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Cascales-Campos PA, González-Gil A, Fernández-Luna E, Gil-Gómez E, Alconchel-Gago F, Romera-García A, Martínez-García J, Nieto-Díaz A, Barceló-Valcarcel F, Gil-Martínez J. Urinary and fecal incontinence in patients with advanced ovarian cancer treated with CRS + HIPEC. Surg Oncol 2020; 36:115-119. [PMID: 33341606 DOI: 10.1016/j.suronc.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/03/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC). METHODS This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey. RESULTS A total of 64 patients were included in the study, with a median age of 55 years (range 28-78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence. DISCUSSION Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.
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Affiliation(s)
- P A Cascales-Campos
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - A González-Gil
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - E Fernández-Luna
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - E Gil-Gómez
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - F Alconchel-Gago
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A Romera-García
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J Martínez-García
- Department of Medical Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A Nieto-Díaz
- Gynecologic Oncology Unit, Department of Gynecologic and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - F Barceló-Valcarcel
- Gynecologic Oncology Unit, Department of Gynecologic and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J Gil-Martínez
- Peritoneal Oncology Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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2
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020; 158:603-607. [PMID: 32571682 DOI: 10.1016/j.ygyno.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - J L Sanchez-Iglesias
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Chiva
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - L Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - A García-Granero
- Department of General Surgery, University Hospital Son Espases, Palma de Mallorca, Spain; Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - J M Cárdenas-Rebollo
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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3
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Alconchel F, Martínez-Alarcón L, Nicolás-López T, Khiri F, Febrero B, Cascales-Campos PA, Martínez-Insfran LA, Ríos A, Fernández-Hernández JA, Rodríguez JM, López-López V, Sánchez-Bueno F, Robles-Campos R, Parrilla P, Ramírez P. Psoas Muscle Index Does Not Predict Post-Transplant Outcomes: A Series of 57 Liver Transplant Recipients. Transplant Proc 2020; 52:549-552. [PMID: 32029312 DOI: 10.1016/j.transproceed.2019.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sarcopenia is defined as the loss of muscle mass and function. Our aim is to evaluate the degree of sarcopenia by measuring the patients on the waiting list for liver transplantation and its influence on the different post-liver transplant outcomes in our group. METHODS The psoas muscle index (PMI, cm2/m2) was calculated (right psoas muscle area [cm2]/the square of the body height [m2]) in 57 patients on the waiting list for liver transplantation in our center, and the post-transplant variables relevant to our study were collected. RESULTS The 57 recipients had a mean age of 57 years (range, 35-73) and had a mean of 7.4 months (range, 0-39) on the liver transplant waiting list. The mean psoas muscle index was 2.39 (range, 1-4), and the mean body mass index was 28.01kg/m2 (range, 22-36). After multivariate analysis we found a positive correlation between the PMI and the body mass index of the recipients (r = 0.320, P = .017), intensive care unit length of stay, and donor age (r = 0.319, P = .042), and between cold ischemia time and graft survival (r = 0.366, P = .009). We found no correlation in our sample between PMI and post-liver transplant complications either in terms of graft or patient survival. CONCLUSION PMI is not representative of total muscle mass and sarcopenia and is not effective in adequately predicting the survival of patients on the waiting list for liver transplantation.
