Left gastric vein to adrenal vein anastomosis: intraoperative solution for gastric venous congestion following extended distal pancreatectomy.

Extended distal pancreatectomy often requires resection of vascular structures and adjacent organs, potentially leading to gastric venous congestion. This case report describes a 49-year-old female who underwent radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma. During the procedure, segmental gastric venous congestion was observed and resolved by anastomosing the left gastric vein to the left adrenal vein. The in-hospital postoperative recovery was initially uneventful; however, the patient was readmitted because of intra-abdominal fluid collection that was managed with antibiotics. Pathological examination confirmed moderately differentiated ductal adenocarcinoma with lymphovascular invasion. The patient received adjuvant mFOLFIRINOX therapy and remains disease-free 12 months after surgery with adequate patency of the anastomosis. This case highlights the importance of recognizing and addressing gastric venous congestion during radical antegrade modular pancreatosplenectomy to prevent complications, such as delayed gastric emptying or gastric necrosis, and proposes left gastric vein to left adrenal vein anastomosis as an effective intraoperative solution.

Association between Helicobacter pylori infection, mismatch repair, HER2 and tumor-infiltrating lymphocytes in gastric cancer.

BACKGROUND: The influence of Helicobacter-pylori (H. pylori) infection and the characteristics of gastric cancer (GC) on tumor-infiltrating lymphocyte (TIL) levels has not been extensively studied. Analysis of infiltrating-immune-cell subtypes as well as survival is necessary to obtain comprehensive information. AIM: To determine the rates of deficient mismatch-repair (dMMR), HER2-status and H. pylori infection and their association with TIL levels in GC. METHODS: Samples from 503 resected GC tumors were included and TIL levels were evaluated following the international-TILs-working-group recommendations with assessment of the intratumoral (IT), stromal (ST) and invasive-border (IB) compartments. The density of CD3, CD8 and CD163 immune cells, and dMMR and HER2-status were determined by immunohistochemistry (IHC). H. pylori infection was evaluated by routine histology and quantitative PCR (qPCR) in a subset of samples. RESULTS: dMMR was found in 34.4%, HER2+ in 5% and H. pylori-positive in 55.7% of samples. High IT-TIL was associated with grade-3 (P = 0.038), while ST-TIL with grade-1 (P < 0.001), intestinal-histology (P < 0.001) and no-recurrence (P = 0.003). dMMR was associated with high TIL levels in the ST (P = 0.019) and IB (P = 0.01) compartments, and ST-CD3 (P = 0.049) and ST-CD8 (P = 0.05) densities. HER2- was associated with high IT-CD8 (P = 0.009). H. pylori-negative was associated with high IT-TIL levels (P = 0.009) when assessed by routine-histology, and with high TIL levels in the 3 compartments (P = 0.002-0.047) and CD8 density in the IT and ST compartments (P = 0.001) when assessed by qPCR. A longer overall survival was associated with low IT-CD163 (P = 0.003) and CD8/CD3 (P = 0.001 in IT and P = 0.002 in ST) and high IT-CD3 (P = 0.021), ST-CD3 (P = 0.003) and CD3/CD163 (P = 0.002). CONCLUSION: TIL levels were related to dMMR and H. pylori-negativity. Low CD8/CD3 and high CD163/CD3 were associated with lower recurrence and longer survival.

Fibrolamellar Carcinoma: A Rare Liver Neoplasm.

Fibrolamellar carcinoma is a rare liver tumor, with most cases arising in people younger than 40 years of age. We present a case series of five patients with histological confirmation of fibrolamellar carcinoma who had liver resection as the primary treatment. The median age of diagnosis was 24 years with nonspecific clinical manifestations in otherwise healthy patients. Alpha-fetoprotein levels were widely variable. Patients had classical imaging, macroscopic, and microscopic findings. Most of our patients underwent a hemihepatectomy and 60% recurred after the first year.

A preoperative risk score based on early recurrence for estimating outcomes after resection of hepatocellular carcinoma in the non-cirrhotic liver.

