The impact of radiofrequency-assisted transection on local hepatic recurrence after resection of colorectal liver metastases

Resection is the gold standard in the treatment of liver metastases from colorectal cancer. An internal cooled radiofrequency electrode was described to achieve tissue coagulation to a greater margin width. The aim of this study is to determinate if a RFassisted transection device (RFAT) has any effect on local hepatic recurrence (LHER) compared to conventional technologies. A study population of 103 patients who had undergone a hepatic surgical resection was retrospectively analysed. Patients were classified into two groups according to the device used: a RF-assisted device (RFAT group; n=45) and standard conventional devices (control group; n=58). LHER was defined as any growing or enhancing tumour in the margin of hepatic resection during follow-up. Cox proportional models were constructed and variables were eliminated only if p>0.20 to protect against residual confounding. To assess the stability of Cox’s regression model and its internal validity, a bootstrap investigation was also performed. Baseline and operative characteristics were similar in both groups. With a mean followup of 28.5 months (range 2-106), in patients with positive margins, we demonstrated 0% of LHER in RFAT vs. 27% in control group (p=0.032). In the multivariate analysis five factors demonstrated significant influence on the final model of LHER: RFAT group, size of the largest metastases, number of resected metastases, positive margin and usage of Pringle-manoeuvre. This study suggests that parenchymal transection using a RFAT able to create deep thermal lesions may reduce LHER especially in case of margin invasion during transectionQuesada-Diez, R.; Moreno, A.; Poves, I.; Berjano, E.; Grande, L.; Burdío Pinilla, F. (2017). The impact of radiofrequency-assisted transection on local hepatic recurrence after resection of colorectal liver metastases. Surgical Oncology. 26(3):229-235. doi:10.1016/j.suronc.2017.04.004S22923526

Duodenopancreatectomía cefálica de urgencia tras una ingesta masiva de cáusticos

La ingesta de sustancias cáusticas es una emergencia que sigue observándose en adultos, principalmente con intención autolítica. Se recomienda un manejo agresivo de estos pacientes, ya que en caso de presentarse hemorragia o sospecha de necrosis y perforación, sólo la cirugía precoz con resección de todas las estructuras lesionadas puede salvar sus vidas. Cuando la..

Radiofrequency-induced heating versus mechanical stapler for pancreatic stump closure: in vivo comparative study

Purpose: To assess the capacity of two methods of surgical pancreatic stump closure in terms of reducing the risk of pancreatic fistula formation (POPF): radiofrequencyinduced heating versus mechanical stapler. Materials and Methods: Sixteen pigs underwent a laparoscopic transection of the neck of the pancreas. Pancreatic anastomosis was always avoided in order to work with an experimental model prone to pancreatic fistula formation (POPF). Pancreatic stump closure was conducted either by stapler (ST Group, n=8) or radiofrequency energy (RF Group, n=8). Both groups were compared for incidence of POPF and histopathologic alterations of the pancreatic remnant. Results: Six animals (75%) in the ST Group and one (14%) in the RF Group were diagnosed of POPF (p=0.019). One animal in the RF Group and three animals in the ST Group had a pseudocyst in close contact with both pancreas stumps. On day 30 postoperative, almost complete atrophy of the exocrine distal pancreas was observed when the main pancreatic duct was efficiently sealed. Conclusions: Our findings suggest that RF-induced heating is more effective at closing the pancreatic stump than mechanical stapler and leads to the complete atrophy of the distal remnant pancreas.This work was supported by the Spanish 'Programa Estatal de Investigacion, Desarrollo e Innovacion Orientada a los Retos de la Sociedad' under grant TEC2014-52383-C3-R (TEC2014-52383-C3-3-R). F.B., R.Q. and E.B. declare stock ownership in Apeiron Medical S.L., a company that has a license for the patent US 8.303.584.B2, on which the device tested in this study is based. The other authors report no conflict of interests or financial ties to disclose. The authors alone are responsible for the content and writing of the paper.Burdío Pinilla, F.; Dorcaratto, D.; Hernandez, L.; Andaluz, A.; Moll, X.; Quesada-Diez, R.; Poves, I.... (2016). Radiofrequency-induced heating versus mechanical stapler for pancreatic stump closure: in vivo comparative study. International Journal of Hyperthermia. 32(3):272-280. https://doi.org/10.3109/02656736.2015.113684527228032

