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González Bayón L, Martín Román L, Lominchar PL. Appendiceal Mucinous Neoplasms: From Clinic to Pathology and Prognosis. Cancers (Basel) 2023; 15:3426. [PMID: 37444536 DOI: 10.3390/cancers15133426] [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: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Appendiceal mucinous neoplasms have been classified differently over time causing confusion when comparing results between working groups in this field and establishing a prognosis of the disease. A historical perspective of the different classification systems of these tumors is essential for the understanding of the evolution of concepts and histopathological definitions that have led up to the present moment. We carried out a systematic review of the pathological classifications of appendiceal mucinous tumors and how they have included the new criteria resulting from clinical and pathological research. The latest classifications by PSOGI and AJCC 8th edition Cancer Staging have made a great effort to incorporate the new pathological descriptions and develop prognostic groups. The introduction of these new classification systems has posed the challenge of verifying how they adapt to our casuistry and which one defines best the prognosis of our patients. We reclassified our series of patients treated for mucinous appendiceal tumors with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy following the PSOGI and the AJCC 8th edition criteria and concluded that both classifications correspond well with the OS and DFS of these patients, with some advantage relative to the PSOGI classification due to a better histopathological description of the different groups.
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Affiliation(s)
- Luis González Bayón
- Peritoneal Carcinomatosis Unit, Department of General Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lorena Martín Román
- Peritoneal Carcinomatosis Unit, Department of General Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pablo Lozano Lominchar
- Peritoneal Carcinomatosis Unit, Department of General Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Martín Román L, Lozano Lominchar P, Baratti D, Vásquez W, González Bayón L. ASO Author Reflections: Predicting Prognosis in Patients with Pseudomyxoma. Ann Surg Oncol 2022; 29:7564-7565. [PMID: 35896919 DOI: 10.1245/s10434-022-12287-5] [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: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Lorena Martín Román
- Peritoneal Carcinomatosis Unit, Hospital General Universitario Gregorio Hospital Marañón, Madrid, Spain.
| | - Pablo Lozano Lominchar
- Peritoneal Carcinomatosis Unit, Hospital General Universitario Gregorio Hospital Marañón, Madrid, Spain
| | - Dario Baratti
- Peritoneal Carcinomatosis Unit, Fondazione IRCCS Nazionale dei Tumori, Milan, Italy
| | - Wencesalo Vásquez
- Peritoneal Carcinomatosis Unit, Hospital General Universitario Gregorio Hospital Marañón, Madrid, Spain
| | - Luis González Bayón
- Peritoneal Carcinomatosis Unit, Hospital General Universitario Gregorio Hospital Marañón, Madrid, Spain
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Pérez Zapata AI, Rodríguez Cuéllar E, de la Fuente Bartolomé M, Martín-Arriscado Arroba C, García Morales MT, Loinaz Segurola C, Giner Nogueras M, Tejido Sánchez Á, Ruiz López P, Ferrero Herrero E, Zarco Pleguezuelos A, Romero Simó M, Caballero Bouza A, Parés Martinez D, Julián Ibáñez JF, Balibrea del Castillo JM, Morales Sevillano X, Díaz-Zorita Aguilar B, Martín Román L, Gomez Ruiz M, Fernández Miguel T, Cagigas Fernandez C, Moreno Bargueiras A, Cano Valderrama O, Alonso Rivera D, Gutiérrez Samaniego M, Elia Guedea M, Córdoba Diaz E, Gracia Solanas JA, Bañuls Matoses A, Macero Á, Sánchez López JD, Vaquero Pérez MA, Rojo López JA, Lima Pinto F, Bra Insa E, Rodríguez Prieto I, Padilla Zegarra ED, Franco Chacon M, Memba Ikuga R, Jorba Martin R, Alcaide Matas F, Troncoso Pereira P, Soria Aledo V, Pérez Guarinos CV, Genzor Rios S, Dobón Rascón MÁ, Núñez Fernández S, Valerias Domínguez E, García García M, Zambrana Campos V, Rebasa Cladera P, Artés Caselles M, Cea Soriano M, Gambí Pisonero D, Jiménez de los Galanes S, Frutos Bernal MD, Delegido García A, Gómez Pérez B, Montero Zorrilla C, Cortés Climent J, Vallejo Bernad C, Bustamante Mosquera R, Blázquez M, Muriel López J, García Pérez JC, Ocaña Jiménez J, Paseiro Crespo G, Pardo Martínez C, García Nebreda M, Fernández Cebrián JM, Casanova Durán V, Ferrer Márquez M, Aguiló Lucía J. Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study. Patient Saf Surg 2022; 16:7. [PMID: 35135570 PMCID: PMC8822669 DOI: 10.1186/s13037-021-00316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/19/2021] [Indexed: 11/11/2022] Open
Abstract
Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.
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Tudela Lerma M, Turégano Fuentes F, Pérez Díaz MD, Rey Valcárcel C, Martín Román L, Ruiz Moreno C, Fernández Vázquez ML, Fernández Martínez M. Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen. Cir Esp 2022; 100:67-73. [PMID: 35120850 DOI: 10.1016/j.cireng.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/12/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. METHODS Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. RESULTS We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RH, followed by the LH and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70.5% of lumbar, 66.5% of epigastric, 62% of flank, and 59% of RH penetrating SW could have been managed without a laparotomy. CONCLUSIONS SNOM of penetrating SW in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RH regions.
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Martín Román L, Fernández-Martínez M, Kayer Mata S, Colombari R, Pascual-Espinosa P, Rey Valcárcel C, Jiménez Gómez LM, Turégano Fuentes F. Relevance of pneumoperitoneum in the conservative approach to complicated acute diverticulitis. A retrospective study identifying risk factors associated with treatment failure. Minerva Surg 2021; 77:327-334. [PMID: 34338467 DOI: 10.23736/s2724-5691.21.08997-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim was to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure. METHODS Observational retrospective cohort study of patients attended at the emergency department for AD from January 2015-August 2019. Patient demographics, blood tests, radiological data and initial treatment strategies were registered. NOM, based on intravenous antibiotics (ATB) and bowel rest, was defined as unsuccessful when emergency surgery (ES) and/or infection-related death took place. Patients initially treated with ES were excluded. Analysis was done with the IBM SPSS statistics 23.0.0.2 software. RESULTS According to modified Hinchey and WSES criteria, 99 (12%) of 826 AD episodes were complicated, with pneumoperitoneum on the CT scan in 89 (90.5%). NOM was undertaken in 93 (94%) cases, with a 91.5% success rate. Multivariate analysis revealed ASA class III-IV, and the presence of fluid collections >3cm in diameter, but not distant free air, to be associated with NOM failure. However, the success rate of NOM was significantly higher in patients with pericolic pneumoperitoneum (98.5%) than in those with distant free air (80%) (p=0.02). Risk factors of NOM failure were an advanced age, high CRP and WBC values, and the presence of free fluid in >2 abdominal quadrants. CONCLUSIONS NOM in hemodynamically stable patients with complicated AD is a safe and feasible approach, even in the context of distant free air. Nevertheless, patients with isolated pericolic air did better in our series.
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Affiliation(s)
- Lorena Martín Román
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain -
| | - María Fernández-Martínez
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Silvia Kayer Mata
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Renan Colombari
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Pablo Pascual-Espinosa
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Cristina Rey Valcárcel
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain.,Emergency Surgery Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Luis M Jiménez Gómez
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Fernando Turégano Fuentes
- Colorectal Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain.,Emergency Surgery Unit, Department of General and G.I. Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
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Tudela Lerma M, Turégano Fuentes F, Pérez Díaz MD, Rey Valcárcel C, Martín Román L, Ruiz Moreno C, Fernández Vázquez ML, Fernández Martínez M. Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen. Cir Esp 2021; 100:S0009-739X(20)30405-X. [PMID: 33593596 DOI: 10.1016/j.ciresp.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 12/12/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. METHODS Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. RESULTS We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RUQ, followed by the LUQ and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70,5% of lumbar, el 66,5% of epigastric, 62% of flank, and 59% of RUQ penetrating SWs could have been managed without a laparotomy. CONCLUSIONS SNOM of penetrating SWs in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RUQ regions.
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