1
|
Ielpo B, Rosso E, d'Addetta MV, Abad M, Vellalta G, Sanchez-Velazquez P, Burdio F. Robotic Approach for Perihilar Cholangiocarcinoma IIIA Type: Step-by-Step Procedure. Ann Surg Oncol 2024; 31:3084-3085. [PMID: 38315334 DOI: 10.1245/s10434-024-14956-z] [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: 10/03/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perihilar cholangiocarcinoma is a challenging technique to be performed by minimally invasive approach being the type III among the most complex procedure. Nowadays, the robotic approach is gaining increasing interest among the surgical community, and more and more series describing robotic liver resection have been reported. However, few cases of minimally invasive Bismuth type IIIA cholangiocarcinoma have been reported. Robotic approach allows for a better dissection and suture thanks to the flexible and precise instruments movements, overcoming some of the limitations of the laparoscopic technique. Therefore, robotic technique can facilitate some of the critical steps of a technically demanding procedure, such as the extended right hepatectomy for perihilar cholangiocarcinoma Bismuth IIIA type. METHODS In this multimedia video we describe, for the first time in the literature, a full robotic surgical step-by-step technique with some tips and tricks for treating a perihilar cholangiocarcinoma Bismuth IIIA type, performing a radical extended right hemihepatectomy, including segment I combined with regional lymphadenectomy anf left bile duct reconstruction. A 55-year-old woman with obstructive jaundice (10 mg/dl) was referred to our center. The endobiliary brushing confirmed adenocarcinoma, and MRI/CT showed a focal perihilar lesion of 2 cm, including the main biliary duct bifurcation and extending up to the right duct (Bismuth Type IIIA hilar cholangiocarcinoma). After endoscopic biliary stents placement and 6 weeks after right portal vein embolization, the future liver remnant, including segments II and III, reached an enough hypertrophy volume with a ratio of 30%. A right hemihepatectomy with caudate lobe, including standard standard lymphadenectomy and left biliary duct reconstruction was performed. RESULTS The operation lasted 670 min with an estimated blood loss of 350 ml. Postoperative pathological examination revealed a moderately differentiated adenocarcinoma pT1N0 with 15 retrieved nodes and free margins. The patient experienced a type A biliary fistula and was discharged on the 21st postoperative day without abdominal drainage. CONCLUSIONS Through the tips and tricks presented in this multimedia article, we show the advantages of the robotic approach for performing correctly one of the most complex surgeries.1-7.
Collapse
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mayra Abad
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
2
|
Ielpo B, Rosso E, d'Addetta MV, Abad M, Vellalta G, Sanchez-Velazquez P, Burdio F. ASO Author Reflections: Robotic Approach for Perihilar Cholangiocarcinoma. Ann Surg Oncol 2024; 31:3106-3107. [PMID: 38334849 DOI: 10.1245/s10434-024-15006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mayra Abad
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
3
|
Ielpo B, Vellalta G, Jaume-Boettcher SM, d'Addetta MV, Sanchez-Velazquez P, Burdio F. Transduodenal robotic ampullectomy: tips and tricks and strategies for postoperative duodenal fistula management (with video). Updates Surg 2024:10.1007/s13304-024-01808-4. [PMID: 38507177 DOI: 10.1007/s13304-024-01808-4] [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: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Transduodenal Ampullectomy (TA) is a procedure for resecting low-malignancy ampullary tumors, with postoperative fistula as a notable complication. This study aims to clarify the indications for TA, outline the surgical robotic technique, and emphasize the importance of comprehensive complication management alongside the surgical approach. This multimedia article provides a detailed exposition of the robotic TA surgical technique, including the most important steps involved in exposing and reimplanting biliary and pancreatic ducts. The procedure encompasses the mobilization of the hepatic flexure of the colon, an extensive Kocher maneuver for duodenal mobilization, and ampulla exposure through a duodenal incision. Employing retraction loop sutures enhances surgical field visibility. Reconstruction involves securing pancreatic and biliary ducts to the duodenal mucosa, each tutored with a silicon catheter, and suturing for ampullectomy completion. The total operative time was 380 min. Final histopathology disclosed high-grade dysplasia with an isolated focus of adenocarcinoma (pT1), accompanied by clear resection margins. A postoperative duodenal fistula occurred, managed successfully through conservative treatment, utilizing subcutaneous drainage. Despite accurate robotic TA execution, complications may arise. This study underscores the importance of a comprehensive approach, incorporating meticulous surgical technique and effective complication management, to optimize patient outcomes.