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Affiliation(s)
- F Alconchel
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
| | - L Martínez-Alarcón
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - T Nicolás-López
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - F Khiri
- University College of Nursing, University of Murcia, Murcia, Spain
| | - B Febrero
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P A Cascales-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - L A Martínez-Insfran
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - A Ríos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J A Fernández-Hernández
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J M Rodríguez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - V López-López
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - F Sánchez-Bueno
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - R Robles-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Parrilla
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Ramírez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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4
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Alconchel F, Martínez-Insfran LA, Cascales-Campos PA, Febrero B, Martínez-Alarcón L, Ríos A, Fernández-Hernández JA, Rodríguez JM, Ruiz-Merino G, Royo-Villanova M, Pons JA, Robles-Campos R, Sánchez-Bueno F, Ramírez P, Parrilla P. Impact of Hepatic Artery Thrombosis on the Success of a Liver Transplant Because of Hepatocellular Carcinoma. Transplant Proc 2020; 52:559-561. [PMID: 32029319 DOI: 10.1016/j.transproceed.2019.11.037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hepatic artery thrombosis is one of the most serious complications after liver transplant. Our objective is to evaluate the impact of arterial thrombosis on the postoperative evolution of a series of patients who received transplants because of hepatocellular carcinoma. METHODS A retrospective study of 100 consecutive hepatocellular carcinoma liver transplants was performed from January 2011 to November 2017. RESULTS Of the 100 transplant recipients, we have observed hepatic artery thrombosis in 4 of them, 3 premature and 1 delayed. All of them received retransplants after diagnosis by hepatic artery ultrasonography and arteriography. The descriptive analysis showed a significant relationship between the appearance of hepatic artery thrombosis with variables of postoperative severity, such as arrhythmias, atelectasis, pleural effusion, hemodialysis requirement, acute kidney failure, and respiratory failure. Although patients with hepatic artery thrombosis had a longer mean hospital stay, this was not statistically significant. There was decreased graft survival and overall survival of patients who experienced hepatic artery thrombosis. CONCLUSION Although the incidence of hepatic artery thrombosis has been relatively low (4%), the early detection of risk factors, such as arterial anatomic anomalies that condition a complex anastomosis, should draw our attention, thus having at our disposal strict ultrasonography and arteriography surveillance protocols as well as prophylactic anticoagulation guidelines for receptors at risk.
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Affiliation(s)
- F Alconchel
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
| | - L A Martínez-Insfran
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P A Cascales-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - B Febrero
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - L Martínez-Alarcón
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - A Ríos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J A Fernández-Hernández
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J M Rodríguez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - G Ruiz-Merino
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - M Royo-Villanova
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain; Intensive Care Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - J A Pons
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain; Department of Hepatology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - R Robles-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - F Sánchez-Bueno
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Ramírez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Parrilla
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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5
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Lopez-Lopez V, Gómez-Ruiz AJ, Eshmuminov D, Cascales-Campos PA, Alconchel F, Arevalo-Perez J, Robles Campos R, Parrilla Paricio P. Surgical oncology in patients aged 80 years and older is associated with increased postoperative morbidity and mortality: A systematic review and meta-analysis of literature over 25 years. Surg Oncol 2019; 33:81-95. [PMID: 32561103 DOI: 10.1016/j.suronc.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The study aim is to analyze the evolution over the last 25 years of the results reported after abdominal oncological surgery in patients aged 80 years of age and older. The primary endpoint was morbidity and mortality in this group of patients; the secondary endpoint was overall survival. METHODS A systematic search strategy was used to browse through Medline/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials using a combination of standardized index terms. Studies published between 1997 and 2017 were selected. Only those studies that showed morbidity and mortality after digestive and hepatobiliary tract oncological surgery in individuals aged 80 years and older were included. The PROSPERO registration number is CRD42018087921. PRISMA and MOOSE guidelines were applied. RESULTS A total of 79 studies were included, categorized by origin of malignancy: esophageal (7), stomach (26), liver (4), pancreas (19), and colorectal (23). Compared with the non-elderly group, the elderly group had similar esophageal morbidity with higher mortality (RR 2.51, 1.50 to 4.21; P = 0.0005); higher gastric morbidity (RR 1.25, 1.09 to 1.43; P = 0.001), and mortality (RR 2.51, 1.81 to 3.49; P = 0.0001); similar liver morbidity and mortality; higher pancreatic morbidity (RR 1.17, 1.03 to 1.33; P = 0.02) and mortality (RR 2.37, 1.86 to 3.03; P < 0.00001); and similar colorectal morbidity with higher mortality (RR 4.44, 1.91 to 10.32; P = 0.005). CONCLUSION Oncological surgery of most abdominal visceral tumors is associated with increased morbidity and mortality in patients older than 80 years.
