.v113.n3.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lipomas account for 50% of soft-tissue tumors and may compress adjacent structures. We report the case of a 49-year-old female patient with intense anal pain associated with defecation urgency, tenesmus, incontinence and dyspareunia. A soft tumor was present in the right buttock suggestive of lipoma. On magnetic resonance imaging an apparently encapsulated mass with a size of 15.7 × 9 × 6 cm was identified extending through the ischioanal fossa and ischiorectal fossa, displacing the levator ani muscle and rectum. The lesion was excised en bloc and the patient was discharged 48 hours later without complications. The pathology report concluded that the lesion corresponded to a lipoma. We performed a bibliographic search in PubMed to assess the association between lipoma and fecal incontinence; Of the 87 articles retrieved, none of them responded to the subject of the study. These symptoms are exceptional in the literature. The diagnosis is made mainly with magnetic resonance imaging and endoscopic ultrasound. An excellent functional outcome was achieved with surgical excision.
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Engstrand J, Abreu de Carvalho LF, Aghayan D, Balakrishnan A, Belli A, Björnsson B, Dasari BVM, Detry O, Di Martino M, Edwin B, Erdmann J, Fristedt R, Fusai G, Gimenez-Maurel T, Hemmingsson O, Hidalgo Salinas C, Isaksson B, Ivanecz A, Izzo F, Knoefel WT, Kron P, Lehwald-Tywuschik N, Lesurtel M, Lodge JPA, Machairas N, Marino MV, Martin V, Paterson A, Rystedt J, Sandström P, Serrablo A, Siriwardena AK, Taflin H, van Gulik TM, Yaqub S, Özden I, Ramia JM, Sturesson C. Liver resection and ablation for squamous cell carcinoma liver metastases. BJS Open 2021; 5:6356812. [PMID: 34426830 PMCID: PMC8382975 DOI: 10.1093/bjsopen/zrab060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
Background Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). Method Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. Results Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). Conclusion Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.
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Affiliation(s)
- J Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - L F Abreu de Carvalho
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Aghayan
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - A Balakrishnan
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Belli
- Department of Abdominal Oncology, HPB Surgical Oncology Unit, National Cancer Institute, Fondazione G. Pascale-IRCCS, Naples, Italy
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - B V M Dasari
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - O Detry
- Department of Abdominal Surgery and Transplantation, CHU Liège, Liège, Belgium
| | - M Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - B Edwin
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - J Erdmann
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - R Fristedt
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Fusai
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - T Gimenez-Maurel
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - O Hemmingsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - C Hidalgo Salinas
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - B Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - A Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - F Izzo
- Department of Abdominal Oncology, HPB Surgical Oncology Unit, National Cancer Institute, Fondazione G. Pascale-IRCCS, Naples, Italy
| | - W T Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - P Kron
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Lehwald-Tywuschik
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - J P A Lodge
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo (PA), Abano, Italy.,General Surgery Department, Policlinico Abano Terme, Abano, Italy
| | - V Martin
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - A Paterson
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Rystedt
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - A K Siriwardena
- Hepatobiliary Surgery Unit, Manchester Royal Infirmary, Manchester, UK
| | - H Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - S Yaqub
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - I Özden
- Department of General Surgery, Istanbul University School of Medicine, Istanbul, Turkey
| | - J M Ramia
- Hospital General Universitario de Alicante. ISABIAL Alicante, Spain
| | - C Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Ramia JM, de Vicente E, Pardo F, Sabater L, Lopez-Ben S, Quijano Y, Villegas T, Blanco-Fernandez G, Diez-Valladares L, Lopez-Rojo I, Martin-Perez E, Pereira F, Gonzalez AJ, Herrera J, García-Domingo MI, Serradilla M. Spanish multicenter study of surgical resection of pancreatic tumors infiltrating the celiac axis: does the type of pancreatectomy affect results? Clin Transl Oncol 2021; 23:318-324. [PMID: 32592157 DOI: 10.1007/s12094-020-02423-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates. METHODS Observational retrospective multicenter study. INCLUSION CRITERIA patient undergoing TP, PD or DP plus CAR for a pancreatic cancer. RESULTS Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups. CONCLUSION It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Pintor Baeza, 11, 03010, Alacant, Alacant, Spain.
