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Pellino G, Podda M, Pata F, Di Saverio S, Ielpo B. Corrigendum to: Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: a sub-analysis of the ACIE Appy Study. Br J Surg 2022; 109:464. [PMID: 35015804 DOI: 10.1093/bjs/znab449] [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: 11/14/2022]
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Pata F, Di Martino M, Podda M, Di Saverio S, Ielpo B, Pellino G. Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study. World J Surg 2022; 46:2021-2035. [PMID: 35810215 PMCID: PMC9332068 DOI: 10.1007/s00268-022-06649-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. METHODS From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. RESULTS A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. CONCLUSION Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide.
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Affiliation(s)
- Francesco Pata
- General Surgery Unit, UOC di Chirurgia, Nicola Giannettasio Hospital, Via Ippocrate, 87064, Corigliano-Rossano, CS, Italy.
- La Sapienza University, Rome, Italy.
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso General Hospital, San Benedetto del Tronto, Italy
| | - Benedetto Ielpo
- Hepatobiliary division, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
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Di Martino M, Van Laarhoven S, Ielpo B, Ramia JM, Manuel-Vázquez A, Martínez-Pérez A, Pavel M, Beltran Miranda P, Orti-Rodríguez R, de la Serna S, Ortega Rabbione GJ, Sanz-Garcia A, Martín-Pérez E. Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route. HPB (Oxford) 2021; 23:1629-1638. [PMID: 34325967 DOI: 10.1016/j.hpb.2021.06.426] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP. METHODS MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration. RESULTS A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29-0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27-0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21-0.44, p < 0.001) in comparison with hydroxyethyl starch (HES). High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41-5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04-1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51-5.19, p = 0.001) compared to moderate fluid rate infusion. CONCLUSIONS In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high-rate infusion.
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Affiliation(s)
- Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Stijn Van Laarhoven
- Department of HPB Surgery University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Benedetto Ielpo
- HPB Unit, University Mar Hospital, Parc Salut, Barcelona, Spain
| | - Jose M Ramia
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, ISABIALAlicante (Spain)
| | - Alba Manuel-Vázquez
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain
| | - Mihai Pavel
- HPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain, Universitat Rovira i Virgili, Departament de Medicina i Cirugia, Reus, Spain, Universitat Rovira i Virgili, Departament de Medicina i Cirugia, Reus, Spain
| | - Pablo Beltran Miranda
- Unidad de Cirugía Hepato-Bilio-Pancreática, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rafael Orti-Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Sofía de la Serna
- HPB Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Guillermo J Ortega Rabbione
- Data Analysis Unit, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ancor Sanz-Garcia
- Data Analysis Unit, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Elena Martín-Pérez
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Pellino G, Podda M, Pata F, Di Saverio S, Ielpo B. Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study. Br J Surg 2021; 108:e332-e335. [PMID: 35015820 DOI: 10.1093/bjs/znab247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023]
Affiliation(s)
- G Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- La Sapienza University, Rome, Italy
| | - S Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy
| | - B Ielpo
- Department of Surgery, HPB Unit, Hospital del Mar - Parc de Salut MAR, University Pompeu Fabra, Barcelona, Spain
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Prieto M, Ortega I, Balibrea JM, Ielpo B. Management of cholelithiasis in times of COVID-19: A challenge for the system. Cir Esp 2021; 99:699-700. [PMID: 34635452 PMCID: PMC8484074 DOI: 10.1016/j.cireng.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Mikel Prieto
- Unidad de Cirugía Hepatobiliar y Trasplante Hepático, Hospital Universitario Cruces, Biocruces Bizkaia HealthResearch Institute, Bilbao, Universidad del País Vasco, Bilbao, Spain.
| | - Irene Ortega
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, Spain
| | - Jose Maria Balibrea
- Departamento de Cirugía Gastrointestinal, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Benedetto Ielpo
- Unidad de Cirugía Hepatobiliopancreática, Hospital del Mar, Universidad Pompeu Fabra, Barcelona, Spain
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Vanni G, Pellicciaro M, Combi F, Papi S, Materazzo M, Segattini S, Rizza S, Chiocchi M, Perretta T, Meucci R, Portarena I, Pistolese CA, Ielpo B, Campanelli M, Lisi G, Chiaravalloti A, Tazzioli G, Buonomo OC. Impact of COVID-19 Pandemic on Surgical Breast Cancer Patients Undergoing Neoadjuvant Therapy: A Multicentric Study. Anticancer Res 2021; 41:4535-4542. [PMID: 34475080 DOI: 10.21873/anticanres.15265] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Due to the SARS-CoV-2 pandemic, many scientific committees proposed neoadjuvant therapy (NACT) bridging treatment as a novel strategy and indication. The aim of the study was to evaluate the impact of COVID-19 pandemic on breast cancer patients undergoing NACT. PATIENTS AND METHODS All breast cancer patients referred to two Breast Units during COVID-19-pandemic were enrolled. RESULTS Out of 814 patients, 43(5.3%) were enrolled in the COVID-19-group and compared with 94 (7.9%) similar Pre-COVID-19 patients. We observed a reduction in the number of patients undergoing NACT, p=0.0019. No difference was reported in terms of clinical presentation, indications, and tumor response. In contrast, a higher number of vascular adverse events was reported (6.9% vs. 0% p=0.029). Immediate breast cancer reconstructions following invasive surgery suffered a significant slowdown (5.9% vs. 47.7%, p=0.019). CONCLUSION COVID-19 caused a reduction in the number of patients undergoing NACT, with no changes in terms of indications, clinical presentation, and tumor response. Furthermore, there was an increased incidence of vascular events.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Francesca Combi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Simona Papi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Silvia Segattini
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Benedetto Ielpo
- Unidad de Chirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, Spain
| | | | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Giovanni Tazzioli
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Ielpo B, Pueyo-Périz EM, Radosevic A, Andaluz A, Berjano E, Grande L, Sánchez-Velázquez P, Burdío F. Clinical case report: endoluminal thermal ablation of main pancreatic duct for patients at high risk of postoperative pancreatic fistula after pancreaticoduodenectomy. Int J Hyperthermia 2021; 38:755-759. [PMID: 33941013 DOI: 10.1080/02656736.2021.1917703] [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] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Multiple attempts have been made to manage the pancreatic stump and the pancreatic duct in order to reduce the rate of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), however radiofrequency-based technologies could help to achieve this goal. Previous encouraging clinical and experimental results support the use of endoluminal thermal ablation (ETHA) of the main pancreatic duct to reduce pancreatic exocrine secretion and hence POPF. We here describe our initial clinical experience with ETHA of the main pancreatic duct in two cases at high risk of POPF. METHODS Two cases underwent PD for malignancy with a high risk of POPF (adenocarcinoma, obese patients, surgical difficulties with heavy intraoperative blood loss, soft pancreas or walled-off pancreatitis and a tight small pancreatic main duct). In both cases, ETHA of the main pancreatic duct was conducted intraoperatively just before Blumgart-type pancreatic-jejunal anastomosis using a ClosureFast catheter (Medtronic, Mansfield, MA, USA) normally used for varicose vein treatment (therefore an off-label use). RESULTS Although a clear radiological POPF was detected in the second case, the clinical postoperative course in both cases was uneventful. Little pancreatic fluid collected in the abdominal drainage with low levels of amylase enzyme, confirming low exocrine pancreatic function. No other procedure-related complications were detected. CONCLUSION Endoluminal thermal ablation of the main pancreatic duct may be a feasible and safe technique to reduce the adverse effects of POPF after PD.
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Affiliation(s)
- Benedetto Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eva M Pueyo-Périz
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Anna Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Luis Grande
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Patricia Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Fernando Burdío
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Torrent-Jansà L, Ielpo B, Salloum C. Metastatic leiomyosarcoma of the inferior vena cava with long-time survival: therapeutic options. Rev Esp Enferm Dig 2021; 113:78-79. [PMID: 33054280 DOI: 10.17235/reed.2020.6863/2020] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 70-year-old male diagnosed with leiomyosarcoma of the inferior vena cava level II, treated with radical resection with negative margins. An hepatic metastasis in segment II is found at the 5th year follow up (fig. 1). Given the good general condition of the patient, the long disease-free period and a single resectable metastasis, the surgical excision was decided. The leiomyosarcoma of the inferior vena cava is a rare tumor of mesenchymal origin. Margins free surgery is the only treatment that increases survival. However, this is the most unfeasible situation since the disease presentation is often with a spread tumor. The singularity of this case is the long disease-free period and a single liver metastasis as recurrence of the disease.
