24 research outputs found
Cirugía laparoscópica hepática y pancreática
The development of laparoscopic surgery also
includes the more complex procedures of abdominal
surgery such as those that affect the liver and the
pancreas. From diagnostic laparoscopy, accompanied
by laparoscopic echography, to major hepatic or
pancreatic resections, the laparoscopic approach has
spread and today encompasses practically all of the
surgical procedures in hepatopancreatic pathology.
Without forgetting that the aim of minimally invasive
surgery is not a better aesthetic result but the
reduction of postoperative complications, it is
undeniable that the laparoscopic approach has
brought great benefits for the patient in every type of
surgery except, for the time being, in the case of big
resections such as left or right hepatectomy or
resections of segments VII and VIII.
Pancreatic surgery has undergone a great
development with laparoscopy, especially in the field
of distal pancreatectomy due to cystic and
neuroendocrine tumours where the approach of choice
is laparoscopic. Laparoscopy similarly plays an
important role, together with echolaparoscopy, in
staging pancreatic tumours, prior to open surgery or
for indicating suitable treatment.
In coming years, it is to be hoped that it will
continue to undergo an exponential development and,
together with the advances in robotics, it will be
possible to witness a greater impact of the
laparoscopic approach on the field of hepatic and
pancreatic surgery
Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report
Diffuse thrombosis of the entire portal system (PVT) and cavernomatous
transformation of the portal vein (CTPV) represents a demanding challenge in
liver transplantation. We present the case of a patient with nodular regenerative
hyperplasia and recurrent episodes of type B hepatic encephalopathy concomitant
with PVT as well as CTPV, successfully treated with orthotopic liver
transplantation. The portal inflow to the graft was carried out through the
confluence of 2 thin paracholedochal varicose veins, obtaining good early graft
function and recovery of the encephalopatic episodes. This alternative should be
kept in mind as an option to assure hepatopetal splanchnic flow in those cases of
diffuse thrombosis and cavernomatous transformation of portal vein.
CI - Copyright (c) 2010 Elsevier Inc. All rights reserved
Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: A systematic seview and meta-analysis from propensity-score matched studies
Background: Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC).
Methods: A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model.
Results: Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]).
Conclusions: This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR
NLRP3 inflammasome: a possible link between obesity-associated low-grade chronic inflammation and colorectal cancer development
Emerging evidence reveals that adipose tissue-associated inflammation is a main mechanism whereby obesity promotes colorectal cancer risk and progression. Increased inflammasome activity in adipose tissue has been proposed as an important mediator of obesity-induced inflammation and insulin resistance development. Chronic inflammation in tumor microenvironments has a great impact on tumor development and immunity, representing a key factor in the response to therapy. In this context, the inflammasomes, main components of the innate immune system, play an important role in cancer development showing tumor promoting or tumor suppressive actions depending on the type of tumor, the specific inflammasome involved, and the downstream effector molecules. The inflammasomes are large multiprotein complexes with the capacity to regulate the activation of caspase-1. In turn, caspase-1 enhances the proteolytic cleavage and the secretion of the inflammatory cytokines interleukin (IL)-1 beta and IL-18, leading to infiltration of more immune cells and resulting in the generation and maintenance of an inflammatory microenvironment surrounding cancer cells. The inflammasomes also regulate pyroptosis, a rapid and inflammation-associated form of cell death. Recent studies indicate that the inflammasomes can be activated by fatty acids and high glucose levels linking metabolic danger signals to the activation of inflammation and cancer development. These data suggest that activation of the inflammasomes may represent a crucial step in the obesity-associated cancer development. This review will also focus on the potential of inflammasome-activated pathways to develop new therapeutic strategies for the prevention and treatment of obesity-associated colorectal cancer development
Peutz-Jeghers syndrome and duodeno-jejunal adenocarcinoma-therapeutic implications
The Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous poliposis describred in 1921. Hemminki in 1997 described the presence of LKB-1 mutation tumor-suppressor gen.The patients with PJS develop a higher cumulative incidence of gastrointestinal, pancreas and extraintestinal tumors, being occasion of a renew interest on hamartomatous polyposis syndromes regarding the clinical care, cancer surveillance treatment and long term follow-up.We report the case of a 38 years old male, diagnosed of PJS who developed a multiple adenocarcinoma in duodenum and yeyunum. Surgically treated and with a long-term free disease survival of 11 years represents the sixth case reported in the spanish literature of PJS associated with a gastrointestinal tumor.A critical review, molecular alterations and the established criteria of tumor screening and surveillance are reviewed
Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results
Background: intraductal papillary mucinous neoplasm
(IPMN) shows a series of lesions which evolve from benign lesions
–adenoma– to invasive carcinoma.
Aim: to analyze the clinical and pathological results of 15 patients
diagnosed of IPMN, and surgically treated according to the
guidelines of International Consensus Conference.
