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Blanco-Fernández G, Serradilla-Martín M, Rotellar F, Latorre R, Jaén-Torrejimeno I, Muñoz-Forner E, Villodre C, Carabias-Hernández A, Kälviäinen-Mejía HK, Gordillo SE, de la Plaza R, Armas-Conde ND, Garcés-Albir M, Morote SC, Manuel-Vázquez A, Serrablo A, Pardo F, Sabater L, Muñoz MPS, Ramia JM. Short- and long-term outcomes after distal pancreatectomy with radiologic infiltration of splenic vessels for pancreatic ductal adenocarcinoma. J Gastrointest Surg 2024; 28:467-473. [PMID: 38583897 DOI: 10.1016/j.gassur.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The effect of radiologic splenic vessels involvement (RSVI) on the survival of patients with pancreatic adenocarcinoma (PAC) located in the body and tail of the pancreas is controversial, and its influence on postoperative morbidity after distal pancreatectomy (DP) is unknown. This study aimed to determine the influence of RSVI on postoperative complications, overall survival (OS), and disease-free survival (DFS) in patients undergoing DP for PAC. METHODS A multicenter retrospective study of DP was conducted at 7 hepatopancreatobiliary units between January 2008 and December 2018. Patients were classified according to the presence of RSVI. A Clavien-Dindo grade of >II was considered to represent a major complication. RESULTS A total of 95 patients were included in the analysis. Moreover, 47 patients had vascular infiltration: 4 had arterial involvement, 10 had venous involvement, and 33 had both arterial and venous involvements. The rates of major complications were 20.8% in patients without RSVI, 40.0% in those with venous RSVI, 25.0% in those with arterial RSVI, and 30.3% in those with both arterial and venous RSVIs (P = .024). The DFS rates at 3 years were 56% in the group without RSVI, 50% in the group with arterial RSVI, and 16% in the group with both arterial and venous RSVIs (P = .003). The OS rates at 3 years were 66% in the group without RSVI, 50% in the group with arterial RSVI, and 29% in the group with both arterial and venous RSVIs (P < .0001). CONCLUSION RSVI increased the major complication rates after DP and reduced the OS and DFS. Therefore, it may be a useful prognostic marker in patients with PAC scheduled to undergo DP and may help to select patients likely to benefit from neoadjuvant treatment.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Department of Surgery, Hospital Universitario de Badajoz, Badajoz, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain.
| | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Raquel Latorre
- Department of surgery. Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | | | | | | | - Roberto de la Plaza
- Department of surgery. Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Silvia Carbonell Morote
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | | | - Alejandro Serrablo
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico Universitario, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Jose M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
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2
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Villodre C, Del Río-Martín J, Blanco-Fernández G, Cantalejo-Díaz M, Pardo F, Carbonell S, Muñoz-Forner E, Carabias A, Manuel-Vazquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kälviäinen-Mejia HK, Rotellar F, Garcés-Albir M, Latorre R, Longoria-Dubocq T, De Armas-Conde N, Serrablo A, Esteban Gordillo S, Sabater L, Serradilla-Martín M, Ramia JM. Textbook outcome in distal pancreatectomy: A multicenter study. Surgery 2024; 175:1134-1139. [PMID: 38071134 DOI: 10.1016/j.surg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. METHODS Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). RESULTS Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. CONCLUSION The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.
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Affiliation(s)
- Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Silvia Carbonell
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | | | | | | | | | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Raquel Latorre
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Alejandro Serrablo
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
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3
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Rojas-Holguín A, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Blanco-Fernández G. Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID). Surg Oncol 2024; 52:102039. [PMID: 38301449 DOI: 10.1016/j.suronc.2024.102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
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Affiliation(s)
- Adela Rojas-Holguín
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Constantino Fondevila-Campo
- Department of Surgery, Hospital Clinic, Barcelona, Spain; Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | - Héctor Marín-Ortega
- Department of Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro J Pérez-Alonso
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain; Department of Surgery, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain.
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4
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Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Ramia JM, Serradilla-Martín M. Evaluation of the validated intraoperative bleeding scale in liver surgery: study protocol for a multicenter prospective study. Front Surg 2023; 10:1223225. [PMID: 37850041 PMCID: PMC10577188 DOI: 10.3389/fsurg.2023.1223225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Surgical hemostasis has become one of the key principles in the advancement of surgery. Hemostatic agents are commonly administered in many surgical specialties, although the lack of consensus on the definition of intraoperative bleeding or of a standardized system for its classification means that often the most suitable agent is not selected. The recommendations of international organizations highlight the need for a bleeding severity scale, validated in clinical studies, that would allow the selection of the best hemostatic agent in each case. The primary objective of this study is to evaluate the VIBe scale (Validated Intraoperative Bleeding Scale) in humans. Secondary objectives are to evaluate the scale's usefulness in liver surgery; to determine the relationship between the extent of bleeding and the hemostatic agent used; and to assess the relationship between the grade of bleeding and postoperative complications. Methods Prospective multicenter observational study including 259 liver resections that meet the inclusion criteria: patients scheduled for liver surgery at one of 10 medium-high volume Spanish HPB centers using an open or minimally invasive approach (robotic/laparoscopic/hybrid), regardless of diagnosis, ASA score <4, age ≥18, and who provide signed informed consent during the study period (September 2023 until the required sample size has been recruited). The participating researchers will be responsible for collecting the data and for reporting them to the study coordinators. Discussion This study will allow us to evaluate the VIBe scale for intraoperative bleeding in humans, with a view to its subsequent incorporation in daily clinical practice. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT05369988?term = serradilla&draw = 2&rank = 3, [NCT0536998].