| | - E de Vicente
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - F Pardo
- Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain
| | - L Sabater
- Department of Surgery, Hospital Clínico, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - S Lopez-Ben
- Department of Surgery, Hospital Josep Trueta, Girona, Spain
| | - Y Quijano
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - T Villegas
- Department of Surgery, Hospital Virgen de las Nieves, Granada, Spain
| | - G Blanco-Fernandez
- Department of Surgery, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - L Diez-Valladares
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - I Lopez-Rojo
- Department of Surgery, Fundación Jimenez Diaz, Madrid, Spain
| | - E Martin-Perez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - F Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - A J Gonzalez
- Department of Surgery, Hospital Quirón Málaga, Malaga, Spain
| | - J Herrera
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - M Serradilla
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Abstract
INTRODUCTION Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. METHODS A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. RESULTS A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. CONCLUSION This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain.
| | - Daniel A Díaz Candelas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain
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de la Fuente-Aguilar V, Beneitez-Mascaraque P, Bergua-Arroyo S, Fernández-Riesgo M, Camón-García I, Cruza-Aguilera I, Ugarte-Yáñez K, Ramia JM. Hydatidosis and the duodenum: A systematic review of the literature. World J Meta-Anal 2020; 8:265-274. [DOI: 10.13105/wjma.v8.i3.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/15/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Injury to the duodenum (fistula formation, compression, or other complications) by a hydatid cyst (HC) is an exceptional complication.
AIM To perform a systematic review of the literature on the fistulization of HC in the duodenum.
METHODS Following PRISMA guidelines, a search for HC with duodenal involvement was carried out in the databases of PubMed, SCielo and EMBASE without time limits.
RESULTS Fourteen patients were identified, seven men and seven women, with a mean age of 53.14 years (SD = 17.65, range: 28-78). Three out of the 14 (21%) had HC relapse. The most frequent clinical manifestations were abdominal pain and nausea and/or vomiting. Various imaging studies were performed in almost all cases, the most commonly used being abdominal computed tomography (10/14, 71%). A range of surgical techniques were reported, most frequently HC drainage (41%) and enucleations (16%). Ten of the 14 patients had no complications and one patient died. The follow-up period and recurrences could not be determined.
CONCLUSION The most frequent symptoms were abdominal pain, nausea and vomiting. Computed tomography was the most used diagnostic imaging technique, and HC drainage and fistula closure via laparotomy was the most frequent treatment. However, all diagnostic and therapeutic options for HC fistulizing the duodenum had a low level of evidence.
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Affiliation(s)
| | | | | | | | - Irene Camón-García
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
| | | | | | - José M Ramia
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante and Institute for Health and Biomedical Research (ISABIAL) Alicante 03010, Spain
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De la Plaza Llamas R, Ramia JM. Cost of postoperative complications: How to avoid calculation errors. World J Gastroenterol 2020; 26:2682-2690. [PMID: 32550746 PMCID: PMC7284181 DOI: 10.3748/wjg.v26.i21.2682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/27/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients’ clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.
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Affiliation(s)
- Roberto De la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
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Gasz A, Danko J, Straka M, Ilic L, M Ramia J. Laparoscopic partial resection of retroperitoneal extramedullary plasmacytoma. Cir Esp 2020; 98:299-301. [PMID: 31610880 DOI: 10.1016/j.ciresp.2019.08.003] [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: 04/17/2019] [Revised: 05/29/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Andrzej Gasz
- Allgemein Öffentliches Ladislaus Betthyany Strattmann Krankenhaus Kittsee, Kittsee, Austria; Hospital Universitario de Guadalajara, Guadalajara, España, Universidad de Alcalá.