BACKGROUND: Liver resection is the mainstay treatment option for patients with hepatocellular carcinoma in the non-cirrhotic liver (NCL-HCC), but almost half of these patients will experience a recurrence within five years of surgery. Therefore, we aimed to develop a rationale-based risk evaluation tool to assist surgeons in recurrence-related treatment planning for NCL-HCC. METHODS: We analyzed single-center data from 263 patients who underwent liver resection for NCL-HCC. Using machine learning modeling, we first determined an optimal cut-off point to discriminate early versus late relapses based on time to recurrence. We then constructed a risk score based on preoperative variables to forecast outcomes according to recurrence-free survival. RESULTS: We computed an optimal cut-off point for early recurrence at 12 months post-surgery. We identified macroscopic vascular invasion, multifocal tumor, and spontaneous tumor rupture as predictor variables of outcomes associated with early recurrence and integrated them into a scoring system. We thus stratified, with high concordance, three groups of patients on a graduated scale of recurrence-related survival. CONCLUSION: We constructed a preoperative risk score to estimate outcomes after liver resection in NCL-HCC patients. Hence, this score makes it possible to rationally stratify patients based on recurrence risk assessment for better treatment planning.

Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer-associated pain: different technical approaches in three challenging cases

Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancerassociated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.

El cáncer de páncreas se puede presentar con dolor abdominal intenso, siendo necesario el uso de analgésicos a largo plazo en muchos de los pacientes. Sin embargo, estos medicamentos pueden tener efectos adversos que finalmente reducen la calidad de vida de los pacientes. La neurólisis del plexo celíaco guiada por ecoendoscopia es un procedimiento que controla el dolor asociado a este tipo de neoplasia y consiste en inyectar un agente neurolítico en o alrededor del plexo celíaco. Presentamos tres casos en los cuales se realizan diferentes técnicas de abordaje terapéutico.

Predictive factors of lymphatic metastasis and evaluation of the Japanese treatment guidelines for endoscopic resection of early gastric cancer in a high-volume center in Perú.

Purpose: This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Methods: Five hundred-one patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify the predictive factors of LNM. EGC patients were distributed according to the indications for endoscopic resection of the Eastern guidelines. The incidence of LNM was evaluated in each group. Results: From 501 patients with EGC, 96 (19.2%) presented LNM. In 279 patients with tumors with submucosal infiltration (T1b), 83 (30%) patients had LNM. Among 219 patients who presented tumors > 3 cm, 63 (29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN (33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%, respectively. In the multivariate analysis, a tumor diameter >3 cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. No patient with differentiated, non-ulcerated mucosal tumors presented LNM regardless of tumor size. Three of 17 patients (18%) with differentiated, ulcerated mucosal tumors and ≤ 3 cm presented LNM. No LNM was evidenced in patients with undifferentiated mucosal tumors and ≤ 2 cm. Conclusions: The presence of LNM in Western EGC patients was independently related to larger tumors (>3 cm), submucosal invasion, lymphovascular and perineural invasion. The Japanese absolute indications for EMR are safe in the Western population. Likewise, Western patients with differentiated, non-ulcerated mucosal tumors, and larger than 2 cm are susceptible to endoscopic resection. Patients with undifferentiated mucosal tumors smaller than 2 cm presented encouraging results and ESD could be recommended only for selected cases.

[Gastric cancer in octogenarians. Is a curative surgery viable?] / C áncer g ástrico en octogenarios ¿Es viable una cirugía con intención curativa?

The objective was to evaluate the association between octogenarian age and the rate of postoperative morbidity and mortality and 5-year survival in older adults at the National Institute of Neoplastic Diseases (INEN) during the period 2000-2013. We developed an observational, retrospective, analytical, paired cohort study. It includes patients with gastric adenocarcinoma as diagnosis, treated by R0 D2 gastrectomy at INEN during the period 2000 to 2013. One group included all octogenarian patients who met the inclusion criteria (92) and the other group made up of non-octogenarian patients, aged between 50 to 70 years because it is the age peak for this pathology (276). In a 1:3 ratio, paired according to sex, tumor stage, and type of gastrectomy, which are the main factors that could influence survival in this population. Octogenarians had lower albumin level (p < 0.002), lower preoperative hemoglobin (p<0.001) and higher ASA classification (p<0.001). 30 days mortality rate was higher in octogenarians but not statistically significant (4.1% vs 1.4%; p=0.099). The 5-year cumulative survival probability was 56% for octogenarians and 58% for non- octogenarians (p=0.763). Clinical stage >= III and postoperative complication grade >= 3 by Clavien Dindo scale were predictors of survival. In conclusion, octogenarians have a higher rate of postoperative morbidity, mainly for respiratory causes. Postoperative mortality and overall survival rates do not differ between octogenarians and non-octogenarians with stomach cancer treated by R0 D2 gastrectomy.