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Affiliation(s)
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
- Department of Surgery, Hospital Universitario German Trials I Pujol, Barcelona, Spain
| | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - José Manuel Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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5
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Rodríguez-Hernández A, Navarro-Villarán E, González R, Pereira S, Soriano-De Castro LB, Sarrias-Giménez A, Barrera-Pulido L, Álamo-Martínez JM, Serrablo-Requejo A, Blanco-Fernández G, Nogales-Muñoz A, Gila-Bohórquez A, Pacheco D, Torres-Nieto MA, Serrano-Díaz-Canedo J, Suárez-Artacho G, Bernal-Bellido C, Marín-Gómez LM, Barcena JA, Gómez-Bravo MA, Padilla CA, Padillo FJ, Muntané J. Corrigendum to 'Regulation of cell death receptor S-nitrosylation and apoptotic signaling by Sorafenib in hepatoblastoma cells'[Redox Biol 6(2015):174-182]. Redox Biol 2023:102744. [PMID: 37246098 DOI: 10.1016/j.redox.2023.102744] [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: 05/30/2023] Open
Affiliation(s)
- A Rodríguez-Hernández
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - E Navarro-Villarán
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - R González
- Department of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071, Córdoba, Spain
| | - S Pereira
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - L B Soriano-De Castro
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - A Sarrias-Giménez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - L Barrera-Pulido
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - J M Álamo-Martínez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - A Serrablo-Requejo
- Hepato-Biliary Surgery Unit, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - G Blanco-Fernández
- Hepato-Biliary-Pancreatic and Liver Transplant Service, Hospital Universitario "Infanta Cristina", Badajoz, Spain
| | - A Nogales-Muñoz
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - A Gila-Bohórquez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - D Pacheco
- Department of General Surgery and Department of Pathology, Hospital Universitario "Rio Hortega", Valladolid, Spain
| | - M A Torres-Nieto
- Department of Pathology, Hospital Universitario "Rio Hortega", Valladolid, Spain
| | - J Serrano-Díaz-Canedo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - G Suárez-Artacho
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - C Bernal-Bellido
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - L M Marín-Gómez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - J A Barcena
- Department of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071, Córdoba, Spain
| | - M A Gómez-Bravo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - C A Padilla
- Department of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071, Córdoba, Spain
| | - F J Padillo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - J Muntané
- Department of General Surgery, Hospital Universitario "Virgen del Rocío"-"Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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6
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Jaén-Torrejimeno I, Ramia JM, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Textbook outcome in the surgical treatment of liver hydatid cyst. Surgery 2023; 173:429-434. [PMID: 36334979 DOI: 10.1016/j.surg.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Textbook outcome is a composite measure used in surgery to define the ideal postoperative period and to assess the quality of care. The aim of this study was to analyze the incidence of textbook outcome and the factors independently associated with its achievement following surgical treatment of liver hydatid cysts. METHODS Retrospective cohort study of patients operated on for liver hydatid cysts between January 2006 and December 2021. Textbook outcome was achieved when all the following criteria were fulfilled: no mortality within 90 days, no major complications within 90 days, no hospital readmission within 90 days, and no prolonged hospital stay. Univariable and multivariable analyses were performed to identify factors associated with textbook outcome. RESULTS During the study period, 296 patients underwent surgery. Textbook outcome was recorded in 65.9% (195/296). Female gender (odds ratio 2.02; P = .010), noncomplicated cyst (odds ratio 3.97, P < .001), and radical surgery (odds ratio 2.26, P = .003) were the variables associated with a higher probability of achieving textbook outcome. CONCLUSION Textbook outcome may be a useful measure to assess the variations in surgical management between different centers, and to improve quality of care after liver hydatid cysts resection.
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Affiliation(s)
| | - José M Ramia
- Department of Surgery, Hospital Universitario de Alicante, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain; Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain; Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud
| | - Noelia De-Armas-Conde
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Facultad de Medicina y Ciencias de la Salud; Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Spain.
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Jaén-Torrejimeno I, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Resection of isolated pancreatic metastases from pulmonary neoplasia: a systematic review. Updates Surg 2022; 74:1817-1825. [DOI: 10.1007/s13304-022-01375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
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8
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Jaén-Torrejimeno I, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study. Acta Trop 2022; 232:106466. [PMID: 35460646 DOI: 10.1016/j.actatropica.2022.106466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cystic echinococcosis is a clinically complex chronic parasitic disease and a major socioeconomic problem in endemic areas. The safety of liver resection in elderly patients is often debated among medical professionals. We analyzed the postoperative morbidity and mortality rates of elderly patients who underwent surgery at our unit. METHODS We retrospectively evaluated patients with liver hydatid cysts which were surgically removed at our unit. Patients were divided into two groups: Group 1 (patients < 70 years), and Group 2 (patients ≥ 70 years). Propensity score matching (PSM) and comparative analyses between groups were performed. RESULTS The unmatched cohort consisted of 279 patients (Group 1: 244; Group 2: 35). After PSM, we compared the outcomes for 56 patients from Group 1 to 31 patients from Group 2. A higher rate of severe complications was observed in Group 2 (25.8% vs 5.36%, p = 0.014). No difference was found in the rates of infectious, cardiorespiratory, or hemorrhagic complications between both groups, and in the mortality rate either (0.00% vs 6.45%, p = 0.124). CONCLUSIONS Liver surgery in selected elderly patients is safe and practicable. The low postoperative morbidity rate in these patients is acceptable, albeit higher, due to their comorbidities.
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Affiliation(s)
- Isabel Jaén-Torrejimeno
- Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Diego López-Guerra
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Adela Rojas-Holguín
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Noelia De-Armas-Conde
- Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España.
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9
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Ramia JM, Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Serradilla-Martín M. Applicability and reproducibility of the validated intraoperative bleeding severity scale (VIBe scale) in liver surgery: A multicenter study. Surgery 2022; 172:1141-1146. [PMID: 35871850 DOI: 10.1016/j.surg.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bleeding is an intraoperative and postoperative complication of liver surgery of concern, and yet evidence to support utility and reproducibility of bleeding scales for liver surgery is limited. We determined the reproducibility of the clinician-reported validated intraoperative bleeding severity scale and its clinical value of implementation in liver surgery. METHODS In this descriptive and observational multicenter study, we assessed the performance of liver surgeons instructed on the clinician-reported intraoperative bleeding severity scale using training videos that covered all 5 grades of bleeding severity. Surgeons were stratified according to years of surgical experience and number of surgeries performed per year based on a median split in low and high values. Intraobserver and interobserver agreement was assessed using Kendall's coefficient of concordance (Kendall's W). RESULTS Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall intraobserver concordance was 0.985, and the overall interobserver concordance was 0.929. For "high experience" surgeons, the intraobserver and interobserver agreement values were 0.990 and 0.941, respectively. For "low experience" surgeons, the intraobserver and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual number of surgeries, intraobserver and interobserver agreement values were 0.995 and 0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and 0.923, respectively, for surgeons who perform ≤35 surgeries year. CONCLUSION The clinician-reported intraoperative bleeding severity scale shows high interobserver and intraobserver concordance, suggesting it is a useful tool for assessing severity of bleeding during liver surgery; years of surgical experience and number of annual procedures performed did not affect the applicability of the clinician-reported intraoperative bleeding severity scale.
