Endoscopic lateral parathyroidectomy as surgical treatment for patients with primary hyperparathyroidism

Antecedentes La mayoría de los cirujanos han aceptado de una manera rápida, la realización de miniprocedimientos abiertos para el tratamiento del hiperparatiroidismo primario. Sin embargo, la utilización de la endoscopia cervical sigue siendo discutible por su dificultad técnica y la estricta selección de los pacientes. Material y métodos Entre los meses de abril del 2010 y del 2013, se incluyó a pacientes con hiperparatiroidismo primario esporádico (sPHPT), que además tenían un adenoma único tanto por ecografía y exploración con sestamibi, y que aceptaron participar en el estudio. Los pacientes fueron operados por cirujanos especialmente entrenados en este tipo de cirugía, utilizando la misma técnica quirúrgica en todos ellos. Se recogieron variables demográficas y características clínicas de los pacientes. Una vez finalizada la recolección de información se procedió al análisis descriptivo de las variables (mediana, desviación estándar y rango). Resultados Realizamos un total de 28 paratiroidectomías mediante el abordaje de paratiroidectomía lateral endoscópica. La edad media de los pacientes fue de 68 años (59-89). Todos los pacientes tuvieron un hiperparatiroidismo primario esporádico. No se detectaron complicaciones intraoperatorias. La morbilidad fue comparable con la que muestran series publicadas en técnica abierta. Tras una mediana de seguimiento de 22 (9-53) meses, hemos detectado que el éxito de la intervención ha sido de 27/28 (96%). Conclusiones El abordaje endoscópico del hiperparatiroidismo primario sPHPT resulta factible, reproducible y ofrece unos resultados comparables al abordaje clásico abierto, diversos factores hacen poco recomendable su realización fuera de hospitales con alto volumen de pacientes y unidades diferenciadas de Cirugía Endocrina

Pheochromocytoma as a rare cause of arterial hypertension in a patient with autosomal dominant polycystic kidney disease: A diagnostic and therapeutic dilemma.

INTRODUCTION: Individuals with autosomal dominant polycystic kidney disease (ADPKD) frequently suffer arterial hypertension even prior to significant loss of renal function, a clinical situation that obscures detection of modifiable secondary causes of hypertension. PRESENTATION OF CASE: A 50-year-old man with ADPKD and polycystic liver and resistant hypertension is diagnosed with a 4-cm right adrenal mass. Cross-sectional MRI is indicative of pheochromocytoma versus adrenocortical carcinoma or metastasis, though there are no typical PCC symptoms and plasma and urine metanephrines are within normal ranges. Since malignancy cannot be excluded, right adrenalectomy is performed. Considering that the enlarged liver poses an obstacle for transperitoneal open and laparoscopic approaches, a retroperitoneoscopic approach is used. Surgical pathology reveals a 4.5-cm pheochromocytoma; the patient no longer requires antihypertensive therapy. DISCUSSION & CONCLUSION: Pheochromocytoma is a rare but treatable cause of hypertension in ADPKD; given the anatomical complexities these patients present, careful preoperative planning and surgical technique are essential to a favorable outcome

A novel and simple formula to predict liver mass in porcine experimental models.

A primary limitation in hepatic surgery is leaving a remnant liver of adequate size and function. Experimental models have been designed to study processes of liver injury and regeneration in this context, yet a formula to accurately calculate liver mass in an animal model is lacking. This study aims to create a novel and simple formula to estimate the mass of the native liver in a species of pigs commonly used in experimental liver surgery protocols. Using data from 200 male weanling Landrace-Large White hybrid pigs, multiple linear regression analysis is used to generate the formula. Clinical features used as variables for the predictive model are body mass and length. The final formula for pig liver mass is as follows: Liver mass (g) = 26.34232 * Body mass (kg) - 1.270629 * Length (cm) + 163.0076; R2 = 0.7307. This formula for porcine liver mass is simple to use and may be helpful in studies using animals of similar characteristics to evaluate restoration of liver mass following major hepatectomy

Metastatic Tissue Proteomic Profiling Predicts 5-Year Outcomes in Patients with Colorectal Liver Metastases