| | - Jan Danko
- Allgemein Öffentliches Ladislaus Betthyany Strattmann Krankenhaus Kittsee, Kittsee, Austria; Hospital Universitario de Guadalajara, Guadalajara, España, Universidad de Alcalá
| | - Maros Straka
- Allgemein Öffentliches Ladislaus Betthyany Strattmann Krankenhaus Kittsee, Kittsee, Austria; Hospital Universitario de Guadalajara, Guadalajara, España, Universidad de Alcalá
| | - Lazo Ilic
- Allgemein Öffentliches Ladislaus Betthyany Strattmann Krankenhaus Kittsee, Kittsee, Austria; Hospital Universitario de Guadalajara, Guadalajara, España, Universidad de Alcalá
| | - José M Ramia
- Allgemein Öffentliches Ladislaus Betthyany Strattmann Krankenhaus Kittsee, Kittsee, Austria; Hospital Universitario de Guadalajara, Guadalajara, España, Universidad de Alcalá
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Latatu-Córdoba MÁ, Ruiz-Blanco S, Sanchez M, Santiago-Boyero C, Soto-García P, Sun W, Ramia JM. Hydatid cyst of the colon: A systematic review of the literature. World J Clin Cases 2019; 7:1634-1642. [PMID: 31367622 PMCID: PMC6658375 DOI: 10.12998/wjcc.v7.i13.1634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary hydatid disease in the colon is an extremely rare finding. We performed a systematic review of cases of hydatidosis of the colon published to date.
AIM To systematic review the published papers about hydatidosis of the colon.
METHODS Following PRISMA guidelines, we performed an unlimited search for articles on CH in the MEDLINE (PubMed), EMBASE, Cochrane, Latindex and Scielo databases, published in English, Spanish, French, German or Italian between January 1, 1960 and December 15, 2018. The search items were: (Colon) AND [(hydatidosis) OR (hydatid disease) OR (echinococcosis)].
RESULTS Nine case reports were found [five men, four women, median age 64.55 years (range: 21-81)]. The most frequent clinical manifestation was abdominal pain (8/9) (88.9%). In almost all cases several image studies were carried out, but abdominal computed tomography was the most used (66.7%). Five resections of the colon (62.5%) and three sutures of the fistula between cyst and colon (37.5%) were performed. Four patients did not present post-operative complications, but one died. Postoperative period was recorded for a mean period of 35 months. No recurrences were recorded.
CONCLUSION The most frequent symptom was abdominal pain (evidence level 4). Computed tomography was the most frequently used diagnostic imaging technique (evidence level 4). Colectomy was the most appropriate treatment (evidence level 5). All the diagnostic and therapeutic options for hydatid cysts located in colon have a low level of evidence.
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Affiliation(s)
| | - Sergio Ruiz-Blanco
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
| | - Matilde Sanchez
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
| | | | - Paula Soto-García
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
| | - Wenzhong Sun
- Faculty of Medicine, Universidad of Alcalá, Alcalá de Henares 28801, Spain
| | - José M Ramia
- Servicio de Cirugía Generaly del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
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De la Plaza Llamas R, Ramia JM. Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator. World J Gastroenterol 2019; 25:2833-2838. [PMID: 31249442 PMCID: PMC6589738 DOI: 10.3748/wjg.v25.i23.2833] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/11/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications. However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently, two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0 (no complications) to 100 (patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.
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Affiliation(s)
- Roberto De la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
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Ramia JM, De-la-Plaza R, Manuel-Vazquez A, Lopez-Marcano A, Morales R. Systematic review of the mesopancreas: concept and clinical implications. Clin Transl Oncol 2018; 20:1385-1391. [PMID: 29675778 DOI: 10.1007/s12094-018-1869-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/21/2018] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 2007, Gockel et al. coined the term mesopancreas (MP). In the next 10 years, a limited number of publications about MP have been published, but little is known about the oncological benefit of MP resection. We performed a systematic review of the literature on MP. METHODS An electronic search was performed in PubMed, EMBASE, Cochrane, Latindex, Scielo, and Koreamed databases until 15 June 2017 to identify all published articles dealing with the subject of MP. Some language restriction was done (Chinese and Rumanian). RESULTS The search yielded 51 articles; 28 articles were selected as relevant. All were retrospective studies focused more on describing technical variants, feasibility and safety than on the cancer results. The R0 rate in patients with MP resection ranged between 57 and 96.7%. In all the articles with a control group, the R0 rate was higher in the MP excision group. Survival data were explicitly stated only in five series. CONCLUSION MP is a difficult-to-excise retropancreatic area. In theory, it is agreed that MP excision raises the rate of R0 resections, which in turn reflected in an improvement in the oncological results; however, at present there are no randomized studies to prove this. Achieving a worldwide consensus on its concept, landmarks, excision technique and oncological results is essential.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain.
