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Blanco-Fernández G, Serradilla-Martín M, Rotellar F, Latorre R, Jaén-Torrejimeno I, Muñoz-Forner E, Villodre C, Carabias-Hernández A, Kälviäinen-Mejía HK, Gordillo SE, de la Plaza R, Armas-Conde ND, Garcés-Albir M, Morote SC, Manuel-Vázquez A, Serrablo A, Pardo F, Sabater L, Muñoz MPS, Ramia JM. Short- and long-term outcomes after distal pancreatectomy with radiologic infiltration of splenic vessels for pancreatic ductal adenocarcinoma. J Gastrointest Surg 2024; 28:467-473. [PMID: 38583897 DOI: 10.1016/j.gassur.2024.01.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The effect of radiologic splenic vessels involvement (RSVI) on the survival of patients with pancreatic adenocarcinoma (PAC) located in the body and tail of the pancreas is controversial, and its influence on postoperative morbidity after distal pancreatectomy (DP) is unknown. This study aimed to determine the influence of RSVI on postoperative complications, overall survival (OS), and disease-free survival (DFS) in patients undergoing DP for PAC. METHODS A multicenter retrospective study of DP was conducted at 7 hepatopancreatobiliary units between January 2008 and December 2018. Patients were classified according to the presence of RSVI. A Clavien-Dindo grade of >II was considered to represent a major complication. RESULTS A total of 95 patients were included in the analysis. Moreover, 47 patients had vascular infiltration: 4 had arterial involvement, 10 had venous involvement, and 33 had both arterial and venous involvements. The rates of major complications were 20.8% in patients without RSVI, 40.0% in those with venous RSVI, 25.0% in those with arterial RSVI, and 30.3% in those with both arterial and venous RSVIs (P = .024). The DFS rates at 3 years were 56% in the group without RSVI, 50% in the group with arterial RSVI, and 16% in the group with both arterial and venous RSVIs (P = .003). The OS rates at 3 years were 66% in the group without RSVI, 50% in the group with arterial RSVI, and 29% in the group with both arterial and venous RSVIs (P < .0001). CONCLUSION RSVI increased the major complication rates after DP and reduced the OS and DFS. Therefore, it may be a useful prognostic marker in patients with PAC scheduled to undergo DP and may help to select patients likely to benefit from neoadjuvant treatment.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Department of Surgery, Hospital Universitario de Badajoz, Badajoz, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain.
| | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Raquel Latorre
- Department of surgery. Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | | | | | | | - Roberto de la Plaza
- Department of surgery. Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Silvia Carbonell Morote
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | | | - Alejandro Serrablo
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Jose M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, 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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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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Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Ramia JM, Serradilla-Martín M. Evaluation of the validated intraoperative bleeding scale in liver surgery: study protocol for a multicenter prospective study. Front Surg 2023; 10:1223225. [PMID: 37850041 PMCID: PMC10577188 DOI: 10.3389/fsurg.2023.1223225] [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: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Surgical hemostasis has become one of the key principles in the advancement of surgery. Hemostatic agents are commonly administered in many surgical specialties, although the lack of consensus on the definition of intraoperative bleeding or of a standardized system for its classification means that often the most suitable agent is not selected. The recommendations of international organizations highlight the need for a bleeding severity scale, validated in clinical studies, that would allow the selection of the best hemostatic agent in each case. The primary objective of this study is to evaluate the VIBe scale (Validated Intraoperative Bleeding Scale) in humans. Secondary objectives are to evaluate the scale's usefulness in liver surgery; to determine the relationship between the extent of bleeding and the hemostatic agent used; and to assess the relationship between the grade of bleeding and postoperative complications. Methods Prospective multicenter observational study including 259 liver resections that meet the inclusion criteria: patients scheduled for liver surgery at one of 10 medium-high volume Spanish HPB centers using an open or minimally invasive approach (robotic/laparoscopic/hybrid), regardless of diagnosis, ASA score <4, age ≥18, and who provide signed informed consent during the study period (September 2023 until the required sample size has been recruited). The participating researchers will be responsible for collecting the data and for reporting them to the study coordinators. Discussion This study will allow us to evaluate the VIBe scale for intraoperative bleeding in humans, with a view to its subsequent incorporation in daily clinical practice. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT05369988?term = serradilla&draw = 2&rank = 3, [NCT0536998].
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Affiliation(s)
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
- Department of Surgery, Hospital Universitario German Trials I Pujol, Barcelona, Spain
| | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - José Manuel Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Ramia JM, Cugat E, De la Plaza R, Gomez-Bravo MA, Martín E, Muñoz-Bellvis L, Padillo FJ, Sabater L, Serradilla-Martín M. Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study. Updates Surg 2023; 75:115-131. [PMID: 36376560 DOI: 10.1007/s13304-022-01415-1] [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: 04/16/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Very few surveys have been carried out of oncosurgical decisions made in patients with pancreatic cancer (PC), or of the possible differences in therapeutic approaches between low/medium and high-volume centers. A survey was sent out to centers affiliated to the Spanish Group of Pancreatic Surgery (GECP) asking about their usual pre-, intra- and post-operative management of PC patients and describing five imaginary cases of PC corresponding to common scenarios that surgeons regularly assess in oncosurgical meetings. A consensus was considered to have been reached when 80% of the answers coincided. We received 69 responses from the 72 GECP centers (response rate 96%). Pre-operative management: consensus was obtained on 7/16 questions (43.75%) with no significant differences between low- vs high-volume centers. Intra-operative: consensus was obtained on 11/28 questions (39.3%). D2 lymphadenectomy, biliary culture, intra-operative biliary margin study, pancreatojejunostomy, and two loops were significantly more frequent in high-volume hospitals (p < 0.05). Post-operative: consensus was obtained on 2/8 questions (25%). No significant differences were found between low-/medium- vs high-volume hospitals. Of the 41 questions asked regarding the cases, consensus was reached on 22 (53.7%). No differences in the responses were found according to the type of hospital. Management and cases: consensus was reached in 42/93 questions (45.2%). At GECP centers, consensus was obtained on 45% of the questions. Only 5% of the answers differed between low/medium and high-volume centers (all intra-operative). A more specific assessment of why high-volume centers obtain the best results would require the design of complex prospective studies able to measure the therapeutic decisions made and the effectiveness of their execution. Clinicaltrials.gov identifier: NCT04755036.
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Affiliation(s)
- Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Sol Naciente 8, 16D, 03016, Alicante, Spain. .,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Esteban Cugat
- Department of Surgery, Hospital Universitario Germans Trias i Puyol and Hospital Universitario Mútua Terrassa, Barcelona, Spain
| | - Roberto De la Plaza
- Department of Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Elena Martín
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Muñoz-Bellvis
- Department of Surgery, University Hospital of Salamanca, Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca and Biomedical Research Networking Centre Consortium-CIBER-CIBERONC, Salamanca, Spain
| | - Francisco J Padillo
- Department of Surgery, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Sánchez-Velázquez P, Pueyo-Périz E, Álamo JM, Suarez Artacho G, Gómez Bravo MÁ, Marcello M, Vicente E, Quijano Y, Ferri V, Caruso R, Dorcaratto D, Sabater L, González Chávez P, Noguera J, Navarro Gonzalo A, Bellido-Luque J, Téllez-Marques C, Ielpo B, Burdio F. Radiofrequency-assisted transection of the pancreas versus stapler in distal pancreatectomy: study protocol for a multicentric randomised clinical trial (TRANSPAIRE). BMJ Open 2022; 12:e062873. [PMID: 36332946 PMCID: PMC9639090 DOI: 10.1136/bmjopen-2022-062873] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To date, no pancreatic stump closure technique has been shown to be superior to any other in distal pancreatectomy. Although several studies have shown a trend towards better results in transection using a radiofrequency device (radiofrequency-assisted transection (RFT)), no randomised trial for this purpose has been performed to date. Therefore, we designed a randomised clinical trial, with the hypothesis that this technique used in distal pancreatectomies is superior in reducing clinically relevant postoperative pancreatic fistula (CR-POPF) than mechanical closures. METHODS AND ANALYSIS TRANSPAIRE is a multicentre randomised controlled trial conducted in seven Spanish pancreatic centres that includes 112 patients undergoing elective distal pancreatectomy for any indication who will be randomly assigned to RFT or classic stapler transections (control group) in a ratio of 1:1. The primary outcome is the CR-POPF percentage. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected POPF in control group of 32%, expected POPF in RFT group of 10% and a clinically relevant difference of 22%. Secondary outcomes include postoperative results, complications, radiological evaluation of the pancreatic stump, metabolomic profile of postoperative peritoneal fluid, survival and quality of life. Follow-ups will be carried out in the external consultation at 1, 6 and 12 months postoperatively. ETHICS AND DISSEMINATION TRANSPAIRE has been approved by the CEIM-PSMAR Ethics Committee. This project is being carried out in accordance with national and international guidelines, the basic principles of protection of human rights and dignity established in the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013), and in accordance with regulations in studies with biological samples, Law 14/2007 on Biomedical Research will be followed. We have defined a dissemination strategy, whose main objective is the participation of stakeholders and the transfer of knowledge to support the exploitation of activities. REGISTRATION DETAILS ClinicalTrials.gov Registry (NCT04402346).