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Affiliation(s)
- José Manuel Ramia
- Department of Surgery, Hospital General Universitario de Alicante, ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| | - Daniel Aparicio-López
- Department of Surgery, Hospital Universitario Miguel Servet, University of Zaragoza, Spain
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain; Department of Surgery, Hospital Mutua de Terrassa, Barcelona, Spain
| | | | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Caballero-Marcos A, Citores MJ, Alonso-Fernández R, Rodríguez-Perálvarez M, Valerio M, Graus Morales J, Cuervas-Mons V, Cachero A, Loinaz-Segurola C, Iñarrairaegui M, Castells L, Pascual S, Vinaixa-Aunés C, González-Grande R, Otero A, Tomé S, Tejedor-Tejada J, Fernández-Yunquera A, González-Diéguez L, Nogueras-Lopez F, Blanco-Fernández G, Díaz-Fontenla F, Bustamante FJ, Romero-Cristóbal M, Martin-Mateos R, Arias-Milla A, Calatayud L, Marcacuzco-Quinto AA, Fernández-Alonso V, Gómez-Gavara C, Muñoz P, Bañares R, Pons JA, Salcedo M. Decreased Long-Term Severe Acute Respiratory Syndrome Coronavirus 2-Specific Humoral Immunity in Liver Transplantation Recipients 12 Months After Coronavirus Disease 2019. Liver Transpl 2022; 28:1039-1050. [PMID: 34919762 DOI: 10.1002/lt.26389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/08/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/05/2023]
Abstract
Long-term humoral immunity and its protective role in liver transplantation (LT) patients have not been elucidated. We performed a prospective multicenter study to assess the persistence of immunoglobulin G (IgG) antibodies in LT recipients 12 months after coronavirus disease 2019 (COVID-19). A total of 65 LT recipients were matched with 65 nontransplanted patients by a propensity score including variables with recognized impact on COVID-19. LT recipients showed a lower prevalence of anti-nucleocapsid (27.7% versus 49.2%; P = 0.02) and anti-spike IgG antibodies (88.2% versus 100.0%; P = 0.02) at 12 months. Lower index values of anti-nucleocapsid IgG antibodies were also observed in transplantation patients 1 year after COVID-19 (median, 0.49 [interquartile range, 0.15-1.40] versus 1.36 [interquartile range, 0.53-2.91]; P < 0.001). Vaccinated LT recipients showed higher antibody levels compared with unvaccinated patients (P < 0.001); antibody levels reached after vaccination were comparable to those observed in nontransplanted individuals (P = 0.70). In LT patients, a longer interval since transplantation (odds ratio, 1.10; 95% confidence interval, 1.01-1.20) was independently associated with persistence of anti-nucleocapsid IgG antibodies 1 year after infection. In conclusion, compared with nontransplanted patients, LT recipients show a lower long-term persistence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. However, SARS-CoV-2 vaccination after COVID-19 in LT patients achieves a significant increase in antibody levels, comparable to that of nontransplanted patients.
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Affiliation(s)
- Aránzazu Caballero-Marcos
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - María Jesús Citores
- Department of Internal Medicine, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA) Majadahonda, Madrid, Spain
| | - Roberto Alonso-Fernández
- Deparment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Rodríguez-Perálvarez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | - Maricela Valerio
- Deparment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Valentín Cuervas-Mons
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Puerta de Hierro Segovia de Aran (IDIPHISA), Madrid, Spain
| | - Alba Cachero
- Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmelo Loinaz-Segurola
- Department of Hepatology/HPB-surgery/Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Lluís Castells
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Internal Medicine, Liver Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Carmen Vinaixa-Aunés
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Hepatology and Liver Transplantation, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rocío González-Grande
- Department of Liver Transplantation, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Alejandra Otero
- Liver Transplant Unit, Hospital de A Coruña, A Coruña, Spain
| | - Santiago Tomé
- Department of Liver Transplantation, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ainhoa Fernández-Yunquera
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Luisa González-Diéguez
- Liver Unit and Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Flor Nogueras-Lopez
- Department of Hepatology and Liver Transplantation, Hospital Virgen de las Nieves, Granada, Spain
| | - Gerardo Blanco-Fernández
- Department of HPB Surgery and Liver Transplantation, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Fernando Díaz-Fontenla
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | | | - Mario Romero-Cristóbal
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Rosa Martin-Mateos
- Department of Digestive Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Ana Arias-Milla
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Calatayud
- Deparment of Clinical Microbiology and Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Víctor Fernández-Alonso
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Concepción Gómez-Gavara
- Department of Internal Medicine, Liver Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Deparment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rafael Bañares
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - José Antonio Pons
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Magdalena Salcedo
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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De-Armas-Conde N, Ramon-Rodriguez J, Prada-Villaverde A, Jaén-Torrejimeno I, López-Guerra D, Blanco-Fernández G. Influence of the tumor site and histopathology after resection for non-colorectal non-neuroendocrine liver metastases. A single center experience. Cir Esp 2022:S2173-5077(22)00091-6. [PMID: 35500759 DOI: 10.1016/j.cireng.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION It remains unclear whether liver resection is justified in patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM). A single-center study was conducted to analyse overall survival (OS), disease-free survival (DFS), and potential prognostic factors in patients with different types of NCNNLM. METHOD A retrospective analysis of all patients who underwent liver resection of NCNNLM from January 2006 to July 2019 was performed. RESULTS A total of 62 patients were analyzed. 82.3% presented metachronous metastases and 74.2% were unilobar. The most frequent primary tumor site (PTS) were breast (24.2%), urinary tract (19.4%), melanoma (12.9%), and pancreas (9.7%). The most frequent primary tumor pathologies were breast carcinoma (24.2%), non-breast adenocarcinoma (21%), melanoma (12.9%) and sarcoma (12.9%). The most frequent surgical procedure performed was minor hepatectomy (72.6%). R0 resection was achieved in 79.5% of cases. The major complications' rate was 9.7% with a 90-day mortality rate of 1.6%. The 1, 3 and 5-year OS/DFS rate were 65%/28%, 45%/36% and 46%/28%, respectively. We identified the response to neoadjuvant therapy and PTS as possible prognostic factors for OS (P =0.06) and DFS (P =0.06) respectively. CONCLUSION Based on the results of our series, NCNNLM resection produces beneficial outcomes in terms of OS and DFS. PTS and the response to neoadjuvant therapy could be the main prognostic factors after resection.
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Affiliation(s)
- Noelia De-Armas-Conde
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Julen Ramon-Rodriguez
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Aranzazu Prada-Villaverde
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Isabel Jaén-Torrejimeno
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Diego López-Guerra
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain; Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Unidad de Cirugía HPB y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain; Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain.