Collapse
Affiliation(s)
- Benedetto Ielpo
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain.
| | - Gemma Vellalta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Sofia-Maria Jaume-Boettcher
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Maria Vittoria d'Addetta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Fernando Burdio
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| |
Collapse
|
4
|
Ielpo B, d'Addetta MV, Anselmo A, Rosso E, de Blasi V, Sanchez-Velazquez P, Vellalta G, Podda M, Burdio F. Levels of Robotic Mesopancreas Dissection According to Malignancy and Vascular Anatomy: What Surgeons Need to Know. Ann Surg Oncol 2024; 31:1916-1918. [PMID: 38071705 PMCID: PMC10838235 DOI: 10.1245/s10434-023-14686-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The robotic approach is attracting increasing interest among the surgical community, and more and more series describing robotic pancreatoduodenectomy have been reported. Thus, surgeons performing robotic pancreatoduodenectomy should be confident with this critical step's potential scenarios. MATERIALS AND METHODS According to Yosuke et al., there are three different levels of mesopancreas dissection. We describe the main steps for a safe mesopancreas dissection by robotic approach. RESULTS This multimedia article provides, for the first time in literature, a comprehensive step-by-step overview of the mesopancreas dissection during robotic pancreatoduodenectomy (PD) and its three different levels according to tumor type. CONCLUSIONS Through the tips and indications presented in this multimedia article, we aim to familiarize surgeons with the mesopancreas dissections levels according to type of malignancy and vascular anatomy.
Collapse
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
- Hepato-Biliary Surgery, Borgoroma Hospital, Verona, Italy
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Vito de Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
5
|
Ielpo B, d'Addetta MV, Anselmo A, Rosso E, de Blasi V, Sanchez-Velazquez P, Vellalta G, Podda M, Burdio F. ASO Visual Abstract: Levels of Robotic Mesopancreas Dissection According to Malignancy and Vascular Anatomy-What Surgeons Need to Know. Ann Surg Oncol 2024; 31:1953. [PMID: 38143266 DOI: 10.1245/s10434-023-14796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
- Hepato-Biliary Surgery, Borgoroma Hospital, Verona, Italy
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxebourg, Luxembourg
| | - Vito de Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxebourg, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
6
|
Masuda Y, Yeo MHX, Burdio F, Sanchez-Velazquez P, Perez-Xaus M, Pelegrina A, Koh YX, Di Martino M, Goh BKP, Tan EK, Teo JY, Romano F, Famularo S, Ferrari C, Griseri G, Piardi T, Sommacale D, Gianotti L, Molfino S, Baiocchi G, Ielpo B. Factors affecting overall survival and disease-free survival after surgery for hepatocellular carcinoma: a nomogram-based prognostic model-a Western European multicenter study. Updates Surg 2024; 76:57-69. [PMID: 37839048 DOI: 10.1007/s13304-023-01656-8] [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: 08/06/2023] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
Few studies have assessed the clinical implications of the combination of different prognostic indicators for overall survival (OS) and disease-free survival (DFS) of resected hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic factors in HCC patients for OS and DFS outcomes and establish a nomogram-based prognostic model to predict the DFS of HCC. A multicenter, retrospective European study was conducted through the collection of data on 413 consecutive treated patients with a first diagnosis of HCC between January 2010 and December 2020. Univariate and multivariate Cox regression analyses were performed to identify all independent risk factors for OS and DFS outcomes. A nomogram prognostic staging model was subsequently established for DFS and its precision was verified internally by the concordance index (C-Index) and externally by calibration curves. For OS, multivariate Cox regression analysis indicated Child-Pugh B7 score (HR 4.29; 95% CI 1.74-10.55; p = 0.002) as an independent prognostic factor, along with Barcelona Clinic Liver Cancer (BCLC) stage ≥ B (HR 1.95; 95% CI 1.07-3.54; p = 0.029), microvascular invasion (MVI) (HR 2.54; 95% CI 1.38-4.67; p = 0.003), R1/R2 resection margin (HR 1.57; 95% CI 0.85-2.90; p = 0.015), and Clavien-Dindo Grade 3 or more (HR 2.73; 95% CI 1.44-5.18; p = 0.002). For DFS, multivariate Cox regression analysis indicated BCLC stage ≥ B (HR 2.15; 95% CI 1.34-3.44; p = 0.002) as an independent prognostic factor, along with multiple nodules (HR 2.04; 95% CI 1.25-3.32; p = 0.004), MVI (HR 1.81; 95% CI 1.19-2.75; p = 0.005), satellite nodules (HR 1.63; 95% CI 1.09-2.45; p = 0.018), and R1/R2 resection margin (HR 3.39; 95% CI 2.19-5.25; < 0.001). The C-Index of the nomogram, tailored based on the previous significant factors, showed good accuracy (0.70). Internal and external calibration curves for the probability of DFS rate showed optimal consistency and fit well between the nomogram-based prediction and actual observations. MVI and R1/R2 resection margins should be considered as significant OS and DFS predictors, while satellite nodules should be included as a significant DFS predictor. The nomogram-based prognostic model for DFS provides a more effective prognosis assessment for resected HCC patients, allowing for individualized treatment plans.
Collapse
Affiliation(s)
- Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ministry of Health Holdings Singapore, Singapore, Singapore
| | - Mark Hao Xuan Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ministry of Health Holdings Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepato Pancreato Biliary Division, Department of Hepato-Pancreato-Biliary Surgery, Hospital del Mar, Universitat Pompeu Fabra, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato Pancreato Biliary Division, Department of Hepato-Pancreato-Biliary Surgery, Hospital del Mar, Universitat Pompeu Fabra, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Marc Perez-Xaus
- Hepato Pancreato Biliary Division, Department of Hepato-Pancreato-Biliary Surgery, Hospital del Mar, Universitat Pompeu Fabra, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Amalia Pelegrina
- Hepato Pancreato Biliary Division, Department of Hepato-Pancreato-Biliary Surgery, Hospital del Mar, Universitat Pompeu Fabra, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Ye Xin Koh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Marcello Di Martino
- Hepatobiliary Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Brian K P Goh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ek Khoon Tan
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Jin Yao Teo
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Fabrizio Romano
- Department of Surgery, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Simone Famularo
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Guido Griseri
- HPB Surgical Unit, San Paolo Hospital, Savona, Italy
| | - Tullio Piardi
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Daniele Sommacale
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Luca Gianotti
- School of Medicine and Surgery, Milano-Bicocca University and HPB Unit, IRCCS San Gerardo Hospital, Monza, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Benedetto Ielpo
- Hepato Pancreato Biliary Division, Department of Hepato-Pancreato-Biliary Surgery, Hospital del Mar, Universitat Pompeu Fabra, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain.
| |
Collapse
|
7
|
Steinhoff H, Acs M, Blaj S, Dank M, Herold M, Herold Z, Herzberg J, Sanchez-Velazquez P, Strate T, Szasz AM, Piso P. Prolonged hyperthermic intraperitoneal chemotherapy duration with 90 minutes cisplatin might increase overall survival in gastric cancer patients with peritoneal metastases. World J Gastroenterol 2023; 29:2850-2863. [PMID: 37274066 PMCID: PMC10237111 DOI: 10.3748/wjg.v29.i18.2850] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Advanced gastric cancer with synchronous peritoneal metastases (GC-PM) is associated with a poor prognosis. Although cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a promising approach, only a limited number of Western studies exist.