Individual patient data meta-analysis of organ failure in acute pancreatitis : protocol of the PANCREA II study

Context Organ failure is a major determinant of mortality in patients with acute pancreatitis. These patients usually requireadmission to high dependency or intensive care units and consume considerable health care resources. Given a low incidence rate of organ failure and a lack of large non-interventional studies in the field of acute pancreatitis, the characteristics of organ failure that influence outcomes of patients with acute pancreatitis remain largely unknown. Therefore, the Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) aims to conduct a meta-analysis of individual patient data from prospective non-interventional studies to determine the influence of timing, duration, sequence, and combination of different organ failures on mortality in patients with acute pancreatitis. Methods Pancreatologists currently active with acute pancreatitis clinical research will be invited to contribute. To be eligible for inclusion patients will have to meet the criteria of acute pancreatitis, develop at least one organ failure during the first week of hospitalization, and not be enrolled into an intervention study. Raw data will then be collated and checked. Individual patient data analysis based on a logistic regression model with adjustment for confounding variables will be done. For all analyses, corresponding 95% confidence intervals and P values will be reported. Conclusion This collaborative individual patient data meta-analysis will answer important clinical questions regarding patients with acute pancreatitis that develop organ failure. Information derived from this study will be used to optimize routine clinical management and improve care strategies. It can also help validate outcome definitions, allow comparability of results and form a more accurate basis for patient allocation in further clinical studies

Laparoscopic Distal Pancreatectomy: Feasibility Study of Radiofrequency-Assisted Transection in a Porcine Model

This is a copy of an article published in the Journal of Laparoendoscopic and Advanced Surgical Techniques © 2012 [copyright Mary Ann Liebert, Inc.]; Journal of Laparoendoscopic and Advanced Surgical Techniques is available online at: http://online.liebertpub.com.Background and Aim: Despite technological improvements in pancreatic surgery, the incidence and morbidity of pancreatic leak after resection of distal pancreas are persistently high in most series. Laparoscopic distal pancreatectomy (LDP) is today the gold standard procedure for benign and certain malignant neoplasms of the pancreatic body and tail in specialized centers. This study evaluated safety and feasibility of a radiofrequency (RF)-assisted transection device in a porcine model of LDP. Materials and Methods: LDP was performed on 10 pigs (median weight, 39.6 kg) using a new device based on an internally cooled RF-assisted electrode (Coolinside (R), Apeiron Medical, Valencia, Spain). The animals were subjected to daily observation and then sacrificed and necropsied at 4 weeks postoperatively. Primary end points were the development of postoperative pancreatic fistula using the Pancreatic Anastomotic Leak Study Group definition and/or the presence of abdominal amylase-rich fluid collections or abscesses during necropsy and pathological study and/or dye extravasation from the pancreatic remnant duct. Secondary end points were intra- or postoperative complications, surgery, and transection duration. Results: No clinically relevant postoperative pancreatic fistulas were observed. In one case a grade A postoperative fistula was diagnosed due to amylase drain concentration of more than 6200 IU/mL on postoperative day 4. Median peritoneal liquid amylase concentration on postoperative day 4 was 2399.0 IU/L (range, 819.2-7122.0 IU/L), similar to the median plasma amylase level of 1520.8 IU/L (range, 1015.3-4056.6 IU/L). Median surgery time was 93.5 minutes (range, 46.0-140.0 minutes), and median transection time was 4.5 minutes (range, 2.0-26.0 minutes). There was one postoperative wound infection. There were no postoperative deaths or major complications. During the histopathological study, the surgical margin of the remaining pancreas showed a common pattern with a central area of necrosis surrounded by granulomatous infiltrate and fibrosis. Ductal obliteration was observed. No purulent inflammatory infiltrate or abscesses were present. Conclusion: Experimental findings suggest that performing pancreatic transection with Coolinside in a animal model of LDP is feasible and safe.This work received financial support from the Spanish "Plan Nacional de I+D+I del Ministerio de Ciencia e Innovacion," grant number TEC2008-01369/TEC, and from the Generalitat Valenciana (Ayudas Complementarias de I+D para Grupos de Calidad ACOMP/2010/008).Dorcaratto, D.; Burdio Pinilla, F.; Fondevila, D.; Andaluz, A.; Poves, I.; Martínez, MÁ.; Quesada, R.... (2012). Laparoscopic Distal Pancreatectomy: Feasibility Study of Radiofrequency-Assisted Transection in a Porcine Model. Journal of Laparoendoscopic and Advanced Surgical Techniques. 22(3):242-248. https://doi.org/10.1089/lap.2011.0417S24224822