| | - R De-la-Plaza
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain
| | - A Manuel-Vazquez
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain
| | - A Lopez-Marcano
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain
| | - R Morales
- Department of Surgery, Hospital Son Espases, Palma de Mallorca, Spain
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Ramia JM, de la Plaza Llamas R, López-Marcano AJ, Valenzuela Torres JDC, García Gil JM. Laparoscopic partial splenectomy for a splenic epidermoid cyst. Cir Esp 2017; 95:613-615. [PMID: 28410628 DOI: 10.1016/j.ciresp.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/05/2017] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza Llamas
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Aylhin Joana López-Marcano
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Del Carmen Valenzuela Torres
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Manuel García Gil
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Ramia JM, Baquedano Rodríguez J, Alonso S, Fernandez-Bueno F, de la Plaza R. Malignant liver adenoma in men: report of 2 cases. Gastroenterol Hepatol 2017; 40:91-93. [PMID: 26952580 DOI: 10.1016/j.gastrohep.2016.01.005] [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] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/09/2016] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, España.
| | | | - Soledad Alonso
- Servicio de Anatomía Patológica, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Fernando Fernandez-Bueno
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Roberto de la Plaza
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, España
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Sabater L, Ausania F, Bakker OJ, Boadas J, Domínguez-Muñoz JE, Falconi M, Fernández-Cruz L, Frulloni L, González-Sánchez V, Lariño-Noia J, Lindkvist B, Lluís F, Morera-Ocón F, Martín-Pérez E, Marra-López C, Moya-Herraiz Á, Neoptolemos JP, Pascual I, Pérez-Aisa Á, Pezzilli R, Ramia JM, Sánchez B, Molero X, Ruiz-Montesinos I, Vaquero EC, de-Madaria E. Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery. Ann Surg 2016; 264:949-958. [PMID: 27045859 DOI: 10.1097/sla.0000000000001732] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. RESULTS These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. CONCLUSIONS EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
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Affiliation(s)
- Luis Sabater
- *Department of Surgery, Hospital Clinico, University of Valencia, Valencia, Spain †Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain ‡Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands §Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Spain ¶Department of Gastroenterology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain ||Department of Surgery, Università Vita e Salute, Ospedale San Raffaele IRCCS, Milano, Italy **Department of Surgery, Institut de Malalties Digestives I Metabòliques, Hospital Clínic, IDIBAPS, Barcelona, Spain ††Department of Medicine, Pancreas Center, University of Verona, Verona, Italy ‡‡Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. §§Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ¶¶Department of Surgery, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. ||||Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain ***Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain †††Unidad de Cirugía Hepato-bilio-pancreática y Trasplante, Hospital Universitari i Politecnic. La Fe, Valencia, Spain ‡‡‡NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK §§§Department of Gastroenterology, Hospital Clinico, University of Valencia, Valencia, Spain ¶¶¶Unit of Digestive Disease, Agencia Sanitaria Costa del Sol, Marbella, Málaga ||||||Department Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy ****Department of Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain ††††Department of HPB Surgery and Liver Transplantation, Hospital Carlos Haya, Malaga, Spain ‡‡‡‡Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain §§§§Department of Digestive Surgery- Division of HBP Surgery, Hospital Universitario Donostia, San Sebastián, Spain ¶¶¶¶Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, IDIBAPS, CiberEHD, Barcelona, Spain ||||||||Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Belén Pérez Mies
- Servicio de Anatomía Patológica, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Vladimir Arteaga
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Jorge García-Parreño
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Ramia JM, de la Plaza R, Benito C, Quiñones JE, García-Parreño J. Severe Liver Trauma and Diaphragmatic Rupture in a Bull Running Event. Cir Esp 2015; 93:350-2. [PMID: 24439512 DOI: 10.1016/j.ciresp.2013.01.022] [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: 08/07/2012] [Revised: 01/19/2013] [Accepted: 01/31/2013] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Carmen Benito
