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Besa A, Domínguez-Garijo P, Curell A, Farguell J, Ibarzábal A, Morales X, Momblan D, Turrado V. Wilkie's syndrome as a rare upper intestinal obstruction cause. Surg Open Sci 2023; 16:155-156. [PMID: 38026828 PMCID: PMC10656207 DOI: 10.1016/j.sopen.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Anaïs Besa
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Paula Domínguez-Garijo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Anna Curell
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Farguell
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Ainitze Ibarzábal
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Xavier Morales
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Dulce Momblan
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Victor Turrado
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
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Momblan D, Gimeno Garcia AZ, Busquets D, Juzgado D, García Lledó J, Ferrero E, Tejedor-Tejada J, Junquera F, Díaz-Tasende J, Moris M, Rodriguez de Santiago E, Gornals J, Garrido C, Gonzalez-Vazquez S, Guarner-Argente C, Repiso A, Esteban JM, Loras C, Seoane A, Fernández-Simon A, Guevara HC, Ibarzabal A, Morales X, Curell A, Cardenas A, Ríos J, de Lacy AM, Sendino O. Endoscopic Vacuum Therapy for Upper Gastrointestinal Leaks and Perforations: Analysis From a Multicenter Spanish Registry. Am J Gastroenterol 2023; 118:1797-1806. [PMID: 37606066 DOI: 10.14309/ajg.0000000000002475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. METHODS This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. RESULTS We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. DISCUSSION EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.
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Affiliation(s)
- Dulce Momblan
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio Z Gimeno Garcia
- Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - David Busquets
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Diego Juzgado
- Department of Gastroenterology, Hospital Quirón Madrid, Madrid, Spain
| | - Javier García Lledó
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Esther Ferrero
- Department of General and Digestive Surgery, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | | | - Félix Junquera
- Department of Gastroenterology, Hospital de Sabadell, Institut d´Investigació i Innovació Parc Taulí I3PT, CIBERehd, Sabadell, Spain
| | - José Díaz-Tasende
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Moris
- Department of Gastroenterology and Hepatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Enrique Rodriguez de Santiago
- Department of Gastroenterology and Hepatology, IRYCIS, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Joan Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carmen Garrido
- Endoscopy Unit, Department of Gastroenterology, Son Espases University Hospital, Illes Balears, Spain
| | | | | | - Alejandro Repiso
- Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain
| | - Jose Miguel Esteban
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Agustín Seoane
- Department of Gastroenterology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Henry Cordova Guevara
- Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ainitze Ibarzabal
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Morales
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Curell
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrés Cardenas
- Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain
| | - José Ríos
- Department of Clinical Farmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Maria de Lacy
- Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain
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Dal Cero M, Román M, Grande L, Yarnoz C, Estremiana F, Gantxegi A, Codony C, Gobbini Y, Garsot E, Momblan D, González-Duaigües M, Luna A, Pérez N, Aldeano A, Fernández S, Olona C, Hermoso J, Pulido L, Sánchez-Cano JJ, Güell M, Salazar D, Gimeno M, Pera M. Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis. Eur J Surg Oncol 2021; 48:768-775. [PMID: 34753620 DOI: 10.1016/j.ejso.2021.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. METHOD All patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. RESULTS In total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, "macroscopically complete resection" had the highest compliance (96.5%) while "no serious complications" had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). CONCLUSION TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.