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Affiliation(s)
- Patricia Sánchez-Velázquez
- Department of Surgery, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Eva Pueyo-Périz
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J M Álamo
- Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | - Manuel Marcello
- Department of Surgery, Alcorcon Hospital Foundation, Alcorcon, Spain
| | - Emilio Vicente
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Yolanda Quijano
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Valentina Ferri
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Riccardo Caruso
- Department of Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery. Biomedical Research Institute INCLIVA, Hospital Clínico Valencia, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery. Biomedical Research Institute INCLIVA, Hospital Clínico Valencia, Valencia, Spain
| | | | - Jose Noguera
- Hospital Juan Canalejo de La Coruña, A Coruña, Spain
| | | | | | | | - Benedetto Ielpo
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Parc Salut Mar Hospital, Barcelona, Spain
| | - Fernando Burdio
- Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Sabater L, Sastre J, de Madaria E. Dr. Luis Aparisi Quereda In memoriam. Gastroenterol Hepatol 2022; 46:S0210-5705(22)00218-7. [PMID: 36243628 DOI: 10.1016/j.gastrohep.2022.08.011] [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] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/26/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Luis Sabater
- Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico de Valencia, Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España.
| | - Juan Sastre
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Valencia, Valencia, España
| | - Enrique de Madaria
- Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, España
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8
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Lopez-Lopez V, Kuemmerli C, Cutillas J, Maupoey J, López-Andujar R, Ramos E, Mils K, Valdivieso A, Valero AP, Martinez PA, Paterna S, Serrablo A, Reese T, Oldhafer K, Brusadin R, Conesa AL, Valladares LD, Loinaz C, Garcés-Albir M, Sabater L, Mocchegiani F, Vivarelli M, Pérez SA, Flores B, Lucena JL, Sánchez-Cabús S, Calero A, Minguillon A, Ramia JM, Alcazar C, Aguilo J, Ruiperez-Valiente JA, Grochola LF, Clavien PA, Petrowsky H, Robles-Campos R. Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama. Surgery 2022; 172:1067-1075. [PMID: 35965144 DOI: 10.1016/j.surg.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)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery. METHODS This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes. RESULTS A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ˂ .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died. CONCLUSION Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
| | - Christoph Kuemmerli
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland; Department of Surgery, Clarunis - University Center for Gastrointestinal and Liver Diseases Basel, Switzerland. https://twitter.com/ChristophKuemme
| | - Jose Cutillas
- Department of General Surgery, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Javier Maupoey
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Rafael López-Andujar
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Emilio Ramos
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Kristel Mils
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Andres Valdivieso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | | | | | - Sandra Paterna
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alejando Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Tim Reese
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
| | - Karl Oldhafer
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
| | - Roberto Brusadin
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Asunción López Conesa
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Luis Díez Valladares
- Department of Surgery, Hepatopancreatobiliary Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
| | - Federico Mocchegiani
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Benito Flores
- Department of Surgery, Morales University Hospital, Madrid, Spain
| | - Jose Luis Lucena
- Department of Surgery, Puerta del Hierro University Hospital, Madrid, Spain
| | - Santiago Sánchez-Cabús
- Hepatobiliopancreatic Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Alicia Calero
- Department of General Surgery, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | | | - Jose Manuel Ramia
- Department of Surgery, University Hospital of Alicante, Spain; Universidad Miguel Hernandez, Alicante, Spain
| | - Cándido Alcazar
- Department of Surgery, University Hospital of Alicante, Spain; Universidad Miguel Hernandez, Alicante, Spain
| | - Javier Aguilo
- Department of General Surgery, Hospital Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain
| | | | - Lukasz Filip Grochola
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
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9
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Ramia JM, Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Serradilla-Martín M. Applicability and reproducibility of the validated intraoperative bleeding severity scale (VIBe scale) in liver surgery: A multicenter study. Surgery 2022; 172:1141-1146. [PMID: 35871850 DOI: 10.1016/j.surg.2022.05.022] [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: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bleeding is an intraoperative and postoperative complication of liver surgery of concern, and yet evidence to support utility and reproducibility of bleeding scales for liver surgery is limited. We determined the reproducibility of the clinician-reported validated intraoperative bleeding severity scale and its clinical value of implementation in liver surgery. METHODS In this descriptive and observational multicenter study, we assessed the performance of liver surgeons instructed on the clinician-reported intraoperative bleeding severity scale using training videos that covered all 5 grades of bleeding severity. Surgeons were stratified according to years of surgical experience and number of surgeries performed per year based on a median split in low and high values. Intraobserver and interobserver agreement was assessed using Kendall's coefficient of concordance (Kendall's W). RESULTS Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall intraobserver concordance was 0.985, and the overall interobserver concordance was 0.929. For "high experience" surgeons, the intraobserver and interobserver agreement values were 0.990 and 0.941, respectively. For "low experience" surgeons, the intraobserver and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual number of surgeries, intraobserver and interobserver agreement values were 0.995 and 0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and 0.923, respectively, for surgeons who perform ≤35 surgeries year. CONCLUSION The clinician-reported intraoperative bleeding severity scale shows high interobserver and intraobserver concordance, suggesting it is a useful tool for assessing severity of bleeding during liver surgery; years of surgical experience and number of annual procedures performed did not affect the applicability of the clinician-reported intraoperative bleeding severity scale.
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Affiliation(s)
- José Manuel Ramia
- Department of Surgery, Hospital General Universitario de Alicante, ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| | - Daniel Aparicio-López
- Department of Surgery, Hospital Universitario Miguel Servet, University of Zaragoza, Spain
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain; Department of Surgery, Hospital Mutua de Terrassa, Barcelona, Spain
| | | | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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10
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Ramia JM, de Vicente E, Pardo F, Sabater L, Lopez-Ben S, Quijano M 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-Martín M. Preoperative hepatic artery embolization before distal pancreatectomy plus celiac axis resection does not improve surgical results: A Spanish multicentre study. Surgeon 2021; 19:e117-e124. [PMID: 33023848 DOI: 10.1016/j.surge.2020.08.012] [Citation(s) in RCA: 3] [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: 02/19/2020] [Revised: 07/16/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal pancreatectomy with celiac axis resection (DP-CAR) is a surgical procedure with high morbidity and mortality performed in patients with locally advanced pancreatic cancer. Preoperative embolization of hepatic artery (PHAE) has been postulated as a technical option to increase resection rate. OBJECTIVE comparison of morbidity and mortality at 90 days, operative time, hospital stay and survival between patients that performed DP-CAR with and without PHAE. METHODS Observational retrospective multicentre study. INCLUSION CRITERIA patient operated in Spanish centers with DP-CAR for pancreatic cancer from April 2004 until 23 June 2018. Preoperative (PHAE, neodjuvant treatment), intraoperative (operative time and blood loss) and postoperative data (morbidity, hospital stay, R0 and survival) were studied. Complications were measured with Clavien classification at 90 days. Specific pancreatic complications were measured using ISGPS classifications. Data were analyzed using R version 3.1.3 (http://www.r-project.org). Level of significance was set at 0.05. RESULTS 41 patients were studied. 26 patients were not embolized (NO-PHAE group) and 15 patients received PHAE. Preoperative BMI and percentage of neoadjuvant chemotherapy were the only preoperative variables different between both groups. The operative time in the PHAE group was shorter (343 min) than in the non-PHAE group (411 min) (p < 0.06). Major morbidity (Clavien > IIIa) and mortality at 90 days were higher in the PHAE group than in the non-PHAE group (60% vs 23% and 26.6% vs 11.6% respectively) (p < 0.004). No statistical difference in overall survival was observed between both groups (p = 0.14). CONCLUSION In our study PHAE is not related with less postoperative morbidity. Even more, major morbidity (Clavien III-IV) and mortality was higher in PHAE group.
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Affiliation(s)
- Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante and ISABIAL, Alicante, Spain.
| | - Emilio de Vicente
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | - Yolanda Quijano M
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Trinidad Villegas
- Department of Surgery, Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | - Elena Martin-Perez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Univ, de Fuenlabrada, Fuenlabrada, Spain
| | | | - Javier Herrera
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitari Miguel Servet, Zaragoza, Spain
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11
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Lopez-Lopez V, Gomez-Perez B, de Vicente E, Jiménez-Galanes S, Mora-Oliver I, Sabater L, Huber T, Lang H, Brusadin R, López Conesa A, Melendez R, Castro Santiago MJ, Ferreras D, Crespo MJ, Cayuela V, Robles-Campos R. Next-generation three-dimensional modelling software for personalized surgery decision-making in perihilar cholangiocarcinoma: multicentre study. Br J Surg 2021; 108:e394-e395. [PMID: 34542590 DOI: 10.1093/bjs/znab320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/17/2021] [Indexed: 01/04/2023]
Abstract
Next-generation three-dimensional modelling software for personalized surgery allows spatially accurate depiction of the hepatic and vasculature anatomy based on the complexity and individual variation in each patient, and could facilitate decision-making about preoperative strategy in perihilar cholangiocarcinoma.
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Affiliation(s)
- V Lopez-Lopez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - B Gomez-Perez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - E de Vicente
- Department of Surgery, HM Sanchinarro University Hospital, Madrid, Spain
| | - S Jiménez-Galanes
- Department of Surgery, University Hospital Infanta Elena, Madrid, Spain
| | - I Mora-Oliver
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | - L Sabater
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | - T Huber
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - R Brusadin
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - A López Conesa
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - R Melendez
- Department of Surgery, University Hospital, Vigo, Spain
| | | | - D Ferreras
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - M J Crespo
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - V Cayuela
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - R Robles-Campos
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
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12
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Garcés-Albir M, Muñoz-Forner E, Dorcaratto D, Sabater L. What does preoperative three-dimensional image contribute to complex pancreatic surgery? Cir Esp 2021; 99:602-607. [PMID: 34391694 DOI: 10.1016/j.cireng.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
The possibility of modelling diagnostic images in three dimensions (3D) in pancreatic surgery is a novelty that provides us multiple advantages. A better visualization of the structures allows us a more accurate planning of the surgical technique and makes it easier the surgery in complex cases. We present the case study of a borderline pancreatic head adenocarcinoma patient to illustrate the advantages of 3D modelling in complex pancreatic surgery. The help of 3D technology allowed us to optimally plan the intervention and facilitate surgical resection. The use of this tool could translate into: shorter operative time, fewer intraoperative complications or an increase in R0 resections. The usability of the program used in our case, agile and intuitive, was an added advantage.
