RESUMEN
BACKGROUND: The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS in low- and high-volume centers across Europe. METHODS: Analysis of the first year (2019) of the E-MIPS registry, including minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). Primary outcome was 90-day mortality. RESULTS: Overall, 959 patients from 54 centers in 15 countries were included, 558 patients underwent MIDP and 401 patients MIPD. Median volume of MIDP was 10 (7-20) and 9 (2-20) for MIPD. Median use of MIDP was 56.0% (IQR 39.0-77.3%) and median use of MIPD 27.7% (IQR 9.7-45.3%). MIDP was mostly performed laparoscopic (401/558, 71.9%) and MIPD mostly robotic (234/401, 58.3%). MIPD was performed in 50/54 (89.3%) centers, of which 15/50 (30.0%) performed ≥20 MIPD annually. This was 30/54 (55.6%) centers and 13/30 (43%) centers for MIPD respectively. Conversion rate was 10.9% for MIDP and 8.4% for MIPD. Overall 90 day mortality was 1.1% (n = 6) for MIDP and 3.7% (n = 15) for MIPD. CONCLUSION: Within the E-MIPS registry, MIDP is performed in about half of all patients, mostly using laparoscopy. MIPD is performed in about a quarter of patients, slightly more often using the robotic approach. A minority of centers met the Miami guideline volume criteria for MIPD.
Asunto(s)
Laparoscopía , Neoplasias Pancreáticas , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias Pancreáticas/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Páncreas/cirugía , Pancreatectomía/efectos adversos , Pancreaticoduodenectomía/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos , Laparoscopía/efectos adversos , Sistema de Registros , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence. METHODS: Multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010-2015. Patients were divided into two groups according to whether they received perioperative CTx or not and were compared using propensity score matching (PSM) analysis. Then, they were stratified according to prognostic risk scores, including: Clinical Risk Score (CRS), Tumour Burden Score (TBS) and Genetic And Morphological Evaluation (GAME) score. RESULTS: The study included 967 patients with a median follow-up of 68 months. After PSM analysis, patients with perioperative CTx presented prolonged overall survival (OS) in comparison with the surgery alone group (82.8 vs 52.5 months, p = 0.017). On multivariable analysis perioperative CTx was an independent predictor of increased OS (HR 0.705, 95%CI 0.705-0.516, p = 0.029). The benefits of perioperative CTx on survival were confirmed in patients with CRS and TBS scores ≤2 (p = 0.022 and p = 0.020, respectively) and in patients with a GAME score ≤1 (p = 0.006). CONCLUSION: Perioperative CTx demonstrated an increase in OS in patients with CRLM. Patients with a low-risk of recurrence seem to benefit from systemic treatment.
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Neoplasias Colorrectales , Neoplasias Hepáticas , Neoplasias Colorrectales/cirugía , Hepatectomía/efectos adversos , Humanos , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Puntaje de Propensión , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue in an anatomical place not related to the pancreas, being it most frequent locations the stomach and small bowel. Its finding in the gallbladder is exceptional. Since the first case was reported by Otschkin in 1916, about 30 cases have been described in literature. We report the case of a 43 years-old male patient who had an urgent laparoscopic cholecystectomy with the diagnosis of acute cholecystitis, which pathological study showed the existence of chronic cholecystitis with heterotopic pancreatic tissue in the gallbladder wall.
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Coristoma/patología , Enfermedades de la Vesícula Biliar/patología , Páncreas , Adulto , Colecistectomía Laparoscópica , Colecistitis/etiología , Colecistitis/cirugía , Coristoma/cirugía , Enfermedades de la Vesícula Biliar/cirugía , Humanos , MasculinoRESUMEN
BACKGROUND: KRAS mutation is a negative prognostic factor for colorectal liver metastases. Several studies have investigated the resection margins according to KRAS status, with conflicting results. The aim of the study was to assess the oncologic outcomes of R0 and R1 resections for colorectal liver metastases according to KRAS status. METHODS: All patients who underwent resection for colorectal liver metastases between 2010 and 2015 with available KRAS status were enrolled in this multicentric international cohort study. Logistic regression models were used to investigate the outcomes of R0 and R1 colorectal liver metastases resections according to KRAS status: wild type versus mutated. The primary outcomes were overall survival and disease-free survival. RESULTS: The analysis included 593 patients. KRAS mutation was associated with shorter overall survival (40 vs 60 months; P = .0012) and disease-free survival (15 vs 21 months; P = .003). In KRAS-mutated tumors, the resection margin did not influence oncologic outcomes. In multivariable analysis, the only predictor of disease-free survival and overall survival was primary tumor location (P = .03 and P = .03, respectively). In KRAS wild-type tumors, R0 resection was associated with prolonged overall survival (74 vs 45 months, P < .001) and disease-free survival (30 vs 17 months, P < .001). The multivariable model confirmed that R0 resection margin was associated with prolonged overall survival (hazard ratio = 1.43, 95% confidence interval: 1.01-2.03) and disease-free survival (hazard ratio = 1.42; 95% confidence interval: 1.06-1.91). CONCLUSIONS: KRAS-mutated colorectal liver metastases showed more aggressive tumor biology with inferior overall survival and disease-free survival after liver resection. Although R0 resection was not associated with improved oncologic outcomes in the KRAS-mutated tumors group, it seems to be of paramount importance for achieving prolonged long-term survival in KRAS wild-type tumors.