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Affiliation(s)
- Mariagiulia Dal Cero
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Yarnoz
- Department of Surgery, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Estremiana
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Amaia Gantxegi
- Department of Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Codony
- Department of Surgery, Hospital Universitari Josep Trueta, Girona, Spain
| | - Yanina Gobbini
- Department of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Elisenda Garsot
- Department of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Dulce Momblan
- Department of Surgery, Hospital Clinic, Barcelona, Spain
| | | | - Alexis Luna
- Department of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Noelia Pérez
- Department of Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Aurora Aldeano
- Department of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain
| | | | - Carles Olona
- Department of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain
| | - Judit Hermoso
- Department of Surgery, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - Laura Pulido
- Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | | | - Mercè Güell
- Department of Surgery, Althaia Xarxa Assistencial i Universitária de Manresa, Manresa, Spain
| | - David Salazar
- Department of Surgery, Hospital Universitari de Igualada, Igualada, Barcelona, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Saez de Gordoa K, Guerrero J, Bishop R, Archilla I, Rodrigo M, Sendino O, Momblan D, Sauri T, Jares P, Cuatrecasas M. Submucosal gland adenocarcinoma of the esophagus. A rare non-Barrett's associated tumor. Gastroenterol Hepatol 2020; 44:367-369. [PMID: 33187748 DOI: 10.1016/j.gastrohep.2020.08.009] [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] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Karmele Saez de Gordoa
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Jose Guerrero
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Rosanna Bishop
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Ivan Archilla
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Maite Rodrigo
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Oriol Sendino
- Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Dulce Momblan
- Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Tamara Sauri
- Oncology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
| | - Pedro Jares
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Barreto T, Muñoz-Guglielmetti D, Vázquez M, Momblan D, Mollà M, Conill C, Sauri T. P-289 Role of the neoadjuvant chemoradiotherapy in esophageal cancer: Our center's experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sendino O, Jung G, Momblan D, de Lacy AM. Resolution of a large infradiaphragmatic leak with endoscopic vacuum therapy after total gastrectomy. Endoscopy 2019; 51:E376-E377. [PMID: 31272116 DOI: 10.1055/a-0929-5508] [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] [Indexed: 12/10/2022]
Affiliation(s)
- Oriol Sendino
- Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gerhard Jung
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Dulce Momblan
- Department of Gastrointestinal Surgery, ICMDM, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Antonio Maria de Lacy
- Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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7
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Diaz-Mercedes S, Archilla I, Camps J, de Lacy A, Gorostiaga I, Momblan D, Ibarzabal A, Maurel J, Chic N, Bombí JA, Balaguer F, Castells A, Aldecoa I, Borras JM, Cuatrecasas M. Budget Impact Analysis of Molecular Lymph Node Staging Versus Conventional Histopathology Staging in Colorectal Carcinoma. Appl Health Econ Health Policy 2019; 17:655-667. [PMID: 31115896 PMCID: PMC6748889 DOI: 10.1007/s40258-019-00482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND The presence of lymph node (LN) metastasis is a critical prognostic factor in colorectal cancer (CRC) patients and is also an indicator for adjuvant chemotherapy. The gold standard (GS) technique for LN diagnosis and staging is based on the analysis of haematoxylin and eosin (H&E)-stained slides, but its sensitivity is low. As a result, patients may not be properly diagnosed and some may have local recurrence or distant metastases after curative-intent surgery. Many of these diagnostic and treatment problems could be avoided if the one-step nucleic acid amplification assay (OSNA) was used rather than the GS technique. OSNA is a fast, automated, standardised, highly sensitive, quantitative technique for detecting LN metastases. OBJECTIVES The aim of this study was to assess the budget impact of introducing OSNA LN analysis in early-stage CRC patients in the Spanish National Health System (NHS). METHODS A budget impact analysis comparing two scenarios (GS vs. OSNA) was developed within the Spanish NHS framework over a 3-year time frame (2017-2019). The patient population consisted of newly diagnosed CRC patients undergoing surgical treatment, and the following costs were included: initial surgery, pathological diagnosis, staging, follow-up expenses, systemic treatment and surgery after recurrence. One- and two-way sensitivity analyses were performed. RESULTS Using OSNA instead of the GS would have saved €1,509,182, €6,854,501 and €10,814,082 during the first, second and third years of the analysis, respectively, because patients incur additional costs in later years, leading to savings of more than €19 million for the NHS over the 3-year time horizon. CONCLUSIONS Introducing OSNA in CRC LN analysis may represent not only an economic benefit for the NHS but also a clinical benefit for CRC patients since a more accurate staging could be performed, thus avoiding unnecessary treatments.
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Affiliation(s)
- Sherley Diaz-Mercedes
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ivan Archilla
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Camps
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | | | - Iñigo Gorostiaga
- Pathology Department, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Dulce Momblan
- Surgical Department, Hospital Clinic, Barcelona, Spain
| | | | - Joan Maurel
- Medical Oncology Department, Hospital Clinic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Chic
- Medical Oncology Department, Hospital Clinic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Antoni Bombí
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Neurological Tissue Bank of the Biobank Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Josep Maria Borras
- Department of Clinical Sciences and Bellvitge Biomedical Research Institute (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Pathology Department, Araba University Hospital, Vitoria-Gasteiz, Spain.
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain.