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12
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Ramon-Rodriguez J, De-Armas-Conde N, Jaén-Torrejimeno I, Prada-Villaverde A, Rojas-Holguín A, López-Guerra D, Blanco-Fernández G. Prognostic value of pre-operative systemic immune-inflammation index and platelet to lymphocyte ratio in peritoneal carcinomatosis of ovarian origin. Surg Oncol 2022; 42:101750. [DOI: 10.1016/j.suronc.2022.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
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13
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Blanco-Fernández G, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Rojas-Holguín A. Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID). Eur J Surg Oncol 2022; 48:133-141. [PMID: 34417061 DOI: 10.1016/j.ejso.2021.08.011] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain.
| | | | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- Department of Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitariode Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
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Blanco-Fernández G, Jaén-Torrejimeno I, De-Armas-Conde N, Rojas-Holguín A, Naharro JS, Castillo-Tuñón JM, López-Guerra D. Prospective Study Correlating External Biliary Stenting and Pancreatic Fistula Following Pancreaticoduodenectomy. J Gastrointest Surg 2021; 25:2881-2888. [PMID: 33768426 DOI: 10.1007/s11605-021-04983-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is the most common complication of pancreaticoduodenectomy (PD). Sometimes POPF is associated with biliary fistula (BF) or "mixed" fistula. The purpose of this study is to assess whether the severity of the fistulae, when present, is decreased with an external biliary stent in place. METHODS In this single-center study, we assessed patients who underwent elective PD from January 2014 to December 2017. Patients were divided into two groups: standard PD (ST-PD) vs. PD with external biliary stent (PD-BS). Demographic, preoperative, intraoperative, and postoperative variables were analyzed, including complications according to the Clavien-Dindo classification, and those specific to pancreatic surgeries, and mortality rates within 90 days of operation. RESULTS A total of 128 patients were included (65 in ST-PD group and 63 in PD-BS group). Postoperative complications occurred in 61.7% of patients (32.8%, Clavien-Dindo ≥ III) and were more common among patients in the PD-BS group (44.4% vs. 23.1%; p = 0.03). POPF was also more common among patients in the PD-BS group (39.7% vs. 18.5%; p = 0.008). No statistically significant differences were found for any other complications. CONCLUSION Based on the results of our study, placement of a transanastomotic external biliary stent does not reduce the rate of pancreatic or biliary fistulae, or their severity; in fact, POPF is more likely when biliary exteriorization is present. TRIAL REGISTRATION NCT04654299.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain.
| | - Noelia De-Armas-Conde
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
| | - Jesús Santos Naharro
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
| | - Juan Manuel Castillo-Tuñón
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Hospital Complex of Badajoz, University of Extremadura, Avda de Elvas, s/n, 06080, Badajoz, Spain
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Jaén-Torrejimeno I, Latorre-Fragua R, López-Guerra D, Rojas-Holguín A, Manuel-Vázquez A, Blanco-Fernández G, Ramia JM. Jaundice as a clinical presentation in liver hydatidosis increases the risk of postoperative biliary fistula. Langenbecks Arch Surg 2021; 406:1139-1147. [PMID: 33389115 DOI: 10.1007/s00423-020-02070-z] [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: 08/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Echinococcosis, also known as hydatidosis, is a zoonosis that is endemic in many countries worldwide. Liver hydatid cysts have a wide variety of clinical manifestations, among which obstructive jaundice is one of the rarer forms. The aims of the study were to analyze the preoperative management of these patients and to record the kind of surgical treatment performed and the short- and long-term postoperative results. METHODS A retrospective two-center observational study of patients operated upon for liver hydatidosis with initial symptoms of obstructive jaundice. Preoperative characteristics, surgical data, and postoperative complications, including biliary fistula, were recorded. RESULTS Of 353 patients operated upon for liver hydatidosis, 44 were included in the study. Thirty-five patients (79.6%) were defined as CE2 or CE3 in the World Health Organization (WHO) classification. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 25 patients (56.8%) and identified intrabiliary communication in 29. Radical surgery was carried out in 29 of the total sample (65.9%). Severe postoperative complications (Clavien-Dindo grade IIIA or higher) were recorded in 25% of patients. The factors associated with greater postoperative morbidity were age above 65 (HR 8.76 [95% CI 0.78-97.85]), cyst location (HR 4.77 [95% CI 0.93-24.42]), multiple cysts (HR 14.58 [95% CI 1.42-149.96]), and cyst size greater than 5 cm (HR 6.88 [95% CI 0.95-50]). CONCLUSION The presentation as obstructive jaundice causes greater postoperative morbidity. The main postoperative complication in these cases, despite radical surgery, is biliary fistula. In our series, routine preoperative ERCP did not show any benefit.
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Affiliation(s)
- Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Raquel Latorre-Fragua
- Department of HBP, General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Alba Manuel-Vázquez
- Department of HBP, General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain.
| | - José Manuel Ramia
- Department of HBP, General and Digestive Surgery, University Hospital of Alicante, Alicante, Spain
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16
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Estaras M, Gonzalez-Portillo MR, Martinez R, Garcia A, Estevez M, Fernandez-Bermejo M, Mateos JM, Vara D, Blanco-Fernández G, Lopez-Guerra D, Roncero V, Salido GM, Gonzalez A. Melatonin Modulates the Antioxidant Defenses and the Expression of Proinflammatory Mediators in Pancreatic Stellate Cells Subjected to Hypoxia. Antioxidants (Basel) 2021; 10:antiox10040577. [PMID: 33918063 PMCID: PMC8070371 DOI: 10.3390/antiox10040577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022] Open
Abstract
Pancreatic stellate cells (PSC) play a major role in the formation of fibrotic tissue in pancreatic tumors. On its side, melatonin is a putative therapeutic agent for pancreatic cancer and inflammation. In this work, the actions of melatonin on PSC subjected to hypoxia were evaluated. Reactive oxygen species (ROS) generation reduced (GSH) and oxidized (GSSG) levels of glutathione, and protein and lipid oxidation were analyzed. The phosphorylation of nuclear factor erythroid 2-related factor (Nrf2), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), and the regulatory protein nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor-alpha (IκBα) was studied. The expression of Nrf2-regulated antioxidant enzymes, superoxide dismutase (SOD) enzymes, cyclooxygenase 2 (COX-2), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were also studied. Total antioxidant capacity (TAC) was assayed. Finally, cell viability was studied. Under hypoxia and in the presence of melatonin generation of ROS was observed. No increases in the oxidation of proteins or lipids were detected. The phosphorylation of Nrf2 and the expression of the antioxidant enzymes catalytic subunit of glutamate-cysteine ligase, catalase, NAD(P)H-quinone oxidoreductase 1, heme oxygenase-1, SOD1, and of SOD2 were augmented. The TAC was increased. Protein kinase C was involved in the effects of melatonin. Melatonin decreased the GSH/GSSG ratio at the highest concentration tested. Cell viability dropped in the presence of melatonin. Finally, melatonin diminished the phosphorylation of NF-kB and the expression of COX-2, IL-6, and TNF-α. Our results indicate that melatonin, at pharmacological concentrations, modulates the red-ox state, viability, and the expression of proinflammatory mediators in PSC subjected to hypoxia.