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Affiliation(s)
- Marina Garcés-Albir
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Instituto de Investigación Biomédica INCLIVA, Departamento de Cirugía, Universitat de Valencia, Valencia, Spain.
| | - Elena Muñoz-Forner
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Instituto de Investigación Biomédica INCLIVA, Departamento de Cirugía, Universitat de Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Instituto de Investigación Biomédica INCLIVA, Departamento de Cirugía, Universitat de Valencia, Valencia, Spain
| | - Luis Sabater
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Instituto de Investigación Biomédica INCLIVA, Departamento de Cirugía, Universitat de Valencia, Valencia, Spain
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13
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Martí Fernández R, Garcés Albir M, Ballester MP, Dorcaratto D, Villagrasa R, Muñoz-Forner E, Gómez-Adrián JC, Sanchiz V, Sabater L, Ortega J. Surgical treatment of an intraductal papillary mucinous neoplasm of the biliary tract diagnosed by SpyGlass®. Rev Esp Enferm Dig 2021; 113:45-47. [PMID: 33054282 DOI: 10.17235/reed.2020.7122/2020] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case of a 76-year-old male with a history of acute cholecystitis who underwent a scheduled laparoscopic cholecystectomy. Chronic cholecystitis with a thickened cystic duct was observed intraoperatively. The anatomic pathology report found high-grade dysplasia that affected the distal edge of the cystic duct. In view of these findings, an endoscopic retrograde cholangiopancreatography (ERCP) was performed with SpyGlass® and an excrescent lesion suggestive of malignancy adjacent to the cystic-common bile duct junction was observed. A resection of the extrahepatic bile duct was performed with lymphadenectomy of the hepatic hilum and hepaticojejunostomy in a subsequent procedure. The definitive pathology report confirmed pancreaticobiliary intraductal papillary mucinous neoplasia with high-grade dysplasia and free margins.
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Affiliation(s)
- Rosa Martí Fernández
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia
| | - Marina Garcés Albir
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, España
| | | | - Dimitri Dorcaratto
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia
| | | | - Elena Muñoz-Forner
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia
| | | | - Vicente Sanchiz
- Unidad de Endoscopias, Hospital Clínico Universitario de Valencia
| | - Luis Sabater
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia
| | - Joaquín Ortega
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, España
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14
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Lapeña-Rodríguez M, Garcés-Albir M, Gadea-Mateo R, Mata-Cano D, Teruel A, Dorcaratto D, Muñoz-Forner E, Ortega-Serrano J, Sabater L. Multiple small bowel perforations during the treatment of primary intestinal extranodal natural killer/T-cell lymphoma, nasal type. Br J Haematol 2021; 193:e39-e42. [PMID: 33928633 DOI: 10.1111/bjh.17229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Lapeña-Rodríguez
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Marina Garcés-Albir
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Ricardo Gadea-Mateo
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Daniel Mata-Cano
- Pathology Department, Hospital Clínico, University of Valencia, Valencia, Spain
| | - Anabel Teruel
- Haematology Department, Hospital Clínico, University of Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Joaquín Ortega-Serrano
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Luis Sabater
- Department of General Surgery, Hospital Clínico, Liver, Biliary and Pancreatic Unit, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
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15
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Moya-Herraiz AA, Dorcaratto D, Martin-Perez E, Escrig-Sos J, Poves-Prim I, Fabregat-Prous J, Larrea Y Olea J, Sanchez-Bueno F, Botello-Martinez F, Sabater L. Non-arbitrary minimum threshold of yearly performed pancreatoduodenectomies: National multicentric study. Surgery 2021; 170:910-916. [PMID: 33875253 DOI: 10.1016/j.surg.2021.03.012] [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: 11/25/2020] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual hospital volume of pancreatoduodenectomies could influence postoperative outcomes. The aim of this study is to establish with a non-arbitrary method the minimum threshold of yearly performed pancreatoduodenectomies in order to improve several postoperative quality outcomes. METHOD Prospective follow-up of patients submitted to pancreatoduodenectomy in participating hospitals during 1 year. The influence of hospital volume on quality outcomes was analyzed by univariable and multivariable models. The minimum threshold of yearly performed pancreatoduodenectomies to improve outcomes was established by Akaike's information criteria. RESULTS Data from 877 patients operated in 74 hospitals were analyzed. Of 12 quality outcomes, 9 were influenced by hospital pancreatoduodenectomy volume on multivariable analysis. To decrease the risk of complications and the risk of retrieving an insufficient number of lymph nodes at least 31 pancreatoduodenectomies per year should be performed. To decrease the risk of prolonged length of stay, postoperative death, and affected surgical margins, at least 37, 6, and 14 pancreatoduodenectomies per year should be performed, respectively. CONCLUSION Several postoperative quality outcomes are influenced by the number of yearly performed pancreatoduodenectomies and could be improved by establishing a minimum threshold of procedures. Number of procedures needed to improve quality outcomes has been established by a non-arbitrary method.
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Affiliation(s)
- Angel Antonio Moya-Herraiz
- Department of Surgery, HPB unit, Hospital General Universitario de Castelló, Castelló de la Plana, Castellón, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver, Biliary and Pancreatic Unit, Hospital Clínico, University of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain.
| | | | - Javier Escrig-Sos
- Department of Surgery, Hospital General Universitario de Castelló, Castelló de la Plana, Castellón, Spain
| | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Larrea Y Olea
- Department of Surgery, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | | | - Luis Sabater
- Department of Surgery, Liver, Biliary and Pancreatic Unit, Hospital Clínico, University of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
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16
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Huerta M, Roselló S, Sabater L, Ferrer A, Tarazona N, Roda D, Gambardella V, Alfaro-Cervelló C, Garcés-Albir M, Cervantes A, Ibarrola-Villava M. Circulating Tumor DNA Detection by Digital-Droplet PCR in Pancreatic Ductal Adenocarcinoma: A Systematic Review. Cancers (Basel) 2021; 13:cancers13050994. [PMID: 33673558 PMCID: PMC7956845 DOI: 10.3390/cancers13050994] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Pancreatic cancer is a digestive tumor that is most difficult to treat and carries one of the worst prognoses. The anatomical location of the pancreas makes it very difficult to obtain enough tumor material to establish a molecular diagnosis, so knowing the biology of this tumor and implementing new targeted-therapies is still a pending issue. The use of liquid biopsy, a blood sample test to detect circulating-tumor DNA fragments (ctDNA), is key to overcoming this difficulty and improving the evolution of this tumor. Liquid biopsies are equally representative of the tissue from which they come and allow relevant molecular and diagnostic information to be obtained in a faster and less invasive way. One challenge related to ctDNA is the lack of consistency in the study design. Moreover, ctDNA accounts for only a small percentage of the total cell-free circulating DNA and prior knowledge about particular mutations is usually required. Thus, our aim was to understand the current role and future perspectives of ctDNA in pancreatic cancer using digital-droplet PCR technology. Abstract Pancreatic cancer (PC) is one of the most devastating malignant tumors, being the seventh leading cause of cancer-related death worldwide. Researchers and clinicians are endeavoring to develop strategies for the early detection of the disease and the improvement of treatment results. Adequate biopsy is still challenging because of the pancreas’s poor anatomic location. Recently, circulating tumor DNA (ctDNA) could be identified as a liquid biopsy tool with huge potential as a non-invasive biomarker in early diagnosis, prognosis and management of PC. ctDNA is released from apoptotic and necrotic cancer cells, as well as from living tumor cells and even circulating tumor cells, and it can reveal genetic and epigenetic alterations with tumor-specific and individual mutation and methylation profiles. However, ctDNA sensibility remains a limitation and the accuracy of ctDNA as a biomarker for PC is relatively low and cannot be currently used as a screening or diagnostic tool. Increasing evidence suggests that ctDNA is an interesting biomarker for predictive or prognosis studies, evaluating minimal residual disease, longitudinal follow-up and treatment management. Promising results have been published and therefore the objective of our review is to understand the current role and the future perspectives of ctDNA in PC.
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Affiliation(s)
- Marisol Huerta
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
| | - Susana Roselló
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of Surgery, Hospital Clínico Universitario of Valencia, University of Valencia, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain; (L.S.); (M.G.-A.)
| | - Ana Ferrer
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Noelia Tarazona
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Desamparados Roda
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Valentina Gambardella
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Clara Alfaro-Cervelló
- Department of Pathology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain;
| | - Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of Surgery, Hospital Clínico Universitario of Valencia, University of Valencia, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain; (L.S.); (M.G.-A.)
| | - Andrés Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
| | - Maider Ibarrola-Villava
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (M.H.); (S.R.); (A.F.); (N.T.); (D.R.); (V.G.); (A.C.)
- CIBERONC, Medical Oncology Unit, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963-862-894
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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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Garcés-Albir M, Muñoz-Forner E, Dorcaratto D, Sabater L. What does preoperative three-dimensional image contribute to complex pancreatic surgery? Cir Esp 2021; 99:S0009-739X(20)30407-3. [PMID: 33516526 DOI: 10.1016/j.ciresp.2020.11.021] [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: 10/05/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022]
Abstract
The possibility of modelling diagnostic images in three dimensions (3D) in pancreatic surgery is a novelty that provides us multiple advantages. A better visualization of the structures allows us a more accurate planning of the surgical technique and makes it easier the surgery in complex cases. We present the case study of a borderline pancreatic head adenocarcinoma patient to illustrate the advantages of 3D modelling in complex pancreatic surgery. The help of 3D technology allowed us to optimally plan the intervention and facilitate surgical resection. The use of this tool could translate into: shorter operative time, fewer intraoperative complications or an increase in R0 resections. The usability of the program used in our case, agile and intuitive, was an added advantage.