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8
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Osorio J, Jericó C, Miranda C, Garsot E, Luna A, Miró M, Santamaría M, Artigau E, Rodríguez-Santiago J, Castro S, Feliu J, Aldeano A, Olona C, Momblan D, Ruiz D, Galofré G, Pros I, García-Albéniz X, Lozano M, Pera M. Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico. Cir Esp 2018; 96:546-554. [DOI: 10.1016/j.ciresp.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022]
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Navarrete A, Momblan D, Fernandez-Esparrach G, Delgado S, Jimenez M, Hessheimer A, Lacy AM. Endoscopic full-thickness resection of esophagogastric junction gastrointestinal stromal tumor assisted by laparoscopy after neoadjuvant therapy. Endoscopy 2017; 48 Suppl 1:E112-4. [PMID: 27008559 DOI: 10.1055/s-0042-104191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Andrés Navarrete
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Dulce Momblan
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
| | | | - Salvadora Delgado
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Marta Jimenez
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Amelia Hessheimer
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Antonio M Lacy
- Gastrointestinal Surgery Department, Hospital Clinic, Barcelona, Spain
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10
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Arroyave Isaza M, Momblan D, Bravo Infante R, Fernandez-Hevia M, Jimenez Toscano M, Rafael Gerardo D, Lacy A. 615. Initial experience in robot assisted minimally invasive esophagectomy (ramie). Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Aldecoa I, Montironi C, Planell N, Pellise M, Fernandez-Esparrach G, Gines A, Delgado S, Momblan D, Moreira L, Lopez-Ceron M, Rakislova N, Martinez-Palli G, Balust J, Bombi JA, de Lacy A, Castells A, Balaguer F, Cuatrecasas M. Endoscopic tattooing of early colon carcinoma enhances detection of lymph nodes most prone to harbor tumor burden. Surg Endosc 2016; 31:723-733. [PMID: 27324339 PMCID: PMC5266760 DOI: 10.1007/s00464-016-5026-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/14/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
Background Colorectal cancer (CRC) screening programs result in the detection of early-stage asymptomatic carcinomas suitable to be surgically cured. Lymph nodes (LN) from early CRC are usually small and may be difficult to collect. Still, at least 12 LNs should be analyzed from colectomies, to ensure a reliable pN0 stage. Presurgical endoscopic tattooing improves LN procurement. In addition, molecular detection of occult LN tumor burden in histologically pN0 CRC patients is associated with a decreased survival rate. We aimed to study the impact of presurgical endoscopic tattooing on the molecular detection of LN tumor burden in early colon neoplasms. Methods A prospective cohort study from a CRC screening-based population was performed at a tertiary academic hospital. LNs from colectomies with and without preoperative endoscopic tattooing were assessed by two methods, hematoxylin and eosin (HE), and RT-LAMP, to detect tumor cytokeratin 19 (CK19) mRNA. We compared the amount of tumor burden and LN yields from tattooed and non-tattooed specimens. Results HE and RT-LAMP analyses of 936 LNs were performed from 71 colectomies containing early carcinomas and endoscopically unresectable adenomas (8 pT0, 17 pTis, 27 pT1, 19 pT2); 47 out of 71 (66.2 %) were tattooed. Molecular positivity correlated with the presence of tattoo in LN [p < 0.001; OR 3.1 (95 % CI 1.7–5.5)]. A significantly higher number of LNs were obtained in tattooed specimens (median 17 LN vs. 14.5 LN; p = 0.019). Conclusions Endoscopic tattooing enables the analysis of those LNs most prone to harbor tumor cells and improves the number of LN harvested. Electronic supplementary material The online version of this article (doi:10.1007/s00464-016-5026-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iban Aldecoa
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | - Carla Montironi
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Maria Pellise
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Gloria Fernandez-Esparrach
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Angels Gines
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Dulce Momblan
- Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Lopez-Ceron
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Natalia Rakislova
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Jaume Balust
- Anestesiology Department, ICMDiM, Hospital Clinic-IDIPAPS, Barcelona, Spain
| | - Josep Antoni Bombi
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