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Affiliation(s)
| | - Benedetto Ielpo
- Unidad de Cirugía Biliopancreática. Cirugía Genera, Complejo Asistencial Universitario de León
| | - Chady Salloum
- Hepatobiliary, Centre Hepato-Biliaire. Hôpital Paul-Brousse, France
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Di Martino M, Caruso R, D'Ovidio A, Núñez-Alfonsel J, Burdió Pinilla F, Quijano Collazo Y, Vicente E, Ielpo B. Robotic versus laparoscopic distal pancreatectomies: A systematic review and meta-analysis on costs and perioperative outcome. Int J Med Robot 2021; 17:e2295. [PMID: 34085371 DOI: 10.1002/rcs.2295] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
AIM The aim of this meta-analysis is to compare perioperative outcomes and costs of robotic and laparoscopic distal pancreatectomy (RDP and LDP). MATERIAL AND METHODS In accordance with the PRISMA guidelines, we searched Medline, EMBASE, Cochrane and Web of Science for reports published before December 2020. RESULTS The literature search identified 11 papers (1 187 patients). RDP showed a lower conversion rate (odds ratio: 2.56, 95% confidence intervals [CI]: 1.31 to 5.00) with no significant differences in bleeding and operative time, complications ≥ Clavien-Dindo grade III, pancreatic fistulas and length of stay. Despite RDP presenting higher costs in all included studies, none of these differences were significant. However, RDP showed higher total costs than LDP (standardized mean differences [SMD]: -1.18, 95% CI: -1.97 to -0.39). A subgroup analysis according to the continent of origin showed that studies coming from Asian research groups kept showing significant differences (SMD: -2.62, 95% CI: -3.38 to -1.85), while Western groups did not confirm these findings. CONCLUSION Based on low-quality evidence, despite some potential technical advantages, RDP still seems to be costlier than LDP.
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Affiliation(s)
- Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Riccardo Caruso
- General Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | - Angelo D'Ovidio
- General Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | - Javier Núñez-Alfonsel
- Instituto de Validación de la Eficiencia Clínica (IVEC), Fundación de Investigación HM Hospitales, Madrid, Spain.,Cátedra Medicina Basada en la Eficiencia, Fundación de Investigación HM Hospitales, Madrid, Spain
| | | | - Yolanda Quijano Collazo
- General Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | - Benedetto Ielpo
- HPB Unit, University Parc Salut Mar Hospital, Barcelona, Spain
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Villamonte M, Burdío F, Pueyo E, Andaluz A, Moll X, Berjano E, Radosevic A, Grande L, Pera M, Ielpo B, Sánchez-Velázquez P. The impact of additional margin coagulation with radiofrequency in liver resections with subcentimetric margin: can we improve the oncological results? A propensity score matching study. Eur J Surg Oncol 2021; 48:82-88. [PMID: 34148824 DOI: 10.1016/j.ejso.2021.06.008] [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: 03/29/2021] [Revised: 05/09/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. METHODS We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. RESULTS No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093-0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). CONCLUSIONS An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.
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Affiliation(s)
- María Villamonte
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Fernando Burdío
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain.
| | - Eva Pueyo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Ana Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | | | - Luís Grande
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Miguel Pera
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Benedetto Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Patricia Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain
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Chin KM, Di Martino M, Syn N, Ielpo B, Hilal MA, Goh BKP, Koh YX, Prieto M. Re-appraising the role of lymph node status in predicting survival in resected distal cholangiocarcinoma - A meta-analysis and systematic review. Eur J Surg Oncol 2021; 47:1267-1277. [PMID: 33549378 DOI: 10.1016/j.ejso.2021.01.004] [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: 12/04/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
This systematic review and meta-analysis aimed to confirm the prognostic value of lymph node ratio (LNR), and determine an optimal LNR cut-off for overall survival (OS) in patients with distal cholangiocarcinoma (DCC) undergoing curative surgery. We additionally aimed to provide a consolidated review of current evidence regarding prognostic significance of positive lymph node count (PLNC) and total lymph node count (TLNC). A systematic search of PubMed, EMBASE and Cochrane Library was conducted from inception to October 2020. Studies were included into meta-analysis if there was histological diagnosis, curative surgery, restriction to DCC and relevant LNR results. Quality assessment was performed using the Newcastle Ottawa Scale. Findings for 1228 patients were pooled across 6 studies. Meta-analysis delineated a dose-effect gradient in which higher LNR cut-offs correlated with larger pooled hazard ratios: 0<LNR<0.2 (HR 1.54; 95% CI 1.08-2.20; p = 0.02), LNR>0.2 (HR 3.26; 95% CI 2.07-5.13; p < 0.00001) and LNR>0.4 (HR 3.59; 95% CI 2.31-5.58; p < 0.00001) when compared against a control group of LNR = 0. LNR of 0.2 (HR 2.12; 95% CI: 1.57-2.86; p < 0.0001) was found to be a significant and ideal cut-off for prognostication of poorer OS. A review of current literature reveals an ongoing debate regarding the comparative prognostic value of differing PLNC cut-offs (0/1/3 versus 0/1/4). TLNC of 10-13 is widely reported to be the minimum necessary to ensure improved long term outcomes. PLNC and LNR are strong prognostic factors for OS in DCC. An ideal LNR cut-off of 0.2 is most significantly associated with poorer OS.
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Affiliation(s)
- Ken Min Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital 20 College Road, Singapore
| | - Marcello Di Martino
- Hepatopancreatobiliary Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Nicholas Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital 20 College Road, Singapore
| | - Benedetto Ielpo
- Hepatopancreatobiliary Unit, Parc Salut Mar Hospital, Barcelona, Passeig Marítim de La Barceloneta 25, 08003, Spain
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Via Leonida Bissolati, 57, 25124, Italy
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital 20 College Road, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore 10 Medical Drive, 117597, Singapore; Duke NUS Medical School, Singapore (8 College Rd, 169857, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital 20 College Road, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore 10 Medical Drive, 117597, Singapore; Duke NUS Medical School, Singapore (8 College Rd, 169857, Singapore.
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Cruces Plaza, S/N, 48903 Barakaldo, Bizkaia, Spain; BioCruces Research Institute, University of the Basque Country Cruces Plaza, 48903 Barakaldo, Bizkaia, Spain
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Prieto M, Ielpo B, Jiménez Fuertes M, González Sánchez MDC, Martín Antona E, Balibrea JM, Aranda Narváez JM. National survey on the treatment of acute appendicitis in Spain during the initial period of the COVID-19 pandemic. Cir Esp 2021; 99:450-456. [PMID: 34092540 PMCID: PMC8163034 DOI: 10.1016/j.cireng.2021.05.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on Spanish hospitals, which have had to allocate all available resources to treat these patients, reducing the ability to attend other common pathologies. The aim of this study is to analyze how the treatment of acute appendicitis has been affected. METHOD A national descriptive study was carried out by an online voluntary specific questionnaire with Google Drive™ distributed by email by the Spanish Association of Surgeons (AEC) to all affiliated surgeons currently working in Spain (5203), opened from April 14th to April 24th. RESULTS We received 337 responses from 170 centers. During the first month of the pandemic, the incidence of acute appendicitis decreased. Although conservative management increased, the surgical option has been the most used in both simple and complicated appendicitis. Despite the fact that the laparoscopic approach continues to be the most widely used in our services, the open approach has increased during this pandemic period. CONCLUSION Highlight the contribution of this study in terms of knowledge of the status of the treatment of acute appendicitis during this first month of the pandemic, being able to serve for a better possible organization in future waves of the pandemic and a reorganization of current protocols and management of acute appendicitis in a pandemic situation.