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Affiliation(s)
- Matias Estaras
- Institute of Molecular Pathology Biomarkers, University of Extremadura, 10003 Caceres, Spain; (M.E.); (M.R.G.-P.); (G.M.S.)
| | - Manuel R. Gonzalez-Portillo
- Institute of Molecular Pathology Biomarkers, University of Extremadura, 10003 Caceres, Spain; (M.E.); (M.R.G.-P.); (G.M.S.)
| | - Remigio Martinez
- Department of Animal Health, Veterinary Faculty, University of Extremadura, 10003 Caceres, Spain;
| | - Alfredo Garcia
- Department of Animal Production, CICYTEX-La Orden, 06187 Badajoz, Spain;
| | - Mario Estevez
- IPROCAR Research Institute, Food Technology, University of Extremadura, 10003 Cáceres, Spain;
| | - Miguel Fernandez-Bermejo
- Department of Gastroenterology, San Pedro de Alcantara Hospital, 10003 Caceres, Spain; (M.F.-B.); (J.M.M.); (D.V.)
| | - Jose M. Mateos
- Department of Gastroenterology, San Pedro de Alcantara Hospital, 10003 Caceres, Spain; (M.F.-B.); (J.M.M.); (D.V.)
| | - Daniel Vara
- Department of Gastroenterology, San Pedro de Alcantara Hospital, 10003 Caceres, Spain; (M.F.-B.); (J.M.M.); (D.V.)
| | - Gerardo Blanco-Fernández
- Hepatobiliary-Pancreatic Surgery and Liver Transplant Unit, Infanta Cristina Hospital, 06080 Badajoz, Spain; (G.B.-F.); (D.L.-G.)
| | - Diego Lopez-Guerra
- Hepatobiliary-Pancreatic Surgery and Liver Transplant Unit, Infanta Cristina Hospital, 06080 Badajoz, Spain; (G.B.-F.); (D.L.-G.)
| | - Vicente Roncero
- Unit of Histology and Pathological Anatomy, Veterinary Faculty, University of Extremadura, 10003 Caceres, Spain;
| | - Gines M. Salido
- Institute of Molecular Pathology Biomarkers, University of Extremadura, 10003 Caceres, Spain; (M.E.); (M.R.G.-P.); (G.M.S.)
| | - Antonio Gonzalez
- Institute of Molecular Pathology Biomarkers, University of Extremadura, 10003 Caceres, Spain; (M.E.); (M.R.G.-P.); (G.M.S.)
- Correspondence:
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17
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Ramia JM, del Rio Martín J, Blanco-Fernández G, Cantalejo-Diaz M, Pardo F, Muñoz-Forner E, Carabias A, Manuel-Vazquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kälviäinen-Mejia HK, Rotellar-Sastre F, Garcés-Albir M, Latorre R, Longoria-Dubocq T, De Armas-Conde N, Serrablo-Requejo A, Gordillo SE, Sabater L, Serradilla-Martín M. Pancreatic mucinous cystic neoplasms located in the distal pancreas: a multicenter study. Gland Surg 2021; 11:795-804. [DOI: 10.21037/gs-21-703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/29/2022] [Indexed: 11/06/2022]
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18
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Colmenero J, Rodríguez-Perálvarez M, Salcedo M, Arias-Milla A, Muñoz-Serrano A, Graus J, Nuño J, Gastaca M, Bustamante-Schneider J, Cachero A, Lladó L, Caballero A, Fernández-Yunquera A, Loinaz C, Fernández I, Fondevila C, Navasa M, Iñarrairaegui M, Castells L, Pascual S, Ramírez P, Vinaixa C, González-Dieguez ML, González-Grande R, Hierro L, Nogueras F, Otero A, Álamo JM, Blanco-Fernández G, Fábrega E, García-Pajares F, Montero JL, Tomé S, De la Rosa G, Pons JA. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients. J Hepatol 2021; 74:148-155. [PMID: 32750442 PMCID: PMC7395653 DOI: 10.1016/j.jhep.2020.07.040] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate. METHODS We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression. RESULTS A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit. CONCLUSIONS Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged. LAY SUMMARY In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.
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Affiliation(s)
- Jordi Colmenero
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Manuel Rodríguez-Perálvarez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Cordoba, Spain.
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ana Arias-Milla
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Muñoz-Serrano
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Graus
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Digestive Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Javier Nuño
- Hepatobiliary and Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mikel Gastaca
- Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Javier Bustamante-Schneider
- Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Alba Cachero
- Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Aránzazu Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ainhoa Fernández-Yunquera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Carmelo Loinaz
- Department of Hepatology/HPB-surgery/Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inmaculada Fernández
- Department of Hepatology/HPB-surgery/Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Constantino Fondevila
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Miquel Navasa
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Mercedes Iñarrairaegui
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain
| | - Lluis Castells
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Internal Medicine, Liver Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Ramírez
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Vinaixa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Luisa González-Dieguez
- Liver Unit and Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocío González-Grande
- Department of Liver Transplantation, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Loreto Hierro
- Department of Paediatric Hepatology and Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - Flor Nogueras
- Department of Hepatology and Liver Transplantation, Hospital Virgen de las Nieves, Granada, Spain
| | - Alejandra Otero
- Liver Transplant Unit, Hospital de A Coruña, A Coruña, Spain
| | - José María Álamo
- Liver Transplant Unit, Hospital Virgen del Rocío, Seville, Spain
| | - Gerardo Blanco-Fernández
- Department of HPB surgery and Liver Transplantation, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Emilio Fábrega
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Digestive Diseases, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Luis Montero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Cordoba, Spain
| | - Santiago Tomé
- Department of Liver Transplantation, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Gloria De la Rosa
- Registro Español de Trasplante Hepático (RETH) y Organización Nacional de Trasplantes (ONT), Madrid, Spain
| | - José Antonio Pons
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Ramia JM, Del Río-Martín JV, Blanco-Fernández G, Cantalejo-Díaz M, Rotellar-Sastre F, Sabater-Orti L, Carabias-Hernandez A, Manuel-Vázquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kalviainen-Mejia HK, Esteban-Gordillo S, Muñoz-Forner E, De la Plaza R, Longoria-Dubocq T, De Armas-Conde N, Pardo-Sanchez F, Garcés-Albir M, Serradilla-Martín M. Distal pancreatectomy with multivisceral resection: A retrospective multicenter study - Case series. Int J Surg 2020; 82:123-129. [PMID: 32860956 DOI: 10.1016/j.ijsu.2020.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multivisceral resection (MVR) is sometimes necessary to achieve disease-free margins in cancer surgery. In certain patients with pancreatic tumors that invade neighboring organs these must be removed to perform an appropriate oncological surgery. In addition, there is an increasing need to perform resections of other organs like liver not directly invaded by the tumor but which require synchronous removal. The results of MVR in pancreatic surgery are controversial. MATERIAL AND METHODS A distal pancreatectomy retrospective multicenter observational study using prospectively compiled data carried out at seven HPB Units. The period study was January 2008 to December 2018. We excluded DP with celiac trunk resection. RESULTS 435 DP were performed. In 62 (14.25%) an extra organ was resected (82 organs). Comparison of the preoperative data of MVR and non-MVR patients showed that patients with MVR had lower BMI, higher ASA and larger tumor size. In the MVR group, the approach was mostly laparotomic and spleen preservation was performed only in 8% of the cases, Blood loss and the percentage of intraoperative transfusion were higher in MVR group. Major morbidity rates (Clavien > IIIa) and mortality (0.8vs.4.8%) were higher in the MVR group. Pancreatic fistula rates were practically the same in both groups. Mean hospital stay was twice as long in the MVR group and the readmission rate was higher in the MVR group. Histology study confirmed a much higher rate of malignant tumors in MVR group. CONCLUSIONS In order to obtain free margins or treat pathologies in several organs we think that DP + MVR is a feasible technique in selected patients; the results obtained are not as good as those of DP without MVR but are acceptable nonetheless. CLINICALTRIALS. GOV IDENTIFIER NCT04317352.