Material and methods: a retrospective analysis of 15 patients
surgically treated between March 1993 and September
2009, according to the International Consensus recommendation.
Demographic, diagnostic tools, surgical report, pathologic
database and actuarial survival were analyzed with a follow-up
from one and a half month through nine years.
Results: 6 patients underwent pancreaticoduodenectomies,
4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial
pancreatectomies (enucleation) and 1 distal pancreatectomy.
A morbidity of 46 and 0% hospital mortality were assessed, with
a median length hospital stay of 10 days. In five cases, the IPMN
was combined type (both main and branch pancreatic ducts involved)
in four main duct-type and branch duct-type in the another
six as well. Several atypia (IPMN carcinoma in situ) was
observed in 2 patients and invasive carcinoma with negative
lymph nodes was identified in 3 patients. A patient without invasive
carcinoma died at 66 months of follow-up for pancreas adenocarcinoma.
The actuarial survival up to recurrence or death
was 105,133 months with a range of follow-up from 1 month
and a half until 9 years.
Conclusions: IPMN main duct or mixed type warrants complete
resection due to its incidence of invasive carcinoma or precursor
lesions of malignancy as well. Due to its multifocal pattern,
patients should be followed in long-term surveillance. The management
of asymptomatic IPMN type branch less than 3 cm is
controversial
Impact of perineural invasion on the outcome of patients with synchronous colorectal liver metastases treated with neoadjuvant chemotherapy and surgery
Purpose: To analyze the prognostic value of variables of the primary tumor in patients with synchronous liver metastases in colorectal cancer (CLRMs) treated with neoadjuvant chemotherapy and surgery.
Methods/patients: From a prospective database, we retrospectively identified all patients with synchronous CLRMs who were treated with neoadjuvant chemotherapy and liver resection. Using univariate and multivariate analyses, we identified the variables associated with tumor recurrence. Overall survival and disease-free survival were calculated using the Kaplan-Meier method with differences determined by the Cox multiple hazards model. Results were compared using the log-rank test.
Results: Ninety-eight patients with synchronous CLRMs were identified. With a median follow-up of 39.8 months, overall survival and disease-free survival at 5 and 10 years were 53%, 41.7%, 29% and 29%, respectively. Univariate analysis identified three variables associated with tumor recurrence: location in the colon (p = 0.025), lymphovascular invasion (p = 0.011) and perineural invasion (p = 0.005). Multivariate analysis identified two variables associated with worse overall survival: perineural invasion (HR 2.36, 95% CI 1.162-4.818, p = 0.018) and performing frontline colectomy (HR 3.286, 95% CI 1.256-8.597, p = 0.015). Perineural invasion remained as the only variable associated with lower disease-free survival (HR 1.867, 95% CI 1.013-3.441, p = 0.045). Overall survival at 5 and 10 years in patients with and without perineural invasion was 68.2%, 54.4% and 29.9% and 21.3%, respectively (HR 5.920, 95% CI 2.241-15.630, p < 0.001).
Conclusions: Perineural invasion in the primary tumor is the variable with most impact on survival in patients with synchronous CLRMs treated with neoadjuvant chemotherapy and surgery
Therapeutic drug monitoring of neoadjuvant mFOLFIRINOX in resected pancreatic ductal adenocarcinoma
Background: Despite a potentially curative treatment, the prognosis after upfront surgery and adjuvant
chemotherapy for patients with resectable pancreatic ductal adenocarcinoma (PDAC) is poor. Modified
FOLFIRINOX (mFOLFIRINOX) is a cornerstone in the systemic treatment of PDAC, including the neoadjuvant setting. Pharmacokinetic-guided (PKG) dosing has demonstrated beneficial effects in other
tumors, but scarce data is available in pancreatic cancer.
Methods: Forty-six patients with resected PDAC after mFOLFIRINOX neoadjuvant approach and included
in an institutional protocol for anticancer drug monitoring were retrospectively analyzed. 5-Fluorouracil
(5-FU) dosage was adjusted throughout neoadjuvant treatment according to pharmacokinetic parameters and Irinotecan (CPT-11) pharmacokinetic variables were retrospectively estimated.
Results: By exploratory univariate analyses, a significantly longer progression-free survival was observed
for patients with either 5-FU area under the curve (AUC) above 28 mcgh/mL. In the multivariate analyses adjusted by age, gender, performance status and resectability
after stratification according to both pharmacokinetic parameters, the risk of progression was significantly reduced in patients with 5-FU AUC 28 mcgh/mL [HR ¼ 0.189, 95% CI 0.073e0.486, p ¼ 0.001].
Conclusions: Pharmacokinetically-guided dose adjustment of standard chemotherapy treatments might
improve survival outcomes in patients with pancreatic ductal adenocarcinoma
Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: A systematic seview and meta-analysis from propensity-score matched studies
Background: Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC).
Methods: A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model.
Results: Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]).
Conclusions: This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR