Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico.

BACKGROUND: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections (SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. METHODS: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. RESULTS: A total of 219 patients were enrolled in the study; 101 (46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. CONCLUSIONS: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes; however, survival was unaffected.

Hepato-pancreato-biliary surgery in Mexico and Latin America during the COVID-19 pandemic (2020): Results from AMHPB survey.

BACKGROUND: The Mexican Hepato-Pancreato-Biliary Association (AMHPB) conducted a survey, aiming to gather experience and opinions of HPB surgeons about HPB surgery in the 2020 COVID-19 pandemic year. METHODS: An online survey was conducted (33 items: demographics, patient referral, COVID-19 screening and limitations, hospital occupancy and surgical practice) to AMHPB members and attendees of the previous meetings of the Society through a self-administered questionnaire. Answers were excluded if respondents were not from Latin America. RESULTS: 88 participants answered (47.5 ± 10 years, 94% male and 65.9% Mexicans). About 8% worked in COVID-19 converted hospitals. About 1.1% did not perform pre-operative COVID-19 testing. Polymerase chain reaction (33%) was the most common COVID-19 pre-operative test. The number of patient referrals decreased 62.5%. About 29.5% had one patient who died from COVID-19 during preoperative surgical evaluation. About 64.7% answered that surgical case volume decreased. About 17% and 23% respondents considered that surgical morbidity and mortality increased, respectively. Hospital resources and COVID-19 infection were responsible for change in surgical outcomes. Lack of ICU beds (54%) was the most common cause of surgical cancellation. CONCLUSION: COVID-19 had a strong negative impact on HPB surgery in Mexico and Latin America in terms of patient reference, case volume and surgical outcomes.

INTRODUCCIÓN: La Asociación Mexicana Hepato-Pancreato-Biliar (AMHPB) realizó una encuesta con el objetivo de recopilar experiencias/opiniones de cirujanos HPB sobre cirugía HPB en el 2020 con pandemia COVID-19. MÉTODOS: Se realizó encuesta virtual (33 ítems: demografía, derivación de pacientes, tamizaje/limitaciones COVID-19, ocupación hospitalaria y práctica quirúrgica) a miembros de la AMHPB y asistentes a reuniones previas de la Sociedad a través de un cuestionario autoadministrado. Se excluyeron las respuestas que no fueran de América Latina. RESULTADOS: Respondieron 88 participantes (47.5 ± 10 años, 94% hombres y 65.9% mexicanos). 8% trabajaba en hospitales reconvertidos COVID-19. 1,1% no realizó prueba COVID-19 preoperatoria. La Polymerase chain reaction (33%) fue laprueba preoperatoria COVID-19 más común. Lareferencia de pacientes disminuyó 62,5%. El 29,5% tuvo paciente fallecido por COVID-19 durante la evaluación preoperatoria. 64,7% respondió que el volumen de casos quirúrgicos disminuyó. El 17% y23% consideraron que la morbilidad y mortalidad quirúrgicas aumentaron respectivamente. Los recursos hospitalarios e infección por COVID-19 influyeron en los resultados quirúrgicos. La falta de camas de UCI (54%) fue lo más común en cancelación quirúrgica. CONCLUSIÓN: COVID-19 tuvo un fuerte impacto negativo en la cirugía HPB en México y América Latina en referencia de pacientes, volumen de casos y resultados quirúrgicos.

Aflatoxin levels and prevalence of TP53 aflatoxin-mutations in hepatocellular carcinomas in Mexico.

OBJECTIVE: To determine the exposure to aflatoxin B1 (AFB1) in southern Mexico and the presence of the aflatoxin signature mutation in hepatocellular carcinoma (HCC) tissue from patients from a cancer referral center. MATERIALS AND METHODS: We estimated the prevalence and distribution of AFB1 in a representative sample of 100 women and men from Chiapas using the National Health and Nutrition Survey 2018-19. We also examined the presence of the aflatoxin signature mutation in codon 249 (R249S), and other relevant mutations of the TP53 gene in HCC tissue blocks from 24 women and 26 men treated in a national cancer referral center. RESULTS: The prevalence of AFB1 in serum samples was 85.5% (95%CI 72.1-93.1) and the median AFB1 was 0.117 pg/µL (IQR, 0.050-0.350). We detected TP53 R249S in three of the 50 HCCs (6.0%) and observed four other G>T transversions potentially induced by AFB1. CONCLUSION: Our analysis provides evidence that AFB1 may have a relevant role on HCC etiology in Mexico.

Liver cancer mortality in Mexico: trend analysis from 1998 to 2018.

OBJECTIVE: To examine overall, sex, and state-specific liver cancer mortality trends in Mexico. Materials and meth-ods. Joinpoint regression was used to examine the trends in age-standardized mortality rates of liver cancer between 1998-2018. Estimated annual percent change with 95% confi-dence intervals (95%CI) were computed. Age-period-cohort models were used to assess the effects of age, calendar year, and birth cohort. RESULTS: The state-specific mortality rates ranged from 3.34 (Aguascalientes) to 7.96 (Chiapas) per 100 000 person-years. Sex-specific rates were roughly equal, nationwide. Overall, we observed a statistically significant decrease in liver cancer mortality rates between 1998-2018 (annual percent change, -0.8%; 95%CI -1.0, -0.6). The overall age-period-cohort models suggest that birth cohort may be the most important factor driving the trends. CONCLUSIONS: While there was overall decline in liver cancer mortality, differences in rates by region were observed. The regional differences may inform future studies of liver cancer etiology across the country.

Liver cancer mortality in Mexico: trend analysis from 1998 to 2018 / Mortalidad por cáncer hepático en México: análisis de tendencias de 1998 a 2018

Abstract: Objective: To examine overall, sex, and state-specific liver cancer mortality trends in Mexico. Materials and methods: Joinpoint regression was used to examine the trends in age-standardized mortality rates of liver cancer between 1998-2018. Estimated annual percent change with 95% confidence intervals (95%CI) were computed. Age-period-cohort models were used to assess the effects of age, calendar year, and birth cohort. Results: The state-specific mortality rates ranged from 3.34 (Aguascalientes) to 7.96 (Chiapas) per 100 000 person-years. Sex-specific rates were roughly equal, nationwide. Overall, we observed a statistically significant decrease in liver cancer mortality rates between 1998-2018 (annual percent change, -0.8%; 95%CI -1.0, -0.6). The overall age-period-cohort models suggest that birth cohort may be the most important factor driving the trends. Conclusions: While there was overall decline in liver cancer mortality, differences in rates by region were observed. The regional differences may inform future studies of liver cancer etiology across the country.

Resumen: Objetivo: Examinar la tendencia general, por sexo y estado, de mortalidad por cáncer hepático en México. Material y métodos: Se utilizó regresión joinpoint para examinar las tendencias en las tasas de mortalidad estandarizadas por edad de cáncer hepático (1998-2018). Se estimó el cambio porcentual anual con intervalos de confianza al 95% (IC95%). Se usaron modelos de edad-periodo-cohorte para evaluar el efecto de edad, año calendario y cohorte de nacimiento. Resultados: La mortalidad osciló entre 3.34 (Aguascalientes) y 7.96 (Chiapas) por 100 000 años-persona. La mortalidad por sexo fue relativamente similar a nivel nacional. La mortalidad general disminuyó entre 1998-2018 (cambio porcentual anual, -0.8%; IC95% -1.0, -0.6). La cohorte de nacimiento parece ser el factor más importante que afecta las tendencias. Conclusiones: A pesar de la disminución de mortalidad por cáncer hepático, se observó variación regional en las tasas. Estas diferencias podrían informar estudios futuros sobre la etiología de cáncer hepático en México.

Aflatoxin levels and prevalence of TP53 aflatoxin-mutations in hepatocellular carcinomas in Mexico / Niveles de aflatoxina y prevalencia de mutaciones del gen TP53 por aflatoxina en carcinoma hepatocelular en México

Abstract: Objective: To determine the exposure to aflatoxin B1 (AFB1) in southern Mexico and the presence of the aflatoxin signature mutation in hepatocellular carcinoma (HCC) tissue from patients from a cancer referral center. Materials and methods: We estimated the prevalence and distribution of AFB1 in a representative sample of 100 women and men from Chiapas using the National Health and Nutrition Survey 2018-19. We also examined the presence of the aflatoxin signature mutation in codon 249 (R249S), and other relevant mutations of the TP53 gene in HCC tissue blocks from 24 women and 26 men treated in a national cancer referral center. Results: The prevalence of AFB1 in serum samples was 85.5% (95%CI 72.1-93.1) and the median AFB1 was 0.117 pg/µL (IQR, 0.050-0.350). We detected TP53 R249S in three of the 50 HCCs (6.0%) and observed four other G>T transversions potentially induced by AFB1. Conclusion: Our analysis provides evidence that AFB1 may have a relevant role on HCC etiology in Mexico.

Resumen: Objetivo: Determinar la exposición a aflatoxina_B1 (AFB1) en el sur de México y la presencia de la mutación característica de AFB1 en tejido de carcinoma hepatocelular (CHC) de pacientes de un centro oncológico. Material y métodos: Se estimó la prevalencia y distribución de AFB1 en una muestra representativa de 100 mujeres y hombres de Chiapas a partir de la Encuesta Nacional de Salud y Nutrición 2018-19. También se observó la presencia de la mutación característica de AFB1 en el codón 249 (R249S), y otras mutaciones relevantes del gen TP53 en bloques de tejido de CHC de 24 mujeres y 26 hombres estudiados en un centro de referencia nacional de oncología. Resultados: La prevalencia de AFB1 en las muestras de suero fue de 85.5% (IC95% 72.1-93.1) y la mediana de la concentración 0.117 pg/µL (IQR, 0.050-0.350). Se detectó TP53 R249S en tres de 50 casos de CHC (6.0%) y se observaron cuatro transversiones G>T potencialmente inducidas por AFB1. Conclusión: El presente análisis proporciona evidencia de que la AFB1 puede tener un papel relevante en la etiología del CHC en México.

Low-risk papillary thyroid cancer recurrence in patients treated with total thyroidectomy and adjuvant therapy vs. patients treated with partial thyroidectomy.

BACKGROUND: Surgical extension for treatment of patients with low-risk papillary thyroid carcinoma is still controversial. We undertook this study to assess if there is a difference in recurrence between patients undergoing total thyroidectomy plus adjuvant therapy and patients treated with only partial thyroidectomy. METHODS: We conducted a longitudinal, observational, analytical study in patients with histopathological diagnosis of low-risk papillary thyroid carcinoma followed for at least 10 years. Patients were divided into two groups: Group 1: Patients treated with total thyroidectomy plus adjuvant therapy (TT) and Group 2: Patients treated with only partial thyroidectomy without adjuvant therapy (HT). Descriptive and inferential statistical methods were used. RESULTS: AMES: 184 patients, recurrence in 5/23 HT and 7/161 TT (p = 0.0016); MACIS: 170 patients, recurrence in 5/24 HT and 5/146 TT (p = 0.0008); DeGroot: 92 patients, recurrence in 3/19 HT and 2/73 TT (p = 0.0254); TNM: 150 patients, recurrence in 5/22 HT and 7/128 TT (p = 0.0058). The time interval for local recurrences was higher in comparison to regional recurrences (p <0.05). In all classifications, recurrences occur mainly with regional metastatic disease (60%). Multifocality, bilateral disease and extracapsular disease showed no statistical difference. There was one incidental injury to a recurrent laryngeal nerve and this was repaired during the same surgical procedure. There was no morbidity due to hypoparathyroidism. CONCLUSIONS: Patients classified as low risk according to any of the studied classifications have a higher risk for recurrence when treated with hemithyroidectomy than when treated with total thyroidectomy plus adjuvant therapy.

[Inappropriate use of antibiotics in acute appendicitis. A survey of Mexican surgeons]. / Uso inapropiado de antibióticos en apendicitis aguda. Resultado de una encuesta a cirujanos mexicanos.

BACKGROUND: Appendectomy is the most common non-elective surgery. The postoperative use of antibiotics depends on the stage of the appendix at the time of surgery. Several classifications establish that state. We determine if these classifications are known and used by Mexican surgeons. METHODS: A descriptive and observational study was performed. A questionnaire was completed by surgeons asking the following questions: Do you use a classification for acute appendicitis? 2) Which classification do you prefer? 3) Do you use antibiotics postoperatively? 4) For what period of time do you administer antibiotics postoperatively? We evaluated if the postoperative treatment is influenced by the use of a classification, using the chi(2) test. RESULTS: One hundred and forty two surgeons were interviewed, 99% used a classification, and 48% indicated postoperative antibiotics, despite the stage of the disease, monotherapy (69%), and for three doses (60%). Fifty two percent used antibiotic only in advanced stages, with two different types (61%), and from 7 to 10 days (66%). We did not find any statistical difference in management, regardless of whether or not an appendicitis classification was used. CONCLUSIONS: Although most surgeons use one classification for acute appendicitis, this does not influence postoperative treatment. This incongruity results in the unjustified use of antibiotics.