Comprehensive and systematic characterization of multi-functionalized cisplatin nano-conjugate: from the chemistry and proteomic biocompatibility to the animal model.

BACKGROUND: Nowadays, nanoparticles (NPs) have evolved as multifunctional systems combining different custom anchorages which opens a wide range of applications in biomedical research. Thus, their pharmacological involvements require more comprehensive analysis and novel nanodrugs should be characterized by both chemically and biological point of view. Within the wide variety of biocompatible nanosystems, iron oxide nanoparticles (IONPs) present mostly of the required features which make them suitable for multifunctional NPs with many biopharmaceutical applications. RESULTS: Cisplatin-IONPs and different functionalization stages have been broadly evaluated. The potential application of these nanodrugs in onco-therapies has been assessed by studying in vitro biocompatibility (interactions with environment) by proteomics characterization the determination of protein corona in different proximal fluids (human plasma, rabbit plasma and fetal bovine serum),. Moreover, protein labeling and LC-MS/MS analysis provided more than 4000 proteins de novo synthetized as consequence of the nanodrugs presence defending cell signaling in different tumor cell types (data available via ProteomeXchanges with identified PXD026615). Further in vivo studies have provided a more integrative view of the biopharmaceutical perspectives of IONPs. CONCLUSIONS: Pharmacological proteomic profile different behavior between species and different affinity of protein coating layers (soft and hard corona). Also, intracellular signaling exposed differences between tumor cell lines studied. First approaches in animal model reveal the potential of theses NPs as drug delivery vehicles and confirm cisplatin compounds as strengthened antitumoral agents.

[Cervical anastomotic leak after esophagectomy: diagnosis and management]. / Fístula cervical postesofagectomía: diagnóstico y tratamiento.

INTRODUCTION: Cervical anastomotic leaks after esophagectomy are still a frequent and severe complication that needs an early diagnosis and an appropriate treatment. The aim of this study was to describe our experience with the management of this complication. PATIENTS AND METHODS: Retrospective study (2003-2011) of a consecutive series of 77 patients with a cervical esophagogastric anastomosis, 18 of them (23.3%) presenting a leak. Fistulae were classified into 4 groups depending on clinical presentation, radiology (esophagogram or CT), surgical findings (in case of re-operation) and, since 2010, endoscopic examination. Type I leaks were an asymptomatic or radiographic leak, type II had local signs limited to the neck, type III was associated with respiratory symptoms due to a pleural or mediastinal collection, and type IV with a systemic disorder secondary to gastric necrosis. RESULTS: Four patients (22.2%) were classified as type I, 8 (44.4%) as type II, 3 (16.6%) as type III, and 3 (16.6%) as type IV. Eight patients were managed conservatively; in 9 a self-expanding stent was used, 5 required a thoracotomy, and one of them (type IV) died. Leaks were related to a higher associated morbidity (61 versus 30%; P=.019) and a longer hospital stay (median of 28.5 vs 14 days; P=.009). CONCLUSIONS: Almost one quarter of cervical esophagogastric anastomoses present some kind of anastomotic leak. Although most of them can be treated conservatively or by endoscopy, they are associated with an increase in morbidity and mortality.

Incidence and risk factors for de novo cholelithiasis after bariatric surgery.

INTRODUCTION: Obesity and rapid weight loss after bariatric surgery (BS) are risk factors for the development of cholelitiasis. The aim of this study is to know the incidence of the de novo symptomatic cholelitiasis (DNSC) after BS and to analyze the risk factors for its development. METHODS: Single-centre retrospective observational study of patients undergoing BS between January 2010 and December 2017. The incidence of DNSC has been studied and sex, age, comorbilities, surgical tecnique, initial BMI and percentage of excess BMI lost (%EBMIL) at 6th, 12th and 24th postoperative months have been analyzed. RESULTS: Among the 415 patients who underwent BS, 280 have been studied since they were not previously cholecystectomized and had a preoperative negative abdominal ultrasound. Twenty-nine developed DNSC (10,35%), with a remarkably higher increase in cumulative incidence during the first postoperative year (CI 5%, IC 95% 2,4-7,6). A higher percentage of excess BMI lost at the 6, 12 and 24 postoperative months was statistically significantly correlated with an increased risk of DNSC. CONCLUSIONS: Incidence of DNSC and cholecystectomy after BS are relatively high, mainly during rapid weight loss period and even more the higher the percentage of excess BMI lost is. Concomitant cholecystectomy during BS in case of preoperative cholelithiasis regardless of symptoms and the use of ursodeoxycholic acid during the period of greater risk for DNSC development are two therapeutic options to consider.