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Affiliation(s)
- V Lopez-Lopez
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - A J Gómez-Ruiz
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain.
| | - D Eshmuminov
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | | | - F Alconchel
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - J Arevalo-Perez
- Memorial Sloan Kettering Cancer Center. Radiology Departament, New York, USA
| | - R Robles Campos
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - P Parrilla Paricio
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
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6
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Arjona-Sanchez A, Rodriguez-Ortiz L, Baratti D, Schneider MA, Gutiérrez-Calvo A, García-Fadrique A, Tuynman JB, Cascales-Campos PA, Martín VC, Morales R, Salti GI, Arteaga X, Pacheco D, Alonso-Gomez J, Yalkin O, Villarejo-Campos P, Sanchez-Hidalgo JM, Casado-Adam A, Cosano-Alvarez A, Rufian-Peña S, Briceño J. RAS Mutation Decreases Overall Survival After Optimal Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy of Colorectal Peritoneal Metastasis: A Modification Proposal of the Peritoneal Surface Disease Severity Score. Ann Surg Oncol 2019; 26:2595-2604. [PMID: 31111351 DOI: 10.1245/s10434-019-07378-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently the most accepted treatment for peritoneal metastases from colorectal cancer. Restrictive selection criteria are essential to obtain the best survival benefits for this complex procedure. The most widespread score for patient selection, the peritoneal surface disease severity score (PSDSS), does not include current biological factors that are known to influence on prognosis. We investigated the impact of including RAS mutational status in the selection criteria for these patients. METHODS We studied the risk factors for survival by multivariate analysis using a prospective database of consecutive patients with carcinomatosis from colorectal origin treated by CRS and HIPEC in our unit from 2009 to 2017. The risk factors obtained were validated in a multicentre, international cohort, including a total of 520 patients from 15 different reference units. RESULTS A total of 77 patients were selected for local análisis. Only RAS mutational status (HR: 2.024; p = 0.045) and PSDSS stage (HR: 2.90; p = 0.009) were shown to be independent factors for overall survival. Early PSDSS stages I and II associated to RAS mutations impaired their overall survival with no significant differences with PSDSS stage III overall survival (p > 0.05). These results were supported by the international multicentre validation. CONCLUSIONS By including RAS mutational status, we propose an updated RAS-PSDSS score that outperforms PSDSS alone providing a quick and feasible preoperative assessment of the expected overall survival for patients with carcinomatosis from colorectal origin undergone to CRS + HIPEC.
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Affiliation(s)
- A Arjona-Sanchez
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain. .,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, University Hospital Reina Sofıa, Córdoba, Spain.
| | - L Rodriguez-Ortiz
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain
| | - D Baratti
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy
| | - M A Schneider
- Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - A Gutiérrez-Calvo
- Surgery Department, Unit of Peritoneal Oncologic Surgery, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - A García-Fadrique
- Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - J B Tuynman
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - P A Cascales-Campos
- Departamento De Cirugía General, Unidad De Cirugía De La Carcinomatosis Peritoneal, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - V Concepción Martín
- Unit of Peritoneal Oncologic Surgery and Colorectal Surgery, Hospital University Nuestra Señora de la Candelaria, Tenerife, Spain
| | - R Morales
- Unit of Oncologic and Pancreatic Surgery, Hospital Son Spaces, Palma de Mallorca, Spain
| | - G I Salti
- Division of Surgical Oncology, The University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, USA
| | - X Arteaga
- Department of Surgery, Donostia Hospital, San Sebastián, Spain
| | - D Pacheco
- Gastroenterology Service, Liver Transplantation Unit, Rio Hortega Hospital, Valladolid, Spain
| | - J Alonso-Gomez
- Department of Surgery, H.U. Gran Canaria Dr. Negrín, Canarias, Spain
| | - O Yalkin
- Department of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - P Villarejo-Campos
- Department of Surgical Oncology, University Hospital Ciudad Real, Ciudad Real, Spain
| | - J M Sanchez-Hidalgo
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, University Hospital Reina Sofıa, Córdoba, Spain
| | - A Casado-Adam
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, University Hospital Reina Sofıa, Córdoba, Spain
| | - A Cosano-Alvarez
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain
| | - S Rufian-Peña
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, University Hospital Reina Sofıa, Córdoba, Spain
| | - J Briceño
- Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, University Hospital Reina Sofıa, Córdoba, Spain
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7