Colorectal cancer (CRC) is one of the most common cancers in the developed countries, and nearly 70% of patients with CRC develop colorectal liver metastases (CRLMs). During the last decades, several scores have been proposed to predict recurrence after CRLM resection. However, these risk scoring systems do not accurately reflect the prognosis of these patients. Therefore, this investigation was designed to identify a proteomic profile in human hepatic tumor samples to classify patients with CRLM as 'mild' or 'severe' based on the 5-year survival. The study was performed on 85 CRLM tumor samples. Firstly, to evaluate any distinct tumor proteomic signatures between mild and severe CRLM patients, a training group of 57 CRLM tumor samples was characterized by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry, and a classification and regression tree (CART) analysis was subsequently performed. Finally, 28 CRLM tumor samples were used to confirm and validate the results obtained. Based on all the protein peaks detected in the training group, the CART analysis was generated, and four peaks were considered to be the most relevant to construct a diagnostic algorithm. Indeed, the multivariate model yielded a sensitivity of 85.7% and a specificity of 86.1%, respectively. In addition, the receiver operating characteristic (ROC) curve showed an excellent diagnostic accuracy to discriminate mild from severe CRLM patients (area under the ROC: 0.903). Finally, the validation process yielded a sensitivity and specificity of 68.8% and 83.3%, respectively. We identified a proteomic profile potentially useful to determine the prognosis of CRLM patients based on the 5-year survival

Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90 days using a propensity method

Laparoscopic hemihepatectomy (LHH) may ofer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010-12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specifc and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien-Dindo grade≥III OHH 23%, LHH 11%, p=0.130; Comprehensive Complication Index OHH 20.0±16.1, LHH 10.9±14.2, p=0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a signifcant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH

Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: 'a note of caution'

BACKGROUND: New systemic chemotherapy agents have improved prognosis in patients with colorectal liver metastases (CLM), but some of them damage the liver parenchyma and ultimately increase postoperative morbidity and mortality after liver resection. The aims of our study were to determine the degree of hemodynamic and pathological liver injury in CLM patients receiving preoperative chemotherapy and to identify an association between these injuries and postoperative complications after liver resection. METHODS: This is a prospective descriptive study of patients with CLM receiving preoperative chemotherapy before curative liver resection from November 2013 to June 2014. All patients had preoperative elastography and hepatic hemodynamic evaluation. We analyzed clinical preoperative data and postoperative outcomes after grouping the patients by chemotherapy type, development of sinusoidal obstructive syndrome (SOS), and development of major complications. RESULTS: Eleven from the 20 patients included in the study received preoperative oxaliplatin-based chemotherapy (OBC). Nine patients had SOS at pathological analysis and five patients developed major complications. Patients receiving preoperative OBC had higher values of hepatic venous pressure gradient (HVPG) and developed more SOS and major complications. Patients developing SOS had higher values of HVPG and developed more major complications. Patients with major complications had higher values of HVPG, and patients with a HVPG of 5 mmHg or greater had more major complications than those under 5 mmHg (20 vs 80%, p = 0.005). CONCLUSIONS: OBC and SOS impair liver hemodynamics in CLM patients. An increase in major complications after liver resection in these patients develops at subclinical HVPG levels

Application of fibrin sealant in patients operated on for differentiated thyroid cancer. What do we improve?

Antecedentes En los últimos años han aparecido diferentes publicaciones que demuestran que los nuevos sellantes adhesivos, como Tissucol®, que son aplicados en el espacio tiroideo reducen las complicaciones locales tras tiroidectomías complejas. Objetivos Mostrar la eficacia del adhesivo de fibrina Tissucol® en la reducción de la estancia hospitalaria postoperatoria de los pacientes intervenidos de carcinoma diferenciado de tiroides en quienes se realizó tiroidectomía total con vaciamiento ganglionar central y unilateral. Material y métodos Realizamos un estudio prospectivo y aleatorizado, durante el periodo comprendido entre mayo de 2009 y octubre de 2013, en pacientes con carcinoma diferenciado de tiroides con metástasis ganglionares cervicales, para la realización de cirugía programada. Se formaron 2 grupos: en los que se utilizó Tissucol® (grupo caso) y en los que no (grupo control). Los pacientes fueron operados por cirujanos especialmente dedicados a patología quirúrgica endocrina, utilizando la misma técnica en todos ellos. Resultados Realizamos 60 tiroidectomías totales con vaciamiento ganglionar: 30 en el grupo caso, que se compararon con 30 del grupo control. No observamos diferencias significativas en la mayoría de las variables estudiadas; no obstante, el grupo caso presentó una menor estancia hospitalaria respecto al grupo control, con una diferencia estadísticamente significativa (p<0.05). Conclusión La aplicación del Tissucol® ha permitido reducir la estancia hospitalaria de los pacientes operados de tiroidectomía total con vaciamiento cervical, lo que representa para el hospital una reducción de costos, sin que ello influya en la aparición de complicaciones relacionadas con la intervención

Validation of Backtable Graft Arterial Anastomosis Between Splenic Artery and Superior Mesenteric Artery: A 21-year Single-center Experience of Pancreas Transplantation

Resumen del trabajo presentado en el IPITA 2021 VIRTUAL CONGRESS, celebrado de forma virtual del 20 al 23 de octubre de 2021Aim: To determine the role of the arterial spleno-mesenteric anastomosis reconstruction technique compared to other types of backtable arterial anastomosis, in terms of vascular complications and long-term patient and graft survival in a single institution. Methods: Retrospective analysis including all pancreas transplants performed over 21 years (1999–2019). For the bench reconstruction: (1) the distal superior mesenteric artery (SMA) was distally dissected and sewn to the splenic artery (SA), or (2) the arteries were reconstructed with an iliac arterial “Y” graft. Results: A total of 412 pancreas transplantations were done. At the bench procedure SMA/SA anastomosis was performed in 376 of patients, arterial iliac “Y” graft in 32 of patients, and no arterial reconstruction was required in 4 of patients. A total of 90 patients presented vascular complications within the 30 days following transplant: (venous (n=64), arterial (n=11), both (n=15), without statistically significant differences between the SMA/SA anastomosis group and others. Regarding acute arterial events:(1) for the SMA/SA anastomosis group, a total of 24 patients presented with thrombosis (n=16), stenosis (n=5), pseudoaneurysm (n=2); (2) for the iliac “Y” graft group, there were 3 patients with thrombosis. Focusing on chronic arterial events:(1)for the SMA/SA anastomosis group, a total of 2 patients presented with chronic thrombosis, 2 with pseudoaneurysm, 2 with arterioenteral fistula and one with arteriovenous fistula;(2)for the iliac “Y” graft group, and one patient with arterioenteral fistula. After a median follow-up of 129.2 [77.2–182] months, no statically differences were found between SMA/SA anastomosis and iliac “Y” graft arterial reconstruction groups at 1, 3, 5 and 10 years in terms of patient and graft survival. Conclusions: The back table procedure used in our institution (SMA/SA) is an easy, effective and safe surgical technique that can be used as the first option for arterial reconstruction or as a good alternative for surgeons to the widely used arterial “Y” graft.Peer reviewe

Las complicaciones biliares en el trasplante hepático de donante vivo no afectan a los resultados a largo plazo

El transplantament hepàtic de donant viu comporta un alt índex de complicacions biliars. El nostre objectiu és avaluar-les, així com els resultats a llarg termini. Es van analitzar 70 casos retrospectivament. 39 de 70 pacients van presentar algun tipus de complicació biliar. Entre ells, 29 van presentar una fuga, 10 una estenosi i 14 ambdues. La probabilitat de presentar una estenosi fou major en els pacients amb fuga biliar prèvia (58% vs. 29,5% als 5 anys p=0,05). Un 70,8% es solucionaren mitjançant radiología intervencionista. No hi van haver diferències de supervivencia amb o sense complicacions de la via biliar.El trasplante hepático de donante vivo conlleva un alto índice de complicaciones biliares. Nuestro objetivo es evaluarlas, así como los resultados a largo plazo. Se analizaron 70 casos retrospectivamente. 39 de 70 pacientes presentaron algún tipo de complicación biliar. De ellos, 29 presentaron una fuga, 10 una estenosis y 14 ambas. La probabilidad de presentar estenosis fue mayor en los pacientes con fuga biliar previa (58% vs. 29,5% a 5 años p=0,05). Un 70,8% se solucionaron mediante radiología intervencionista. No hubo diferencias de supervivencia con o sin complicaciones de la vía biliar