Incidence and risk factors for de novo cholelithiasis after bariatric surgery. / Incidencia y factores de riesgo para el desarrollo de colelitiasis tras cirugía bariátrica.

INTRODUCTION: Obesity and rapid weight loss after bariatric surgery (BS) are risk factors for the development of cholelitiasis. The aim of this study is to know the incidence of the de novo symptomatic cholelitiasis (DNSC) after BS and to analyze the risk factors for its development. METHODS: Single-centre retrospective observational study of patients undergoing BS between January 2010 and December 2017. The incidence of DNSC has been studied and sex, age, comorbilities, surgical tecnique, initial BMI and percentage of excess BMI lost (%EIMCP) at 6th, 12th and 24th postoperative months have been analyzed. RESULTS: Among the 415 patients who underwent BS, 280 have been studied since they were not previously cholecystectomized and had a preoperative negative abdominal ultrasound. Twenty-nine developed DNSC (10.35%), with a remarkably higher increase in cumulative incidence during the first postoperative year (5%, 95% CI 2,4-7,6). A higher percentage of excess BMI lost at the 6, 12 and 24 postoperative months was statistically significantly correlated with an increased risk of DNSC. CONCLUSIONS: Incidence of DNSC and cholecystectomy after BS are relatively high, mainly during rapid weight loss period and even more the higher the percentage of excess BMI lost is. Concomitant cholecystectomy during BS in case of preoperative cholelithiasis regardless of symptoms and the use of ursodeoxycholic acid during the period of greater risk for DNSC development are two therapeutic options to consider.

Minimally invasive and robotic surgery in the surgical treatment of esophagogastric junction cancer. / Cirugía mínimamente invasiva y robótica en el tratamiento quirúrgico de las neoplasias de la unión esofagogástrica.

Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.

Estadiaje ganglionar en el adenocarcinoma gástrico / Lymph node stage in gastric adenocarcinoma

Resumen Objetivos: El sistema linfático del estómago es complejo y multidireccional, siendo difícil predecir el patrón de diseminación linfática en el adenocarcinoma (ADC) gástrico. Los objetivos de este trabajo son determinar si el analizar los grupos ganglionares de la pieza quirúrgica por separado tiene implicaciones en el estadiaje, además estudiar la afectación de diferentes grupos ganglionares. Materials y Método: Estudio observacional retrospectivo de pacientes intervenidos de gastrectomía y linfadenectomía con intención curativa por ADC en un hospital de referencia (2017-2021).,_Se han comparado aquellos pacientes cuya pieza quirúrgica se estudió en su totalidad (grupo A) con aquellos en los que se separaron los grupos ganglionares para su análisis (grupo B). En el grupo B, se ha analizado la afectación ganglionar de diferentes grupos ganglionares en base a la localización tumoral y el estadio pT. Resultados: Se incluyeron 150 pacientes. La media de ganglios analizados fue significativamente mayor cuando se separaron los grupos ganglionares (grupo B) (24,01 respecto a 20,49). La afectación ganglionar fue del 45,8%, 58,3% y 55,5% en los tumores de tercio superior, medio e inferior respectivamente, y los grupos difirieron en base a la localización tumoral. El riesgo de afectación ganglionar fue significativamente mayor y hubo más grupos ganglionares perigástricos afectos cuanto mayor era el estadio pT. Conclusiones: Separar los grupos ganglionares previo a su análisis aumenta el número de ganglios analizados mejorando el estadiaje ganglionar. Existen diferentes rutas de drenaje linfático dependiendo de la localización tumoral y la afectación ganglionar aumenta de forma paralela al estadio pT.

Objectives: The lymphatic system of the stomach is complex and multidirectional, making it difficult to predict the pattern of lymphatic spread in gastric adenocarcinoma (GAC). The aim of this paper is to determine if analyzing the lymph node groups of the surgical specimen separately has implications in the pathological staging, as well as to study the involvement rate of different lymph node groups. Material and Method: Retrospective observational study of patients who underwent curative intent gastrectomy and lymphadenectomy for GAC in a reference hospital (2017-2021). Those patients whose surgical specimen was studied as a whole (group A) were compared with those in whom the lymph node groups were separated by surgeons before analysis (group B). In group B, the involvement of different lymph node groups was analyzed based on tumor location and pT stage. Results: 150 patients were included. The mean number of lymph nodes analyzed was significantly higher when the lymph node groups were separately analyzed (group B) (24.01 compared to 20.49). Lymph node involvement was 45.8%, 58.3%, and 55.5% in tumors of the upper, middle, and lower third, respectively, and the involved groups differed depending on the tumor location. The higher the pT stage was, the risk of lymph node involvement was significantly higher and there were more perigastric lymph node groups affected. Conclusions: Separating lymph node groups prior to their analysis increases the number of lymph nodes analyzed and therefore improves lymph node staging. There are different lymphatic drainage routes depending on the tumor location and lymph node involvement increases in parallel with the pT stage.

