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Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N, Castillo Diego J. Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 2023; 75:589-597. [PMID: 36763301 DOI: 10.1007/s13304-023-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
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Affiliation(s)
- Marcos Gomez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Roberto Ballestero Diego
- Urology, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Patricia Tejedor
- Colorectal Surgery Unit, General Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Carmen Cagigas Fernandez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Lidia Cristobal Poch
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Natalia Suarez Pazos
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
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Cristóbal Poch L, Cagigas Fernández C, Gómez-Ruiz M, Ortega Roldán M, Cantero Cid R, Castillo Diego J, Gómez-Fleitas M. Implementation of an enhanced recovery after surgery program with robotic surgery in high-risk patients obtains optimal results after colorectal resections. J Robot Surg 2021; 16:575-586. [PMID: 34278544 DOI: 10.1007/s11701-021-01281-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/04/2021] [Indexed: 01/23/2023]
Abstract
Enhanced recovery after surgery programs reduce postoperative complications and length of stay after laparoscopic colorectal surgery, but are still under evaluation after robotic colorectal surgery. To evaluate potential benefits in terms of length of stay and complications of an Enhanced recovery after surgery program in colorectal surgery. A subanalysis was performed to assess what combination of surgical approach and perioperative care had better outcomes. Prospective observational cohort study. 300 consecutive colorectal surgery patients: 150 were prospectively included in the enhanced recovery after Surgery program group and 150 retrospectively in the traditional care group, and subdivided according to the type of surgery, in Hospital Marques de Valdecilla, between 2013 and 2016. Postoperative complications decreased significantly (p = 0.002) from 46 to 28% (traditional care vs program group). The length of stay was decreased by 2 days (p < 0.001). Multivariate analysis indicated similar effect sizes after adjusting for age, gender, Charlson score, and type of surgery. Type of surgery was an independent predictive factor for postoperative complications and length of stay. Compared to open surgery, postoperative complications decreased by 50% (p < 0.001) after robotic surgery and by 40% (p = 0.01) after laparoscopic surgery, while the median length of stay decreased by three days (p < 0.001) after minimally invasive surgery. Enhanced recovery after surgery program and minimally invasive surgery were associated with decreased morbidity and length of stay after colorectal surgery compared to open surgery and traditional care. An enhanced recovery after surgery program with robotic surgery in high-risk patients might be beneficial.
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Affiliation(s)
- Lidia Cristóbal Poch
- Colorectal Surgery Unit. Hospital Universitario "Marques de Valdecilla", Av. de Valdecilla S/N, 25, 39008, Santander, Cantabria, Spain.
| | - Carmen Cagigas Fernández
- Colorectal Surgery Unit. Hospital Universitario "Marques de Valdecilla", Av. de Valdecilla S/N, 25, 39008, Santander, Cantabria, Spain
| | - Marcos Gómez-Ruiz
- Colorectal Surgery Unit. Hospital Universitario "Marques de Valdecilla", Av. de Valdecilla S/N, 25, 39008, Santander, Cantabria, Spain.,Surgical Innovation Research Group Valdecilla Biomedical Research Center, IDIVAL, Santander, Cantabria, Spain
| | - Marta Ortega Roldán
- University of Cantabria, Av de Los Castros, 39008, Santander, Cantabria, Spain
| | - Ramón Cantero Cid
- Colorectal Surgery Unit. Hospital Universitario "La Paz", Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit. Hospital Universitario "Marques de Valdecilla", Av. de Valdecilla S/N, 25, 39008, Santander, Cantabria, Spain
| | - Manuel Gómez-Fleitas
- University of Cantabria, Colorectal Surgery Unit, Hospital Universitario, "Marques de Valdecilla", Av da. Valdecilla S/N, 39008, Santander, Cantabria, Spain
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Cristóbal Poch L, Santarrufina Martínez S, Laínez Escribano M, Anderson EJ, Castillo Diego J, Sanz Gimenez-Rico JR. Pilonidal disease. Three flap procedures every colorectal surgeon should know-a video vignette. Colorectal Dis 2021; 23:1286-1287. [PMID: 33560557 DOI: 10.1111/codi.15575] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
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Gómez Ruiz M, Cagigas Fernández C, Alonso Martín J, Cristobal Poch L, Manuel Palazuelos C, Barredo Cañibano FJ, Gómez Fleitas M, Castillo Diego J. Robotic Assisted Transanal Polypectomies: Is There Any Indication? Cir Esp 2017; 95:601-609. [PMID: 29146073 DOI: 10.1016/j.ciresp.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/09/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. METHODS Between February 2014 and October 2015, 9patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality. RESULTS A total of 5 male and 4 female patients underwent robotic TAMIS. Lesions were 6,22cm from the anal verge. Mean size was 15,8cm2. All procedures were performed in the lithotomy position. Closure of the defect was performed in all cases. Mean blood loss was 39,8ml. Mean operative time was 71,9min. No severe postoperative complications or readmissions occured. Median hospital stay was 2,5 days. CONCLUSIONS Robotic TAMIS is useful to treat complex rectal lesions. Our transanal platform allowed a wider range of movements of the robotic arms and to perform all procedures in the lithotomy position.