STARD1 promotes NASH-driven HCC by sustaining the generation of bile acids through the alternative mitochondrial pathway

Background & Aims Besides their physiological role in bile formation and fat digestion, bile acids (BAs) synthesised from cholesterol in hepatocytes act as signalling molecules that modulate hepatocellular carcinoma (HCC). Trafficking of cholesterol to mitochondria through steroidogenic acute regulatory protein 1 (STARD1) is the rate-limiting step in the alternative pathway of BA generation, the physiological relevance of which is not well understood. Moreover, the specific contribution of the STARD1-dependent BA synthesis pathway to HCC has not been previously explored. Methods STARD1 expression was analyzed in a cohort of human non-alcoholic steatohepatitis (NASH)-derived HCC specimens. Experimental NASH-driven HCC models included MUP-uPA mice fed a high-fat high-cholesterol (HFHC) diet and diethylnitrosamine (DEN) treatment in wild-type (WT) mice fed a HFHC diet. Molecular species of BAs and oxysterols were analyzed by mass spectrometry. Effects of NASH-derived BA profiles were investigated in tumour-initiated stem-like cells (TICs) and primary mouse hepatocytes (PMHs). Results Patients with NASH-associated HCC exhibited increased hepatic expression of STARD1 and an enhanced BA pool. Using NASH-driven HCC models, STARD1 overexpression in WT mice increased liver tumour multiplicity, whereas hepatocyte-specific STARD1 deletion (Stard1ΔHep) in WT or MUP-uPA mice reduced tumour burden. These findings mirrored the levels of unconjugated primary BAs, β-muricholic acid and cholic acid, and their tauroconjugates in STARD1-overexpressing and Stard1ΔHep mice. Incubation of TICs or PMHs with a mix of BAs mimicking this profile stimulated expression of genes involved in pluripotency, stemness and inflammation. Conclusions The study reveals a previously unrecognised role of STARD1 in HCC pathogenesis, wherein it promotes the synthesis of primary BAs through the mitochondrial pathway, the products of which act in TICs to stimulate self-renewal, stemness and inflammation. Lay summary Effective therapy for hepatocellular carcinoma (HCC) is limited because of our incomplete understanding of its pathogenesis. The contribution of the alternative pathway of bile acid (BA) synthesis to HCC development is unknown. We uncover a key role for steroidogenic acute regulatory protein 1 (STARD1) in non-alcoholic steatohepatitis-driven HCC, wherein it stimulates the generation of BAs in the mitochondrial acidic pathway, the products of which stimulate hepatocyte pluripotency and self-renewal, as well as inflammation.We acknowledge support from grants PID2019-111669RB-100, SAF2017-85877R and SAF2015-73579-JIN from Plan Nacional de I+D funded by the Agencia Estatal de Investigación (AEI), the Fondo Europeo de Desarrollo Regional (FEDER) and CIBEREHD; the center grant P50AA011999 Southern California Research Center for ALPD and Cirrhosis funded by NIAAA / NIH; as well as support from AGAUR of the Generalitat de Catalunya SGR-2017-1112, European Cooperation in Science & Technology (COST) ACTION CA17112 Prospective European Drug-Induced Liver Injury Network, the ‘ER stress-mitochondrial cholesterol axis in obesity-associated insulin resistance and comorbidities’-Ayudas FUNDACION BBVA and the Red Nacional 2018-102799-T de Enfermedades Metabólicas y Cáncer, and Project 201916/31 "Contribution of mitochondrial oxysterol and bile acid metabolism to liver carcinogenesis" 2019 by Fundació Marato TV3. We also acknowledge the support from the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, Spain (PI16/00598, co-funded by European Regional Development Fund / European Social Fund, ‘Investing in your future’) and Centro Internacional sobre el Envejecimiento (OLD-HEPAMARKER, 0348_CIE_6_E), Spain. We also acknowledge support from R01 CA2344128 and U01 AA022614 grants to M.K.Peer reviewe