Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival

Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID)

Background and objectives: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease -free survival. Methods: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. Results: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). Conclusion: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival. (C) 2021 The Authors. Published by Elsevier Ltd

Resultados a corto y largo plazo de la cirugía de la Hidatidosis hepática en una región endémica a principios del siglo XXI

Tesis doctoral por compendio de publicaciones.Programa de Doctorado en Biología Molecular y Celular, Biomedicina y Biotecnología por la Universidad de Extremadura.La equinococosis quística o hidatidosis hepática es una zoonosis parasitaria producida por el estado larvario del género Echinococcus. Es una enfermedad crónica, compleja y de distribución mundial, que aún hoy en día presenta una prevalencia considerable y supone un elevado coste sanitario. El ser humano es un huésped intermedio accidental que se contagia a través del contacto con animales o con la ingesta de agua o comida contaminada por los parásitos. El lugar más frecuente de aparición de este tipo de quistes es el hígado. Debido a que el área de salud de Extremadura es una región endémica, en este trabajo analizamos principalmente los resultados tras la cirugía de los quistes hidatídicos en nuestra unidad. Analizamos los factores de riesgo relacionados con la morbimortalidad postoperatoria así como los factores relacionados con la recaída y el patrón de recidiva de estos pacientes. Se propone un seguimiento inicial más espaciado, dado que la recidiva no suele ocurrir de forma precoz, y prolongar en el tiempo los controles ya que puede aparecer hasta 10 años después de la intervención. En este trabajo también analizamos los resultados quirúrgicos en varios subgrupos poblacionales. Aquellos pacientes con ictericia obstructiva al diagnóstico, presentan mayor riesgo de morbimortalidad postoperatoria así como mayor frecuencia de fistula biliar postoperatoria. Los pacientes considerados ancianos, aquellos mayores de 70 años, sometidos a cirugía por la presencia de estos quistes, presentan una mayor morbilidad postoperatoria como era previsible dado la comorbilidad concomitante, pero en un rango asumible, y sin presentar mayor mortalidad postoperatoria.Cyst echinococcosis or liver hydatidosis is a parasitic zoonosis caused by the larval stage of the genus Echinococcus. It is a chronic, complex disease of worldwide distribution, which even today has a considerable prevalence and represents a high health cost. Humans are an accidental intermediate host who are infected through contact with animals or by ingesting water or food contaminated by the parasites. The most frequent site of occurrence of cysts is the liver. As the Extremadura health area is a endemic region, we mainly analyze the results after surgery for hydatid cysts in our unit in this work. We analyze the risk factors related to postoperative morbimortality as well as the factors related to relapse and recurrence pattern of these patients. A more distant initial follow-up is proposed, given that relapse does not usually occur early, and prolonged follow-up over time, since it can appear up to 10 years after the intervention. In this work we also analyzed the surgical results in various population subgroups. Those patients with obstructive jaundice at diagnosis present a higher risk of postoperative morbimortality as well as a higher frequency of postoperative biliary fistula. Elderly patients, those older than 70 years, who underwent surgery for the presence of these cysts, presented greater postoperative morbidity, as it was expected given the concomitant comorbidity, but within an acceptable range, and without presenting greater postoperative mortality

Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study

Financiación de acceso abierto gracias al acuerdo CRUE-CSIC con Elsevier.Cystic echinococcosis is a clinically complex chronic parasitic disease and a major socioeconomic problem in endemic areas. The safety of liver resection in elderly patients is often debated among medical professionals. We analyzed the postoperative morbidity and mortality rates of elderly patients who underwent surgery at our unit. Methods: We retrospectively evaluated patients with liver hydatid cysts which were surgically removed at our unit. Patients were divided into two groups: Group 1 (patients < 70 years), and Group 2 (patients ≥ 70 years). Propensity score matching (PSM) and comparative analyses between groups were performed. Results: The unmatched cohort consisted of 279 patients (Group 1: 244; Group 2: 35). After PSM, we compared the outcomes for 56 patients from Group 1 to 31 patients from Group 2. A higher rate of severe complications was observed in Group 2 (25.8% vs 5.36%, p = 0.014). No difference was found in the rates of infectious, cardiorespiratory, or hemorrhagic complications between both groups, and in the mortality rate either (0.00% vs 6.45%, p = 0.124). Conclusions: Liver surgery in selected elderly patients is safe and practicable. The low postoperative morbidity rate in these patients is acceptable, albeit higher, due to their comorbidities.La equinococosis quística es una enfermedad parasitaria crónica clínicamente compleja y un problema socioeconómico importante en áreas endémicas. La seguridad de la resección hepática en pacientes de edad avanzada a menudo se debate entre los profesionales médicos. Analizamos la morbimortalidad postoperatoria de los pacientes ancianos intervenidos quirúrgicamente en nuestra unidad. Métodos: Evaluamos retrospectivamente a pacientes con quiste hidatídico hepático que fueron extirpados quirúrgicamente en nuestra unidad. Los pacientes se dividieron en dos grupos: Grupo 1 (pacientes < 70 años) y Grupo 2 (pacientes ≥ 70 años). Se realizaron análisis de emparejamiento por puntuación de propensión (PSM) y comparativos entre grupos. Resultados: La cohorte no emparejada constaba de 279 pacientes (Grupo 1: 244; Grupo 2: 35). Después de la PSM, comparamos los resultados de 56 pacientes del Grupo 1 con 31 pacientes del Grupo 2. Se observó una mayor tasa de complicaciones graves en el Grupo 2 (25,8 % frente a 5,36 %, p = 0,014). No se encontró diferencia en las tasas de complicaciones infecciosas, cardiorrespiratorias o hemorrágicas entre ambos grupos, ni tampoco en la tasa de mortalidad (0,00% vs 6,45%, p = 0,124). Conclusiones: La cirugía hepática en pacientes ancianos seleccionados es segura y factible. La baja tasa de morbilidad postoperatoria en estos pacientes es aceptable, aunque mayor, debido a sus comorbilidades.peerReviewe

Prognostic value of pre-operative systemic immune-inflammation index and platelet to lymphocyte ratio in peritoneal carcinomatosis of ovarian origin

Background and objectives: The aim of this study was to investigate the impact of systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) on the survival outcomes of patients who underwent to cytoreductive surgery (CRS) and HIPEC for ovarian peritoneal carcinomatosis. Methods: A retrospective analysis of 68 cases following surgery at our department between 2015 and 2020 was performed. Receiver Operating Characteristic (ROC) curve was used with Youden index to calculate the optimal cutoff values for SII, PLR and NLR. Results: Univariate analysis revealed that high preoperative values of SII, PLR and NLR were correlated with worse overall survival (OS) and disease-free survival (DFS) in these patients. In the multivariable analysis, high SII was recognized as an independent prognostic factor for OS (CI 95%: 0.002- 3.835, p = 0.097) and high PLR was recognized as an independent prognostic factor for DFS (CI 95%: 0.253–2.248, p = 0.007). Conclusion: SII and PLR could be useful prognostic tools to predict outcomes of patients who underwent to CRS and HIPEC for ovarian peritoneal carcinomatosis.Trasfondo y objetivos: El objetivo de este estudio fue investigar el impacto del índice de inflamación inmune sistémica (SII), la proporción de plaquetas a linfocitos (PLR) y la proporción de neutrófilos a linfocitos (NLR) en los resultados de supervivencia de los pacientes que se sometieron a cirugía citorreductora (CRS) y HIPEC para carcinomatosis peritoneal de ovario. Métodos: Se realizó un análisis retrospectivo de 68 casos tras cirugía en nuestro servicio entre 2015 y 2020. Se utilizó la curva de característica operativa del receptor (ROC) con el índice de Youden para calcular los valores de corte óptimos para SII, PLR y NLR. Resultados: El análisis univariante reveló que los valores preoperatorios altos de SII, PLR y NLR se correlacionaron con una peor supervivencia general (SG) y supervivencia libre de enfermedad (DFS) en estos pacientes. En el análisis multivariable, el SII elevado se reconoció como factor pronóstico independiente de SG (IC 95 %: 0,002-3,835, p = 0,097) y el PLR alto se reconoció como factor pronóstico independiente de SLE (IC 95 %: 0,253–2,248, p = 0,007). Conclusión: SII y PLR podrían ser herramientas de pronóstico útiles para predecir los resultados de los pacientes que se sometieron a CRS e HIPEC por carcinomatosis peritoneal de ovario.Financiación de acceso abierto gracias al acuerdo CRUE-CSIC con Elsevier.peerReviewe

Duodenal Adenocarcinoma: The Relationship between Type of Surgery and Site of Recurrence in a Spanish Cohort

We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical intervention and immediate postoperative period; and post-surgical follow-up information, such as recurrence, overall survival (OS), and disease-free survival (DFS). A total of 32 patients underwent surgery. The median age was 69.74 years (IQR 60.47–79.09) and the male/female distribution was 3:1. The surgeries performed were: pancreaticoduodenectomy (PD) in 16 (50%) patients, segmental resection in 13 (40.6%), and the local excision of the lesion in three (9.4%). The R0 rate was higher in PD (86.7% vs. 42.9%; p = 0.013). The OS and DFS rate at one, three and five years was 95%, 70%, and 60% and 86%, 55%, and 48%, respectively. There was a greater trend towards recurrence in patients who did not undergo PD (53.8% vs. 25%; p = 0.14) and conservative surgery seemed to be associated with more local recurrence than PD (57.1% vs. 33.3%; p = 0.49). PD and limited resection are both valid options in the cases of non-ampullary duodenal adenocarcinoma, although PD presented lower rates of loco-regional recurrence

Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: a Spanish multicenter study (PANMEKID)

Background and objectives: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. Methods: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. Results: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). Conclusion: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

GECOP-MMC: phase IV randomized clinical trial to evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) with mytomicin-C after complete surgical cytoreduction in patients with colon cancer peritoneal metastases.

The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies. GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1-10; 11-15; 16-20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values. HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years. EudraCT number: 2019-004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, )