Long-term evolution of acinar-to-ductal metaplasia and b-cell mass after radiofrequency-assisted transection of the pancreas in a controlled large animal model

Background: Pancreatic duct ligation (PDL) has been used as a model of chronic pancreatitis and as a model to increase β-cell mass. However, studies in mice have demonstrated acinar regeneration after PDL, questioning the long-term validity of the model. We aim to elucidate whether RF-assisted transection (RFAT) of the main pancreatic duct is a reliable PDL model, both in short (ST, 1-month) and long-term (LT, 6-months) follow-ups. Methods: Eleven pigs were subjected to RFAT. Biochemical (serum/peripancreatic amylase and glucose) and histological changes (including a semiautomatic morphometric study of over 1000 images/pancreas and IHC analysis) were evaluated after ST or LT follow-up and also in fresh pancreas specimens that were used as controls for 1 (n=4) and 6 months (n=6). Results: The distal pancreas in the ST was characterized by areas of acinar-to-ductal metaplasia (56%) which were significantly reduced at LT (21%) by fibrotic replacement and adipose tissue. The endocrine mass showed a normal increase. Conclusion: RFAT in the pig seems to be an appropriate PDL model without restoration of pancreatic drainage or reduction of endocrine mass."This work was supported by the Spanish "Plan Estatal de Investigacion, Desarrollo e Innovacion Orientada a los Retos de la Sociedad" under Grant TEC2014-52383-C3 (TEC2014-52383-C3-3-R). RQ, EB, FB declare stock ownership in Apeiron Medical S.L., a company that has a license for the patent US 8.303.584.B2, on which the device have been employed.Quesada-Diez, R.; Andaluz, A.; Cáceres, M.; Moll, X.; Iglesias, M.; Dorcaratto, D.; Poves, I.... (2016). Long-term evolution of acinar-to-ductal metaplasia and b-cell mass after radiofrequency-assisted transection of the pancreas in a controlled large animal model. Pancreatology. 16:38-43. https://doi.org/10.1016/j.pan.2015.10.014S38431

Outcomes After Minimally-invasive Versus Open Pancreatoduodenectomy: A Pan-European Propensity Score Matched Study

OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed

Pancreatic cancer risk in relation to lifetime smoking patterns, tobacco type, and dose-response relationships.

BACKGROUND: Despite smoking being a well-established risk factor for pancreatic cancer (PC), there is a need to further characterize PC risk according to lifespan smoking patterns and other smoking features. Our aim was to deeply investigate them within a large European case-control study. METHODS: Tobacco smoking habits and other relevant information was obtained from 2,009 cases and 1,532 controls recruited in the PanGenEU study using standardized tools. Multivariate logistic regression analysis was performed to evaluate PC risk by smoking characteristics and interactions with other PC risk factors. Fractional polynomials and restricted cubic splines were used to test for non-linearity of the dose-response relationships and to analyse their shape. RESULTS: Relative to never-smokers, current smokers (OR=1.72, 95%CI: 1.39-2.12), those inhaling into the throat (OR=1.48, 95%CI: 1.11-1.99), chest (OR=1.33, 95%CI: 1.12-1.58), or using non-filtered cigarettes (OR=1.69, 95%CI: 1.10-2.61), were all at an increased PC risk. PC risk was highest in current black tobacco smokers (OR=2.09, 95%CI: 1.31-3.41), followed by blond tobacco smokers (OR=1.43, 95%CI: 1.01-2.04). Childhood exposure to tobacco smoke relative to parental smoking was also associated with increased PC risk (OR=1.24, 95%CI: 1.03-1.49). Dose-response relationships for smoking duration, intensity, cumulative dose, and smoking cessation were non-linear and showed different shapes by tobacco type. Effect modification by family history of PC and diabetes was likely. CONCLUSIONS: This study reveals differences in PC risk by tobacco type and other habit characteristics, as well as non-linear risk associations. IMPACT: This characterization of smoking-related PC risk profiles may help in defining PC high-risk populations