Cáncer gástrico en octogenarios ¿Es viable una cirugía con intención curativa?

El objetivo de la presente investigación es evaluar la asociación entre la edad octogenaria y la tasa de morbimortalidad posoperatoria y supervivencia a los 5 años en adultos mayores tratados mediante gastrectomía R0 D2 en el Instituto Nacional de Enfermedades Neoplásicas (INEN) durante el periodo 2000-2013. Se realizó un estudio observacional, retrospectivo, analítico de cohorte pareado, que incluye pacientes con diagnóstico de adenocarcinoma gástrico tratados mediante gastrectomía R0 D2 en el INEN durante los años 2000 a 2013. Un grupo compuesto por todos los pacientes octogenarios que cumplieron los criterios de inclusión (92) y otro grupo compuesto por pacientes no octogenarios, con edades entre 50 a 70 años por ser el pico de presentación para esta patología (276). En una proporción 1:3, pareados según sexo, estadio tumoral y tipo de gastrectomía, los cuales constituyen los principales factores que podrían influir en la sobrevida de esta población. Los octogenarios presentaron menor albúmina (p<0,002), menor hemoglobina preoperatoria (p<0,001) y mayor clase ASA (p<0,001). La tasa de mortalidad a 30 días fue mayor en los octogenarios, pero no estadísticamente significativa (4,1% vs 1,4%; p=0,099). La probabilidad acumulada de supervivencia a 5 años fue 56% para octogenarios y 58% para los controles (p=0,763). El estadio clínico ≥ III y complicación posoperatoria grado ≥3 por Clavien Dindo fueron factores asociados de supervivencia. En conclusión, los octogenarios presentan mayor tasa de morbilidad posoperatoria, principalmente de causa respiratoria. Las tasas de mortalidad posoperatoria y supervivencia global no difieren entre octogenarios y no octogenarios con cáncer de estómago tratados mediante gastrectomía R0 D2.

The objective was to evaluate the association between octogenarian age and the rate of postoperative morbidity and mortality and 5-year survival in older adults at the National Institute of Neoplastic Diseases (INEN) during the period 2000-2013. We developed an observational, retrospective, analytical, paired cohort study. It includes patients with gastric adenocarcinoma as diagnosis, treated by R0 D2 gastrectomy at INEN during the period 2000 to 2013. One group included all octogenarian patients who met the inclusion criteria (92) and the other group made up of non-octogenarian patients, aged between 50 to 70 years because it is the age peak for this pathology (276). In a 1:3 ratio, paired according to sex, tumor stage, and type of gastrectomy, which are the main factors that could influence survival in this population. Octogenarians had lower albumin level (p<0.002), lower preoperative hemoglobin (p<0.001) and higher ASA classification (p<0.001). 30 days mortality rate was higher in octogenarians but not statistically significant (4.1% vs 1.4%; p=0.099). The 5-year cumulative survival probability was 56% for octogenarians and 58% for non- octogenarians (p=0.763). Clinical stage ≥ III and postoperative complication grade ≥ 3 by Clavien Dindo scale were predictors of survival. In conclusion, octogenarians have a higher rate of postoperative morbidity, mainly for respiratory causes. Postoperative mortality and overall survival rates do not differ between octogenarians and non-octogenarians with stomach cancer treated by R0 D2 gastrectomy.

Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer-associated pain: different technical approaches in three challenging cases.

Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancer-associated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.

Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer.