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Affiliation(s)
- Mikel Prieto
- Servicio de Cirugía General, Unidad de Cirugía Hepatobiliar y Trasplante Hepático, Hospital Universitario Cruces, Bilbao, Universidad del País Vasco UPV-EHU, Spain.
| | - Benedetto Ielpo
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, Spain
| | - Montiel Jiménez Fuertes
- Unidad de Trauma y Cirugía de Urgencias, Unidad CHBP, Servicio de Cirugía General y Digestiva, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Esteban Martín Antona
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de San Carlos, Madrid, Universidad Complutense de Madrid, Sección de Infección Quirúrgica de la AEC, Sección de Obesidad Mórbida de la AEC, Spain
| | - José M Balibrea
- Servicio de Cirugía Gastrointestinal (ICMDiM), Hospital Clínic de Barcelona, Universitat de Barcelona, Sección de Infección Quirúrgica de la AEC, Spain
| | - José Manuel Aranda Narváez
- Servicio de Cirugía General, Hospital Regional Universitario Carlos Haya, Málaga, Sección de Trauma y Cirugía de Urgencias de la AEC, Spain
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Caruso R, Vicente E, Quijano Y, Duran H, Fabra I, Diaz E, Malave L, Agresott R, Cañamaque LG, Ielpo B, Ferri V. Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer. Discov Oncol 2021; 12:16. [PMID: 35201442 PMCID: PMC8777577 DOI: 10.1007/s12672-021-00405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. DATA DESCRIPTION We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.
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Affiliation(s)
- Riccardo Caruso
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Luis Malave
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Ruben Agresott
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Lina García Cañamaque
- Division of Nuclear Medicine, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Benedetto Ielpo
- HPB Unit, University Parc Salut Mar Hospital, Barcelona, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
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Ielpo B, Podda M, Pellino G, Pata F, Di Saverio S. Stress response during the early phase of the pandemic: lessons learned and opportunities. Br J Surg 2021; 108:e313. [PMID: 34000031 PMCID: PMC8499720 DOI: 10.1093/bjs/znab182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Benedetto Ielpo
- HPB Unit Surgical Department, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Mauro Podda
- Department of emergency surgery, Cagliari University Hospital 'Policlinico D. Casula', Cagliari, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Science, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Francesco Pata
- Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Roma Italy.,Cambridge Colorectal Unit, Addenbrooke'S University Hospital NHS Foundation Trust, Cambridge, UK
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Addenbrooke'S University Hospital NHS Foundation Trust, Cambridge, UK
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65
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. [National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic]. Cir Esp 2021; 99:346-353. [PMID: 38620242 PMCID: PMC7368890 DOI: 10.1016/j.ciresp.2020.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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Affiliation(s)
- Benedetto Ielpo
- Unidad de Cirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, España
| | - Mikel Prieto
- Unidad Hepatobiliar, Transplante Hepático y Retroperitoneo, Hospital Universitario Cruces, Bilbao, España
| | - Irene Ortega
- Sección de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Universidad Europea de Madrid, Madrid, España
| | - José María Balibrea
- Servicio de Cirugía Gastrointestinal (ICMDiM), Hospital Clínic de Barcelona, Universitat de Barcelona. Sección de Infección Quirúrgica, AEC, Barcelona, España
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
| | - Montse Juvany
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España
| | | | - José Manuel Ramia
- Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España
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66
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic. Cirugía Española (English Edition) 2021. [PMID: 32892980 PMCID: PMC8088215 DOI: 10.1016/j.cireng.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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Ielpo B, Prieto M, Ortega I, Gómez-Bravo MÁ, Ramia JM. Reply to editor letter. Cir Esp 2021; 99:396-397. [PMID: 33637297 PMCID: PMC7901362 DOI: 10.1016/j.ciresp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Benedetto Ielpo
- Unidad de Cirugía Hepatobiliopancreática, Hospital del Mar, Barcelona, España.
| | - Mikel Prieto
- Unidad Hepatobiliar y Trasplantes, Hospital Universitario Cruces, Bilbao, Vizcaya, España
| | - Irene Ortega
- Sección de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, España
| | - Miguel Ángel Gómez-Bravo
- Unidad de Cirugía Hepatobiliopancreática y Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - José Manuel Ramia
- Servicio de Cirugía, Hospital Universitario de Alicante, Alicante, España
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Podda M, Pata F, Pellino G, Ielpo B, Di Saverio S. Acute appendicitis during the COVID-19 lockdown: never waste a crisis! Br J Surg 2021; 108:e31-e32. [PMID: 33640949 PMCID: PMC7929268 DOI: 10.1093/bjs/znaa073] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- M Podda
- Department of Emergency Surgery, Cagliari University Hospital 'Duilio Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Rome, Italy
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - B Ielpo
- Unidad de Cirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, Spain
| | - S Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, Azienda Socio-Sanitaria Territoriale (ASST) Sette Laghi, Regione Lombardia, Italy
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Durán H, Olivares S, Ielpo B, Quijano Y, Caruso R, Ferri V, Malavé L, Fabra I, Díaz E, D'Ovidio A, Angresott R, Vicente E. Prognostic Value of Lymph Node Status for Actual Long-Term Survival in Resected Pancreatic Cancer. Surg Technol Int 2020; 37:79-84. [PMID: 32841360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The prognostic factors for long-term survival after curative resection of pancreatic adenocarcinoma are still poorly understood. The purpose of this study was to identify the prognostic factors of long-term survival after resection of pancreatic adenocarcinoma based on actual 5-year survival including different lymph node status classifications. METHOD A total of 106 patients who underwent pancreatectomy were enrolled at our institution and retrospectively analyzed according to actual survival (> vs < 5 years), as well as several currently available node classifications: N0/N1, N0/N1/N2, and lymph-node ratio (LNR) including multivariate logistic regression. RESULTS The actual 5-year overall survival rate of the series was 12.26%. In a univariate analysis, operative blood loss and blood transfusion, completion of adjuvant treatment, histological differentiation, perineural invasion, N0/N1, N0/N1/N2 and LNR were significant predictive factors for actual long-term survival. A multivariate analysis showed that only N0/N1 was an independent predictive factor for actual 5-year survival (OR: 1.593; 0.730-1.325; p= 0.264). CONCLUSION The nodal involved status is the strongest independent unfavorable factor for actual long-term survival after pancreatic resection for adenocarcinoma.
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Affiliation(s)
- Hipolito Durán
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Sergio Olivares
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Benedetto Ielpo
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain, University Hospital Mar, Parcsalut, HPB unit, Barcelona, Spain
| | - Yolanda Quijano
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain, Cátedra Internacional de Investigación en Cirugía General y Digestiva, Universidad CatólicaSan Antonio de Murcia, Spain
| | - Riccardo Caruso
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Valentina Ferri
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Luis Malavé
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Isabel Fabra
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Eduardo Díaz
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Angelo D'Ovidio
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Rúben Angresott
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain
| | - Emilio Vicente
- Department of General Surgery, HM Sanchinarro University Hospital, Madrid, Spain, Organization for the Development and Research of Surgical Oncology, Madrid, Spain, Cátedra Internacional de Investigación en Cirugía General y Digestiva, Universidad CatólicaSan Antonio de Murcia, Spain
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Caruso R, Vicente E, Quijano Y, D'Ovidio A, Ielpo B, Ferri V. Review with video of a laparoscopic transabdominal preperitoneal (TAPP) repair for giant inguinoscrotal hernia. Int J Surg Case Rep 2020; 76:549-551. [PMID: 33207429 PMCID: PMC7607209 DOI: 10.1016/j.ijscr.2020.10.063] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Giant inguinoscrotal (GIS) hernias are rarely encountered in clinical settings and are often associated with mental neglect for many years. This type of hernia is defined as "giant" if it descends below the mid-point of the inner thigh of a patient in an upright position. The laparoscopic repair approach of a GIS hernia is technically challenging. It has been claimed that laparoscopic surgery has several advantages over the open surgical approach, with less pain and an earlier recovery. The aim of this video is to evaluate the efficacy of TAPP (laparoscopic transabdominal preperitoneal) in order to treat a GIS hernia. CASE PRESENTATION A 65-year-old male without a relevant past medical history was admitted to the emergency service with abdominal pain, belching and nausea. He denied any other symptoms, and no previous surgical operations were recorded. Physical examination showed a large mass in the left scrotum below the mid-point of the inner thigh of the patient in an upright position. A CT scan confirmed the diagnosis of a GIS. A laparoscopic TAPP procedure was decided upon as the best course of treatment. RESULTS The patient underwent a successful repair procedure. The operation time was 150 min. No intraoperative blood transfusion was necessary. The patient's diet was resumed on the first day post surgery, and the postoperative hospital stay was three days. CONCLUSIONS Laparoscopic TAPP repair is a safe and feasible method for surgically managing GIS hernias.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Angelo D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
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Ielpo B, Podda M, Pellino G, Pata F, Caruso R, Gravante G, Di Saverio S. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study. Br J Surg 2020; 108:717-726. [PMID: 34000031 PMCID: PMC7675377 DOI: 10.1002/bjs.11999] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/23/2020] [Indexed: 02/05/2023]
Abstract
Background Surgical strategies are being adapted to face the COVID‐19 pandemic. Recommendations on
the management of acute appendicitis have been based on expert opinion, but very little
evidence is available. This study addressed that dearth with a snapshot of worldwide
approaches to appendicitis. Methods The Association of Italian Surgeons in Europe designed an online survey to assess the
current attitude of surgeons globally regarding the management of patients with acute
appendicitis during the pandemic. Questions were divided into baseline information,
hospital organization and screening, personal protective equipment, management and
surgical approach, and patient presentation before versus during the
pandemic. Results Of 744 answers, 709 (from 66 countries) were complete and were included in the
analysis. Most hospitals were treating both patients with and those without COVID. There
was variation in screening indications and modality used, with chest X‐ray plus
molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of
complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively
before, but 23·7 and 5·3 per cent, during the pandemic (both
P < 0·001). One‐third changed their approach from laparoscopic to
open surgery owing to the popular (but evidence‐lacking) advice from expert groups
during the initial phase of the pandemic. No agreement on how to filter surgical smoke
plume during laparoscopy was identified. There was an overall reduction in the number of
patients admitted with appendicitis and one‐third felt that patients who did present had
more severe appendicitis than they usually observe. Conclusion Conservative management of mild appendicitis has been possible during the pandemic. The
fact that some surgeons switched to open appendicectomy may reflect the poor guidelines
that emanated in the early phase of SARS‐CoV‐2.