AIM To investigate the clinicopathological outcomes of patients who underwent CRS-HIPEC for GC-PM.
METHODS A retrospective analysis of patients with GC-PM was conducted. All patients were seen at the Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany between January 2011 and July 2021 and underwent CRS-HIPEC. Preoperative laboratory results, the use of neoadjuvant trastuzumab, and the details of CRS-HIPEC, including peritoneal carcinomatosis index, completeness of cytoreduction, and surgical procedures were recorded. Disease-specific (DSS), and overall survival (OS) of patients were calculated.
RESULTS A total of 73 patients were included in the study. Patients treated with neoadjuvant trastuzumab (n = 5) showed longer DSS (P = 0.0482). Higher white blood cell counts (DSS: P = 0.0433) and carcinoembryonic antigen levels (OS and DSS: P < 0.01), and lower hemoglobin (OS and DSS: P < 0.05) and serum total protein (OS: P = 0.0368) levels were associated with shorter survival. Longer HIPEC duration was associated with more advantageous median survival times [60-min (n = 59): 12.86 mo; 90-min (n = 14): 27.30 mo], but without statistical difference. To obtain additional data from this observation, further separation of the study population was performed. First, propensity score-matched patient pairs (n = 14 in each group) were created. Statistically different DSS was found between patient pairs (hazard ratio = 0.2843; 95% confidence interval: 0.1119-0.7222; P = 0.0082). Second, those patients who were treated with trastuzumab and/or had human epidermal growth factor receptor 2 positivity (median survival: 12.68 mo vs 24.02 mo), or had to undergo the procedure before 2016 (median survival: 12.68 mo vs 27.30 mo; P = 0.0493) were removed from the original study population.
CONCLUSION Based on our experience, CRS-HIPEC is a safe and secure method to improve the survival of advanced GC-PM patients. Prolonged HIPEC duration may serve as a good therapy for these patients.
Collapse
Affiliation(s)
- Heinrich Steinhoff
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg 93049, Germany
| | - Miklos Acs
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg 93049, Germany
| | - Sebastian Blaj
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg 93049, Germany
| | - Magdolna Dank
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
| | - Magdolna Herold
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
| | - Jonas Herzberg
- Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek 21465, Germany
| | | | - Tim Strate
- Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek 21465, Germany
| | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg 93049, Germany
| |
Collapse
|
8
|
Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. Superior Mesenteric Artery First Approach for Minimally Invasive Pancreaticoduodenectomy: A Step-By-Step Surgical Technique Video. Ann Surg Oncol 2023; 30:1500-1503. [PMID: 36335270 DOI: 10.1245/s10434-022-12743-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the past decade, minimally invasive pancreaticoduodenectomy has been gaining interest. However, minimally invasive pancreaticoduodenectomy remains technically challenging and is associated with a steep learning curve. Additionally, the operating surgeon should be cognizant of replicating the same oncological steps as observed in the typical open approach. In view of this, there exist various maneuvers that are designed to achieve negative margins and a safer mesopancreatic dissection. One of these techniques is the superior mesenteric artery first approach, which is garnering interest among pancreatic surgeons. MATERIAL AND METHODS According to existing literature, there are several superior mesenteric artery dissections approaches. We describes 5 different minimally invasive approaches. RESULTS This multimedia manuscript provide, for the first time in literature, a comprehensive step-by-step overview of the superior mesenteric artery first approach for minimally invasive pancreaticoduodenectomy by a team of expert surgeons from various international institutions. CONCLUSIONS Through the tips and indications presented in this article, we aim to guide the choice of this approach according to tumor location, type of minimally invasive approach and the operating surgeon's experience and increase familiarity with such a complex procedure.
