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Sentí Farrarons S, Pardo Aranda F, Galofré Recasens M, Espin Álvarez F, Herrero Fonollosa E, García Domingo MI, Cremades Pérez M, Zárate Pinedo A, Camps Lassa J, Navinés López J, Cugat Andorra E. Venous resection in pancreatic oncologic surgery: Different techniques for different situations. Cir Esp 2023; 101:816-823. [PMID: 36706805 DOI: 10.1016/j.cireng.2023.01.001] [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: 02/23/2022] [Revised: 08/03/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION To report the clinical results of patients with malignant pancreatic lesions who underwent oncological surgery with vascular resection. The type of intervention performed, types of vascular reconstruction, the pathological anatomy results, postoperative morbidity and mortality, and survival at 3 and 5 years were analyzed. METHODS Retrospective, cross-sectional and comparative analysis. We include 41 patients with malignant pancreatic lesions who underwent surgery with vascular resection due to vascular involvement, from 2013 to 2021. RESULTS The most performed surgery was pancreaticoduodenectomy (Whipple procedure) using median laparotomy, in 35 out of the 41 patients (85%). One of the cases in the series was performed laparoscopically. Type 1 reconstruction (simple suture) was performed in 11 (27%) patients, type 2 in 4 (10%) cases, type 3 (end-to-end) in 23 (56%) cases, and type 4 reconstruction by autologous graft in 3 (7%) cases. The mean length of the resected venous segment was 21 (11-46) mm, and mean surgical time was 290 (220-360) minutes. 90% (37/41) were pancreatic adenocarcinoma. 83% were considered R0, and there was involvement in the resected vascular section in 41% of the cases. Four patients had Clavien Dindo morbidity >3, and there were no cases of postoperative mortality. Survival at 3 years was 48% and at 5 years 20%. CONCLUSIONS The aggressive surgical treatment with venous resection in pancreatic malignant lesions to ensure R0 and its vascular reconstruction is a feasible technique, with an acceptable morbid-mortality rate and overall survival.
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Affiliation(s)
- Sara Sentí Farrarons
- Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Maria Galofré Recasens
- Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Francesc Espin Álvarez
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Eric Herrero Fonollosa
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Maria Isabel García Domingo
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Manel Cremades Pérez
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Judith Camps Lassa
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Jordi Navinés López
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorra
- Jefe Clínico de la Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Jefe Clínico de la Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Galipienzo J, Otta-Oshiro RJ, Salvatierra D, Medrano C, López-Rojo I, Linero M. Perioperative management of non-deferrable oncologic surgeries during COVID-19 pandemic in Madrid, Spain. Is it safe? Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00132-8. [PMID: 34565569 PMCID: PMC8062419 DOI: 10.1016/j.redar.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/01/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Surgical treatment during COVID-19 pandemic is controversial. Currently, most clinical guidelines advise to defer surgical patients during the COVID-19 pandemic, although the supporting data is sparse. We assumed that a COVID-19-free hospital, on the back of strong isolation measures and targeted screening, could reduce complications and enable us to continue treating high-risk patients. METHODS Prospective study with retrospective analysis of 355 patients who had undergone nondeferrable oncological surgery between March 16th, 2020, and April 14th, 2020, at our institution. The aim of the study was to assess the hospital restructuring and surgical protocols to be able to safely handle non-deferrable surgeries during the first wave of the COVID-19 pandemic. We implemented structural changes and an updated surgical-anesthetic protocol in order to isolate COVID-19 patients from other surgical patients. Comprehensive targeted screening for COVID-19 patients was made. PCR tests were requested for suspected COVID-19 patients. We analyzed mortality and complications related to both surgery and COVID-19 during hospital admission and also 15 and 30 days after surgery. We compared it with a sample of similar patients in the pre-pandemic period. RESULTS Of the 355 patients enrolled in our study, 21 were removed due to COVID-19 infection, leaving a total of 334 patients in our final analysis. Post-operative complications were found in 37 patients (11.07%). Two patients died after surgery (0.6%). At the end of the study, COVID-19-related adverse outcomes were detected in six patients (1.79%). When comparing the complications of our original sample with the complications that occurred in the pre-COVID era, we found no statistically significant differences. CONCLUSIONS Our results show that the surgical treatment of oncologic patients during the COVID-19 pandemic is safe, as long as the hospital performs surgeries under strict isolation measures and a robust screening method. It is necessary to select COVID-19 free hospitals for this matter in this and future pandemics.