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Affiliation(s)
- B Ielpo
- Department of Surgery, Hepatopancreatobiliary Unit, University Hospital Leon, Leon, Spain
| | - M Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Azienda Ospedaliero-Universitaria, Cagliari, Italy
| | - G Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,Department of General Surgery, La Sapienza University, Rome, Italy
| | - R Caruso
- Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - G Gravante
- Department of General Surgery, Ospedale 'Francesco Ferrari', Casarano, Italy
| | - S Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione LombardiaVarese, Italy
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Worth PJ, Leal J, Ding Q, Trickey A, Dua MM, Chatzizacharias N, Soonawalla Z, Athanasopoulos P, Toumpanakis C, Hansen P, Parks RW, Connor S, Parker K, Koea J, Srinavasa S, Ielpo B, Vicente Lopez E, Lawrence B, Visser BC. Pancreatic grade 3 neuroendocrine tumors behave similarly to neuroendocrine carcinomas following resection: a multi-center, international appraisal of the WHO 2010 and WHO 2017 staging schema for pancreatic neuroendocrine lesions. HPB (Oxford) 2020; 22:1359-1367. [PMID: 32081540 DOI: 10.1016/j.hpb.2019.12.014] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2017, the WHO updated their 2010 classification of pancreatic neuroendocrine tumors, introducing a well-differentiated, highly proliferative grade 3 tumor, distinct from neuroendocrine carcinomas. The aim of this study was to investigate the clinical significance of this update in a large cohort of resected tumors. METHODS Using a multicenter, international dataset of patients with pancreatic neuroendocrine lesions, patients were classified both according to the WHO 2010 and 2017 schema. Multivariable survival analyses were performed, and the models were evaluated for discrimination ability and goodness of fit. RESULTS Excluding patients with a known germline MEN1 mutation and incomplete data, 544 patients were analyzed. The performance of the WHO 2010 and 2017 models was similar, however surgically resected grade 3 tumors behaved very similarly to neuroendocrine carcinomas. CONCLUSION The addition of a grade 3 NET classification may be of limited utility in surgically resected patients, as these lesions have similar postoperative survival compared to carcinomas. While the addition may allow for a more granular evaluation of novel treatment strategies, surgical intervention for high grade tumors should be considered judiciously.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul Hansen
- Providence Portland Cancer Center, United States
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73
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Vanni G, Legramante JM, Pellicciaro M, DE Carolis G, Cotesta M, Materazzo M, Buonomo C, Farinaccio A, Santori F, Saraceno F, Ielpo B, Aiello F, Paganelli C, Grande M, DE Andreis G, Chiocchi M, Palombi L, Buonomo OC. Effect of Lockdown in Surgical Emergency Accesses: Experience of a COVID-19 Hospital. In Vivo 2020; 34:3033-3038. [PMID: 32871849 PMCID: PMC7652486 DOI: 10.21873/invivo.12137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIM SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses. PATIENTS AND METHODS Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed. RESULTS During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005). CONCLUSION We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jacopo Maria Legramante
- Department of Medical Systems, Università di Tor Vergata, Rome, Italy
- Emergency Department, Policlinico Tor Vergata, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Maria Cotesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anes-thetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Andrea Farinaccio
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anes-thetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | | | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Michele Grande
- Department of General and Emergency Surgery, University of Tor Vergata, Rome, Italy
| | | | - Marcello Chiocchi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radio-therapy, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Vidal-Vanaclocha F, Crende O, García de Durango C, Herreros-Pomares A, López-Doménech S, González Á, Ruiz-Casares E, Vilboux T, Caruso R, Durán H, Gil A, Ielpo B, Lapuente F, Quijano Y, Vicente E, Vidal-Lartitegui L, Sotomayor EM. Liver prometastatic reaction: Stimulating factors and responsive cancer phenotypes. Semin Cancer Biol 2020; 71:122-133. [PMID: 32805395 DOI: 10.1016/j.semcancer.2020.08.001] [Citation(s) in RCA: 4] [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: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
Cancer is first a localized tissue disorder, whose soluble and exosomal molecules and invasive cells induce a host response providing the stromal components of the primary tumor microenvironment (TME). Once the TME is developed, cancer-derived molecules and cells can more efficiently spread out and a whole-body response takes place, whose pathophysiological changes may result in a paraneoplastic syndrome. Remote organ-specific prometastatic reactions may also occur at this time, facilitating metastatic activities of circulating tumor cells (CTCs) through premetastatic niche development at targeted organs. However, additional signaling factors from the inter-organ communication network involved in the pathophysiology and comorbidities of cancer patients may also regulate prometastatic reaction-stimulating effects of cancer and non-cancer tissue factors. This article provides a conceptual overview of our ongoing clinical research on the liver prometastatic reaction (LPR) of patients with colorectal cancer (CRC), their portal vein- and hepatic artery-driven LPR-Stimulating Factors (LPR-SF), and their resulting LPR-derived Metastasis-Stimulating Factors (LPR-MSF) acting on liver-invading CRC cells. In addition, we also provide new insights on the molecular subtyping of LPR-responsive cancer phenotypes in patients with CRC and melanoma; and on how to investigate and interpret the prometastatic infrastructure in the real pathophysiological context of patients with cancer undergoing surgical procedures and receiving pharmacological treatments with multiple side effects, including those affecting the LPR, its stimulating factors and responsive cancer phenotypes.