Gastrectomía vertical versus by-pass gástrico en Y de Roux: resultados a corto y medio plazo / Sleeve gastrectomy vs gastric bypass: results in the short and medium term

Resumen Introducción: La gastrectomía vertical (GV) y el by-pass gástrico (BPG) son los procedimientos más utilizados en el tratamiento de la obesidad. El objetivo de este trabajo es comparar ambas técnicas tanto en pérdida ponderal como en mejoría de las comorbilidades asociadas. Materiales y Método: Estudio observacional ambispectivo de los pacientes sometidos a BPG y GV desde enero de 2011 hasta diciembre de 2013. Se ha analizado la pérdida de peso y de IMC, la tasa de éxito, la reganancia de peso, el impacto en las comorbilidades asociadas y la morbimortalidad de ambas técnicas. Resultados: 172 pacientes fueron intervenidos (92 BPG y 80 GV). El BPG presenta mejores resultados en cuanto a pérdida de peso y mejoría de las comorbilidades. El grupo GV presenta mayor reganancia de peso. Ambos procedimientos presentan resultados similares en cuanto a morbimortalidad.

Introduction: Sleeve gastrectomy (SG) and gastric bypass (GBP) are the most commonly used procedures in the treatment of obesity. The objective of this paper is to compare these two techniques in regard to weight loss and improvement of the associated comorbidities. Material and Method: An ambispective observational study of patients undergoing GBP and SG from January 2011 to December 2013. Weight loss, BMI, success rate, weight regain, impact on associated comorbidities and morbimortality of both techniques were analysed. Results: 172 patients underwent operations (92 GBP and 80 SG). GBP had better results in regard to weight loss and improvement of comorbidities. The SG group had greater weight regain. The two procedures had similar results in regard to morbimortality.

[Laparoscopic treatment of ventral hernia under spinal anesthesia]. / Tratamiento laparoscópico de la hernia ventral con anestesia intradural.

INTRODUCTION: Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair. PATIENTS AND METHOD: Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum. RESULTS: Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration. CONCLUSIONS: Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted.

[Minimally invasive esophagectomy]. / Esofagectomía mínimamente invasiva.

INTRODUCTION: Currently, the bases for the treatment of esophageal cancer are surgical resection and chemotherapy. Among the various surgical techniques used, minimally invasive esophagectomy (MIE) aims to reduce surgical aggression and cardiopulmonary complications while maintaining basic oncological principles. We present the results of our initial experience with this technique in the treatment of esophageal cancer. MATERIAL AND METHOD: Fourteen patients with a diagnosis of esophageal cancer were selected to undergo MIE in three stages: right thoracoscopy, laparoscopy, and left cervicotomy with cervical esophagogastric anastomosis. Histological diagnosis was epidermoid carcinoma (n = 11) and high grade dysplasia (n = 3), one of which was highly suspicious of malignant transformation. After extension studies, preoperative clinical stages were as follows: stage 0 (n = 3), stage IIA (n = 10), and stage III (n = 1). Seven patients were treated with chemotherapy and neoadjuvant radiotherapy and the remainder underwent surgery without prior treatment. RESULTS: The mean operating time was 299 minutes (range: 195-425). The conversion rate was 14% (n = 2). Mortality was 0% and morbidity was 50%, consisting of three major complications and four minor complications. No anastomotic dehiscence or wound infections were observed. Complete (R0) resections were achieved in 92.8% (n = 13). Transfusion needs were 1.1 U/patient. The mean number of nodes removed was 10.2/patient (range: 5-17). The mean length of hospital stay was 21 days (range: 9-64). Postoperative follow-up ranged from 1 to 17 months. All patients were alive and disease-free except for one patient with liver metastases. CONCLUSIONS: Although MIE is a demanding technique, we believe that it is technically feasible in the treatment of esophageal cancer with acceptable postoperative morbidity and mortality. Consequently, it should be considered as an alternative to open surgery in selected patients.