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12
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Vieira E, G. Ruano E, C. Figueroa AL, Aranda G, Momblan D, Carmona F, Gomis R, Vidal J, Hanzu FA. Altered clock gene expression in obese visceral adipose tissue is associated with metabolic syndrome. PLoS One 2014; 9:e111678. [PMID: 25365257 PMCID: PMC4218799 DOI: 10.1371/journal.pone.0111678] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/29/2014] [Indexed: 12/21/2022] Open
Abstract
Clock gene expression was associated with different components of metabolic syndrome (MS) in human adipose tissue. However, no study has been done to compare the expression of clock genes in visceral adipose tissue (VAT) from lean and obese subjects and its clinical implications. Therefore, we studied in lean and obese women the endogenous 24 h expression of clock genes in isolated adipocytes and its association with MS components. VAT was obtained from lean (BMI 21-25 kg/m2; n = 21) and morbidly obese women (BMI >40 kg/m2; n = 28). The 24 h pattern of clock genes was analyzed every 6 hours using RT-PCR. Correlation of clinical data was studied by Spearman analysis. The 24 h pattern of clock genes showed that obesity alters the expression of CLOCK, BMAL1, PER1, CRY2 and REV-ERB ALPHA in adipocytes with changes found in CRY2 and REV-ERB ALPHA throughout the 24 h period. The same results were confirmed in VAT and stromal cells (SC) showing an upregulation of CRY2 and REV-ERB ALPHA from obese women. A positive correlation was observed for REV-ERB ALPHA gene expression with BMI and waist circumference in the obese population. Expression of ROR ALPHA was correlated with HDL levels and CLOCK with LDL. Obese subjects with MS exhibited positive correlation in the PER2 gene with LDL cholesterol, whereas REV-ERB ALPHA was correlated with waist circumference. We identified CRY2 and REV-ERB ALPHA as the clock genes upregulated in obesity during the 24 h period and that REV-ERB ALPHA is an important gene associated with MS.
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Affiliation(s)
- Elaine Vieira
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Diabetes and Obesity Research Laboratory, IDIBAPS, Barcelona, Spain
- * E-mail:
| | - Elena G. Ruano
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Diabetes and Obesity Research Laboratory, IDIBAPS, Barcelona, Spain
| | | | - Gloria Aranda
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain
| | - Dulce Momblan
- Department of Gastrointestinal Surgery, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Carmona
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ramon Gomis
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Diabetes and Obesity Research Laboratory, IDIBAPS, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Vidal
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Diabetes and Obesity Research Laboratory, IDIBAPS, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Felicia A. Hanzu
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Diabetes and Obesity Research Laboratory, IDIBAPS, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain
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Saavedra-Perez D, Delgado S, Almenara R, Ibarzabal A, Pavel M, Momblan D, Morales X, Bravo R, Corcelles R, Lacy A. 287. Laparoscopic-assisted rectal cancer resection: Long-term outcomes in a 14-year cohort from a single center. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Corcelles R, Vidal J, Delgado S, Ibarzabal A, Bravo R, Momblan D, Espert J, Morales X, Almenara R, Lacy AM. [Effects of gastric bypass on estimated cardiovascular risk in morbidly obese patients with metabolic syndrome]. Cir Esp 2013; 92:16-22. [PMID: 24157415 DOI: 10.1016/j.ciresp.2013.05.014] [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: 02/08/2013] [Revised: 05/11/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery. MATERIAL AND METHODS We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10 year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages. RESULTS We reported an overall 4.1±3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2±1,6 (P<.001). In patients with metabolic syndrome according to ATP-III criteria, basal REGICOR score was 4.8±3.1 whereas in no metabolic syndrome patients 2.2±1.8. Evaluation 12 months after surgery, determined a significant reduction in both groups (metabolic syndrome and non metabolic syndrome) with a mean REGICOR score of 2.3±1.6 and 1.6±1.0 respectively. CONCLUSION The results of our study demonstrate favorable effects of gastric bypass on the cardiovascular risk factors included in the REGICOR equation.
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Affiliation(s)
- Ricard Corcelles
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España.