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Affiliation(s)
- Marina Garcés-Albir
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia. Instituto de Investigación Biomédica INCLIVA. Departamento de Cirugía, Universitat de Valencia, Valencia, España.
| | - Elena Muñoz-Forner
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia. Instituto de Investigación Biomédica INCLIVA. Departamento de Cirugía, Universitat de Valencia, Valencia, España
| | - Dimitri Dorcaratto
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia. Instituto de Investigación Biomédica INCLIVA. Departamento de Cirugía, Universitat de Valencia, Valencia, España
| | - Luis Sabater
- Unidad HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia. Instituto de Investigación Biomédica INCLIVA. Departamento de Cirugía, Universitat de Valencia, Valencia, España
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Ramia JM, del Rio Martín J, Blanco-Fernández G, Cantalejo-Diaz M, Pardo F, Muñoz-Forner E, Carabias A, Manuel-Vazquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kälviäinen-Mejia HK, Rotellar-Sastre F, Garcés-Albir M, Latorre R, Longoria-Dubocq T, De Armas-Conde N, Serrablo-Requejo A, Gordillo SE, Sabater L, Serradilla-Martín M. Pancreatic mucinous cystic neoplasms located in the distal pancreas: a multicenter study. Gland Surg 2021; 11:795-804. [DOI: 10.21037/gs-21-703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/29/2022] [Indexed: 11/06/2022]
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20
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Roselló S, Pizzo C, Huerta M, Muñoz E, Aliaga R, Vera A, Alfaro-Cervelló C, Jordá E, Garcés-Albir M, Roda D, Dorcaratto D, Tarazona N, Torondel S, Guijarro J, Sánchiz V, Gambardella V, Fleitas-Kanonnikoff T, Lluch P, Pascual I, Ferrández A, Sabater L, Cervantes A. Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre. ESMO Open 2020; 5:e000929. [PMID: 33229503 PMCID: PMC7684818 DOI: 10.1136/esmoopen-2020-000929] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/19/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Pancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting. METHODS This is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient's characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test. RESULTS Between August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinic acid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95% CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001). CONCLUSION A neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS.
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Affiliation(s)
- Susana Roselló
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Claudio Pizzo
- Oncology Unit, Oncology Department, ASST di Cremona, Ospedale di Cremona, Cremona, Italy
| | - Marisol Huerta
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Elena Muñoz
- Surgery, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Roberto Aliaga
- Radiology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Almudena Vera
- Radiology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Clara Alfaro-Cervelló
- Pathology, Biomedical Research Institute Incliva, Hospital Clínico Universitario, Valencia, Spain
| | - Esther Jordá
- Radiation Oncology, Biomedical Research Institute Incliva, Hospital Clínico Universitario, Valencia, Spain
| | - Marina Garcés-Albir
- Surgery, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Desamparados Roda
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Dimitri Dorcaratto
- Surgery, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Noelia Tarazona
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Sergio Torondel
- Radiology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Jorge Guijarro
- Radiology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Vicente Sánchiz
- Gastroenterology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Valentina Gambardella
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Tania Fleitas-Kanonnikoff
- Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Paloma Lluch
- Gastroenterology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain
| | - Isabel Pascual
- Gastroenterology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; Gastroenterology, University of Valencia, Valencia, Spain
| | - Antonio Ferrández
- Pathology, Biomedical Research Institute Incliva, Hospital Clínico Universitario, Valencia, Spain; Pathology, University of Valencia, Valencia, Spain
| | - Luis Sabater
- Surgery, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; Surgery, University of Valencia, Valencia, Spain
| | - Andrés Cervantes
- CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain; Department of Medical Oncology, University of Valencia, Valencia, Spain.
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Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D, Ortega J, Sabater L. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg 2020; 24:2579-2586. [PMID: 31792903 DOI: 10.1007/s11605-019-04424-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/25/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate whether percutaneous cholecystostomy (PC) for the treatment of acute calculous cholecystitis (ACC) has better results than emergency cholecystectomy (EC) in elderly and high-risk surgical patients. METHODS Patients ≥ 70 years and/or ≥ ASA-PS 3 with ACC treated with PC or EC between 2005 and 2016 were retrospectively reviewed. Both techniques were compared regarding morbi-mortality, hospital stay, complications and readmissions. A subgroup analysis in higher risk patients (≥ 70 years plus ≥ ASA-PS 3) was also performed. A binary logistic regression analysis for outcome variables to calculate the OR was carried out. RESULTS A total of 461 patients were included in the study. The results of PC were worse compared to EC: 30-day mortality (8.6 vs. 1.7%, OR 18.4), 90-day mortality (10.4 vs. 2.1%, OR 10.3), length of stay (days) (13.21 ± 8.2 vs. 7.48 ± 7.67, OR 8.7) and readmission rate (35.1 vs. 12.6%, OR 4.7). Complications were lower for PC (14 vs. 22.6%, OR 0.41), but there were no significant differences in the number of severe complications (Clavien-Dindo ≥ III). Higher-risk subgroup analysis (n = 193; PC = 128, EC = 65) showed similar results to the whole series. Patients with ACC for more than 3 days had more risk of severe complications in both groups (OR 2.26; OR 2.76). CONCLUSION PC was associated with an increased risk of mortality at 30 and 90 days, more readmissions and longer hospital stay. Although PC presents a lower risk of complications, the percentage of severe complications (Clavien-Dindo ≥ III) does not show significant differences.
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Affiliation(s)
- Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain.
| | - Víctor Martín-Gorgojo
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Raúl Perdomo
- Department of Surgery, Hospital Maciel, 11000, Montevideo, Uruguay
| | | | - Elena Muñoz-Forner
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Joaquín Ortega
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
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Roselló Keränen S, Pizzo C, Huerta M, Muñoz E, Alfaro-Cervello C, Aliaga R, Vera A, Jordá E, Garcés M, Roda D, Tarazona N, Dorcaratto D, Guijarro J, Sánchiz V, Fleitas T, Lluch P, Pascual I, Ferrandez A, Cervantes A, Sabater L. 1565P Clinical outcome after perioperative treatment on locally advanced and borderline pancreatic cancer: Experience of a single academic center. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Papaccio F, Bravo MG, Cabeza-Segura M, Gimeno-Valiente F, Gambardella V, Garzón-Lloría Z, García-Micó B, Huerta M, Martínez-Ciarpaglini C, Alfaro-Cervello C, Sabater L, Lombardi P, Rentero-Garrido P, Zúñiga-Trejos S, Keränen SR, Fleitas T, Tarazona N, Roda D, Cervantes A, Castillo J. 490P Metastatic colorectal cancer derived organoids recapitulate genomic profile and treatment response of the original tumor. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pérez-Santiago L, Dorcaratto D, Garcés-Albir M, Muñoz-Forner E, Huerta Álvaro M, Roselló Keranën S, Sabater L. The actual management of colorectal liver metastases. MINERVA CHIR 2020; 75:328-344. [PMID: 32773753 DOI: 10.23736/s0026-4733.20.08436-9] [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: 11/08/2022]
Abstract
Colorectal cancer is one of the most frequent cancers in the world and between 50% and 60% of patients will develop colorectal liver metastases (CRLM) during the disease. There have been great improvements in the management of CRLM during the last decades. The combination of modern chemotherapeutic and biological systemic treatments with aggressive surgical resection strategies is currently the base for the treatment of patients considered unresectable until few years ago. Furthermore, several new treatments for the local control of CRLM have been developed and are now part of the arsenal of multidisciplinary teams for the treatment of these complex patients. The aim of this review was to summarize and update the management of CRLM, its controversies and relevant evidence.
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Affiliation(s)
- Leticia Pérez-Santiago
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain -
| | - Marina Garcés-Albir
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Elena Muñoz-Forner
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Marisol Huerta Álvaro
- Department of Medical Oncology, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Susana Roselló Keranën
- Department of Medical Oncology, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Luis Sabater
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
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Fernández-Moreno MC, Dorcaratto D, Garcés-Albir M, Muñoz E, Arvizu R, Ortega J, Sabater L. Impact of type and severity of postoperative complications on long-term outcomes after colorectal liver metastases resection. J Surg Oncol 2020; 122:212-225. [PMID: 32335938 DOI: 10.1002/jso.25946] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/02/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative complications (POCs) after hepatic resection for colorectal liver metastases (CRLM) adversely affect long-term survival. The aim of this study was to analyze the effect of POC etiology and severity on overall survival (OS) and disease-free survival (DFS). METHODS A retrospective study of 254 consecutive hepatectomies for CRLM was performed. Univariate and multivariate analyses were performed to determine the effects of demographic, tumor-related and perioperative variables on OS and DFS. A 1:1 propensity score matching (PSM) was then used to compare patients with different POC etiology: infective (Inf-POC), noninfective (Non-inf POC), and no-complications (No-POC). RESULTS Inf-POC, Non-inf POC, and No-POC patients represented 18.8%, 19.2%, and 62% of the sample, respectively. In univariate and multivariate analyses infectious POC were independent risk factors for decreased OS and DFS. After PSM, Inf-POC group presented decreased OS and DFS when compared with Non-inf POC (5-year OS 31.8% vs 51.6%; P = .05 and 5-year DFS 13.6% vs 31.9%; P = .04) and with No-POC (5-year OS 29.4% vs 58.7%; P = .03 and 5-year DFS 11.8% vs 39.7%; P = .03). There were no differences between Non-inf POC and No-POC patients. POC severity calculated using the Comprehensive Complications Index did not influence OS and DFS before and after PSM. CONCLUSION The negative oncological impact of POCs after CRLM resection is determined by infective etiology not by severity.
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Affiliation(s)
- María-Carmen Fernández-Moreno
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Elena Muñoz
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Ricardo Arvizu
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Luis Sabater
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
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Serradilla M, Del Rio JV, Blanco G, Rotellar F, Sabater L, Manuel A, Carabias A, Hernández P, Esteban S, Muñoz E, Kälviäinen H, Pardo F, Garcés M, Longoria-Dubocq T, Cantalejo M, Sánchez-Rubio M, Díaz JJ, Paterna S, Serrablo A, Ramia JM. Does distal laparoscopic pancreatectomy decrease morbidity and mortality? A multicentre study (ERPANDIS). Int J Surg 2020. [DOI: 10.1016/j.ijsu.2020.01.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Garcés-Albir M, Martí-Fernández R, Martínez-Fernández G, Peña-Aldea A, Muñoz Forner E, Sanchiz-Soler V, Dorcaratto D, Gálvez-Castillo C, Martín Arévalo J, Sabater L, Ortega J. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Rev Esp Enferm Dig 2019; 111:690-695. [PMID: 31368333 DOI: 10.17235/reed.2019.6245/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. METHODS a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. RESULTS 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. CONCLUSION ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.