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Affiliation(s)
- Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain.
| | | | | | | | | | - Luis Sabater-Orti
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | | | | | | | | | | | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | - Texell Longoria-Dubocq
- University of Puerto Rico School of Medicine, Department of Surgery, j Puerto Rico, Puerto Rico
| | | | | | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Jaen-Torrejimeno I, López-Guerra D, Blanco-Fernández G. Letter in Reply to Pattern of Relapse in Hepatic Hydatidosis and Variables Associated with Its Morbidity and Relapse: Analysis of 238 Cases in a Single Hospital. J Gastrointest Surg 2020; 24:2178-2179. [PMID: 32500415 DOI: 10.1007/s11605-020-04677-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Isabel Jaen-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura , Avda de Elvas s/n, Badajoz, 06080, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura , Avda de Elvas s/n, Badajoz, 06080, Spain.
| | - Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura , Avda de Elvas s/n, Badajoz, 06080, Spain
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21
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Gonzalez A, Estaras M, Martinez-Morcillo S, Martinez R, García A, Estévez M, Santofimia-Castaño P, Tapia JA, Moreno N, Pérez-López M, Míguez MP, Blanco-Fernández G, Lopez-Guerra D, Fernandez-Bermejo M, Mateos JM, Vara D, Roncero V, Salido GM. Melatonin modulates red-ox state and decreases viability of rat pancreatic stellate cells. Sci Rep 2020; 10:6352. [PMID: 32286500 PMCID: PMC7156707 DOI: 10.1038/s41598-020-63433-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/30/2020] [Indexed: 12/13/2022] Open
Abstract
In this work we have studied the effects of pharmacological concentrations of melatonin (1 µM-1 mM) on pancreatic stellate cells (PSC). Cell viability was analyzed by AlamarBlue test. Production of reactive oxygen species (ROS) was monitored following CM-H2DCFDA and MitoSOX Red-derived fluorescence. Total protein carbonyls and lipid peroxidation were analyzed by HPLC and spectrophotometric methods respectively. Mitochondrial membrane potential (ψm) was monitored by TMRM-derived fluorescence. Reduced (GSH) and oxidized (GSSG) levels of glutathione were determined by fluorescence techniques. Quantitative reverse transcription-polymerase chain reaction was employed to detect the expression of Nrf2-regulated antioxidant enzymes. Determination of SOD activity and total antioxidant capacity (TAC) were carried out by colorimetric methods, whereas expression of SOD was analyzed by Western blotting and RT-qPCR. The results show that melatonin decreased PSC viability in a concentration-dependent manner. Melatonin evoked a concentration-dependent increase in ROS production in the mitochondria and in the cytosol. Oxidation of proteins was detected in the presence of melatonin, whereas lipids oxidation was not observed. Depolarization of ψm was noted with 1 mM melatonin. A decrease in the GSH/GSSG ratio was observed, that depended on the concentration of melatonin used. A concentration-dependent increase in the expression of the antioxidant enzymes catalytic subunit of glutamate-cysteine ligase, catalase, NAD(P)H-quinone oxidoreductase 1 and heme oxygenase-1 was detected in cells incubated with melatonin. Finally, decreases in the expression and in the activity of superoxide dismutase were observed. We conclude that pharmacological concentrations melatonin modify the redox state of PSC, which might decrease cellular viability.
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Affiliation(s)
- Antonio Gonzalez
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Caceres, Spain.
| | - Matias Estaras
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Caceres, Spain
| | | | - Remigio Martinez
- Department of Animal Health, Veterinary Faculty, University of Extremadura, Caceres, Spain
| | - Alfredo García
- Department of Animal Production, CICYTEX-La Orden, Guadajira, Badajoz, Spain
| | - Mario Estévez
- IPROCAR Research Institute, Food Technology, University of Extremadura, 10003, Cáceres, Spain
| | - Patricia Santofimia-Castaño
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Parc Scientifique et Technologique de Luminy, Marseille, France
| | - Jose A Tapia
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Caceres, Spain
| | - Noelia Moreno
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Caceres, Spain
| | - Marcos Pérez-López
- Unit of Toxicology, Veterinary Faculty, University of Extremadura, Caceres, Spain
| | - María P Míguez
- Unit of Toxicology, Veterinary Faculty, University of Extremadura, Caceres, Spain
| | - Gerardo Blanco-Fernández
- Hepatobiliary-Pancreatic Surgery and Liver Transplant Unit, Infanta Cristina Hospital, Badajoz, Spain
| | - Diego Lopez-Guerra
- Hepatobiliary-Pancreatic Surgery and Liver Transplant Unit, Infanta Cristina Hospital, Badajoz, Spain
| | | | - Jose M Mateos
- Department of Gastroenterology, San Pedro de Alcantara Hospital, Caceres, Spain
| | - Daniel Vara
- Department of Gastroenterology, San Pedro de Alcantara Hospital, Caceres, Spain
| | - Vicente Roncero
- Unit of Histology and Pathological Anatomy, Veterinary Faculty, University of Extremadura, Caceres, Spain
| | - Gines M Salido
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Caceres, Spain
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22
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Jaen-Torrejimeno I, Rojas-Holguín A, López-Guerra D, Ramia JM, Blanco-Fernández G. Pancreatic resection for metastatic renal cell carcinoma. A systematic review. HPB (Oxford) 2020; 22:479-486. [PMID: 31672281 DOI: 10.1016/j.hpb.2019.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/20/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) can lead to secondary pancreatic tumors even years after nephrectomy was performed. Surgical resection in selected patients shows appropriate survival rates. METHODS A systematic review was performed following PRISMA guidelines. This review finished in May 2019 and included patients with resected pancreatic metastasis(es). The main purpose was to evaluate the results of surgical resection of pancreatic tumors secondary to kidney cancer. RESULTS After the screening process of articles, 21 were selected for the systematic review, which included 354 patients, whose disease-free interval (DFI) was 105.11 (0-361.56) months. Of these patients, 34.6% had additional metastases elsewhere at the time of the surgery, and 48.6% were symptomatic. Postoperative morbidity was 40.2%, The 5-year overall survival (OS) rate was 53.9% (26-75). CONCLUSION Pancreatic surgery for the resection of RCC metastasis(es) is considered safe and shows low morbidity and mortality rates among selected patients in medical institutions where this type of procedure is commonly performed.