| | - Josep Vidal
- Servicio de Endocrinología, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Salvadora Delgado
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Ainitze Ibarzabal
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Raquel Bravo
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Dulce Momblan
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Juanjo Espert
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Xavi Morales
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Raúl Almenara
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Antonio M Lacy
- Servicio de Cirugía Gastrointestinal, Unidad Funcional de la Obesidad, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
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Pera M, Gallego R, Montagut C, Martín-Richard M, Iglesias M, Conill C, Reig A, Balagué C, Pétriz L, Momblan D, Bellmunt J, Maurel J. Phase II trial of preoperative chemoradiotherapy with oxaliplatin, cisplatin, and 5-FU in locally advanced esophageal and gastric cancer. Ann Oncol 2012; 23:664-670. [PMID: 21652581 DOI: 10.1093/annonc/mdr291] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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: 10/06/2023] Open
Abstract
BACKGROUND Based on a phase I study showing the feasibility of combining of oxaliplatin, cisplatin, and 5-fluorouracil (5-FU) (OCF) with radiation therapy (RT) in esophageal cancer, the efficacy of this regimen in esophageal, gastroesophageal (GE), and gastric (G) cancer was assessed in this phase II multicenter study. PATIENTS AND METHODS Patients with resectable tumors were eligible. Treatment included two cycles of oxaliplatin 85 mg/m(2), cisplatin 55 mg/m(2), and continuously infused 5-FU 3 g/m(2) in 96 h and concurrent RT (45 Gy), followed by surgery after 6-8 weeks. Primary end point was complete pathologic response (pCR). RESULTS Forty-one patients were enrolled. Tumor location was esophagus 39% (squamous 10/adenocarcinoma 6), GE junction 32%, and stomach 29%. G3-G4 adverse events included asthenia (27%) and neutropenia (14%). One toxic death occurred. Thirty-one patients (75.6%) underwent surgery (R0 in 94%). Pathologic response was achieved in 58% of patients, with pCR in 50% and 16% of esophageal and GE/G cancer, respectively. pCR was achieved in 67% of squamous cell carcinoma. Survival: median follow-up, 50.4 months; median progression-free survival and overall survival were 23.2 and 28.4 months, respectively. CONCLUSION Preoperative OCF plus RT showed an acceptable toxicity and promising activity especially in squamous cell esophageal cancer.
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Affiliation(s)
- M Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Universitat Autónoma de Barcelona, Barcelona.
| | - R Gallego
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
| | - C Montagut
- Service of Medical Oncology, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | | | | | - C Conill
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
| | - A Reig
- Services of Radiotherapy, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | | | - L Pétriz
- Services of Radiation Therapy, Hospital de Sant Pau, Barcelona
| | - D Momblan
- Service of Gastrointestinal Surgery, Hospital Clinic, Barcelona, Spain
| | - J Bellmunt
- Service of Medical Oncology, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | - J Maurel
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
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Gallego R, Fuster D, Ginés A, Ortín J, Ayuso JR, Momblan D, Arguis P, Conill C, Pons F, Maurel J. Usefulness of PET/CT in the diagnosis of distant metastases of potentially operable gastric adenocarcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15598 Background: 1) To evaluate the usefulness of Positron Emission Tomography with combined 18F-Fluorodeoxyglucose with Computed Tomography (PET/CT) in the diagnosis of distant metastases in patients with gastric adenocarcinoma (GAC) compared to spiral double contrast thoracoabdominal Computed Tomography (CT); 2) To establish the utility of PET/CT in the detection of peritoneal carcinomatosis compared to laparoscopy. Methods: Thirty prospective patients (22 men, 8 women; mean age 67±11) who underwent endoscopic ultrasound and were classified as T2–3N1 or T3Nx GAC were included in this study. Whole body images were obtained 1 hour after injection of 370 MBq of 18F-Fluorodeoxyglucose. CT was performed within 2 weeks of PET/CT. Laparoscopy was performed without remarkable incidences. All findings were confirmed by histopathology examination and/or by at least 6 months follow- up. Results: Distant metastases were found in 9/30 cases: carcinomatosis (3), retroperitoneal (3) or mediastinal (2) pathological lymph nodes and one case of bone metastases (1). PET/CT diagnosed unsuspected distant metastases by CT in 4/9 patients (retroperitoneal (1) or mediastinal (2) pathological lymph nodes and 1 case of bone metastasis in the spine). In 1/3 patients with histopathological confirmed diagnosis of peritoneal carcinomatosis by laparoscopic findings was negative by PET/CT, and considered as a false negative case. On the other hand, 3 patients with initially positive peritoneal carcinomatosis by invasive laparoscopy were finally diagnosed as benign lesions. These lesions did not show significant uptake in PET/CT and were considered as true negative cases. Conclusions: 1) PET/CT is useful in the diagnosis of distant metastases in patients with GAC 2) Further studies are needed to establish the role of PET/CT to detect peritoneal carcinomatosis. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Ginés
- Hospital Clínic, Barcelona, Spain