Background: Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru; however, there are no prospective trials for adjuvant chemotherapy in GC after curative gastrectomy in this country. The objective of this study was to evaluate the effectiveness of adjuvant chemotherapy in stage II-III gastric cancer patients who underwent D2 gastrectomy. Methods: We included patients with stage II-III gastric cancer who underwent radical gastrectomy and D2 dissection between 2014 and 2016 at our institution. Patients received 3-week cycles of capecitabine (1,000 mg/m2 twice daily on days 1-14) plus oxaliplatin (130 mg/m2 on day 1) for 6 months. Survival curves were estimated with the Kaplan-Meier method, and the Cox proportional hazards model was used to identify prognostic factors for survival. Results: In total, 173 patients were included: 100 (57.8%) patients received adjuvant chemotherapy and surgery (AChS) and 73 (42.2%) surgery alone (SA). Three-year disease-free survival (DFS) was higher in the AChS groups (69%) than in the SA group (52.6%) (p = 0.034). Regarding overall survival (OS), 31 patients (31%) died in the AChS group compared with 34 (46.6%) in the SA group (p = 0.027). In the multivariate analysis, adjuvant chemotherapy was an independent prognostic factor for DFS (HR = 0.60; 95% CI = 0.37-0.97; p = 0.036) and OS (HR = 0.58; 95% CI = 0.36-0.95; p = 0.029). ACh showed consistent benefit in DFS and OS for patients with albumin >3.5 g/dL, lymphovascular and perineural invasion, pT4, pN2-3, pathologic stage (PS) IIIA and IIIB and lymph node ratio (LNR) > 13.1. Conclusion: These data suggest that adjuvant capecitabine and oxaliplatin reduce the recurrence and mortality in patients with stage II-III gastric cancer who underwent D2 gastrectomy. PS IIIA and IIIB and LNR > 13.1 benefited more from receiving adjuvant chemotherapy and poorly cohesive gastric carcinoma did not significantly reduce the rates of survival.

Prevalencia, factores de riesgo y desenlace de delirium en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen / Delirium prevalence, risk factors and outcome in the Intensive Care Unit at Hospital Ángeles del Carmen / Prevalência, fatores de risco e resultados do delirium na Unidade de Cuidados Intensivos Hospital Ángeles del Carmen

Resumen: Introducción: El delirium es común en pacientes críticos, se asocia con múltiples factores de riesgo, mal pronóstico y aumento de la mortalidad. Material y métodos: Se realizó un estudio observacional analítico en la Unidad de Cuidados Intensivos entre 2017 y 2018. Se documentó la prevalencia de delirium, los factores de riesgo y su asociación con mortalidad, tratamiento farmacológico y no farmacológico. Se utilizó el paquete estadístico IBM© SPSS© Statistics V24. Resultados: Se incluyeron 563 pacientes. La prevalencia fue de 14% (n = 79). Los factores de riesgo más significativos fueron demencia (OR 9.0), sedación (OR 6.7), etilismo (OR 5.0), EuroSCORE > 5% (OR 4.8), ingesta deficiente (OR 4.6), infección nosocomial (OR 3.2), ventilación mecánica no invasiva (OR 2.8) y edad > 67 años (OR 2.7). La mortalidad fue de 10.1% (13.9% con delirium, 10.3% con delirium hiperactivo/mixto y 23.8% con delirium hipoactivo, OR 1.93, IC 95% de 0.88-4.19, p = 0.12). La ausencia de tratamiento no farmacológico se asoció a mayor mortalidad (30.8 vs 10.6%, OR 2.74, IC 95% de 1.02-7.39, p = 0.05). Conclusión: La prevalencia de delirium en nuestra unidad es baja, con diferente proporción por tipo de delirium y diferentes factores de riesgo. El delirium hipoactivo y la omisión de tratamiento no farmacológico se asociaron a mayor mortalidad.

Abstract: Introduction: Delirium is a common condition in critical care patients, and is associated with multiple risk factors, poor prognosis and high mortality rate. Material and methods: An observational analytic study was conducted in a the Intensive Care Unit during 2017-2018, documenting delirium prevalence, risk factors and their association with mortality, pharmacological and non-pharmacological treatment, using IBM© SPSS© Statistics V24. Results: 563 patients were included, finding a prevalence of 14% (n = 79). The most significant risk factors were preexisting dementia (OR 9.0), sedation (OR 6.7), alcohol abuse (OR 5.0), non-invasive mechanical ventilation (OR 2.8) and age > 67 years (OR 2.7). The general mortality rate was 10.1% (13.9% in patients with delirium, 10.3% in hyperactive/mixed delirium and 23.8% in hypoactive delirium, OR 1.93, CI 95% 0.88-4.19, p = 0.12). Absence of non-pharmacological treatment was associated with higher mortality (30.8 vs 10.6%, OR 2.74, CI 95% 1.02-7.39, p = 0.05). Conclusion: There is a low prevalence of delirium in our unit, with differences in delirium types and risk factors. Hypoactive delirium and absence of non-pharmacological treatment were associated with higher mortality.

Resumo: Antecedentes: Delirium é comum em pacientes críticos e está associado a múltiplos fatores de risco, mau prognóstico e aumento da mortalidade. Material e métodos: Realizou-se um estudo observacional analítico na unidade de terapia intensiva entre 2017 e 2018. Foram documentadas a prevalência de delirium, fatores de risco e sua associação com mortalidade, tratamento farmacológico e não farmacológico. Utilizou-se o pacote estatístico IBM©SPSS©Statistics V24. Resultados: Incluíram-se 563 pacientes. A prevalência foi de 14% (n = 79). Os fatores de risco mais significativos foram demência (OR 9.0), sedação (OR 6.7), alcoolismo (OR 5.0), Euroscore > 5% (OR 4.8), má ingestão (OR 4.6), infecção hospitalar (OR 3.2), ventilação mecânica não invasiva (OR 2.8) e idade > 67 anos (OR 2.7). A mortalidade foi de 10.1% (13.9% com delirium, 10.3% com delirium hiperativo/misto e 23.8% com delirium hipoativo, OR 1.93, IC 95% 0.88-4.19, p = 0.12). A ausência de tratamento não farmacológico foi associada a maior mortalidade (30.8 vs 10.6%, OR 2.74, IC 95% 1.02-7.39, p = 0.05). Conclusão: A prevalência de delirium em nossa unidade é baixa, com proporção diferente por tipo de delirium e diferentes fatores de risco. Delirium hipoativo e omissão de tratamento não farmacológico foram associados a maior mortalidade.

Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru.

OBJECTIVE: The study aimed to describe and compare minimally invasive surgery (MIS) and open surgery for rectal cancer in Peru. MATERIAL AND METHODS: A retrospective single-center analysis was performed for all patients who underwent sphinctersparing surgery for non-metastatic rectal cancer at Instituto Nacional de Enfermedades Neoplásicas in Peru between January 2016 and December 2020. Clinical, perioperative, pathological, and survival outcomes were compared between both groups. A propensity score matching method was used to minimize bias. RESULTS: 162 patients were included in the final analysis. 124 had open surgery and 38 had MIS. Patients, clinical tumour, pathological characteristics, and perioperative were similar between groups after matching. Similar circumferential resection margin (CRM) with optimal quality of the mesorectum (p=1.000) but higher number of lymph nodes resected in open surgery group (p=0.741) was described. The leakage rate was slightly higher in the MIS group (p=0.358) with 10.5%, while the postoperative hospital stay was longer in the open surgery group after matching (p=0.001; OR 95% 5.2 CI: 1.8-15.6). The estimated recurrence-free survival (RFS) and overall survival (OS) at 3 years in open surgery and MIS was 71.8% (95% CI; 0.58-0.89) and 70% (95% CI; 0.56-0.88) (p=0.431) and 77.7% (95% CI; 0.64-0.94) and 88.9% (95% CI; 0.79-0.99) (p=0.5), respectively. CONCLUSIONS: Shorter postoperative hospital stay in the minimally invasive surgery group was reported. RFS, OS, and recurrence rates were similar between both groups. This approach is for non-metastatic rectal cancer in referral centers in Peru.

The relationship between tumour infiltrating lymphocytes, Epstein-Barr virus and Helicobacter pylori infection in gastric cancer.