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sánchez-Iglesias JL, Olloqui A, García-Granero Á, Matute L, Fornes V, Domingo S. Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study. Gynecol Oncol 2019; 153:549-554. [PMID: 30952369 DOI: 10.1016/j.ygyno.2019.03.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/22/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecology, Valencian Institute of Oncology, Valencia, Spain
| | | | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - Á García-Granero
- Department of General Surgery, University Hospital La Fe, Valencia, Spain
| | - L Matute
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - V Fornes
- Unit of Biostatistics, Health Research Institute Hospital La Fe, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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8
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Martínez-Insfran LA, Alconchel F, Ramírez P, Cascales-Campos PA, Carbonell G, Barona L, Pons JA, Sánchez-Bueno F, Robles-Campos R, Parrilla P. Liver Transplantation for Fulminant Hepatic Failure Due to Heat Stroke: A Case Report. Transplant Proc 2019; 51:87-89. [PMID: 30661899 DOI: 10.1016/j.transproceed.2018.03.137] [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] [Received: 01/26/2018] [Accepted: 03/15/2018] [Indexed: 11/16/2022]
Abstract
Heat stroke is a condition caused by an excessive increase in body temperature in a relatively short period of time, and is clinically characterized by central nervous system dysfunction, including delirium, seizures, coma, and severe hyperthermia. In this context, the resulting fulminant hepatic failure makes liver transplant the best choice when there are no guarantees of better results with conservative treatment. We present our experience in this case, possible alternative choices, and the current role of liver transplantation in the resolution of fulminant liver failure due to heat stroke. CASE REPORT: We report the case of a 32-year-old man with a history of malabsorption syndrome and unconfirmed celiac disease controlled with a gluten-free diet, who, while working on a typical summer midday in southern Spain (approximately 40°C), abruptly presented with loss of consciousness, coma, and a temperature of 42°C, as well as seizures at the initial medical assessment that subsided after the administration of diazepam. On the third day, the patient presented with multiple organ dysfunction syndrome, requiring mechanical ventilation, hemodialysis, and inotropic support. He did not improve with the support of conservative treatment, therefore it was decided to perform an urgent liver transplant, after which he recovered completely. CONCLUSIONS: Liver transplantation should be a main choice of treatment for cases in which, despite intensive medical treatment, there is still clinical and analytical evidence of massive and/or irreversible hepatocellular damage.
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Affiliation(s)
- L A Martínez-Insfran
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - F Alconchel
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain.
| | - P Ramírez
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - P A Cascales-Campos
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - G Carbonell
- Department of Radiology, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - L Barona
- Department of Pathology, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - J A Pons
- Department of Hepatology, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - F Sánchez-Bueno
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - R Robles-Campos
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
| | - P Parrilla
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca (Murcia)-IMIB-Arrixaca, Murcia, Spain
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9
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López-López V, Lynn PB, Gil J, García-Salom M, Gil E, González A, Muñoz IP, Cascales-Campos PA. Effect of Paclitaxel-based Hyperthermic Intraperitoneal Chemotherapy (HIPEC) on colonic anastomosis in a rat model. Clin Transl Oncol 2018; 21:505-511. [PMID: 30229392 DOI: 10.1007/s12094-018-1948-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Paclitaxel has been used frequently for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for ovarian carcinomatosis. Cytoreductive surgery and HIPEC are associated with high rates of morbidity being anastomotic dehiscence one of the most frequent. The objective of this study is to quantify the effect of Paclitaxel-based HIPEC on colonic anastomosis in an experimental rat model. METHODS After left colon resection and anastomosis, animals were randomized into four groups: Controls (C); Hyperthermia (H); Normothermic Intraperitoneal Paclitaxel (CP) and Paclitaxel-based HIPEC (HP). On postoperative day four, animals' peritoneal cavities were examined macroscopically, colon anastomosis burst pressures measured and specimens analyzed histologically. RESULTS Thirty-nine animals were randomized and 36 were included in the analysis. H group presented the highest burst pressure 105.11 ± 22.9 mmHg, which was 27% higher than C (77.89 ± 27.6 mmHg). On the other hand, HP presented the lowest burst pressure 64 ± 26 mmHg, 16% lower than C group and 39% lower than H, being this latter difference statistically significant (p = 0.004). There were no significant differences regarding weight loss, adhesion scores, perianastomotic abscesses and histological findings (inflammation, fibroblasts, neoangiogenesis, and collagen among groups). CONCLUSION Strength of colonic anastomosis was improved by isolated hyperthermia and negatively affected by Paclitaxel-based HIPEC.