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Affiliation(s)
- Marina Garcés-Albir
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Rosa Martí-Fernández
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Guillermo Martínez-Fernández
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Andrés Peña-Aldea
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - Elena Muñoz Forner
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Vicente Sanchiz-Soler
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - Dimitri Dorcaratto
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Consuelo Gálvez-Castillo
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - José Martín Arévalo
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Luis Sabater
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Joaquín Ortega
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
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Pico Y, Belenguer V, Corcellas C, Diaz-Cruz MS, Eljarrat E, Farré M, Gago-Ferrero P, Huerta B, Navarro-Ortega A, Petrovic M, Rodríguez-Mozaz S, Sabater L, Santín G, Barcelo D. Contaminants of emerging concern in freshwater fish from four Spanish Rivers. Sci Total Environ 2019; 659:1186-1198. [PMID: 31096332 DOI: 10.1016/j.scitotenv.2018.12.366] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/03/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
This study investigated the occurrence of 135 contaminants of emerging concern (CECs) - pharmaceuticals, pesticides, a set of endocrine disrupting compounds (EDCs) (parabens, bisphenols, hormones, triazoles, organophosphorus flame retardants and triclosan), UV-filters, perfluoroalkyl substances (PFASs) and halogenated flame retardants (HFRs) - in 59 fish samples, collected in 2010 in 4 Spanish Rivers (Guadalquivir, Júcar, Ebro and Llobregat). Of the 135 CECs, 76 including 8 pharmaceuticals, 25 pesticides, 10 EDCs, 5 UV-filters, 15 PFASs and 13 HFRs were detected. Pharmaceuticals were the less frequently found and at lower concentrations. Pesticides, EDCs, UV-filters, PFASs and HFRs were detected more frequently (>50% of the samples). The maximum concentrations were 15 ng/g dry weight (dw) for pharmaceuticals (diclofenac), 840 ng/g dw for pesticides (chlorpyrifos), 224 ng/g dw for EDCs (bisphenol A), 242 ng/g dw for UV-filters (EHMC), 1738 ng/g dw for PFASs (PFHxA) and 64 ng/g dw for HFRs (Dec 602). The contaminants detected in fish are commonly detected also in sediments. In light of current knowledge, the risk assessment revealed that there was no risk for humans related to the exposure to CECs via freshwater fish consumption. However, results provide detailed information on the mixtures of CECs accumulated that would be very useful to identify their effects on aquatic biota.
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Affiliation(s)
- Y Pico
- Food and Environmental Safety Research Group, Desertification Research Centre (CIDE) Joint Centre University of Valencia-CSIC-Generalitat Valencian, Moncada-Náquera Road, Km 4.5, 46113 Moncada, Valencia, Spain.
| | - V Belenguer
- Food and Environmental Safety Research Group, Desertification Research Centre (CIDE) Joint Centre University of Valencia-CSIC-Generalitat Valencian, Moncada-Náquera Road, Km 4.5, 46113 Moncada, Valencia, Spain
| | - C Corcellas
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - M S Diaz-Cruz
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - E Eljarrat
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - M Farré
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - P Gago-Ferrero
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - B Huerta
- Catalan Institute for Water Research (ICRA), C/ Emili Grahit, 101, Edifici H2O, Parc Científic i Tecnològic de la Universitat de Girona, 17003 Girona, Spain
| | - A Navarro-Ortega
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - M Petrovic
- Catalan Institute for Water Research (ICRA), C/ Emili Grahit, 101, Edifici H2O, Parc Científic i Tecnològic de la Universitat de Girona, 17003 Girona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Lluis Company 25, 08010 Barcelona, Spain
| | - S Rodríguez-Mozaz
- Catalan Institute for Water Research (ICRA), C/ Emili Grahit, 101, Edifici H2O, Parc Científic i Tecnològic de la Universitat de Girona, 17003 Girona, Spain
| | - L Sabater
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - G Santín
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain
| | - D Barcelo
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, IDAEA-CSIC, C/ Jordi Girona 18-26, 08034 Barcelona, Spain; Catalan Institute for Water Research (ICRA), C/ Emili Grahit, 101, Edifici H2O, Parc Científic i Tecnològic de la Universitat de Girona, 17003 Girona, Spain
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Mora-Oliver I, Garcés-Albir M, Dorcaratto D, Muñoz-Forner E, Izquierdo Moreno A, Carbonell-Aliaga MP, Sabater L. Pancreatoduodenectomy with artery-first approach. MINERVA CHIR 2019; 74:226-236. [PMID: 30600965 DOI: 10.23736/s0026-4733.18.07944-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
"Artery-first approach" encompasses different aspects for the surgical treatment of pancreatic cancer. It is a surgical technique or set of techniques which share in common the dissection of the main arterial vasculature involved in pancreatic cancer, before any irreversible surgical step is performed. On the other hand it represents the need for a meticulous dissection of the arterial planes and clearing of the retropancreatic tissue between the superior mesenteric artery, the common hepatic artery and portal vein in an attempt to achieve R0 resections. The recent expansion of this approach is based mainly on three factors: venous involvement should not be considered a contraindication for resection, most of the pancreatic resections performed with a standard procedure may be in fact non-oncological (R1) resections and the postero-medial or vascular margin is the most frequently invaded by the tumor. This review aimed to summarize and update the artery-first approach in pancreaticoduodenectomy.
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Affiliation(s)
- Isabel Mora-Oliver
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Elena Muñoz-Forner
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Ana Izquierdo Moreno
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Mari P Carbonell-Aliaga
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain - .,Biomedical Research Institute INCLIVA, Valencia, Spain
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Loinaz C, Ochando F, Vicente E, Serrablo A, López Cillero P, Gomez M, Fabregat J, Varo E, Miyar de León A, Fondevila C, Valdivieso A, Blanco G, Sanchez B, López Andújar R, Fundora Y, Cugat E, Diez Valladares L, Herrera J, García Gil A, Morales R, Pardo F, Sabater L, Lopez Baena J, Muñoz Bellvis L, Martin Perez E, Perez Saborido B, Suarez M, Meneu J, Albiol M, Sanjuanbenito A, Ramia J, Pereira F, Paseiro G, Palomo J, León M. Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nuñez M, Sgromo M, Lacal V, Nuñez S, Sabater L, Corazza R, Balinotti S, Veron M. Febrile Neutropenia in Acute Myeloblastic Leukemia (AML) clinical and microbiological features of infectious episodes and evaluation of mortality. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Sabater L, Muñoz E, Roselló S, Dorcaratto D, Garcés-Albir M, Huerta M, Roda D, Gómez-Mateo MC, Ferrández-Izquierdo A, Darder A, Cervantes A. Borderline resectable pancreatic cancer. Challenges and controversies. Cancer Treat Rev 2018; 68:124-135. [PMID: 29957372 DOI: 10.1016/j.ctrv.2018.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Pancreatic cancer is a dismal disease with an increasing incidence. Despite the majority of patients are not candidates for curative surgery, a subgroup of patients classified as borderline resectable pancreatic cancer can be selected in whom a sequential strategy of neoadjuvant therapy followed by surgery can provide better outcomes. Multidisciplinary approach and surgical pancreatic expertise are essential for successfully treating these patients. However, the lack of consensual definitions and therapies make the results of studies very difficult to interpret and hard to be implemented in some settings. In this article, we review the challenges of borderline resectable pancreatic cancer, the complexity of its management and controversies and point out where further research and international cooperation for a consensus strategy is urgently needed.
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Affiliation(s)
- Luis Sabater
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Elena Muñoz
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Susana Roselló
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marisol Huerta
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Desamparados Roda
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | | | | | - Antonio Darder
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Andrés Cervantes
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
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Dorcaratto D, Hogan NM, Muñoz E, Garcés M, Limongelli P, Sabater L, Ortega J. Is Percutaneous Transhepatic Biliary Drainage Better than Endoscopic Drainage in the Management of Jaundiced Patients Awaiting Pancreaticoduodenectomy? A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2018; 29:676-687. [DOI: 10.1016/j.jvir.2017.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 02/08/2023] Open
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Pérez S, Finamor I, Martí-Andrés P, Pereda J, Campos A, Domingues R, Haj F, Sabater L, de-Madaria E, Sastre J. Role of obesity in the release of extracellular nucleosomes in acute pancreatitis: a clinical and experimental study. Int J Obes (Lond) 2018; 43:158-168. [PMID: 29717278 DOI: 10.1038/s41366-018-0073-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES A high body mass index increases the risk of severe pancreatitis and associated mortality. Our aims were: (1) To determine whether obesity affects the release of extracellular nucleosomes in patients with pancreatitis; (2) To determine whether pancreatic ascites confers lipotoxicity and triggers the release of extracellular nucleosomes in lean and obese rats. METHODS DNA and nucleosomes were determined in plasma from patients with mild or moderately severe acute pancreatitis either with normal or high body mass index (BMI). Lipids from pancreatic ascites from lean and obese rats were analyzed and the associated toxicity measured in vitro in RAW 264.7 macrophages. The inflammatory response, extracellular DNA and nucleosomes were determined in lean or obese rats with pancreatitis after peritoneal lavage. RESULTS Nucleosome levels in plasma from obese patients with mild pancreatitis were higher than in normal BMI patients; these levels markedly increased in obese patients with moderately severe pancreatitis vs. those with normal BMI. Ascites from obese rats exhibited high levels of palmitic, oleic, stearic, and arachidonic acids. Necrosis and histone 4 citrullination-marker of extracellular traps-increased in macrophages incubated with ascites from obese rats but not with ascites from lean rats. Peritoneal lavage abrogated the increase in DNA and nucleosomes in plasma from lean or obese rats with pancreatitis. It prevented fat necrosis and induction of HIF-related genes in lung. CONCLUSIONS Extracellular nucleosomes are intensely released in obese patients with acute pancreatitis. Pancreatitis-associated ascitic fluid triggers the release of extracellular nucleosomes in rats with severe pancreatitis.