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Affiliation(s)
- Isabel Jaen-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain.
| | - Jose M Ramia
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
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23
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López-Guerra D, Santos-Naharro J, Rojas-Holguín A, Jaen-Torrejimeno I, Prada-Villaverde A, Blanco-Fernández G. Postoperative bleeding and biliary leak after liver resection: A cohort study between two different fibrin sealant patches. Sci Rep 2019; 9:12001. [PMID: 31427638 PMCID: PMC6700165 DOI: 10.1038/s41598-019-48529-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
Different topical products have been tested in liver resection to get a control of bleeding. This study compares the effectiveness and complications between two haemostatic agents Tachosil versus Hemopatch. A cohort study including patients who underwent liver resection since November 2014 to April 2016 was conducted. The study was performed in a single institution. Demographic variables, intraoperative characteristics and postoperative complications were analysed. A total of 92 patients (50 in Tachosil group and 42 in Hemopatch group) were included. No differences were found in patients who required intraoperative (Tachosil 6 (12%) vs Hemopatch 2 (4.8%); p = 0.28) and postoperative (Tachosil 4 (8%) vs Hemopatch 3 (7.1%); p = 0.87) blood transfusion. There were no differences in length of hospital stay (Tachosil 7.02 ± 4.1 days vs Hemopatch 7.63 ± 9.1; p = 0.67). Overall postoperative complications were similar between both patches (Tachosil 21 (42%) vs Hemopatch 14 (33%); p = 0.48). No differences were found in specific complications, however Hemopatch showed a higher incidence of intraabdominal abscess 5 (11.9%) and vs 0 (0%) p = 0.01.In this study no differences have been found between Hemopatch and Tachosil in the effectiveness and overall postoperative complication after liver resection, although Hemopatch shows a higher incidence of intraabdominal abscess. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Diego López-Guerra
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain.
| | - Jesús Santos-Naharro
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Isabel Jaen-Torrejimeno
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Aranzazu Prada-Villaverde
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
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24
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Oriol I, Sabe N, Càmara J, Berbel D, Ballesteros MA, Escudero R, Lopez-Medrano F, Linares L, Len O, Silva JT, Oliver E, Soldevila L, Pérez-Recio S, Guillem LL, Camprubí D, LLadó L, Manonelles A, González-Costello J, Domínguez MA, Fariñas MC, Lavid N, González-Rico C, Garcia-Cuello L, Arnaiz de Las Revillas F, Fortun J, Aguado JM, Jimenez-Romero C, Bodro M, Almela M, Paredes D, Moreno A, Pérez-Cameo C, Muñoz-Sanz A, Blanco-Fernández G, Cabo-González JA, García-López JL, Nuño E, Carratalà J. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study. Open Forum Infect Dis 2019; 6:ofz180. [PMID: 31198815 PMCID: PMC6546202 DOI: 10.1093/ofid/ofz180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 01/29/2023] Open
Abstract
Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.
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Affiliation(s)
- I Oriol
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - N Sabe
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - J Càmara
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - D Berbel
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - M A Ballesteros
- Intensive Care Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - R Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - F Lopez-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - L Linares
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | - E Oliver
- Donor Coordination Unit, Bellvitge University Hospital, Barcelona, Spain
| | - L Soldevila
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Pérez-Recio
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L L Guillem
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubí
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L LLadó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - A Manonelles
- Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J González-Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - M A Domínguez
- Spanish Network for Research in Infectious Diseases (REIPI).,Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona
| | - M C Fariñas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - N Lavid
- Donor Coordination Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - C González-Rico
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - L Garcia-Cuello
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - F Arnaiz de Las Revillas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - J Fortun
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Jimenez-Romero
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Bodro
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Almela
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - D Paredes
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - A Moreno
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Pérez-Cameo
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Muñoz-Sanz
- Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | | | | | - J L García-López
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - E Nuño
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - J Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
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25
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Matito-Díaz MJ, Blanco-Fernández G, Fernández-Pérez J, López-Guerra D. Leiomyoma of the round ligament of the liver: report of one case. Rev Esp Enferm Dig 2015; 107:644-6. [PMID: 26437987 DOI: 10.17235/reed.2015.3725/2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
Tumoral conditions in the round ligament of the liver are very uncommon and exhibit nonspecific manifestations, hence a high level of suspicion is necessary for their diagnosis. We report the case of a 47-year-old female patient who presented with abdominal pain for several months; imaging studies showed a lesion of indeterminate nature likely connected with the falciform ligament, and only intraoperative findings acknowledged the presence of an apparently benign tumor in the round ligament of the liver, which biopsy confirmed. Following the excision of the round ligament the patient had a favorable course. As this is a pathologically benign lesion we deem its surgical management both advisable and sufficient. However, because of its small prevalence and the scarcity of literature involving this condition, further studies would be needed to provide information on natural history, treatment, and long-term prognosis.