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Affiliation(s)
- Fernando Vidal-Vanaclocha
- Dept. Biochemistry and Molecular Medicine, GW Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA; Institute of Applied Molecular Medicine (IMMA), CEU-San Pablo University School of Medicine, Boadilla del Monte, Madrid, Spain; Persona Biomed Inc., Alexandria, Virginia, USA.
| | - Olatz Crende
- Dept Cell Biology and Histology, Basque Country University School of Pharmacy, Vitoria/Gasteiz, Spain
| | | | | | | | - Álvaro González
- Institute of Applied Molecular Medicine (IMMA), CEU-San Pablo University School of Medicine, Boadilla del Monte, Madrid, Spain
| | - Eva Ruiz-Casares
- Institute of Applied Molecular Medicine (IMMA), CEU-San Pablo University School of Medicine, Boadilla del Monte, Madrid, Spain
| | | | - Riccardo Caruso
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | - Hipólito Durán
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | - Antonio Gil
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | - Benedetto Ielpo
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | - Fernando Lapuente
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Yolanda Quijano
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, HM-Sanchinarro University Hospital, CEU San Pablo University, Madrid, Spain
| | | | - Eduardo M Sotomayor
- Department of Hematology and Oncology, George Washington University, Washington, DC, USA
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75
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Prieto M, Ielpo B, Jiménez Fuertes M, González Sánchez MDC, Martín Antona E, Balibrea JM, Aranda Narváez JM. National survey on the treatment of acute appendicitis in Spain during the initial period of the COVID-19 pandemic. Cir Esp 2020; 99:450-456. [PMID: 34629482 PMCID: PMC7340022 DOI: 10.1016/j.ciresp.2020.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 12/18/2022]
Abstract
Introducción La pandemia por COVID-19 ha tenido una importante repercusión en los hospitales españoles, que han tenido que destinar todos los recursos disponibles al tratamiento de estos pacientes, reduciendo la capacidad de atender otras enfermedades habituales. Este estudio pretende analizar cómo se ha visto afectado el tratamiento de la apendicitis aguda. Método Se ha realizado un estudio nacional descriptivo mediante una encuesta online voluntaria, realizada en Google Drive™ distribuida por correo electrónico por la Asociación Española de Cirujanos (AEC) a todos los cirujanos miembros en activo (5.203) del 14 de abril al 24 de abril del 2020. Resultados Se han recibido 337 respuestas de 170 centros nacionales. Durante el primer mes de la pandemia, ha disminuido la incidencia de apendicitis aguda. La opción quirúrgica ha sido la más utilizada tanto en cuadros simples como en complicados, aunque el manejo conservador se ha incrementado. A pesar de que el abordaje laparoscópico sigue siendo el más utilizado en nuestros hospitales, la vía abierta ha presentado un incremento durante esta pandemia. Conclusió Resaltar la aportación este estudio en cuanto conocimiento del estado del tratamiento de la apendicitis aguda durante este primer mes de pandemia, pudiendo servir para una posible mejor organización en próximas olas de la pandemia y a un replanteamiento de los protocolos actuales y manejo de la apendicitis aguda en caso de pandemia.
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Affiliation(s)
- Mikel Prieto
- Servicio de Cirugía General, Unidad de Cirugía Hepatobiliar y Trasplante Hepático, Hospital Universitario Cruces, Bilbao, Universidad del País Vasco UPV-EHU.
| | - Benedetto Ielpo
- Departamento de Cirugía General, Unidad de Cirugía Hepatobiliar, Complejo Asistencial Universitario de León
| | - Montiel Jiménez Fuertes
- Unidad de Trauma y Cirugía de Urgencias, Unidad CHBP, Servicio de Cirugía General y Digestiva, Hospital Universitario Fundación Jiménez Díaz
| | | | - Esteban Martín Antona
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de San Carlos, Madrid, profesor asociado Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Sección de Infección Quirúrgica de la AEC, Sección de Obesidad Mórbida de la AEC
| | - José M Balibrea
- Servicio de Cirugía Gastrointestinal (ICMDiM), Hospital Clínic de Barcelona, Universitat de Barcelona, Sección de Infección Quirúrgica de la AEC
| | - José Manuel Aranda Narváez
- Servicio de Cirugía General, Hospital Regional Universitario Carlos Haya, Málaga, Sección de Trauma y Cirugía de Urgencias de la AEC
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Ielpo B, Pittau G, Ciacio O, Tedeschi M, Pietrasz D, Torrent L, Sa Cunha A, Cherqui D. Standardized laparoscopic right hepatic lobe mobilization. J Hepatobiliary Pancreat Sci 2020; 29:e30-e32. [PMID: 32506772 DOI: 10.1002/jhbp.782] [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] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Benedetto Ielpo
- Department of General and Digestive Surgery, HPB Unit, University Hospital of León, León, Spain
| | - Gabriella Pittau
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Oriana Ciacio
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Michele Tedeschi
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Daniel Pietrasz
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Laia Torrent
- Department of General and Digestive Surgery, Hospital del Mar, Barcelona, Spain
| | - Antonio Sa Cunha
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Daniel Cherqui
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
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Di Martino M, Ielpo B, de Nova JLM, Muñoz EA, Santamaria C, Diago V, Martín-Pérez E. Lymph Node Ratio, Perineural Invasion and R1 Resection as Independent Prognostic Factors in Pancreatic Adenocarcinoma: A Retrospective Cohort Study. Surg Technol Int 2020; 36:82-88. [PMID: 32190897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The prognosis of pancreatic ductal adenocarcinoma has been associated with several factors. The aim of the present study was to correlate tumor-related factors and pathological findings with disease-free survival (DFS) and overall survival (OS) in patients undergoing pancreaticoduodenectomy. MATERIAL AND METHODS From a prospectively maintained database, we reviewed 89 pancreatic ductal adenocarcinomas in patients who underwent pancreaticoduodenectomy from 2010 to 2014. The impact of histopathologic or tumor-related data, including a lymph node ratio greater than 15% (LNR15), on survival was analyzed. RESULTS Univariate analysis of DFS and OS showed that vascular resection, pT, pN, LNR15, microvascular, lymphatic, and perineural invasion, and R1 resection influenced survival. Only LNR15, perineural invasion and R1 resection were independent predictors for both DFS (HR 6.39, p = 0.011; HR 8.53, p = 0.003; HR 9.68, p = 0.002, respectively) and OS (HR 4.21, p = 0.039; HR 5.41, p = 0.020; HR 4.41, p = 0.036, respectively). CONCLUSIONS This study demonstrates that LNR15, perineural invasion and R1 resection are independently associated with DFS and OS.
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Affiliation(s)
- Marcello Di Martino
- Department of Surgery, HPB Unit, University Hospital La Princesa, Madrid, Spain
| | - Benedetto Ielpo
- Department of Surgery, HPB Unit, University Hospital Leon, Leon, Spain
| | | | | | | | - Victoria Diago
- Department of Surgery, HPB Unit, University Hospital Leon, Leon, Spain
| | - Elena Martín-Pérez
- Department of Surgery, HPB Unit, University Hospital La Princesa, Madrid, Spain
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78
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Rodriguez-Pascual J, Nuñez-Alfonsel J, Ielpo B, Lopez M, Alvarez-Gallego R, Muñoz CG, Quijano Y, De Vicente E, Cubillo Gracián A, Saborido C. Watch-and-wait policy versus robotic resection in locally advanced rectal cancer patients after clinical complete response following chemoradiotherapy: A cost-effectiveness study (RECCOSTE). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19374] [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: 11/20/2022] Open
Abstract
e19374 Background: Chemoradiotheray (CR) followed by standard Surgical Resection (SR) is the standard treatment for distal locally-advanced rectal cancer (LARC) patients after a clinical compete response (cCR). Some novel approach suggested better functional results using robotic rectal resection (RRR) or avoiding surgical procedure, called Watch and Wait (WW) strategy. Methods: A Markov model-based, cost-utility analysis estimating mean costs and QALYs per patient was performed to compare SR, RRR and WW strategies for patients achieving a cCR to CRT. Rates of local regrowth, recurrence and distant metastasis were derived from series comparing WW to SR and from our previous comparative study of RRR versus SR. Lifetime incremental cost-utility ratio was calculated between strategies, and sensitivity analysis were performed to study model uncertainly. A willingness-to-pay of 30.000 per Quality Adjusted-Life Year (QALY) was used as a threshold to determine the most cost-effective treatment. Results: The base case 15-years cancer-specific survival was 93.5% (95% confidence interval [CI] 91.5-94.9] on a WW program, compared to 95.9% [95%CI 93.6-97.7] after RRR. WW was dominant relative to RRR with cost savings of $48,566.58 (95%CI $47,635.77 - $49,497.39 ) and incremental QALY of 7.47 (95%CI 1.46 – 7.48). WW was also dominant relative to LRR, with cost savings of $48,764.49 (95%CI $47,768.49 - $49,760.48 ) and incremental QALY of 7.44 (95%CI 7,43 – 7.45). WW remained dominant in sensitivity analysis unless the rate of SR fell to 73.0%). Conclusions: This study provides data of cost-effectiveness differences between SR, RRR, WW approaches in LARC after cCR, showing a benefit for WW.