| | - J. Ortín
- Hospital Clínic, Barcelona, Spain
| | | | | | | | | | - F. Pons
- Hospital Clínic, Barcelona, Spain
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Pera M, Gallego R, Martin-Richard M, Montagut C, Iglesias M, Conill C, Balaguer C, Petriz L, Momblan D, Maurel J. Phase II study with preoperative oxaliplatin (O), cisplatin (P), 5-fluorouracil (F) (OPF) and radiation (XRT) in patients with esophageal (ES), gastroesophageal (GE), and gastric (G) cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15612 Background: A phase I study showed the feasibility of the triplet combination (OPF) with XRT in ES and GE cancer (Maurel et al, IJRBOP, 2005). We conducted a phase II study to evaluate the efficacy of the regimen. Methods: Enrolled pts had resectable, high-risk (HR) based on endoscopic ultrasonography (EUS) (uT3, uN1 or uT4 if deemed resectable) ES, GE and G cancer. The primary objective was to determine the pathologic complete response (pCR). If 2 or more pCR were reported in the first 18 pts treated, enrollment continues with 23 additional pts. Eligibility criteria: squamous cell or adenocarcinoma of the ES, GE or G cancer and ECOG Performance status (PS) 0–1. Staging was done with EUS and computed spiral tomography. Laparoscopic staging was mandatory for pts with ES, GE and G adenocarcinoma. Pts received 2 cycles of O 85 mg/m2, P 55 mg/m2, F (3 g/m2 in 96h CI) q4w, with concomitant 45 Gy XRT in 25 fractions; surgery was planned 5–8 weeks after XRT. All pathological specimens were reviewed by a unique pathologist and regression analysis was recorded using Cologne (C) and M.D.Anderson (MDA) classification for ES and European Journal of Surgical Oncology (EJSO) for GE and G. Results: Between 5/04 to 12/07, 41 pts were enrolled in 5 Spanish Institutions. Median age 62 yrs (39–75 yrs); Male/female 83%/17%; PS 0/1 27%/73%; ES/GE/G 39%/32%/29%; EUS stageT3N0 (20%), T2–3N1 (65%) and T4 (10%). G3/4 adverse events included asthenia (27%), infection (7%), diarrhea (7%) and stomatitis (5%). There were 2 toxic deaths. Of the 31 pts who underwent surgery, there were R0=94%/R1=3%/R2= 3%. 7/41 pts (17%) achieved pCR. Using C and MDA classification, 9/14 (61%) and 12/14 (85%) ES achieved grade IV/III and P0/P1 regression, respectively. With EJSO classification 3/17 (18%) GE and G tumors achieved pCR. Median time to progression or death (PFS) was 16.2 (CI:12.2-NR) months (mo). Median overall survival (OS) was 28.9 mo. (CI: 22.5-NR). Conclusions: Although in the whole group pCR, PFS and OS does not appear superior to results achieved in other trials with preoperative P/F/XRT in HR pts, the OPF regimen seems specially active in ES cancer. No significant financial relationships to disclose.
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Affiliation(s)
- M. Pera
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - R. Gallego
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - M. Martin-Richard
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Montagut
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - M. Iglesias
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Conill
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Balaguer
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - L. Petriz
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - D. Momblan
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - J. Maurel
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
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Vidal J, Nicolau J, Romero F, Casamitjana R, Momblan D, Conget I, Morínigo R, Lacy AM. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glucagon-like peptide-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab 2009; 94:884-91. [PMID: 19106269 DOI: 10.1210/jc.2008-1620] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT An enlarged incretin response after Roux-en-Y gastric bypass (RYGBP) has been proposed to promote excessive beta-cell function and mass. OBJECTIVE The objective of the study was to determine whether RYGBP is associated with a steadily increased glucagon-like peptide 1 (GLP-1) response and a disruption of the relationship between insulin sensitivity and insulin secretion required to maintain plasma glucose in the normal range. DESIGN AND PATIENTS This was a cross-sectional study. Twenty-four women divided into three groups according to time after RYGBP (9-15, 21-30, and more than 36 months). Eight normal-weight and eight morbidly obese women served as controls. MAIN OUTCOME MEASURES GLP-1 was determined after a standardized test meal. Insulin secretion (AIRg) and insulin sensitivity (S(I)) were derived from an iv glucose tolerance test. Postprandial glucose profile was recorded with a continuous glucose monitoring system. RESULTS Area under the curve(0-120) of GLP-1 was larger after RYGBP compared with controls (P < 0.01) but was comparable among surgical groups (P =0.314). Time after surgery was not associated with changes in S(I) (P = 0.657), AIRg (P = 0.329), or the disposition index (DI = AIRgS(I), P = 0.915). After surgery, the GLP-1 response and the DI were not significantly correlated (P = 0.304). Glucose less than 50 mg/dl was found in operated subjects, but the proportion did not increase with time after surgery (P = 0.459). Neither the GLP-1 response (P = 0.620) nor the DI (P = 0.457) differed significantly between those with or without hypoglycemic episodes. CONCLUSIONS Although the GLP-1 response to meal intake is steadily elevated after RYGBP, this does not result over time in the development of an inappropriate insulin secretion relative to the prevailing insulin sensitivity or the occurrence of hypoglycemic episodes.