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Affiliation(s)
- J Galipienzo
- Servicio de Anestesia, MD Anderson Cancer Center, Madrid, España.
| | - R J Otta-Oshiro
- Servicio de Urología, MD Anderson Cancer Center, Madrid, España
| | - D Salvatierra
- Servicio de Anestesia, MD Anderson Cancer Center, Madrid, España
| | - C Medrano
- Servicio de Anestesia, MD Anderson Cancer Center, Madrid, España
| | - I López-Rojo
- Servicio de Cirugía General, MD Anderson Cancer Center, Madrid, España
| | - M Linero
- Servicio de Anestesia, MD Anderson Cancer Center, Madrid, España
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Álvarez Peña E, Garcia-Botella A, Martín-Pérez E, Álvarez Gallego M, Martínez Cortijo S, Pascual Migueláñez I, Pérez Díaz L, Ramos Rodríquez JL, Espín-Basany E, Sánchez Santos R, Guirao Garriga X, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cir Esp 2021; 99:174-182. [PMID: 33341242 PMCID: PMC7744030 DOI: 10.1016/j.ciresp.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/30/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.
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Affiliation(s)
| | - Miguel Angel Gómez Bravo
- Cirugía general y del aparato digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Marcello Di Martino
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Mikel Gastaca
- Cirugía general y del aparato digestivo, Hospital Universitario Cruces, Bilbao, España
| | - Elena Martín-Pérez
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Santiago Sánchez Cabús
- Cirugía general y del aparato digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Santiago López Ben
- Cirugía general y del aparato digestivo, Hospital Dr. Josep Trueta, Girona, España
| | | | - Rafael López-Andújar
- Cirugía general y del aparato digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Manuel Barrera
- Cirugía general y del aparato digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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Gómez Tarradas JM, Pujol Fontrodona G, López-Baamonde M, Sánchez D, Jiménez MJ, Navarro-Ripoll R. Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy. ACTA ACUST UNITED AC 2020; 67:15-9. [PMID: 31353039 DOI: 10.1016/j.redar.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging. PATIENTS AND METHODS A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed. RESULTS Between May 2015 and October 2018 7patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5of the 7patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6of the 7patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed. CONCLUSIONS HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.
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Chávez M, Ziegler G, Cotrina J, Galarreta J, de la Cruz M, Mantilla R. Current situation of soft tissue sarcomas: Registry of a Latin American cancer institute. Cir Esp 2019; 97:203-212. [PMID: 30777256 DOI: 10.1016/j.ciresp.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/12/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (SFT) are a group of rare and heterogeneous neoplasms (representing less than 1% of cancer in adults and 15% in pediatric patients), for which there is no updated records in the Latin American population. This study aims to describe the current situation of patients treated at a cancer institute in Latin America. METHODS We obtained records from 250 patients with a diagnosis of SFT, treated at the National Institute of Neoplastic Diseases of Peru (INEN) during the period 2009-2013, with a mean follow-up of 62 months. The following data were recorded: epidemiological, clinical, treatment and follow-up. The analysis of global survival was done with the Cox proportional hazards model. RESULTS SFT showed a greater frequency in males (60.8%), with a peak incidence after 50 years of age (69.6%). Tumor location was predominantly in the lower extremities (64.4%), and the most frequent histologic subtypes were: undifferentiated pleomorphic sarcoma (34%) and liposarcomas (25.6%); clinical stage iii was the most frequent (30.8%). The 5-year overall survival rate was 63.9%, while the statistical analysis found a significant association between global survival and the variables: age (>50 years), tumor size (>5cm), depth (subfascial), histologic grade (G3), local and distant recurrence, showing shorter survival times in these groups. CONCLUSIONS This study has clarified the epidemiology, treatment and prognosis, as well as the variables that have an impact on the survival of the Latin American patients with SFT studied.
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Affiliation(s)
- Marcelo Chávez
- Departamento de mamas, piel y tumores de partes blandas, Hospital Nacional Guillermo Almenara Irigoyen (ES SALUD), Lima, Perú.
| | | | - José Cotrina
- Departamento de mamas, piel y tumores de partes blandas, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - José Galarreta
- Departamento de mamas, piel y tumores de partes blandas, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Miguel de la Cruz
- Departamento de mamas, piel y tumores de partes blandas, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Raúl Mantilla
- Departamento de mamas, piel y tumores de partes blandas, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
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Díaz-Cambronero O, Matoses-Jaén S, García-Claudio N, García-Gregorio N, Molins-Espinosa J. [Preoperative management of anemia in oncologic surgery]. ACTA ACUST UNITED AC 2015; 62 Suppl 1:45-51. [PMID: 26320344 DOI: 10.1016/s0034-9356(15)30007-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 12/17/2022]
Abstract
Preoperative anemia in patients with cancer is highly prevalent, is associated with increased perioperative morbidity and is a risk factor for transfusion. There is evidence that patients who undergo transfusions have higher morbidity, increased cancer recurrence and poorer survival. The pathophysiology of anemia is multifactorial, with an inflammatory component to which chronic blood loss and nutritional deficiencies can be associated. Therefore, preoperative anemia in patients with cancer should be treated appropriately, given that there is sufficient time in the preoperative period. Of the currently available options, parenteral iron is an effective alternative, especially for those types of cancer that have an associated hemorrhagic component.
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Affiliation(s)
- O Díaz-Cambronero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - S Matoses-Jaén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - N García-Claudio
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - N García-Gregorio
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J Molins-Espinosa
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
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