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Affiliation(s)
| | | | - Benedetto Ielpo
- Gastrointestinal Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | | | | | | | - Yolanda Quijano
- Gastrointestinal Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Emilio De Vicente
- Gastrointestinal Surgery Department, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | | | - Carlos Saborido
- Hospital la Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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79
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Vicente E, Núñez‐Alfonsel J, Ielpo B, Ferri V, Caruso R, Duran H, Diaz E, Malave L, Fabra I, Pinna E, Isernia R, Hidalgo A, Quijano Y. A cost‐effectiveness analysis of robotic versus laparoscopic distal pancreatectomy. Int J Med Robot 2020; 16:e2080. [DOI: 10.1002/rcs.2080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/13/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Emilio Vicente
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Javier Núñez‐Alfonsel
- Instituto de Validación de la Eficiencia Clínica (IVEC)Fundación de Investigación HM Hospitales Madrid Spain
| | - Benedetto Ielpo
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Valentina Ferri
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Riccardo Caruso
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Hipolito Duran
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Eduardo Diaz
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Luis Malave
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Isabel Fabra
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Eva Pinna
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Roberta Isernia
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
| | - Alvaro Hidalgo
- Department of Economic Analysis and FinancesUniversity of Castilla‐La Mancha Toledo Spain
| | - Yolanda Quijano
- Department of General SurgeryHospital Universitario HM Sanchinarro, HM Hospitales Madrid Spain
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Affiliation(s)
- Benedetto Ielpo
- Department of General Surgery, Division of HBP Surgery, Leon University Hospital, Leon, Spain
| | - Javier Nuñez-Alfonsel
- Instituto de Validación de la Eficiencia Clínica, Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Maria Victoria Diago
- Department of General Surgery, Division of HBP Surgery, Leon University Hospital, Leon, Spain
| | - Álvaro Hidalgo
- Department of Economics and Finance, Universidad de Castilla la Mancha, Toledo, Spain
| | - Yolanda Quijano
- Department of General Surgery, Sanchinarro University Hospital HM, Madrid, Spain
| | - Emilio Vicente
- Department of General Surgery, Sanchinarro University Hospital HM, Madrid, Spain
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Caruso R, Quijano Y, Ferri V, Duran H, Diaz E, Fabra I, Malave L, Isernia R, Pinna E, D'Ovidio A, Núñez-Alfonsel J, Plaza C, Ielpo B, Vicente E. Venous Resection for Locally Advanced Pancreatic Cancer: Time Trend and Outcome Analysis of 65 Consecutive Resections at a High-Volume Center. Surg Technol Int 2019; 35:92-99. [PMID: 31687780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Locally advanced pancreatic cancer (LAPC) is a highly malignant carcinoma with an extremely poor prognosis. Vascular venous invasion is a frequent finding in patients with pancreatic cancer. The aim of this study was to investigate the morbidity, mortality, and survival of patients with advanced pancreatic cancer. METHODS We retrospectively reviewed our experience of 65 consecutive pancreatic surgeries with venous resection for pancreatic cancer in three hospitals: Ramon y Cajal (Madrid, Spain) from 2002 to 2004, Monteprincipe University Hospital (Madrid, Spain) from 2005 to 2006 and Sanchinarro University Hospital (Madrid, Spain) from 2007 to December 2017. Prognostic factors were analyzed by the log-rank test and a multivariate proportional hazard regression analysis. RESULTS Major venous reconstruction was performed by primary lateral venorrhaphy in 11 patients (17%), primary end-to-end anastomosis in 46 (70.7%) and reconstruction with a Gore-Tex® patch (W.L. Gore & Associates, Inc., Flagstaff, AZ) in 8 (12.3%). In 58% of the patients, the pathological examination showed infiltration of the vascular specimen. About 85% of the procedures performed were R0. The perioperative morbidity rate with Dindo-Clavien classification = III was 21.5%. Tumor size and nodal status were the only prognostic variables, which significantly decreased survival by a multivariate analysis. CONCLUSIONS Major vascular resection to achieve macroscopic tumor clearance can be performed safely with acceptable operative morbidity and mortality. Nevertheless, it is justified only in carefully selected cases.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Hipolito Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Eduardo Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Isabel Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Luis Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Roberta Isernia
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Eva Pinna
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Angelo D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Javier Núñez-Alfonsel
- Instituto de Validación de la Eficiencia Clínica (IVEc) Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Carlos Plaza
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
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82
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Caruso R, Vicente E, Núñez-Alfonsel J, Ferri V, Diaz E, Fabra I, Malave L, Duran H, Isernia R, D'Ovidio A, Pinna E, Ielpo B, Quijano Y. Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. J Robot Surg 2019; 14:627-632. [PMID: 31620970 DOI: 10.1007/s11701-019-01033-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000€ and 30,000€ per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain. .,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain.
| | - E Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - J Núñez-Alfonsel
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - V Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - I Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - L Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - H Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - R Isernia
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - A D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Pinna
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - B Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Y Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
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83
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Ferri V, Vicente Lopez E, Quijano Collazo Y, Caruso R, Duran Gimenez Rico H, Ielpo B, Diaz Reques E, Fabra Cabrera I, Malavè Cardozo L, Isernia R, Pinna E, Plaza Hernandezv C, Garcerant M, Garcia Cañamaques L, Perez Dueñas V. Quantitative analysis of 18-FDG-PET/MRI to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer. A prospective preliminary study. Acta Oncol 2019; 58:1246-1249. [PMID: 31144557 DOI: 10.1080/0284186x.2019.1622774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Emilio Vicente Lopez
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eduardo Diaz Reques
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Isabel Fabra Cabrera
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Luis Malavè Cardozo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Roberta Isernia
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eva Pinna
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Marjorie Garcerant
- Division of Nuclear Medicin, Sanchinarro Hospital, San Pablo University, Madrid, Spain
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84
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Ferri V, Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Caruso R. Diagnosis and treatment of pancreas divisum: A literature review. Hepatobiliary Pancreat Dis Int 2019; 18:332-336. [PMID: 31155429 DOI: 10.1016/j.hbpd.2019.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis. Recurrent acute pancreatitis, chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5% of the patients with pancreas divisum. This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum. DATA SOURCES We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum. RESULTS There are limited reports available on this topic in the literature. We analyzed and described the main indications in the treatment of pancreas divisum, focusing on surgical treatment and a discussion of the different approaches. Furthermore, we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy (the Nakao procedure). CONCLUSIONS Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease. Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications. Many techniques, of greater or lesser complexity, have been proposed.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain.
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
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85
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Simó V, Arredondo J, Hernán C, Jiménez LM, Ielpo B, Fernández J, Villafañe A, Pastor E. Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients. Cir Esp 2019; 97:510-516. [PMID: 31351576 DOI: 10.1016/j.ciresp.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. METHODS Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous vs. non simultaneous abdominal-perineal surgery. RESULTS Mean patient age was 67 years (56-75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9±1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262±40.7min; it was shorter in females (P<.001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5cm (0.5-2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P=.047). The mean number of retrieved lymph-nodes was 15.2±11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4-8). Morbidities occurred in 36% of cases, and one patient died. CONCLUSIONS According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature.
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Affiliation(s)
- Vicente Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jorge Arredondo
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España.
| | - Cristina Hernán
- Servicio de Medicina Preventiva, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luís Miguel Jiménez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Benedetto Ielpo
- Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jesús Fernández
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Amaya Villafañe
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Enrique Pastor
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
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86
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Navarro EB, López EV, Quijano Y, Caruso R, Ferri V, Durand H, Cabrera IF, Reques ED, Ielpo B, Glagolieva AY, Plaza C. Impact of BRCA1/2 gene mutations on survival of patients with pancreatic cancer: A case-series analysis. Ann Hepatobiliary Pancreat Surg 2019; 23:200-205. [PMID: 31225426 PMCID: PMC6558134 DOI: 10.14701/ahbps.2019.23.2.200] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/19/2022] Open
Abstract
BRCA gene mutations are found in up to 10% of pancreatic adenocarcinoma cases. We present a description of 4 cases along with a review of the current literature regarding pathogenesis, target treatment, response and survival rates in these types of malignancies. We describe four cases of pancreatic adenocarcinoma, in three of which the BRCA2 mutation was identified, in one - BRCA1 gene alteration. Two patients underwent surgery following the neoadjuvant treatment with Folfirinox and radiotherapy; in the first case, a distal pancreatectomy with splenectomy was performed and in the second one - the Whipple's procedure. In both cases, a complete pathological response was reported. Other 2 patients were treated with Folfirinox after BRCA mutation identification and acceptable life expectancy was obtained. The association of pathologic complete response (PCR) with lower rates of local recurrence and better survival in patients with various types of adenocarcinomas is well known. Identification of such patients carrying BRCA mutations could provide an application of better personalized treatment. In some patients with pancreatic cancer, especially when there is clinical or demographic reason to suspect a genetic predisposition, a confirmation of the presence of BRCA mutations could provide an opportunity to use target treatment with beneficial outcomes regarding survival.
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Affiliation(s)
- Ernesto Barzola Navarro
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Emilio Vicente López
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Yolanda Quijano
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Riccardo Caruso
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Valentina Ferri
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Hipolito Durand
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Isabel Fabra Cabrera
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Eduardo Diaz Reques
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Benedetto Ielpo
- Department of General and Digestive Surgery, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - Carlos Plaza
- Department of Pathology, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
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87
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Ferri V, Ielpo B, Duran H, Diaz E, Fabra I, Plaza C, Quijano Y, Vicente E. Clinical Presentation and Anatopathologic Finding of a Hepatic Vascular Hamartoma: a Case Report. Ann Hepatol 2019; 18:225-229. [PMID: 31113595 DOI: 10.5604/01.3001.0012.7919] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/21/2017] [Indexed: 02/04/2023]
Abstract
HVH (hepatic vascular hamartoma) is a tumor like malformation arising from the vascular tissue of the liver. HVH has been previously reported in animals and presents distintive features from the most frequent benign tumor like malformation of the liver, the hepatic mesenchymal hamartoma (HMH). Herein we report a case of HVH localized in hepatic segment 4b, involving the gastro hepatic ligament, successfully treated with total excision. We describe the anatomo-pathologic findings focusing on the clinical and radiological presentation, the intraoperative characteristics and the differential diagnosis.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain.
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Carlos Plaza
- Division of Anatomic Pathology, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
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88
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Affiliation(s)
- Benedetto Ielpo
- HPB Unit, General Surgery, University Hospital of Leon, Calle Altos de Nava s/n León, Spain
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89
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Ielpo B, Silva J, Simó V, Arredondo J, Diago MV. Robotic and laparoscopic colorectal resection is safe in elderly patients. Ann Laparosc Endosc Surg 2018. [DOI: 10.21037/ales.2018.10.01] [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: 11/06/2022]
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90
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Ielpo B, Simó V, Pastor E, Arredondo J, Villafañe A, Fuentes S, Padilla L, Orille V, Lorenzo E, Corona A, Diago MV. Combined transanal minimally invasive surgery (TAMIS) and retroperitoneal laparoscopy for resection of lymph node recurrence of ovarian cancer. Tech Coloproctol 2018; 22:725. [PMID: 30225755 DOI: 10.1007/s10151-018-1849-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- B Ielpo
- Department of General Surgery, León University Hospital, León, Spain.
| | - V Simó
- Department of General Surgery, León University Hospital, León, Spain
| | - E Pastor
- Department of General Surgery, León University Hospital, León, Spain
| | - J Arredondo
- Department of General Surgery, León University Hospital, León, Spain
| | - A Villafañe
- Department of General Surgery, León University Hospital, León, Spain
| | - S Fuentes
- Department of General Surgery, León University Hospital, León, Spain
| | - L Padilla
- Department of Gynecology, León University Hospital, León, Spain
| | - V Orille
- Department of Gynecology, León University Hospital, León, Spain
| | - E Lorenzo
- Department of Gynecology, León University Hospital, León, Spain
| | - A Corona
- Department of Gynecology, León University Hospital, León, Spain
| | - M V Diago
- Department of General Surgery, León University Hospital, León, Spain
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91
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Caruso R, Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Ferri V. Robotic assisted gastrectomy compared with open resection: a case-matched study. Updates Surg 2018; 71:367-373. [PMID: 29728921 DOI: 10.1007/s13304-018-0533-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/04/2017] [Accepted: 04/26/2018] [Indexed: 12/29/2022]
Abstract
In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy and to compare outcomes between open and robotic gastric resections. This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analyzed. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 19). The patient characteristics of the two groups have been compared. Robotic resection resulted in less blood loss, shorter postoperative hospital stay, and a longer operating time. The two groups had similar complication rates. Pathological data were similar for both procedures. Robotic gastrectomy for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. Robotic gastrectomy resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy.
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Affiliation(s)
- Riccardo Caruso
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
| | - Emilio Vicente
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Benedetto Ielpo
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain
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92
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Ielpo B, Caruso R, Duran H, Diaz E, Fabra I, Malavé L, Quijano Y, Vicente E. Robotic versus standard open pancreatectomy: a propensity score-matched analysis comparison. Updates Surg 2018; 71:137-144. [PMID: 29582359 DOI: 10.1007/s13304-018-0529-1] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/19/2018] [Indexed: 02/08/2023]
Abstract
Interest in robotic pancreatectomy has been greatly increasing over the last decade. However, evidence supporting the benefits of robotic over open pancreatectomy is still outstanding. This study aims to assess the safety and efficacy of robotic pancreatectomy compared with the conventional open surgical approach. Propensity score-matched (1:1) was used to balance age, sex, BMI, ASA, tumor size, and malignancy of 17 robotic pancreaticoduodenectomies (PD), 12 pancreatic enucleations (PE), and 28 distal pancreatectomies (DP); and was compared with the open standard approach. Robotic PD was associated with longer operative time (594 vs. 413 min; p = 0.03) and decreased blood loss (190 vs. 394 ml; p = 0.001). Robotic PE showed a lower mean length of hospital stay (8.4 vs. 12.8 days; p = 0.04) and, in addition, robotic DP showed less blood loss (175 vs. 375 ml; p = 0.01), less severe morbidities (7.14 vs. 17.9%; p = 0.02), and a reduced mean length of hospital stay (8.9 vs. 15.1; p = 0.001). Overall, conversion rate was 4 (7%). Robotic pancreatectomy is as safe and effective as the standard open surgical approach with reduced blood loss in PD and DP, length of hospital stay in PE and DP, and severe morbidity in DP.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain.
| | - Riccardo Caruso
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Luis Malavé
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro University Hospital, San Pablo CEU University of Madrid, Calle Oña 10, 28050, Madrid, Spain
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93
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Nuñez Alfonsel J, Ielpo B, M VGL, Belda Iniesta C. Evaluación del impacto presupuestario del servicio integral de asistencia domiciliaria nutricional. Global & Regional Health Technology Assessment 2018. [DOI: 10.1177/2284240318799588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Javier Nuñez Alfonsel
- Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
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94
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Vicente E, Quijano Y, Ielpo B. Distal pancreatectomy with celiac trunk resection without reconstruction (with video). J Visc Surg 2017; 155:75-76. [PMID: 29277391 DOI: 10.1016/j.jviscsurg.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Vicente
- Madrid Norte Sanchinarro San Pablo university hospital, General Surgery department, Calle Oña 10, 28050 Madrid, Spain
| | - Y Quijano
- Madrid Norte Sanchinarro San Pablo university hospital, General Surgery department, Calle Oña 10, 28050 Madrid, Spain
| | - B Ielpo
- Madrid Norte Sanchinarro San Pablo university hospital, General Surgery department, Calle Oña 10, 28050 Madrid, Spain.
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Malave L, Caruso R. Role of robotic-assisted pancreatic surgery: lessons learned from our initial experience. Hepatobiliary Pancreat Dis Int 2017; 16:652-658. [PMID: 29291786 DOI: 10.1016/s1499-3872(17)60054-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 06/23/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Minimally invasive surgery has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. In fact, the indication for robotic surgery in pancreatic disease has been controversial. The present study aimed to assess the safety and feasibility of robotic pancreatic resection. METHODS We retrospectively reviewed our experience of robotic pancreatic resection done in Sanchinarro University Hospital. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed. RESULTS From October 2010 to April 2016, 50 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 50 patients, 26 were male and 24 female. The average age of all patients was 62 years. Operative time was 370 minutes. Among the procedures performed were 16 pancreaticoduodenectomies (PD), 23 distal pan-createctomies (DP), 11 tumor enucleations (TE). The mean hospital stay was 17.6 days in PD group, 9.0 days in DP group and 8.4 days in TE group. Pancreatic fistula occurred in 10 cases (20%), 2 after PD, 3 after DP, and 5 after TE. Four patients had postoperative transfusion in PD group and one in DP group. Conversion to open laparotomy occurred in four patients (8%). No serious intraoperative complications were observed. CONCLUSIONS From our early experience, robotic pancreatic surgery is a safe and feasible procedure. Further experience and follow-up are required to confirm the role of robotic approach in pancreatic surgery.