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Neoplasias Colorrectales , Hepatectomía , Neoplasias Hepáticas , Márgenes de Escisión , Mutación , Proteínas Proto-Oncogénicas p21(ras) , Humanos , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/mortalidad , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/mortalidad , Proteínas Proto-Oncogénicas p21(ras)/genética , Masculino , Femenino , Persona de Mediana Edad , Anciano , Supervivencia sin Enfermedad , Estudios Retrospectivos , Pronóstico , Anciano de 80 o más Años , AdultoRESUMEN
(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.
RESUMEN
Páncreas ectópico o heterotópico se define como la presencia de tejido pancreático en una localización anatómica que no tiene relación con el páncreas, siendo sus localizaciones más frecuentes el estómago y el intestino delgado. Su hallazgo en la vesícula biliar es excepcional. Desde que Otschkin publicara el primer caso en 1916, alrededor de 30 más han sido descritos en la literatura. Presentamos el caso de un paciente varón de 43 años al que se le realizó una colecistectomía laparoscópica urgente con diagnóstico de colecistitis aguda cuyo estudio histopatológico demostró la existencia de colecistitis crónica con tejido pancreático heterotópico en la pared de la vesícula biliar (AU)
Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue in an anatomical place not related to the pancreas, being it most frequent locations the stomach and small bowel. Its finding in the gallbladder is exceptional. Since the first case was reported by Otschkin in 1916, about 30 cases have been described in literature. We report the case of a 43 years-old male patient who had an urgent laparoscopic cholecystectomy with the diagnosis of acute cholecystitis, which pathological study showed the existence of chronic cholecystitis with heterotopic pancreatic tissue in the gallbladder Wall (AU)
Asunto(s)
Adulto , Humanos , Masculino , Páncreas/patología , Páncreas , Vesícula Biliar/patología , Vesícula Biliar , Colecistitis Aguda/patología , Colecistitis Aguda , Colecistectomía Laparoscópica/instrumentación , Colecistectomía Laparoscópica/métodos , Colecistectomía LaparoscópicaRESUMEN
OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with local-regional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient's survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.
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Neoplasias de las Glándulas Suprarrenales/cirugía , Carcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/mortalidad , Adulto , Carcinoma/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Reoperación , Factores de TiempoRESUMEN
OBJETIVO: Comunicamos el caso de unapaciente con un cáncer suprarrenal intervenido que presentóposteriormente recidivas locorregional y a distancia,enfatizando la importancia del tratamiento quirúrgicoagresivo para lograr supervivencias a veces noesperadas a largo plazo. En la actualidad, representael gold standard y todos los casos deben comunicarsepara estimular a los distintos grupos a trabajar enesta línea.MÉTODO/RESULTADOS: se presenta el caso de unapaciente de 29 años que consultó por dolor en flancoizquierdo, diagnosticándose en los estudios de imagenun tumor suprarrenal; fue intervenida, realizándoseresección de un carcinoma suprarrenal izquierdo(Estadio II). Posteriormente presentó recidiva locorregional(en dos ocasiones) y a distancia (en hígado), siendoresecada la enfermedad en las tres ocasiones en sutotalidad. En el momento actual, 7 años después deldiagnóstico, está viva y libre de enfermedad.CONCLUSIÓN: la recidiva del cáncer suprarrenal seha considerado letal a corto plazo desde el punto devista pronóstico. Sin embargo, un abordaje quirúrgicoagresivo de la enfermedad recurrente y metastásicapuede prolongar de forma significativa la supervivenciadel paciente y lograr, en ocasiones, status de libre deenfermedad varios años después del diagnóstico deltumor primario
OBJECTIVES: We report the case of afemale patient with adrenal carcinoma who had undergonesurgery and presented with local-regional and distantrecurrences, emphasizing the importance of theaggressive surgical treatment to achieve long-term survivalwhich is unexpected sometimes. Currently, it representsthe gold standard and all cases should be reported tostimulate other groups to work in this line.METHODS/RESULTS: We report the case of a 29-yearoldfemale patient who consulted for left flank pain,being diagnosed of an adrenal tumor by radiologicaltests; she underwent surgical excision of a left adrenalcarcinoma (stage II). Later on she presented with localregionalrecurrences (2 times) and distant metastases(liver) undergoing excision in three procedures.Currently, the patient is alive and free of disease 7 yearsafter diagnosis.CONCLUSIONS: Adrenal cancer recurrences havebeen considered lethal in the short-term. Nevertheless,an aggressive surgical approach of local recurrencesand metastasic disease may significantly prolongpatients survival and, sometimes, leave the patient diseasefree several years after the diagnosis of the primarytumor