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Affiliation(s)
- V López-López
- Virgen de la Arrixaca Clinic and University Hospital, General Surgery, IMIB, El Palmar, Murcia, Spain.
| | - P B Lynn
- Surgery Department, New York University School of Medicine, New York, NY, USA
| | - J Gil
- Virgen de la Arrixaca Clinic and University Hospital, General Surgery, IMIB, El Palmar, Murcia, Spain
| | - M García-Salom
- Virgen de la Arrixaca Clinic and University Hospital, General Surgery, IMIB, El Palmar, Murcia, Spain
| | - E Gil
- Virgen de la Arrixaca Clinic and University Hospital, General Surgery, IMIB, El Palmar, Murcia, Spain
| | - A González
- Gerencia del Area de Salud III (Lorca), Murcia, Spain
| | - I P Muñoz
- Hospital Virgen del Castillo (Yecla), Murcia, Spain
| | - P A Cascales-Campos
- Virgen de la Arrixaca Clinic and University Hospital, General Surgery, IMIB, El Palmar, Murcia, Spain
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10
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González-Sánchez MR, Cascales-Campos PA, López-Espín JJ, Febrero B, Pons JA, Vargas Acosta A, Ros J, Sánchez-Bueno F, Robles R, Sáenz L, Ramírez P, Parilla P. Donors Older Than 75 Years Do Not Influence the Appearance of Biliary Complications After Liver Transplantation. Transplant Proc 2018; 50:640-643. [PMID: 29579875 DOI: 10.1016/j.transproceed.2017.11.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/21/2017] [Accepted: 11/11/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND In recent years, several studies have shown that the age of the donor may be related to an increase in the occurrence of biliary complications (BCs), which remain the main cause of morbidity after liver transplantation. This study analyzed the type and management of these BCs, the impact of BCs on graft and patient survival rates, and the influence of some characteristics of donors and recipients on BC appearance in patients transplanted with donors 75 years of age or older. PATIENTS AND METHODS From 2003 to 2016, 100 liver transplantations with donors 75 years of age or older (15.6%) were performed in our hospital. The data were compared with a control group of 400 patients with younger donors (case-control 1:4 per chronology). RESULTS The BC rate in the group of patients transplanted with organs from elderly donors was 18%, compared to 21.5% in the control group. Specifically, in the immediate post-transplantation period, 14% of the elderly donor group and 13.8% of the control group presented some BCs, with no statistically significant differences in the incidence, type, and treatment of BCs between the two groups. The occurrence of BCs was not a factor associated with graft and patient survival rates. In the global population, donor death by cerebral vascular accident and male donors have influenced the occurrence of BCs. CONCLUSIONS The advanced age of the donor has not influenced BC rates after transplantation.
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Affiliation(s)
- M R González-Sánchez
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain.
| | - P A Cascales-Campos
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - J J López-Espín
- Operation Research Institute, University of Miguel Hernández, Elche, Spain
| | - B Febrero
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - J A Pons
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - A Vargas Acosta
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - J Ros
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - F Sánchez-Bueno
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - R Robles
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - L Sáenz
- Clinical Analysis Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - P Ramírez
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
| | - P Parilla
- Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain
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11
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Sánchez-Lorencio MI, Saenz L, Ramirez P, Villalba-López F, de la Orden V, Mediero-Valeros B, Revilla Nuin B, Gonzalez MR, Cascales-Campos PA, Ferreras-Martínez D, Noguera-Velasco JA, Díaz-Rubio E, Parrilla P. Matrix Metalloproteinase 1 as a Novel Biomarker for Monitoring Hepatocellular Carcinoma in Liver Transplant Patients. Transplant Proc 2018; 50:623-627. [PMID: 29579870 DOI: 10.1016/j.transproceed.2017.11.061] [Citation(s) in RCA: 6] [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] [Received: 07/15/2017] [Revised: 10/20/2017] [Accepted: 11/11/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Orthotopic liver transplantation (LT) is considered to be one of the few curative treatments available for early stages of hepatocellular carcinoma (HCC). Alfa-fetoprotein (AFP) is the most-used biomarker for HCC despite low sensitivity and specificity. Matrix metalloproteinase 1 (MMP-1) has been considered to be involved in the process of vascular invasion of the malignant cells. The objective of this study was to assess the use of MMP-1 for the management of HCC patients for LT. METHODS Levels in serum of MMP-1 (ng/mL) and AFP (ng/mL) were assessed in 20 HCC patients (Milan criteria) before and 1, 6, and 12 months after LT. RESULTS There was a strong significant correlation between levels of MMP-1 and levels of AFP (ρ = .954; P ≤ .05). There were statistical differences in the levels of MMP-1 and APF between the pre-transplantation and post-transplantation groups (1 and 12 months). Increments of both markers 6 months after LT compared with the levels 1 month after LT were detected in 4 of the 20 HCC patients. The detection of recurrence by means of imaging was coincident with the increment of both markers 6 months after LT in 3 of those 4 patients. CONCLUSIONS After 12 months of follow-up, levels of MMP-1 were comparable to AFP levels after LT. Levels of both markers increase 6 months after LT in patients showing recurrence, indicating discriminatory power to predict relapse and thus serving as valuable markers for HCC monitoring. MMP-1 could be useful in the management of HCC after LT.