Collapse
Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Rosso
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| |
Collapse
|
9
|
Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. ASO Author Reflections: Superior Mesenteric Artery Dissection for Minimally Invasive Pancreaticoduodenectomy: A Technique That All Surgeons Should be Familiar With. Ann Surg Oncol 2023; 30:1504-1505. [PMID: 36402897 DOI: 10.1245/s10434-022-12820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- Department of Surgery, HPB and Transplant Surgery Unit, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| |
Collapse
|
10
|
Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. ASO Visual Abstract: Superior Mesenteric Artery-First Approach for Minimally-Invasive Pancreaticoduodenectomy: A Step-by-Step Surgical Technique Video. Ann Surg Oncol 2023; 30:1506-1507. [PMID: 36550328 DOI: 10.1245/s10434-022-12851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| |
Collapse
|
11
|
Ielpo B, Podda M, Burdio F, Sanchez-Velazquez P, Guerrero MA, Nuñez J, Toledano M, Morales-Conde S, Mayol J, Lopez-Cano M, Espín-Basany E, Pellino G. Cost-Effectiveness of Robotic vs. Laparoscopic Surgery for Different Surgical Procedures: Protocol for a Prospective, Multicentric Study (ROBOCOSTES). Front Surg 2022; 9:866041. [PMID: 36227017 PMCID: PMC9549953 DOI: 10.3389/fsurg.2022.866041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery. Methods The Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure). Discussion The results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.
Collapse
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
- *Correspondence: Benedetto Ielpo
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Maria-Alejandra Guerrero
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Miguel Toledano
- General Surgery Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | | |
Collapse
|
12
|
Ielpo B, Burdio F, Martinez A, Sanchez-Velazquez P. Pancreatectomy with concomitant portal vein resection in the current neoadjuvant era. Hepatobiliary Surg Nutr 2022; 11:295-298. [PMID: 35464289 PMCID: PMC9023828 DOI: 10.21037/hbsn-21-547] [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: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 08/30/2023]
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Martinez
- Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
13
|
Tschuor C, Ferrarese A, Kuemmerli C, Dutkowski P, Burra P, Clavien PA, Imventarza O, Crawford M, Andraus W, D'Albuquerque LAC, Hernandez-Alejandro R, Dokus MK, Tomiyama K, Zheng S, Echeverri GJ, Taimr P, Fronek J, de Rosner-van Rosmalen M, Vogelaar S, Lesurtel M, Mabrut JY, Nagral S, Kakaei F, Malek-Hosseini SA, Egawa H, Contreras A, Czerwinski J, Danek T, Pinto-Marques H, Gautier SV, Monakhov A, Melum E, Ericzon BG, Kang KJ, Kim MS, Sanchez-Velazquez P, Oberkofler CE, Müllhaupt B, Linecker M, Eshmuminov D, Grochola LF, Song Z, Kambakamba P, Chen CL, Haberal M, Yilmaz S, Rowe IA, Kron P. Allocation of liver grafts worldwide - Is there a best system? J Hepatol 2019; 71:707-718. [PMID: 31199941 DOI: 10.1016/j.jhep.2019.05.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 01/11/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. METHODS Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. RESULTS Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. CONCLUSION The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. LAY SUMMARY An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
Collapse
Affiliation(s)
- Christoph Tschuor
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Alberto Ferrarese
- Multivisceral Transplant Unit - Gastroenterology, Padua University Hospital, Padua, Italy
| | - Christoph Kuemmerli
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Philipp Dutkowski
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Patrizia Burra
- Multivisceral Transplant Unit - Gastroenterology, Padua University Hospital, Padua, Italy.
| | - Pierre-Alain Clavien
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|