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Amaya J, Repetto A, Rubí S, Fuster J, Martínez M, García-Granero A. 18F-DOPA PET/CT: Diagnosis of a synchronous appendiceal neuroendocrine tumor in a patient with Medullary Thyroid Cancer. Rev Esp Med Nucl Imagen Mol 2023; 42:339-340. [PMID: 36972798 DOI: 10.1016/j.remnie.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023]
Affiliation(s)
- J Amaya
- Servicio de Medicina Nuclear, Hospital Universitario Son Espases, 07110 Palma, Spain.
| | - A Repetto
- Servicio de Medicina Nuclear, Hospital Universitario Son Espases, 07110 Palma, Spain
| | - S Rubí
- Servicio de Medicina Nuclear, Hospital Universitario Son Espases, 07110 Palma, Spain; Instituto de Investigación Sanitaria Illes Balears (IdISBa), Islas Baleares, Spain; Departamento de Medicina, Universidad de las Islas Baleares (UIB)E-07122, Palma, Spain
| | - J Fuster
- Servicio de Oncología Clínica, Hospital Universitario Son Espases, 07110 Palma, Spain
| | - M Martínez
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, 07110 Palma, Spain
| | - A García-Granero
- Servicio de Cirugía General y Ap. Digestivo, Hospital Universitario Son Espases, 07110 Palma, Spain; Instituto de Investigación Sanitaria Illes Balears (IdISBa), Islas Baleares, Spain; Departamento de Medicina, Universidad de las Islas Baleares (UIB)E-07122, Palma, Spain
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020; 158:603-607. [PMID: 32571682 DOI: 10.1016/j.ygyno.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - J L Sanchez-Iglesias
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Chiva
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - L Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - A García-Granero
- Department of General Surgery, University Hospital Son Espases, Palma de Mallorca, Spain; Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - J M Cárdenas-Rebollo
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Pellino G, Frasson M, García-Granero A, Granero-Castro P, Ramos Rodríguez JL, Flor-Lorente B, Bargallo Berzosa J, Alonso Hernández N, Labrador Vallverdú FJ, Parra Baños PA, Ais Conde G, Garcia-Granero E. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients. Colorectal Dis 2018; 20:986-995. [PMID: 29920911 DOI: 10.1111/codi.14309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
AIM Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. METHOD We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. RESULTS We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). CONCLUSION Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
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Affiliation(s)
- G Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.,Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania 'Luigi Vanvitelli', Naples, Italy
| | - M Frasson
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - A García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.,Human Anatomy and Embryology Department, University of Valencia, Valencia, Spain
| | - P Granero-Castro
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | - B Flor-Lorente
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | | | | | | | | | - E Garcia-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
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García-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreño O, Garcia-Granero E. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 2014; 16:O335-8. [PMID: 24853735 DOI: 10.1111/codi.12670] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/17/2013] [Accepted: 04/23/2014] [Indexed: 12/13/2022]
Abstract
AIM This technical note describes the use of an endostapler for the definitive treatment of supralevator abscess upward from an intersphincteric origin. METHOD A two-stage treatment was performed. First an endoanal drainage was performed by inserting a mushroom catheter in the supralevator abscess cavity. In the second stage transanal unroofing of the fistula was performed with an endostapler. RESULTS Since 2011, three patients have been treated in this way. After 2 years of follow up, none of the patients had recurrence of the abscess or been referred for anal incontinence. CONCLUSION The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin may be an alternative to decrease the risk of recurrence and incontinence.
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Affiliation(s)
- A García-Granero
- Department of General Surgery, Hospital Arnau de Vilanova, Valencia, Spain
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Navarro-Vicente F, García-Granero A, Frasson M, Blanco F, Flor-Lorente B, García-Botello S, García-Granero E. Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery. Colorectal Dis 2012; 14:382-5. [PMID: 21689319 DOI: 10.1111/j.1463-1318.2011.02630.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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] [Indexed: 01/25/2023]
Abstract
AIM Intraoperative peripheral nerve injury can have permanent neurological consequences. Its incidence is not known and varies according to the location and the surgical specialty. This study was a prospective analysis of intraoperative peripheral nerve injury as a complication of abdominal colorectal surgery. METHOD All patients who underwent major colorectal abdominal surgery in our Colorectal Unit between 1996 and 2009 were analyzed. Data on nerve injury were prospectively collected. RESULTS There were 2304 patients, of whom eight (0.3%) experienced intraoperative peripheral nerve injury. This occurred in 5/2211 (0.2%) open procedures and in 3/93 (3%) laparoscopic procedures. There was no association between intraoperative peripheral nerve injury and age, gender, body mass index, surgeon, operation time, American Society of Anesthesiology (ASA) score and urgent surgery. The use of Allen-type stirrups and a vacuum bag (in laparoscopic surgery) seemed to be protective for nerve injury in the lower and upper limbs respectively. CONCLUSION Adequate positioning and the use of pressure-free positioning devices may prevent intraoperative peripheral nerve injury, particularly during laparoscopy.
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Affiliation(s)
- F Navarro-Vicente
- Coloproctology Unit, Department of General Surgery, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
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