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Affiliation(s)
- M I Sánchez-Lorencio
- Clinical Analysis Department, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - L Saenz
- Clinical Analysis Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
| | - P Ramirez
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - F Villalba-López
- Clinical Analysis Department, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - V de la Orden
- CTC Unit, Molecular Oncology Laboratory, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos, CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - B Mediero-Valeros
- CTC Unit, Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - M R Gonzalez
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - P A Cascales-Campos
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - D Ferreras-Martínez
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - J A Noguera-Velasco
- Clinical Analysis Department, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - E Díaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - P Parrilla
- Liver Transplant Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
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12
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Cascales-Campos PA, Ramírez P, González-Sánchez MR, Alconchel F, Martínez-Insfran LA, Sánchez-Bueno F, Robles R, Pons JA, Vargas Á, Sanmartín J, Royo-Villanova M, Parrilla P. Orthotopic Liver Transplantation With Elderly Donors (Over 80 Years of Age): A Prospective Evaluation. Transplant Proc 2018; 50:3594-3600. [PMID: 30577243 DOI: 10.1016/j.transproceed.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Our main objective was to assess the clinical outcomes obtained in a single orthotopic liver transplant (OLT) hospital with donors ≥80 years of age compared to a control group of patients subjected to OLT during the same period of time with donors who were under 65 years of age. METHODS A prospective analysis was carried out on all the OLTs performed using liver grafts from donors in a state of brain death and with an age of ≥80 years (study group) between April 2007 and January 2015. The results of the study group (n = 36) were compared with those of a control group of patients less than 65 years of age receiving transplants with grafts. RESULTS A total of 51 potential donors ≥80 years were assessed, with a total of 36 liver transplants being carried out and their results were compared with a control group of 283 patients receiving transplants. The median follow-up time of the patients in the series was 36 months (range: 24-120 months). Graft survival at 1, 2, and 3 years was 77%, 72%, and 62%, respectively, among the patients in the study group and 79%, 73%, and 65% among the patients in the control group, and there were no statistically significant differences. Patient survival at 1, 2, and 3 years was 86%, 82%, and 75%, respectively, among the patients in the study group and 82%, 76%, and 72% among the patients in the control group, also without there being any statistically significant differences. CONCLUSIONS There is no age limit for liver transplant donors. The use of octogenarian donors makes it possible to increase the pool of donors while providing enough safety for the recipient.
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Affiliation(s)
- P A Cascales-Campos
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - P Ramírez
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - M R González-Sánchez
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - F Alconchel
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain.