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Affiliation(s)
- Josep Vidal
- Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona, Spain.
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Rull R, Vidal O, Momblan D, González FX, López-Boado MA, Fuster J, Grande L, Bruguera M, Cabrer K, García-Valdecasas JC. Evaluation of potential liver donors: limits imposed by donor variables in liver transplantation. Liver Transpl 2003; 9:389-93. [PMID: 12682892 DOI: 10.1053/jlts.2003.50050] [Citation(s) in RCA: 62] [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] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate the predictive value of different donor and recipient parameters that have been recognised previously as proven and to suggest prognostic factors for immediate liver function and final outcome after liver transplantation. We evaluated a total of 228 liver grafts transplanted in the last 3 years in our institution. Parameters were recorded for the donor (age, polytransfusion, atherosclerosis, presence of infection, episodes of hypoxia or hypotension, use of vasoactive drugs, intensive care unit stay, steatosis, and ischemia time) and recipient (red blood cell requirements, immediate liver function [score], incidence of hepatic artery thrombosis, survival, and cause of death or retransplantation). Liver biopsy after reperfusion of the donor liver was performed before closure of the abdomen. Donor age over 65 years and presence of steatosis were associated significantly with initial poor function. The mortality rate at 6 months was related to donor age over 65 years. When donor age over 65 years was combined with transfusion requirement of > 10 U of red blood cells (RBC), the incidence of graft loss increased to 53%. The probability of graft survival at two years decreased when donor age was over 65 years. Moreover, when donor age over 65 years was combined with requirement of > 10 units RBC the probability of 2-year survival was significantly reduced. This study shows, for the first time, that the use of donor livers from older donors in liver transplant procedures, requiring more than 10 U of RBC, results in a significantly worse prognosis in terms of immediate liver function and long-term survival.
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Affiliation(s)
- Ramón Rull
- Liver Transplantation Unit, Hospital Clinic i Provincial de Barcelona, Spain
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Rull R, García-Valdecasas JC, Momblan D, Grande L, Vidal O, Fuster J, González FX, López-Boado MA, Cabrer K, Visa J. Evaluation of potential liver donors: expanding donor criteria? Transplant Proc 2002; 34:229-30. [PMID: 11959258 DOI: 10.1016/s0041-1345(01)02736-1] [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: 10/18/2022]
Affiliation(s)
- R Rull
- Liver Transplant Unit, Hospital Clinic, I Provincial de Barcelona, Barcelona, Spain
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Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, Momblan D, Visa J. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 2000; 14:22-6. [PMID: 10653230 DOI: 10.1007/s004649900004] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of colorectal carcinoma increases in the elderly. Regardless of age as an isolated factor, postoperative complications represent the main factor in increasing hospital mortality. METHODS The aim of this study was to compare the short-term results (first 30 postoperative days) after laparoscopically assisted colectomy (LAC) and open segmental colectomy (OC) in colorectal carcinoma between two groups of patients, older than 70 and younger than 70 years of age. In the study from November 1993 to June 1998, 255 patients were evaluated to participate. RESULTS Peristalsis, oral intake, and discharge from the hospital occurred earlier in LAC than in OC treated patients, in the two age groups. The mean operative time was significantly longer in the LAC than in the OC patients in the two age groups. No differences were observed in morbidity between LAC and OC in the group younger than 70 years of age. However, the overall morbidity was significantly lower in the LAC group in patients older than 70 years. One patient in the LAC group older than 70 years died. CONCLUSION These results suggest that laparoscopically assisted colectomy may be particularly indicated in elderly patients.
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Affiliation(s)
- S Delgado
- Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Spain
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