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Affiliation(s)
- Salvador Pérez
- Department of Physiology, School of Pharmacy, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain
| | - Isabela Finamor
- Department of Physiology, School of Pharmacy, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain.,Department of Physiology and Pharmacology, Federal University of Santa Maria (UFSM), 1000, Santa Maria, Brazil
| | - Pablo Martí-Andrés
- Department of Physiology, School of Pharmacy, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain
| | - Javier Pereda
- Department of Physiology, School of Pharmacy, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain
| | - Ana Campos
- Department of Chemistry, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Rosário Domingues
- Department of Chemistry, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Fawaz Haj
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Luis Sabater
- Department of Surgery, University of Valencia, University Clinic Hospital, Av. Blasco Ibañez 15, 46010, Valencia, Spain
| | - Enrique de-Madaria
- Department of Gastroenterology, University General Hospital of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Juan Sastre
- Department of Physiology, School of Pharmacy, University of Valencia, Av. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain.
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García-García AB, Gómez-Mateo MC, Hilario R, Rentero-Garrido P, Martínez-Domenech A, Gonzalez-Albert V, Cervantes A, Marín-Garcia P, Chaves FJ, Ferrández-Izquierdo A, Sabater L. mRNA expression profiles obtained from microdissected pancreatic cancer cells can predict patient survival. Oncotarget 2017; 8:104796-104805. [PMID: 29285214 PMCID: PMC5739601 DOI: 10.18632/oncotarget.20076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/17/2017] [Indexed: 12/14/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most devastating malignancies in developed countries because of its very poor prognosis and high mortality rates. By the time PDAC is usually diagnosed only 20-25% of patients are candidates for surgery, and the rate of survival for this cancer is low even when a patient with PDAC does undergo surgery. Lymph node invasion is an extremely bad prognosis factor for this disease. Methods We analyzed the mRNA expression profile in 30 PDAC samples from patients with resectable local disease (stages I and II). Neoplastic cells were isolated by laser-microdissection in order to avoid sample ‘contamination’ by non-tumor cells. Due to important differences in the prognoses of PDAC patients with and without lymph node involvement (stage IIB and stages I-IIA, respectively), we also analyzed the association between the mRNA expression profiles from these groups of patients and their survival. Results We identified expression profiles associated with patient survival in the whole patient cohort and in each group (stage IIB samples or stage I-IIA samples). Our results indicate that survival-associated genes are different in the groups with and without affected lymph nodes. Survival curves indicate that these expression profiles can help physicians to improve the prognostic classification of patients based on these profiles.
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Affiliation(s)
- Ana-Barbara García-García
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Madrid, Spain.,Unidad de Genómica y Diagnóstico Genético. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - M Carmen Gómez-Mateo
- Department of Pathology, Faculty of Medicine and Odontology, University of Valencia and Clinical Hospital of Valencia, and Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain.,Current/Present address: Pathology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | - Rebeca Hilario
- Unidad de Genómica y Diagnóstico Genético. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Pilar Rentero-Garrido
- Unidad de Genómica y Diagnóstico Genético. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Alvaro Martínez-Domenech
- Department of Surgery, University of Valencia, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Veronica Gonzalez-Albert
- Unidad de Genómica y Diagnóstico Genético. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Andres Cervantes
- Hematology and Medical Oncology Unit, Biomedical Research Institute INCLIVA and Department of Medicine, University of Valencia, Valencia, Spain
| | - Pablo Marín-Garcia
- Bioinformatics Unit. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Felipe Javier Chaves
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Madrid, Spain.,Unidad de Genómica y Diagnóstico Genético. Fundación Investigación Clínico de Valencia, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Antonio Ferrández-Izquierdo
- Department of Pathology, Faculty of Medicine and Odontology, University of Valencia and Clinical Hospital of Valencia, and Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
| | - Luis Sabater
- Department of Surgery, University of Valencia, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Clínico de Valencia (INCLIVA), Valencia, Spain
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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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Ferro O, Soria J, Garcés M, Guijarro J, Gámez JM, Sabater L. [Pseudoaneurysm of the superior mesenteric artery after pancreatoduodenectomy]. Gastroenterol Hepatol 2015; 39:400-2. [PMID: 26096289 DOI: 10.1016/j.gastrohep.2015.05.003] [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] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Oscar Ferro
- Servicio de Cirugía General y Aparato Digestivo, Departamento de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Jetzabel Soria
- Servicio de Cirugía General y Aparato Digestivo, Departamento de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Marina Garcés
- Servicio de Cirugía General y Aparato Digestivo, Departamento de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Jorge Guijarro
- Servicio de Radiología Intervencionista, Hospital Clínico Universitario, Valencia, España
| | - Juan Manuel Gámez
- Servicio de Cirugía General y Aparato Digestivo, Departamento de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Luis Sabater
- Servicio de Cirugía General y Aparato Digestivo, Departamento de Cirugía, Hospital Clínico Universitario, Valencia, España.
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Pérez S, Pereda J, Sabater L, Sastre J. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis. Free Radic Biol Med 2015; 81:145-55. [PMID: 25157787 DOI: 10.1016/j.freeradbiomed.2014.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/31/2014] [Accepted: 08/03/2014] [Indexed: 02/08/2023]
Abstract
Upon hemolysis extracellular hemoglobin causes oxidative stress and cytotoxicity due to its peroxidase activity. Extracellular hemoglobin may release free hemin, which increases vascular permeability, leukocyte recruitment, and adhesion molecule expression. Pancreatitis-associated ascitic fluid is reddish and may contain extracellular hemoglobin. Our aim has been to determine the role of extracellular hemoglobin in the local and systemic inflammatory response during severe acute pancreatitis in rats. To this end we studied taurocholate-induced necrotizing pancreatitis in rats. First, extracellular hemoglobin in ascites and plasma was quantified and the hemolytic action of ascitic fluid was tested. Second, we assessed whether peritoneal lavage prevented the increase in extracellular hemoglobin in plasma during pancreatitis. Third, hemoglobin was purified from rat erythrocytes and administered intraperitoneally to assess the local and systemic effects of ascitic-associated extracellular hemoglobin during acute pancreatitis. Extracellular hemoglobin and hemin levels markedly increased in ascitic fluid and plasma during necrotizing pancreatitis. Peroxidase activity was very high in ascites. The peritoneal lavage abrogated the increase in extracellular hemoglobin in plasma. The administration of extracellular hemoglobin enhanced ascites; dramatically increased abdominal fat necrosis; upregulated tumor necrosis factor-α, interleukin-1β, and interleukin-6 gene expression; and decreased expression of interleukin-10 in abdominal adipose tissue during pancreatitis. Extracellular hemoglobin enhanced the gene expression and protein levels of vascular endothelial growth factor (VEGF) and other hypoxia-inducible factor-related genes in the lung. Extracellular hemoglobin also increased myeloperoxidase activity in the lung. In conclusion, extracellular hemoglobin contributes to the inflammatory response in severe acute pancreatitis through abdominal fat necrosis and inflammation and by increasing VEGF and leukocyte infiltration into the lung.
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Affiliation(s)
- Salvador Pérez
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot, Valencia, Spain
| | - Javier Pereda
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot, Valencia, Spain
| | - Luis Sabater
- Department of Surgery, University of Valencia, University Clinic Hospital, 46010 Valencia, Spain
| | - Juan Sastre
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot, Valencia, Spain.
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Aguilar G, Albiol S, Alcaide J, Alonso M, Alonso V, Andreu M, Aparicio J, de la Vega FA, Arrivi A, Ayuso JR, Bohn U, Bouzas R, Cano JM, Castañón C, Castells A, Cerdà P, Cerezo L, Conill C, Cuatrecasas M, Pozo MND, Delgado JI, Enriquez-Navascues JM, Escudero P, Espín E, l RE, Falcó E, Farré J, Feliu J, Fernández-Martos C, Ferrer AI, Gallego R, Galvez E, de Albéniz XG, Olmo DG, García-Carbonero R, Dorronsoro MG, Martín CG, Moreno SG, Hernández A, Iraola A, Jímenez E, Jiménez MC, Jurado I, Leno R, León A, Martín E, Martín M, Maurel J, Méndez JC, Méndez R, Palma P, Pardo F, Pereira F, Pérez-Altozano J, Pérez E, Rodríguez J, Ruiz-Casado AI, Sabater L, Sarría L, Segura A, Sevilla I, Tobeña M, Torres E, Viudez A, Zanui M, Zorrilla M. Guidelines for diagnosis, staging and treatment of metastatic colorectal cancer by Grupo Español Multidisciplinar en Cancer Digestivo (GEMCAD). Colorectal Cancer 2015. [DOI: 10.2217/crc.15.9] [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: 11/21/2022]
Abstract
Abstract Advances in the care of patients with metastatic colorectal cancer arise from well-designed clinical trials. In the present document we address specific challenges in the design of clinical trials for metastatic colorectal cancer regarding staging and standard of care according to prognosis, as well as some relevant methodological issues.