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Affiliation(s)
- Marcos Gómez Ruiz
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carmen Cagigas Fernández
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Lidia Cristobal Poch
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carlos Manuel Palazuelos
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Francisco Javier Barredo Cañibano
- Anestesiología en Cirugía General, Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Departamento de Innovación y Cirugía Robótica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
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Gavilanes Calvo C, Manuel Palazuelos JC, Alonso Martín J, Castillo Diego J, Martín Parra I, Gómez Ruiz M, Gómez Fleitas M. [Transanal endoscopic operations for rectal tumours]. Cir Esp 2013; 92:38-43. [PMID: 24169437 DOI: 10.1016/j.ciresp.2013.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/11/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. METHODS In this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery,…). RESULTS The indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery. All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. CONCLUSIONS TEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation.
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Affiliation(s)
- Carlos Gavilanes Calvo
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - Joaquín Alonso Martín
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Ignacio Martín Parra
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Marcos Gómez Ruiz
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Cátedra de Cirugía General, Universidad de Cantabria, Santander, España
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Bernal J, Garrido-Bailón E, Del Nozal MJ, González-Porto AV, Martín-Hernández R, Diego JC, Jiménez JJ, Bernal JL, Higes M. Overview of pesticide residues in stored pollen and their potential effect on bee colony (Apis mellifera) losses in Spain. J Econ Entomol 2010; 103:1964-1971. [PMID: 21309214 DOI: 10.1603/ec10235] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the last decade, an increase in honey bee (Apis mellifera L.) colony losses has been reported in several countries. The causes of this decline are still not clear. This study was set out to evaluate the pesticide residues in stored pollen from honey bee colonies and their possible impact on honey bee losses in Spain. In total, 1,021 professional apiaries were randomly selected. All pollen samples were subjected to multiresidue analysis by gas chromatography-mass spectrometry (MS) and liquid chromatography-MS; moreover, specific methods were applied for neonicotinoids and fipronil. A palynological analysis also was carried out to confirm the type of foraging crop. Pesticide residues were detected in 42% of samples collected in spring, and only in 31% of samples collected in autumn. Fluvalinate and chlorfenvinphos were the most frequently detected pesticides in the analyzed samples. Fipronil was detected in 3.7% of all the spring samples but never in autumn samples, and neonicotinoid residues were not detected. More than 47.8% of stored pollen samples belonged to wild vegetation, and sunflower (Heliantus spp.) pollen was only detected in 10.4% of the samples. A direct relation between pesticide residues found in stored pollen samples and colony losses was not evident accordingly to the obtained results. Further studies are necessary to determine the possible role of the most frequent and abundant pesticides (such as acaricides) and the synergism among them and with other pathogens more prevalent in Spain.
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Affiliation(s)
- J Bernal
- IU CINQUIMA, Analytical Chemistry Group, University of Valladolid, E-47071 Valladolid, Spain.
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Nozal MJ, Bernal JL, Toribio ML, Diego JC, Ruiz A. Rapid and sensitive method for determining free amino acids in honey by gas chromatography with flame ionization or mass spectrometric detection. J Chromatogr A 2004; 1047:137-46. [PMID: 15481469 DOI: 10.1016/j.chroma.2004.07.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper describes a rapid, sensitive and specific method for determination of free amino acids in honey involving a new reaction of derivatization and gas chromatography (GC) with flame ionization (FID) and mass spectrometric (MS) detection. The method allows the determination of 22 free amino acids in honey samples in a short time: 8 and 5 min for GC-FID and GC-MS, respectively. Quantitation was performed using Norvaline as internal standard, with detection limits ranging between 0.112 and 1.795 mg/L by GC-FID and between 0.001 and 0.291 mg/L by GC-MS in the selected-ion monitoring mode. The method was validated and applied to a set of 74 honey samples belonging to four different botanical origins: eucaliptus, rosemary, orange and heather. The statistical treatment of data shows a correct classification of different origins over 90%.
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Affiliation(s)
- Ma J Nozal
- Department of Analytical Chemistry, Faculty of Sciences, University of Valladolid, Valladolid E-47005, Spain.
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del Nozal MJ, Bernal JL, Diego JC, Gómez LA, Ruiz JM, Higes M. Determination of oxalate, sulfate and nitrate in honey and honeydew by ion-chromatography. J Chromatogr A 2000; 881:629-38. [PMID: 10905741 DOI: 10.1016/s0021-9673(00)00271-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An ion chromatographic method for determining the anions oxalate, sulfate and nitrate in honey and honeydew samples is described. To prevent matrix interference and to isolate the anions a clean-up step using solid-phase extraction on anionic cartridges and eluting with a 0.01 M chromate solution is recommended. The anions are separated on an anionic column with a mobile phase of borate-gluconate buffer and using conductimetric detection. The method is applied to the analysis of samples from different botanical origin.
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Affiliation(s)
- M J del Nozal
- Analytical Chemistry Department, Faculty of Sciences, University of Valladolid, Spain
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