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Affiliation(s)
- M José Matito-Díaz
- Cirugía General y Aparato Digestivo, Hospital Infanta Cristina (Badajoz), España
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26
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Rodríguez-Hernández A, Navarro-Villarán E, González R, Pereira S, Soriano-De Castro LB, Sarrias-Giménez A, Barrera-Pulido L, Álamo-Martínez JM, Serrablo-Requejo A, Blanco-Fernández G, Nogales-Muñoz A, Gila-Bohórquez A, Pacheco D, Torres-Nieto MA, Serrano-Díaz-Canedo J, Suárez-Artacho G, Bernal-Bellido C, Marín-Gómez LM, Barcena JA, Gómez-Bravo MA, Padilla CA, Padillo FJ, Muntané J. Regulation of cell death receptor S-nitrosylation and apoptotic signaling by Sorafenib in hepatoblastoma cells. Redox Biol 2015; 6:174-182. [PMID: 26233703 PMCID: PMC4534573 DOI: 10.1016/j.redox.2015.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/18/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Nitric oxide (NO) plays a relevant role during cell death regulation in tumor cells. The overexpression of nitric oxide synthase type III (NOS-3) induces oxidative and nitrosative stress, p53 and cell death receptor expression and apoptosis in hepatoblastoma cells. S-nitrosylation of cell death receptor modulates apoptosis. Sorafenib is the unique recommended molecular-targeted drug for the treatment of patients with advanced hepatocellular carcinoma. The present study was addressed to elucidate the potential role of NO during Sorafenib-induced cell death in HepG2 cells. We determined the intra- and extracellular NO concentration, cell death receptor expression and their S-nitrosylation modifications, and apoptotic signaling in Sorafenib-treated HepG2 cells. The effect of NO donors on above parameters has also been determined. Sorafenib induced apoptosis in HepG2 cells. However, low concentration of the drug (10nM) increased cell death receptor expression, as well as caspase-8 and -9 activation, but without activation of downstream apoptotic markers. In contrast, Sorafenib (10 µM) reduced upstream apoptotic parameters but increased caspase-3 activation and DNA fragmentation in HepG2 cells. The shift of cell death signaling pathway was associated with a reduction of S-nitrosylation of cell death receptors in Sorafenib-treated cells. The administration of NO donors increased S-nitrosylation of cell death receptors and overall induction of cell death markers in control and Sorafenib-treated cells. In conclusion, Sorafenib induced alteration of cell death receptor S-nitrosylation status which may have a relevant repercussion on cell death signaling in hepatoblastoma cells.
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Affiliation(s)
- A Rodríguez-Hernández
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - E Navarro-Villarán
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - R González
- Departament of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain
| | - S Pereira
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - L B Soriano-De Castro
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - A Sarrias-Giménez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario "Virgen del Rocío"/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - L Barrera-Pulido
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - J M Álamo-Martínez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - A Serrablo-Requejo
- Hepato-Biliary Surgery Unit, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - G Blanco-Fernández
- Hepato-Biliary-Pancreatic and Liver Transplant Service, Hospital Universitario "Infanta Cristina", Badajoz, Spain
| | - A Nogales-Muñoz
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - A Gila-Bohórquez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - D Pacheco
- Department of General Surgery and Department of Pathology, Hospital Universitario "Rio Hortega", Valladolid, Spain
| | - M A Torres-Nieto
- Department of Pathology, Hospital Universitario "Rio Hortega", Valladolid, Spain
| | - J Serrano-Díaz-Canedo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - G Suárez-Artacho
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - C Bernal-Bellido
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - L M Marín-Gómez
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - J A Barcena
- Departament of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain
| | - M A Gómez-Bravo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - C A Padilla
- Departament of Biochemistry and Molecular Biology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain
| | - F J Padillo
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - J Muntané
- Department of General Surgery, Hospital Universitario "Virgen del Rocío" - "Virgen Macarena"/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, Spain; CENTRO DE INVESTIGACIÓN BIOMÉDICA EN RED de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Onieva-González FG, Galeano-Díaz F, Matito-Díaz MJ, López-Guerra D, Fernández-Pérez J, Blanco-Fernández G. [Inflammatory pseudotumour of the liver. Importance of intra-operative histopathology]. CIR CIR 2015; 83:151-5. [PMID: 25986975 DOI: 10.1016/j.circir.2015.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 02/18/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory pseudotumour is a rare entity, considered benign, and characterised by inflammatory cell mesenchymal proliferation. CLINICAL CASE The case is presented 70 year-old man with fever of unknown origin syndrome. He was diagnosed with liver abscesses (one segment IV, adjacent to gallbladder fundus and segment VI), who progressed slowly after antibiotic treatment. In the absence of a diagnosis, although fine needle puncture-aspiration and different imaging tests were performed, elective surgery was decided. The intra-operative histopathology reported the existence of an inflammatory pseudotumour. CONCLUSIONS Inflammatory pseudotumours are clinically classified into different types according to their aetiology, varying therapeutic management based on the same. It is very difficult to diagnose because of the absence of symptoms, blood disorders, or specific radiological findings. Definitive diagnosis often requires histopathological confirmation, in most cases by percutaneous liver puncture, but sometimes exploratory laparotomy or even performing a hepatectomy for confirmation is necessary. The natural history of inflammatory pseudotumour is its regression; thus conservative management may be used through regular checks until resolution, or can be treated with antibiotics, anti-inflammatories and even corticosteroids. Surgical resection is indicated for persistent unresolved systemic symptoms despite medical treatment, in those situations where growth is evident, with or without symptoms, when involving the hepatic hilum, and finally, in case where the possibility of malignancy cannot be ruled out.
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Affiliation(s)
| | - Francisco Galeano-Díaz
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - María José Matito-Díaz
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Diego López-Guerra
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Juana Fernández-Pérez
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Gerardo Blanco-Fernández
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
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Barzola-Navarro EJ, Flores-García JÁ, López-Guerra D, Tejera-Pérez C, Rodríguez-Díez N, Gómez-Durán A, Rubio-Fernández A, Blanco-Fernández G. Duodenal Ewing´s sarcoma: Unusual location and atypical EWRS-1 translocation. Rev Esp Enferm Dig 2015; 107:109-110. [PMID: 25659392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Onieva-González FG, Blanco-Fernández G, Munuera-Romero L, Márquez-Rojas J, Robles-Marcos M, Solórzano-Peck G. Wernicke's encephalopathy after cephalic pancreaticoduodenectomy. Rev Esp Enferm Dig 2012; 103:594-6. [PMID: 22149564 DOI: 10.4321/s1130-01082011001100009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Wernicke's encephalopathy is an acute neurological disorder resulting from thiamine deficiency. We report a case in a young patient who underwent a cephalic duodenopancreatectomy with a bleeding duodenal ulcer refractory to endoscopic and surgical treatment, requiring total parenteral nutrition, without thiamine supplementation.
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González-Ballester D, Blanco-Fernández G, Tejero-García M, Márquez-Rojas J, Botello-Martínez F, Solórzano-Peck G, Catalina-Fernández I. Kikuchi-Fujimoto, abdominal tumor as atypical location. Rev Esp Enferm Dig 2010; 102:455-7. [PMID: 20617873 DOI: 10.4321/s1130-01082010000700015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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