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Affiliation(s)
| | - Santiago Albiol
- Department of Medical Oncology, Hospital del Espíritu Santo, Barcelona, Spain
| | - Julia Alcaide
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Martina Alonso
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
| | - Vicente Alonso
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Jorge Aparicio
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | | | - Antonio Arrivi
- Department of Medical Oncology, Clinica Rotger, Palma de Mallorca, Spain
| | - Juan Ramón Ayuso
- Department of Radiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Uriel Bohn
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Rosa Bouzas
- Department of Radiology, Hospital Universitario de Vigo, Vigo, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Carmen Castañón
- Department of Medical Oncology, Complejo Asistencial de León, León, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paula Cerdà
- Department of Medical Oncology, Instituto Oncológico Teknon, Barcelona, Spain
| | - Laura Cerezo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | - Jose Ignacio Delgado
- Department of Medical Oncology, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | | | - Pilar Escudero
- Department of Medical Oncology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Eloy Espín
- Department of Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael Estevan l
- Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - Esther Falcó
- Department of Medical Oncology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - José Farré
- Department of Surgery, Hospital Quirón, Torrevieja, Spain
| | - Jaime Feliu
- Department of Medical Oncology, Hospital La Paz, Madrid, Spain
| | | | - Ana Isabel Ferrer
- Department of Medical Oncology, Hospital Obispo Polanco, Teruel, Spain
| | - Rosa Gallego
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Elisa Galvez
- Department of Medical Oncology, Hospital General Universitario de Elda, Alicante, Spain
| | | | | | | | | | - Carlos Gómez Martín
- Department of Medical Oncology, Hospital Universitario 12 de octubre, Madrid, Spain
| | | | - Ana Hernández
- Department of Radiation Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Amparo Iraola
- Department of Medical Oncology, Hospital Verge dels Lliris, Alcoi, Spain
| | - Esther Jímenez
- Department of Radiation Oncology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Ismael Jurado
- Department of Pathology, Hospital Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Rubén Leno
- Department of Medical Oncology, Hospital Virgen del Puerto, Plasencia, Spain
| | - Ana León
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - Elena Martín
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Marta Martín
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Joan Maurel
- Department of Medical Oncology, Hospital Clinic Barcelona, C. Villarroel 170, 08030 Barcelona, Spain
| | | | - Ramiro Méndez
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Palma
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Elisabet Pérez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Javier Rodríguez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella & Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Sarría
- Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Angel Segura
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | - Isabel Sevilla
- Department of Medical Oncology, Hospital Clínico de Málaga, Málaga, Spain
| | - Maria Tobeña
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Esperanza Torres
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Viudez
- Department of Medical Oncology, Complejo Universitario de Navarra, Pamplona, Spain
| | - Montserrat Zanui
- Department of Medical Oncology, Hospital de Mataró, Barcelona, Spain
| | - Miriam Zorrilla
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
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Sabater L, Gómez-Mateo MDC, López-Sebastián J, Muñoz-Forner E, Morera-Ocón F, Cervantes A, Roselló S, Camps-Vilata B, Ferrández A, Ortega J. Implicaciones pronósticas del estudio estandarizado de los márgenes de resección en el cáncer de páncreas. Cir Esp 2014; 92:532-8. [DOI: 10.1016/j.ciresp.2013.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 10/25/2022]
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Abstract
Extracellular haemoglobin (EHb) is considered a toxic molecule due to its cytotoxicity and peroxidase activity. EHb may release free hemin that increases vascular permeability, leukocyte recruitment, and adhesion molecule expression. Pancreatitis-associated ascitic fluid is reddish and may contain cell-free hemoglobin. Our aim was to determine the role of EHb in the local and systemic inflammatory response during severe acute pancreatitis in rats. To this end, taurocholate-induced necrotizing pancreatitis in rats was used. EHb levels were quantified in ascites and plasma and the hemolytic action of ascitic fluid was tested. Furthermore, we assessed if peritoneal lavage prevented the increase in EHb levels in plasma during pancreatitis. Finally, hemoglobin was purified from rat erythrocytes and administered i.p. to assess the local and systemic effects of ascitic-associated EHb during acute pancreatitis. EHb levels markedly increased in ascitic fluid and plasma during necrotizing pancreatitis. Peroxidase activity was very high in ascites. The peritoneal lavage abrogated the increase in cell-free hemoglobin in plasma. The administration of EHb enhanced ascites, dramatically increased abdominal fat necrosis, up-regulated tumor necrosis factor-a, interleukin 1ß and interleukin 6 gene expression and decreased expression of interleukin 10 in abdominal adipose tissue during pancreatitis. EHb enhanced the gene expression and protein levels of vascular endothelial growth factor (VEGF) and other hypoxia inducible factor-related genes [inducible nitric oxide synthase (inos), endothelial nitric oxide synthase (enos) and hexokinase 2] in the lung. EHb also increased myeloperoxidase activity in the lung. In conclusion, extracellular hemoglobin contributes to the inflammatory response in severe acute pancreatitis through abdominal fat necrosis and inflammation and increasing VEGF and leukocyte infiltration in the lung.
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Affiliation(s)
- Salvador Pérez
- School of Pharmacy (University of Valencia), Physiology, Spain.
| | - Javier Pereda
- School of Pharmacy (University of Valencia), Physiology, Spain
| | - Luis Sabater
- School of Medicine (University of Valencia), Surgery, Spain
| | - Juan Sastre
- School of Pharmacy (University of Valencia), Physiology, Spain
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Moreno ML, Escobar J, Izquierdo-Álvarez A, Gil A, Pérez S, Pereda J, Zapico I, Vento M, Sabater L, Marina A, Martínez-Ruiz A, Sastre J. Disulfide stress: a novel type of oxidative stress in acute pancreatitis. Free Radic Biol Med 2014; 70:265-77. [PMID: 24456905 DOI: 10.1016/j.freeradbiomed.2014.01.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/26/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
Glutathione oxidation and protein glutathionylation are considered hallmarks of oxidative stress in cells because they reflect thiol redox status in proteins. Our aims were to analyze the redox status of thiols and to identify mixed disulfides and targets of redox signaling in pancreas in experimental acute pancreatitis as a model of acute inflammation associated with glutathione depletion. Glutathione depletion in pancreas in acute pancreatitis is not associated with any increase in oxidized glutathione levels or protein glutathionylation. Cystine and homocystine levels as well as protein cysteinylation and γ-glutamyl cysteinylation markedly rose in pancreas after induction of pancreatitis. Protein cysteinylation was undetectable in pancreas under basal conditions. Targets of disulfide stress were identified by Western blotting, diagonal electrophoresis, and proteomic methods. Cysteinylated albumin was detected. Redox-sensitive PP2A and tyrosine protein phosphatase activities diminished in pancreatitis and this loss was abrogated by N-acetylcysteine. According to our findings, disulfide stress may be considered a specific type of oxidative stress in acute inflammation associated with protein cysteinylation and γ-glutamylcysteinylation and oxidation of the pair cysteine/cystine, but without glutathione oxidation or changes in protein glutathionylation. Two types of targets of disulfide stress were identified: redox buffers, such as ribonuclease inhibitor or albumin, and redox-signaling thiols, which include thioredoxin 1, APE1/Ref1, Keap1, tyrosine and serine/threonine phosphatases, and protein disulfide isomerase. These targets exhibit great relevance in DNA repair, cell proliferation, apoptosis, endoplasmic reticulum stress, and inflammatory response. Disulfide stress would be a specific mechanism of redox signaling independent of glutathione redox status involved in inflammation.
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Affiliation(s)
- Mari-Luz Moreno
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain
| | - Javier Escobar
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain; Division of Neonatology, University Hospital Materno-Infantil La Fe, 46026 Valencia, Spain
| | - Alicia Izquierdo-Álvarez
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Anabel Gil
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain
| | - Salvador Pérez
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain
| | - Javier Pereda
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain
| | - Inés Zapico
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain; Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Madrid, Spain
| | - Máximo Vento
- Division of Neonatology, University Hospital Materno-Infantil La Fe, 46026 Valencia, Spain
| | - Luis Sabater
- Department of Surgery, University Clinic Hospital, University of Valencia, 46010 Valencia, Spain
| | - Anabel Marina
- Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Madrid, Spain
| | - Antonio Martínez-Ruiz
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Juan Sastre
- Department of Physiology, School of Pharmacy, University of Valencia, 46100 Burjasot (Valencia), Spain.
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Ramia JM, Bernardo C, Valdivieso A, Dopazo C, Jover JM, Albiol MT, Pardo F, Fernandez Aguilar JL, Gutierrez Calvo A, Serrablo A, Diez Valladares L, Pereira F, Sabater L, Muffak K, Figueras J. [Multicentre study on hepatic adenomas]. Cir Esp 2014; 92:120-5. [PMID: 23827931 DOI: 10.1016/j.ciresp.2012.12.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/02/2012] [Accepted: 12/16/2012] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatic adenomas (HA) are benign tumours which can present serious complications, and as such, in the past all were resected. It has now been shown that those smaller than 3 cm not expressing β-catenin only result in complications in exceptional cases and therefore the therapeutic strategy has been changed. MATERIAL AND METHOD Retrospective study in 14 HPB units. INCLUSION CRITERIA patients with resected and histologically confirmed HA. STUDY PERIOD 1995-2011. RESULTS 81 patients underwent surgery. Age: 39.5 years (range: 14-75). Sex: female (75%). Consumption of oestrogen in women: 33%. Size: 8.8 cm (range, 1-20 cm). Only 6 HA (7.4%) were smaller than 3 cm. The HA median was 1 (range: 1-12). Nine patients had adenomatosis (>10HA). A total of 51% of patients displayed symptoms, the most frequent (77%) being abdominal pain. Eight patients (10%) began with acute abdomen due to rupture and/or haemorrhage. A total of 67% of the preoperative diagnoses were correct. Surgery was scheduled for 90% of patients. The techniques employed were: major hepatectomy (22%), minor hepatectomy (77%) and one liver transplantation. A total of 20% were performed laparoscopically. The morbidity rate was 28%. There were no cases of mortality. Three patients had malignisation (3.7%). The follow-up period was 43 months (range 1-192). Two recurrences were detected and resected. DISCUSSION Patients with resected HA are normally women with large lesions and oestrogen consumption was lower than expected. Its correct preoperative diagnosis is acceptable (70%). The major hepatectomy rate is 25% and the laparoscopy rate is 20%. There was a low morbidity rate and no mortality.