Objective: Epstein-Barr virus (EBV) and Helicobacter pylori (HP) infections have been extensively recognised as gastric cancer (GC) triggers, and recent publications suggest they could behave as predictive markers for immune-modulating therapies. Tumour-infiltrating lymphocytes (TILs) have also been identified as a predictive biomarker for immunotherapy in different malignancies. This study aimed to investigate the association between EBV and HP infection with TIL levels in GC. Methods: TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital pathology software. EBV infection was detected by in situ hybridisation (ISH) and by quantitative polymerase chain reaction (qPCR). Methylation status of EBV-related genes was detected by PCR and a methylome analysis was performed by the Illumina Infinium MethylationEPIC BeadChip. HP status was detected by qPCR. Results: We included 98 resected GC Peruvian cases in our evaluation. Median TIL percentage was 30. The proportion of EBV+ detected by ISH was 24.1%, of EBV+ detected by qPCR was 41.8%, while 70% showed methylation of EBV-related genes, and 58.21% of cases were HP+. Younger age (p = 0.024), early stages (p = 0.001), HP+ (p = 0.036) and low CD8 density (p = 0.046) were associated with longer overall survival (OS). High TIL level was associated with intestinal subtype (p < 0.001), with grade 2 (p < 0.001), with EBV qPCR+ (p = 0.001), and with methylation of EBV-related genes (p = 0.007). Cases with high TIL level and cases that are EBV positive share eight genes with similarly methylated status in the metabolomic analysis. High CD8 density was associated with EBV PCR+ (p = 0.012) and HP- (0.005). Conclusion: Lower CD8 density and HP+ predict longer OS. High TIL level is associated with EBV+ and methylation of EBV-related genes, while lower CD8 density is associated with HP+ GC.

Is air an issue? A severe case of subcutaneous emphysema in an immunocompromised patient.

Abdominal crepitus and air in the subcutaneous tissue should be recognized early, as the most common etiologies for subcutaneous emphysema are fatal if not treated acutely. We present the case of a patient who developed subcutaneous emphysema as a consequence of the dehiscence of a previously closed gastrocutaneous fistula.

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study.

BACKGROUND: Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM: To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS: We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS: Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8th Edition. Recurrence occurred primarily in the liver (n = 8), peritoneum (n = 4), and lung (n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION: Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.

Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru / Cirugía abierta versus mínimamente invasiva con preservación del esfínter para el cáncer de recto: un estudio de cohorte retrospectivo de un solo centro en Perú

ABSTRACT Objective : The study aimed to describe and compare minimally invasive surgery (MIS) and open surgery for rectal cancer in Peru. Material and methods : A retrospective single-center analysis was performed for all patients who underwent sphinctersparing surgery for non-metastatic rectal cancer at Instituto Nacional de Enfermedades Neoplásicas in Peru between January 2016 and December 2020. Clinical, perioperative, pathological, and survival outcomes were compared between both groups. A propensity score matching method was used to minimize bias. Results : 162 patients were included in the final analysis. 124 had open surgery and 38 had MIS. Patients, clinical tumour, pathological characteristics, and perioperative were similar between groups after matching. Similar circumferential resection margin (CRM) with optimal quality of the mesorectum (p=1.000) but higher number of lymph nodes resected in open surgery group (p=0.741) was described. The leakage rate was slightly higher in the MIS group (p=0.358) with 10.5%, while the postoperative hospital stay was longer in the open surgery group after matching (p=0.001; OR 95% 5.2 CI: 1.8-15.6). The estimated recurrence-free survival (RFS) and overall survival (OS) at 3 years in open surgery and MIS was 71.8% (95% CI; 0.58-0.89) and 70% (95% CI; 0.56-0.88) (p=0.431) and 77.7% (95% CI; 0.64-0.94) and 88.9% (95% CI; 0.79-0.99) (p=0.5), respectively. Conclusions: Shorter postoperative hospital stay in the minimally invasive surgery group was reported. RFS, OS, and recurrence rates were similar between both groups. This approach is for non-metastatic rectal cancer in referral centers in Peru.