| | - L A Martínez-Insfran
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - F Sánchez-Bueno
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - R Robles
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - J A Pons
- Department of Hepatology, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - Á Vargas
- Department of Hepatology, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - J Sanmartín
- Intensive Care Department, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - M Royo-Villanova
- Intensive Care Department, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
| | - P Parrilla
- Liver Transplantation Unit, Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB Arrixaca, Murcia, Spain
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13
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Rosique F, Cabezuelo JB, Ferreras D, González-Sánchez MR, Ros J, Pons JA, Cascales-Campos PA, Sánchez-Bueno F, Robles R, Ramírez P, Parrilla P. Long-term Survival and Evolution of the Kidney Function for Liver Transplant Patients Who Required Postoperative Dialysis. Transplant Proc 2018; 50:634-636. [PMID: 29579873 DOI: 10.1016/j.transproceed.2017.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 11/16/2022]
Abstract
Patients who underwent orthotopic liver transplantation (OLT) frequently develop chronic kidney disease, with those who present postoperative acute kidney failure and require renal replacement therapy (RRT) at higher risk. The objective of the study was to assess the kidney function and long-term survival of patients who underwent OLT and required RRT during or in the immediate postoperative period. Medical records of OLT and postoperative RRT patients with over 6-month survival were reviewed between January 1, 2005, and December 31, 2015. A variance analysis was carried out for repeated measurements to compare the estimate glomerular filtration rate (eGFR) baseline with the different periods (statistical significance level P < .05). Kaplan-Meier estimator was used to estimate the survival rate. Of 539 patients, 20 (3.7%) met the selection criteria. The basal eGFR at 6 months and 1, 3, 5, and 7 years was 93.41 ± 25, 78.28 ± 33, 73.06 ± 29, 65.96 ± 19, 79.81 ± 28, and 59.06 ± 24 mL/min/1.73 m2, respectively. The comparison of the eGFR baseline within the different periods was statistically significant at 1 year and at 3 years. Four patients died, 3 of them due to sepsis and 1 due to recurrence of hepatitis C virus infection. The average survival was 28 months. The probability of surviving at 1 year was 100%, at 3 years was 84.21% (95% confidence interval: 58.65-94.62), and at 5 and 10 years was 78.6% (95% confidence interval: 52.49-91.39). In conclusion, we have found a progressive worsening of the kidney function in the long term in patients who required postoperative dialysis. However, actuarial survival of these patients was very successful.
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Affiliation(s)
- F Rosique
- Department of Nephrology, Hospital General Universitario Reina Sofía, Murcia, Spain.
| | - J B Cabezuelo
- Department of Nephrology, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - D Ferreras
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M R González-Sánchez
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J Ros
- Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J A Pons
- Department of Digestive, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P A Cascales-Campos
- Department of Digestive, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - F Sánchez-Bueno
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - R Robles
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P Ramírez
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P Parrilla
- Department of General Surgery. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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14
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Cascales-Campos PA, López-López V, Muñoz-Casares FC, Feliciangeli E, Torres Melero J, Barrios P, Morales R, Ramos I, Ortega G, Camps B, González-Bayón L, Bretcha-Boix P, Farré-Alegre J, González-Moreno S, Gil J. Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish group of peritoneal cancer surgery (GECOP) multicenter study. Surg Oncol 2016; 25:111-6. [PMID: 27312037 DOI: 10.1016/j.suronc.2016.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 12/09/2015] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients ≥75 years from a Spanish multi-institutional experience. METHODS This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade I-IV) and major (grade III-IV) postoperative morbidity. RESULTS A total of 85 patients aged ≥75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade I-II) and 16 complications in 12 patients (14.1%) were moderate-severe (grade III-IV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22-14.12, p = 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87-57.46, p < 0.001). Regarding grade III-IV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR: 9.15, 95% CI 1.38-60.57, p = 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI 1.40-91.32, p = 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44-51.16, p = 0.018) were independent factors. CONCLUSIONS Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged ≥75 years can be performed with morbidity and mortality similar to that described in the literature.
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Affiliation(s)
- P A Cascales-Campos
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain.
| | - V López-López
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
| | | | - E Feliciangeli
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
| | - J Torres Melero
- Hospital Universitario De Torrecárdenas, Almería, Andalucia, Spain
| | - P Barrios
- Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain
| | - R Morales
- Hospital Universitario Son Espases, Palma de Mayorca, Islas Baleares, Spain
| | - I Ramos
- Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain
| | - G Ortega
- Hospital Universitario De Fuenlabrada, Madrid, Spain
| | - B Camps
- Hospital General Universitario, Valencia, Valencia, Spain
| | | | - P Bretcha-Boix
- Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain
| | - J Farré-Alegre
- Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain
| | | | - J Gil
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
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