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Affiliation(s)
- José Manuel Ramia
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Carmen Bernardo
- Sección Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Central de Asturias, Oviedo, España
| | - Andrés Valdivieso
- Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital de Cruces, Bilbao, España
| | - Cristina Dopazo
- Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Vall d'Hebron, Barcelona, España
| | - José María Jover
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital de la Cruz Roja, Getafe, Madrid, España
| | - M Teresa Albiol
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Josep Trueta, Girona, España
| | - Fernando Pardo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Clínica Universitaria de Navarra, Pamplona, España
| | - José Luis Fernandez Aguilar
- Unidad Hepatobiliopancreática, Unidad de Gestión Clinica de Cirugía General, Digestiva y Trasplantes, Servicio de Cirugía, Hospital Carlos Haya, Málaga, España
| | - Alberto Gutierrez Calvo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Alejandro Serrablo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Miguel Servet, Zaragoza, España
| | - Luis Diez Valladares
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico San Carlos, Madrid, España
| | - Fernando Pereira
- Servicio de Cirugía, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España
| | - Luis Sabater
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Karim Muffak
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Virgen de las Nieves, Granada, España
| | - Joan Figueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Josep Trueta, Girona, España
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Figueras J, Sabater L, Planellas P, Muñoz-Forner E, Lopez-Ben S, Falgueras L, Sala-Palau C, Albiol M, Ortega-Serrano J, Castro-Gutierrez E. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg 2014; 100:1597-605. [PMID: 24264781 DOI: 10.1002/bjs.9252] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anastomotic leakage of pancreaticojejunostomy (PJ) remains the single most important source of morbidity after pancreaticoduodenectomy (PD). The primary aim of this randomized clinical trial comparing PG with PJ after PD was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula. METHODS Patients undergoing PD were randomized to receive either a duct-to-duct PJ or a double-layer invaginated PG. The primary endpoint was the rate of pancreatic fistula, using the definition of the International Study Group on Pancreatic Fistula. Secondary endpoints were the evaluation of severe abdominal complications (Clavien-Dindo grade IIIa or above), endocrine and exocrine function. RESULTS Of 123 patients randomized, 58 underwent PJ and 65 had PG. The incidence of pancreatic fistula was significantly higher following PJ than for PG (20 of 58 versus 10 of 65 respectively; P = 0.014), as was the severity of pancreatic fistula (grade A: 2 versus 5 per cent; grade B-C: 33 versus 11 per cent; P = 0.006). The hospital readmission rate for complications was significantly lower after PG (6 versus 24 per cent; P = 0.005), weight loss was lower (P = 0.025) and exocrine function better (P = 0.022). CONCLUSION The rate and severity of pancreatic fistula was significantly lower with this PG technique compared with that following PJ. REGISTRATION NUMBER ISRCTN58328599 (http://www.controlled-trials.com).
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Affiliation(s)
- J Figueras
- Departments of Hepatobiliary and Pancreatic Surgery, 'Dr Josep Trueta' Hospital, Institute of Biomedical Research of Girona (IDIBGI), Girona
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Sabater L, García-Granero A, Escrig-Sos J, Gómez-Mateo MDC, Sastre J, Ferrández A, Ortega J. Outcome Quality Standards in Pancreatic Oncologic Surgery. Ann Surg Oncol 2014; 21:1138-46. [DOI: 10.1245/s10434-013-3451-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 12/16/2022]
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Martínez J, Abad-González Á, Aparicio JR, Aparisi L, Boadas J, Boix E, de las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez Ó, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, De-Madaria E. Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 1 (diagnóstico). Gastroenterología y Hepatología 2013; 36:326-39. [DOI: 10.1016/j.gastrohep.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/14/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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Barău A, Ruiz-Sauri A, Valencia G, Gómez-Mateo MDC, Sabater L, Ferrandez A, Llombart-Bosch A. High microvessel density in pancreatic ductal adenocarcinoma is associated with high grade. Virchows Arch 2013; 462:541-6. [PMID: 23579431 DOI: 10.1007/s00428-013-1409-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 10/29/2012] [Revised: 03/04/2013] [Accepted: 03/28/2013] [Indexed: 12/29/2022]
Abstract
The objectives of this work are to study angiogenesis in pancreatic ductal adenocarcinoma using computerized morphometric and image analysis and to compare the microvascular density in intratumoral and peritumoral areas and normal pancreatic tissue. Microvascular density was analyzed in 60 cases of pancreatic ductal adenocarcinoma and 30 samples of normal pancreatic tissue using an avidin-biotin immunoperoxidase technique with an anti-CD31 antibody. Microvascular density (MVD) was analyzed through digital microimaging and computerized analysis. The blood vessel density in the tumor was significantly higher than in peritumoral areas and in normal pancreatic tissue. Well differentiated pancreatic ductal adenocarcinomas contained higher MVD than poorly differentiated carcinomas. In pancreatic adenocarcinoma, MVD is higher than in peritumoral tissue or normal pancreatic tissue.
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Affiliation(s)
- Anca Barău
- Department of Internal Medicine, Emergency County Hospital Craiova, University of Medicine and Pharmacy Craiova, Petru Rareş 2, Craiova, 200349, Romania.
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de-Madaria E, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de-Las-Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, Martínez J. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology 2012; 13:18-28. [PMID: 23395565 DOI: 10.1016/j.pan.2012.11.310] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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: 07/12/2012] [Revised: 11/11/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis (CP) is a complex disease with a wide range of clinical manifestations. This range comprises from asymptomatic patients to patients with disabling symptoms or complications. The management of CP is frequently different between geographic areas and even medical centers. This is due to the paucity of high quality studies and clinical practice guidelines regarding its diagnosis and treatment. The aim of the Spanish Pancreatic Club was to give current evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. These experts were selected according to clinical and research experience in CP. A list of questions was made and two experts reviewed each question. A draft was later produced and discussed with the entire panel of experts in a face-to-face meeting. The level of evidence was based on the ratings given by the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus, recommendations were given regarding the management of pain, pseudocysts, duodenal and biliary stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.
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Affiliation(s)
- E de-Madaria
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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Martínez J, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de Las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero E, de-Madaria E. The Spanish Pancreatic Club recommendations for the diagnosis and treatment of chronic pancreatitis: part 1 (diagnosis). Pancreatology 2012; 13:8-17. [PMID: 23395564 DOI: 10.1016/j.pan.2012.11.309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 11/13/2012] [Accepted: 11/18/2012] [Indexed: 12/11/2022]
Abstract
Chronic pancreatitis (CP) is a relatively uncommon, complex and heterogeneous disease. The absence of a gold standard applicable to the initial phases of CP makes its early diagnosis difficult. Some of its complications, particularly chronic pain, can be difficult to manage. There is much variability in the diagnosis and treatment of CP and its complications amongst centers and professionals. The Spanish Pancreatic Club has developed a consensus on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. A list of questions was drafted, and two experts reviewed each question. Then, a draft was produced and shared with the entire panel of experts and discussed in a face-to-face meeting. This first part of the consensus addresses the diagnosis of CP and its complications.
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Affiliation(s)
- J Martínez
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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Pereda J, Pérez S, Escobar J, Arduini A, Asensi M, Serviddio G, Sabater L, Aparisi L, Sastre J. Obese rats exhibit high levels of fat necrosis and isoprostanes in taurocholate-induced acute pancreatitis. PLoS One 2012; 7:e44383. [PMID: 23028532 PMCID: PMC3445528 DOI: 10.1371/journal.pone.0044383] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/02/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Obesity is a prognostic factor for severity in acute pancreatitis in humans. Our aim was to assess the role of oxidative stress and abdominal fat in the increased severity of acute pancreatitis in obese rats. METHODOLOGY Taurocholate-induced acute pancreatitis was performed in lean and obese Zucker rats. Levels of reduced glutathione, oxidized glutathione, L-cysteine, cystine, and S-adenosylmethionine were measured in pancreas as well as the activities of serine/threonine protein phosphatases PP1 and PP2A and tyrosin phosphatases. Isoprostane, malondialdehyde, triglyceride, and free fatty acid levels and lipase activity were measured in plasma and ascites. Lipase activity was measured in white adipose tissue with and without necrosis and confirmed by western blotting. FINDINGS Under basal conditions obese rats exhibited lower reduced glutathione levels in pancreas and higher triglyceride and free fatty acid levels in plasma than lean rats. S-adenosyl methionine levels were markedly increased in pancreas of obese rats. Acute pancreatitis in obese rats led to glutathione oxidation and lower reduced glutathione levels in pancreas together with decreased activities of redox-sensitive phosphatases PP1, and PP2A. S-adenosyl methionine levels decreased but cystine levels increased markedly in pancreas upon pancreatitis. Acute pancreatitis triggered an increase in isoprostane levels in plasma and ascites in obese rats. Free fatty acid levels were extremely high in pancreatitis-associated ascitic fluid from obese rats and lipase was bound with great affinity to white adipose tissue, especially to areas of necrosis. CONCLUSIONS Our results show that oxidative stress occurs locally and systemically in obese rats with pancreatitis favouring inactivation of protein phosphatases in pancreas, which would promote up-regulation of pro-inflammatory cytokines, and the increase of isoprostanes which might cause powerful pulmonary and renal vasoconstriction. Future studies are needed to confirm the translational relevance of the present findings obtained in a rat model of taurocholate-induced pancreatic damage and necrosis.
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Affiliation(s)
- Javier Pereda
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
| | - Salvador Pérez
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
| | - Javier Escobar
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
- Division of Neonatology, University Hospital Materno-Infantil La Fe, Valencia, Spain
| | - Alessandro Arduini
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
| | - Miguel Asensi
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
| | - Gaetano Serviddio
- Department of Medical and Occupational Sciences, University of Foggia, Foggia, Italy
| | - Luis Sabater
- Department of Surgery, University of Valencia, Universitary Clinic Hospital, Valencia, Spain
| | - Luis Aparisi
- Laboratory of Pancreatic Function, Universitary Clinic Hospital, Valencia, Spain
| | - Juan Sastre
- Department of Physiology, School of Pharmacy, University of Valencia, Burjasot, Valencia, Spain
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