- Unidad de Cuidados Intensivos, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José E Quiñones
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Jorge García-Parreño
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Ramia JM, Garrote D, Muffak K, Villegas T, Ferrón A. Carcinoid tumor of the extrahepatic bile duct in an adolescent: prolonged disease-free survival after surgical resection. Cir Esp 2014; 92:636-8. [PMID: 23768505 DOI: 10.1016/j.ciresp.2013.01.017] [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: 01/11/2013] [Accepted: 01/21/2013] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Daniel Garrote
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital Virgen de las Nieves, Granada, España
| | - Karim Muffak
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital Virgen de las Nieves, Granada, España
| | - Trinidad Villegas
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital Virgen de las Nieves, Granada, España
| | - Antonio Ferrón
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital Virgen de las Nieves, Granada, España
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Ramia JM, Serrablo A, De la Plaza R, Esarte J, Gijón L, Sarria L, Figueras J, García-Parreño J. Is radical surgery feasible in liver hydatid cysts in contact with the inferior vena cava? World J Surg 2014; 38:2940-5. [PMID: 24889413 DOI: 10.1007/s00268-014-2658-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cysts in contact with the inferior vena cava (IVC) represent a challenge for hepato-pancreatico-biliary surgeons. Although the literature on the topic is scarce, the most widely accepted approach is conservative surgery. Partial cyst resection is recommended, because radical resection is considered a high-risk procedure. STUDY DESIGN This was a retrospective study over the period January 2007-December 2012. We operated on 103 patients with liver hydatidosis. A total of 32 patients (31 %) had a liver cyst in contact with the IVC. We proposed a cyst classification based on location of the cyst and length of contact and degrees of involvement of the IVC. RESULTS Median size of the contacting cyst measured by computed tomography (CT) was 12 cm. On CT, median length of contact with the IVC was 37 mm. The median degree of involvement was 90°. Radical surgery was performed in 20 patients (62.5 %). No IVC resection was done. Morbidity rate was 28 %, and mortality was 3 %. In follow-up (median 27 months), no relapses or problems related to IVC flow were detected. Postoperative stay and transfusion rate were higher in the conservative surgery group, but these patients presented fewer complications. There was no relationship between circumferential grades and length of contact with the IVC and the type of surgery performed. CONCLUSIONS Liver hydatid cysts in contact with the IVC are large cysts usually located in the right liver. They do not normally cause clinical symptoms related to IVC contact. Radical surgery is feasible, and was performed in 60 % of our series, but it is technically demanding. We propose a classification of cysts in contact with the IVC.
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Affiliation(s)
- J M Ramia
- Hepato-Bilio-Pancreatic Surgical Unit, Department of Surgery, Guadalajara University Hospital, C/General Moscardó 26, 5-1, 28020, Guadalajara, Madrid, Spain,
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Moreno P, de la Quintana Basarrate A, Musholt TJ, Paunovic I, Puccini M, Vidal O, Ortega J, Kraimps JL, Bollo Arocena E, Rodríguez JM, González López O, Del Pozo CD, Iacobone M, Veloso E, Del Pino JM, García Sanz I, Scott-Coombes D, Villar-Del-Moral J, Rodríguez JI, Vázquez Echarri J, González Sánchez C, Gutiérrez Rodríguez MT, Escoresca I, Nuño Vázquez-Garza J, Tobalina Aguirrezábal E, Martín J, Candel Arenas MF, Lorenz K, Martos JM, Ramia JM. Adrenalectomy for solid tumor metastases: results of a multicenter European study. Surgery 2013; 154:1215-22; discussion 1222-3. [PMID: 24238044 DOI: 10.1016/j.surg.2013.06.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [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: 02/28/2013] [Accepted: 06/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers. METHODS Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible. RESULTS Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69-33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs. 23 months; P = .038). CONCLUSION Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.
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Affiliation(s)
- Pablo Moreno
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Affiliation(s)
- J M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, C/General Moscardó 26, 5-1, 28020 Madrid, Spain.