RESUMEN Objetivo : El estudio tuvo como objetivo describir y comparar la cirugía mínimamente invasiva (CMI) y la cirugía abierta para el cáncer de recto en el Perú. Material y métodos : Se realizó un análisis retrospectivo unicéntrico de todos los pacientes que se sometieron a cirugía conservadora de esfínter por cáncer de recto no metastásico en el Instituto Nacional de Enfermedades Neoplásicas de Perú entre enero de 2016 y diciembre de 2020. Clínica, perioperatoria, patológica y supervivencia se compararon los resultados entre ambos grupos. Se utilizó un método de emparejamiento por puntaje de propensión para minimizar el sesgo. Resultados : 162 pacientes fueron incluidos en el análisis final. 124 tuvieron cirugía abierta y 38 CMI. Los pacientes, el tumor clínico, las características patológicas y el perioperatorio fueron similares entre los grupos después del emparejamiento. Se describió un margen de resección circunferencial (MRC) similar con calidad óptima del mesorrecto (p=1,000) pero mayor número de ganglios linfáticos resecados en el grupo de cirugía abierta (p=0,741). La tasa de fuga fue ligeramente superior en el grupo CMI (p=0,358) con un 10,5%, mientras que la estancia hospitalaria postoperatoria fue mayor en el grupo de cirugía abierta tras el emparejamiento (p=0,001; OR 95% 5,2 IC: 1,8-15,6). La supervivencia libre de recidiva (SLR) estimada y la supervivencia global (SG) a los 3 años en cirugía abierta y CMI fue del 71,8% (IC 95%; 0,58-0,89) y del 70% (IC 95%; 0,56-0,88) (p=0,431) y 77,7% (IC 95%; 0,64-0,94) y 88,9% (IC 95%; 0,79-0,99) (p=0,5), respectivamente. Conclusiones : Se reportó menor estancia hospitalaria postoperatoria en el grupo de cirugía mínimamente invasiva. Las tasas de SLR, SG y recurrencia fueron similares entre ambos grupos. Este abordaje es para cáncer de recto no metastásico en centros de referencia en Perú.

Cáncer de hígado: ¿Antigua o nueva amenaza para los jóvenes de países en vía de desarrollo?

Entre las neoplasias malignas más frecuentes del mundo, el carcinoma hepatocelular (CHC) es la segunda causa de muerte relacionada con el cáncer (1). Su incidencia se ha duplicado durante las dos últimas décadas y la mayor carga se produce en los países de ingresos bajos y medianos. Los tumores hepáticos primarios malignos suelen describirse como una patología que afecta principalmente a hombres mayores de 40 años con un hígado cirrótico; rara vez se han registrado en personas más jóvenes y normalmente, en menores de 40, lo más común es el hepatoblastoma

A preoperative nomogram for predicting long-term survival after resection of large hepatocellular carcinoma (>10 cm).

BACKGROUND: It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients. METHODS: We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables. RESULTS: We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities. CONCLUSION: We constructed a preoperative nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages.

Monosegment associating liver partition and portal vein ligation for staged hepatectomy: Preserving segment 1 as the only liver remnant after hepatocellular carcinoma recurrence.

Since the inception of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, many centres have used this technique for patients who would otherwise be considered unresectable due to insufficient future liver remnant. In this report, we presented the case of a paediatric patient with recurrent hepatocellular carcinoma who underwent monosegment ALPPS (M-ALPPS) hepatectomy preserving segment 1 as the sole liver remnant using indocyanine green (ICG) as a fluorescence guide.

Metallomic profile in non-cirrhotic hepatocellular carcinoma supports a phenomenon of metal metabolism adaptation in tumor cells.

We have previously described a form of hepatocellular carcinoma (HCC) in non-cirrhotic liver (HCC-NC) developed by Peruvian patients. We analyzed the metallomic profile in hepatic tissues from two independent cohorts exhibiting HCC-NC. Clinical, histopathological data, and HCC and non-tumoral liver (NTL) samples of 38 Peruvian and 38 French HCC-NC patients, were studied. Twelve metals were quantified using ICP/MS: Mn, Fe, Cu, Co, Zn, As, Se, Rb, Mo, Cd, Pb, and Sn. Associations between metals and survival were assessed. Our data showed significant differences between cohorts. Mean ages were 40.6 ± 20, 67.5 ± 9 years old for Peruvians and French, respectively. Fifty percent of the Peruvian patients were positive for the HBsAg, versus 3% in French patients. Mn, Cu, Zn, As, Se, Rb, Mo, Cd, Sn metal concentrations were higher in NTL of Peruvians. Importantly, metal concentrations were lower in HCC areas compared to NTL tissues in both cohorts, except for Cu for which mean concentration was higher in HCC (p < 0.05). Se concentration in HCC was associated with extended survival only in Peruvians. Our data, obtained in Peruvian and French HCC-NC cohorts, highlights similarity in the metallomic profile of HCC compared to NTL during the hepatic tumorigenesis in these specific groups of patients.