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Affiliation(s)
- Emilio Vicente
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Benedetto Ielpo
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Luis Malave
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
| | - Riccardo Caruso
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain.
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Ielpo B, Caruso R, Duran H, Diaz E, Fabra I, Malavé L, Ferri V, Alvarez R, Cubillo A, Plaza C, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. A comparative study of neoadjuvant treatment with gemcitabine plus nab-paclitaxel versus surgery first for pancreatic adenocarcinoma. Surg Oncol 2017; 26:402-410. [PMID: 29113659 DOI: 10.1016/j.suronc.2017.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 07/04/2017] [Revised: 08/05/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Neoadjuvant treatment has been reported to prolong survival in patients with potentially resectable pancreatic adenocarcinoma (PA). However, there are currently limited clinical results available using nab-paclitaxel and gemcitabine in PA. This paper compares the oncological results of patients affected by potentially resectable PA who underwent surgery first (SF) versus surgery following neoadjuvant treatment (NAT). METHODS This is an observational, comparative study whereby data were abstracted from a prospective database of patients affected by PA from 2007 to 2016. RESULTS We included a total of 81 patients (36 SF and 45 NAT) which resulted in being preoperatively similar. Among the NAT patients, treatment was well tolerated and the resection rate was 68.8% (31/45 patients). There was a trend towards a higher R1 resection rate in the SF group compared with the NAT (13.8% vs 3.2%; p = 0.1). Median overall survival in the resected NAT group was higher (30.6 vs 22.1 months; p = 0.04). In the borderline resectable group, overall survival was found to be four times higher compared with SF (43.6 versus 13.5 months; p = 0.001). CONCLUSIONS These data suggest that neoadjuvant treatment with gemcitabine/nab-paclitaxel is a safe and effective option for potentially resectable PA compared with the SF approach.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain.
| | - Riccardo Caruso
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Luis Malavé
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Rafael Alvarez
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Antonio Cubillo
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Carlos Plaza
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Sara Lazzaro
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Denis Kalivaci
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro HM University Hospital, CEU San Pablo University of Madrid, Spain
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Malavé L, Ferri V, Lazzaro S, Kalivaci D, Caruso R. Ex Situ Hepatectomy and Liver Autotransplantation for Cholangiocarcinoma. Ann Surg Oncol 2017; 24:3990-3990. [DOI: 10.1245/s10434-017-6104-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, Ferri V, Nuñez J, Ruiz-Ocaña A, Jorge E, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. Robotic versus laparoscopic distal pancreatectomy: A comparative study of clinical outcomes and costs analysis. Int J Surg 2017; 48:300-304. [PMID: 29122707 DOI: 10.1016/j.ijsu.2017.10.075] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/12/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The robotic surgery cost presents a critical issue which has not been well addressed yet. This study aims to compare the clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). METHODS Data were abstracted prospectively from 2011 to 2017. An independent company performed the financial analysis. RESULTS A total of 28 RDP and 26 LDP were included. The mean operative time was significantly lower in the LDP (294 vs 241 min; p = 0.02). The main intra and post-operative data were similar, except for the conversion rate (RDP: 3.6% vs LDP: 19.2%; p = 0.04) and hospital stay (RDP: 8.9 vs LDP 13.1 days; p = 0.04). The mean total costs were similar in both groups (RDP: 9198.64 € vs LDP: 9399.74 €; p > 0.5). CONCLUSIONS RDP showed lower conversion rate and shorter hospital stay than LDP at the price of longer operative time. RDP is financially comparable to LDP.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain.
| | - Hipolito Duran
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Riccardo Caruso
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Luis Malavé
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - J Nuñez
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain; IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Plaza del conde de valle de Suchil 2, 28015, Madrid, Spain
| | - A Ruiz-Ocaña
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - E Jorge
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Sara Lazzaro
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Denis Kalivaci
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
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Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, Ferri V, Nuñez J, Ruiz-Ocaña A, Jorge E, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis 2017; 32:1423-1429. [PMID: 28791457 DOI: 10.1007/s00384-017-2876-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Accepted: 07/25/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. METHODS This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. RESULTS A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. CONCLUSION Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain.
| | - H Duran
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Diaz
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - I Fabra
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - R Caruso
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - L Malavé
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - V Ferri
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - J Nuñez
- (IVEC) Instituto de Validación de la Eficiencia Clínica, Fundación de Investigación HM Hospitales, Plaza del Conde de valle de Suchil 2, 28015, Madrid, Spain
| | - A Ruiz-Ocaña
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Jorge
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - S Lazzaro
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - D Kalivaci
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - Y Quijano
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Vicente
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
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Vicente E, Quijano Y, Ielpo B, Duran H. Total pancreatoduodenectomy en bloc with superior mesenteric artery and vein resection after gemcitabine and nab-paclitaxel neoadjuvancy. Surg Oncol 2017; 26:276-277. [PMID: 29804945 DOI: 10.1016/j.suronc.2017.05.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/23/2017] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pancreatectomy for locally advanced adenocarcinoma affecting the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) is still under discussion [1]. However, in selected cases, in light of the advancement of recent neoadjuvant treatments, it must be taken into account [2,3]. This video demonstrates some of the technical aspects of SMA and SMV resection as well as some tips of vascular reconstruction. METHODS A 48-year-old man with a large adenocarcinoma of the uncinated process affecting the SMA and SMV underwent 3 cycles of gemcitabine and nab-paclitaxel neoadjuvancy. Post chemotherapy studies showed no disease progression with a normalization of CA 19.9 and SUV of FDG PET CT scan and a downsizing of the tumor, as well. Therefore, an en bloc total spleno-pancreato-duodenectomy with resection of SMA and SMV was planned. RESULTS Through a bilateral subcostal incision, an "arterial first approach" [3] was performed. Considering the large length of the vascular resection, the replacement of the resected SMA and SMV was performed using two PTFE grafts, as showed in the video. Postoperative pathology showed margins free from disease with an important pathological response (grade 2 of Ryan classification adapted from rectal cancer) [4]. The post-operative course was uneventful and the patient is still free from disease at 31 months from surgery. CONCLUSIONS This case is part of a large experience our group have acquired since we started neoadjuvancy in 2010. In our experience, we gathered 25 cases of locally advanced pancreatic tumors, of which 12 underwent to pancreatic resection after good response to the neoadjuvant treatment. In 5 of them concomitant SMA and SMV resection was required and post-operative mortality occurred in 1 of them. Morbidities and mortalities are higher compared with standard pancreatectomies, specially related to the vascular reconstruction (bleeding, graft thrombosis) [5]. However, in some circumstances like young age, great radiological and biological response to neoadjuvancy (such as the case herein presented), surgery might be considered the best option of care providing the only possibility to increase survival for these types of locally advanced tumors. However, further studies are needed to know which patients might benefit from this approach. En bloc total spleno-pancreato-duodenectomy with resection of SMA and SMV might be considered as an effective procedure in selected cases of pancreatic adenocarcinoma with good response to preoperative treatment.
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Affiliation(s)
- E Vicente
- Madrid Norte Sanchinarro San Pablo University Hospital, General Surgery Department, Calle Oña 10, 28050 Madrid, Spain
| | - Y Quijano
- Madrid Norte Sanchinarro San Pablo University Hospital, General Surgery Department, Calle Oña 10, 28050 Madrid, Spain
| | - B Ielpo
- Madrid Norte Sanchinarro San Pablo University Hospital, General Surgery Department, Calle Oña 10, 28050 Madrid, Spain.
| | - H Duran
- Madrid Norte Sanchinarro San Pablo University Hospital, General Surgery Department, Calle Oña 10, 28050 Madrid, Spain
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