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Ramia JM, de la Plaza R, Quiñones JE, Veguillas P, Adel F, García-Parreño J. [Gastroenteric reconstruction route after pancreaticoduodenectomy: antecolic versus retrocolic]. Cir Esp 2013; 91:211-6. [PMID: 23452819 DOI: 10.1016/j.ciresp.2013.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/20/2012] [Revised: 12/20/2012] [Accepted: 01/11/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Delayed gastric emptying (DGE) is a relatively common complication after cephalic pancreaticoduodenectomy (CPD). Its origin is not very clear, and it is believed that its appearance is due to multiple factors (hormones, appearance of other complications, particularly pancreatic fistulas, and the surgical technique). Among the technical aspects associated with DGE, it has been proposed that the route of gastroenteric reconstruction (antecolic or retrocolic) could have an effect on its incidence. MATERIAL AND METHODS A systemic review was made of the literature, searching for articles that compared both reconstruction routes after CPD, finding only 11 articles: 4 randomised clinical trials, one prospective study, and 6 retrospective studies. A meta-analysis could not be performed on them, due to the large methodological differences between them. RESULTS In the 4 randomised studies, 2 were in favour of the antecolic route, and 2 did not observe any differences between either of them. The antecolic route obtained a much lower DGE rate than the retrocolic one in the only prospective study. In 4 of the retrospective studies the antecolic route obtained a very low rate. The results of both routes were similar in another 2 retrospective studies, with the retrocolic route slightly better in one of them. CONCLUSIONS Using the published literature, the gastric reconstruction route associated with less DGE after CPD cannot currently be determined.
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
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Ramia JM, García-Bracamonte B, de la Plaza R, Ortiz P, García-Parreño J, Vanaclocha F. [Surgical treatment of melanoma liver metastases]. Cir Esp 2013; 91:4-8. [PMID: 23219418 DOI: 10.1016/j.ciresp.2012.10.002] [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: 02/23/2012] [Revised: 10/05/2012] [Accepted: 10/16/2012] [Indexed: 02/07/2023]
Abstract
The appearance of liver metastases during the follow-up of a patient with a skin melanoma has classically been considered a sign of a very poor prognosis. There are limited therapeutic options, since these lesions are non-resectable and form part of a disseminated disease in several organs. In certain cases, in those where the disease is restricted to the liver or accompanied by a resectable extra-hepatic disease, hepatectomy can be useful, obtaining acceptable survivals of about 25% at 5 years, although hepatic or skin recurrence is usually early. The limited number of patient cases published, the absence of randomised studies, and the heterogeneity of the series, makes it difficult to reach conclusions to be able to recommend which patients may benefit from liver resection, with an acceptable level of scientific evidence, and thus define its real usefulness. There are also no action plans defined as to when and what type of adjuvant therapy we should use.
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
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Ramia JM, Figueras J, de la Plaza R, García-Parreño J. [Resection of liver metastases in patients with extrahepatic disease]. Cir Esp 2012; 90:483-9. [PMID: 22682358 DOI: 10.1016/j.ciresp.2012.01.010] [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: 08/17/2011] [Revised: 11/22/2011] [Accepted: 01/05/2012] [Indexed: 02/07/2023]
Abstract
Patients who have liver metastasis and extrahepatic metastatic disease (EMD) have been considered as a patient subgroup with a very poor prognosis. Therefore, the presence of EMD was traditionally considered a contraindication for liver resection. But, survivals of around 30% at 5 years, and higher than that achieved with chemotherapy only obtained in some patients with liver metastasis of colorectal origin and EMD who had a resection performed on the hepatic and extrahepatic disease, obliges us to re-think what we must do in these patients. We have carried out an exhaustive review of the literature in an attempt to establish some working guidelines based on current scientific evidence. In summary, we can say that the presence of resectable EMD in patients with liver metastasis must not be considered as an absolute contraindication for liver resection, although the results are inferior to those obtained in patients without EMD. Patients with EMD localised in the ganglia of the coeliac trunk or aorto-cava have a short survival. The use of chemotherapy prior to the surgery is recommended to operate stable patients, or who respond to the chemotherapy and not in progression.
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
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Ramia JM, Figueras J, De la Plaza R, García-Parreño J. Cysto-biliary communication in liver hydatidosis. Langenbecks Arch Surg 2012; 397:881-7. [PMID: 22374106 DOI: 10.1007/s00423-012-0926-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 01/03/2012] [Accepted: 02/13/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver hydatidosis is a severe health problem in endemic areas. Due to migration from these countries to other zones, now it is a worldwide problem. Liver hydatidosis can provoke many complications (abscess, fistula to adjacent organs, migration, etc.), but the most frequent and one of the most severe complication is the communication between the cyst and the biliary tree. AIM The aim of this study is to perform a review on the epidemiology, clinical features, diagnostic methods, and therapeutic options to treat the communication between the cyst and the biliary tree. RESULTS Due to the lack of randomized clinical trial or meta-analysis on this topic, we performed a classical review and included our personal algorithm. CONCLUSIONS The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. The percentage of patients with the communication between the cyst and the biliary tree is not well known because there is no accepted definition. The therapeutic options are multiple and related to the size of the communication, the location of the cyst, and the experience of the hepatobiliary surgeon. ERCP is now an important tool for the treatment of the communication between the cyst and the biliary tree.
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Affiliation(s)
- J M Ramia
- Hepato-Bilio-Pancreatic Surgical Unit, Department of Surgery, Guadalajara University Hospital, Guadalajara, Spain.
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Ramia JM, de la Plaza R, Quiñones-Sampedro JE, Ramiro C, Veguillas P, García-Parreño J. Walled-off pancreatic necrosis. Neth J Med 2012; 70:168-71. [PMID: 22641624 DOI: pmid/22641624] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute severe pancreatitits may be complicated by the development of 'walled-off pancreatic necrosis' (WOPN), which is characterised by a mixture of solid components and fluids on imaging studies as a consequence of organised pancreatic tissue necrosis. We present here an overview of the definition, clinical features, and diagnostic and therapeutic management of this clinical condition, which is mostly based on consensus as adequate clinical trials are lacking.
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Affiliation(s)
- J M Ramia
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital of Guadalajar, Guadalajara, Spain.
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Ramia JM, Villar J, Castaño J, Nogueras F, Mansilla A, Martín-Vivaldi R, Garrote D, Ferron JA. [Central pontine myelinolysis after liver transplantation]. Cir Esp 2006; 80:411-2. [PMID: 17192230 DOI: 10.1016/s0009-739x(06)70999-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up.
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Affiliation(s)
- J M Ramia
- Unidad de Cirugía Hepatobiliopancreatica y Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Granada, Spain.
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Santiago F, Bueno P, Olmedo C, Comino A, Hassan L, Ferrón-Celma I, Muffak K, Serradilla M, Mansilla A, Ramia JM, Villar JM, Garrote D, Ramirez A, Ferrón JA. Time course of intraoperative cytokine levels in liver transplant recipients. Transplant Proc 2006; 38:2492-4. [PMID: 17097978 DOI: 10.1016/j.transproceed.2006.08.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We evaluated the levels of several cytokines (interleukin [IL]-2, IL-4, IL-6, IL-10, tumor necrosis factor [TNF]-alpha, and interferon [IFN]-gamma) in plasma samples obtained before surgical intervention (T0) and during intraoperative liver transplantation: after induction of anesthesia (I-1), 15 minutes of anhepatic phase (I-2), 5 minutes before reperfusion (I-3), 10 minutes after reperfusion (I-4), 20 minutes after reperfusion (I-5), 60 minutes after reperfusion (I-6), and 1 hour after liver transplantation (I-7). Cytokine levels were determined using a technique which combines ELISA technique and flow cytometry. The study was approved by the local clinical research (ethics) committee. Written informed consent was obtained from patients' relatives. Twenty patients (14 men, 6 women) aged 23 to 61 years, recipients of a liver transplantation were studied. The cytokine IL-2 plasma values were maintained during the whole study period, with a slight increase at 15 minutes of anhepatic phase (I-2). IL-4 showed a peak value 20 minutes after reperfusion (I-5). IL-6 increased its plasma value starting at 15 minutes of anhepatic phase (I-2), maintaining high concentrations during the whole intraoperative period. IL-10 increased progressively, reaching a maximum 1 hour after transplantation (I-7). TNF-alpha reached maximum plasma levels 20 minutes after reperfusion (I-5), whereas IFN-gamma showed a peak at 15 minutes of anhepatic phase (I-2). Our results indicate that the anhepatic phase (I-2) is the earliest phase during which proinflammatory and anti-inflammatory cytokines, such as IL-6 and IL-10, respectively, are involved during liver transplantation. We conclude that IL-6 is the first cytokine involved in the inflammatory response during liver transplantation.
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Affiliation(s)
- F Santiago
- Anesthesiology Service, Virgen de las Nieves University Hospital, Granada, Spain
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Hassan L, Bueno P, Ferrón-Celma I, Ramia JM, Garrote D, Muffak K, Barrera L, Villar JM, García-Navarro A, Mansilla A, Gomez-Bravo MA, Bernardos A, Ferrón JA. Early postoperative response of cytokines in liver transplant recipients. Transplant Proc 2006; 38:2488-91. [PMID: 17097977 DOI: 10.1016/j.transproceed.2006.08.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We evaluated the early postoperative response of several cytokines (IL-2, IL-4, IL-6, IL-10, TNF-alpha, IFN-gamma) prior to liver transplantation (T(0)) as well as 1, 6, and 12 hours and 1, 2, 3, 5, and 7 days afterward. Cytokine concentrations were correlated with serum levels of bilirubin as a predictor of postoperative complications. Cytokine levels were determined in plasma samples from 16 liver transplant recipients (13 men, 3 women) aged 43 to 61 years. IL-6 and IL-10 reached their maximum concentrations 1 hour after transplantation. Each increase in IL-6 correlated to a rise in IL-10. IL-2, IL-4, TNF-alpha, and IFN-gamma had a particular time-course for each patient studied. Bilirubin fell to almost normal values but not in cases of postoperative complications, where IL-6 showed values four times higher compared to those of liver transplant recipients who did not show postoperative complications. IL-6 and IL-10 plasma concentrations and serum bilirubin level might be useful as a predictive factor of postoperative complications in liver transplant recipients.
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Affiliation(s)
- L Hassan
- Experimental Surgery Research Unit, Virgen de las Nieves University Hospital, Granada, Spain
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Abstract
OBJECTIVE to present our experience with the treatment of hepatolithiasis. EXPERIMENTAL DESIGN a retrospective study. Every patient operated on during 2002-2004. RESULTS mean age was 68.2 years. All patients were male. Two patients had been operated on before. The other three suffered from: monolobar Caroli s disease (1), cholangiocarcinoma (1), and hepatolihtiasis without clear etiologic factors (1). All of them had intrahepatic and extrahepatic litihiasis. Clinical signs included: pain in RUQ, fever, and jaundice. Bilirubin was 3.5 mg/dl (min: 1.7, max: 5.9), GGT: 676.2 IU/l (min: 29, max: 2039), and alkaline phosphatase: 400 IU/l (min: 100, max: 1136). Abdominal ultrasounds always correctly diagnosed HL. CT (3 patients) only diagnosed one case. ERCP (3 patients) and cholangio-MRI (2 patients) always diagnosed HL correctly. Surgical procedures were: hepatojejunostomy with lavage of bile duct (2 cases) and hepatectomy (3 cases) -both right (1) and left (2). We always performed an intraoperative ultrasonography and choledoscopy. Morbidity was: biliary fistula (1 case) treated by percutaneous drainage. No mortality occurred. Median stay was 8.8 days. Mean follow-up is 12 months (min: 11, max: 20). No relapse has been observed. CONCLUSIONS HL is infrequent in Spain. Surgical treatment, usually liver resection, obtains good results with low morbidity and mortality.
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Affiliation(s)
- J M Ramia
- Unit of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Service of Gastrointestinal Surgery, Hospital Virgen de las Nieves, Granada, Spain.
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