ABSTRACT
(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.
ABSTRACT
El tipo de gastrectomﾃｭa, total (GT) o distal (GD), en el cﾃ｡ncer gﾃ｡strico medio o distal no estﾃ｡ claramente consensuada, sobre todo cuando es indiferenciado o difuso de Lauren. Pretendemos en este metaanﾃ｡lisis definir en tﾃｩrminos de supervivencia y morbimortalidad cuﾃ｡l de las 2 tﾃｩcnicas debiera ser recomendada. Se han incluido trabajos prospectivos y retrospectivos que comparen ambas tﾃｩcnicas hasta un total de 6.303 pacientes (3.641 GD y 2.662 GT). La GD se asociﾃｳ de forma significativa con menos complicaciones, menos fﾃｭstulas anastomﾃｳticas y menos mortalidad peroperatoria. El nﾃｺmero de ganglios en la GD fue significativamente menor, pero siempre por encima de 15. Por ﾃｺltimo, la supervivencia a 5 aﾃｱos de la GD fue tambiﾃｩn superior. Por tanto, la GD, siempre que se obtenga un margen de seguridad e independientemente del tipo histolﾃｳgico, debe efectuarse en la cirugﾃｭa de cﾃ｡ncer distal de estﾃｳmago
There is no clear agreement on the type of gastrectomy to be used (either total [TG] or distal [DG]) in middle or distal gastric cancer, especially when it is undifferentiated or Lauren diffuse type. In this meta-analysis, we intend to define which of the 2 techniques should be recommended, based on survival, morbidity and mortality rates. Prospective and retrospective studies comparing both techniques have been included for a total of 6303 patients (3,641 DG and 2,662 TG). DG was significantly associated with fewer complications, fewer anastomotic fistulae, and less perioperative mortality. The number of lymph nodes in DG was significantly lower, but always above 15. Finally, even the 5-year survival of DG was also higher. Therefore, DG, as long as a safety margin is obtained and regardless of the histological type, should be performed in surgery for distal stomach cancer
Subject(s)
Humans , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Gastrectomy/methods , Gastrectomy/mortality , Adenocarcinoma/mortality , Stomach Neoplasms/mortality , Time Factors , Treatment Outcome , Survival AnalysisABSTRACT
There is no clear agreement on the type of gastrectomy to be used (either total [TG] or distal [DG]) in middle or distal gastric cancer, especially when it is undifferentiated or Lauren diffuse type. In this meta-analysis, we intend to define which of the 2techniques should be recommended, based on survival, morbidity and mortality rates. Prospective and retrospective studies comparing both techniques have been included for a total of 6303 patients (3,641 DG and 2,662 TG). DG was significantly associated with fewer complications, fewer anastomotic fistulae, and less perioperative mortality. The number of lymph nodes in DG was significantly lower, but always above 15. Finally, even the 5-year survival of DG was also higher. Therefore, DG, as long as a safety margin is obtained and regardless of the histological type, should be performed in surgery for distal stomach cancer.
Subject(s)
Anastomosis, Surgical/adverse effects , Gastrectomy/adverse effects , Gastrectomy/mortality , Stomach Neoplasms/surgery , Female , Gastrectomy/methods , Gastric Fistula/epidemiology , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Male , Margins of Excision , Perioperative Period/mortality , Postoperative Complications/epidemiology , Prospective Studies , Retrospective Studies , Stomach Neoplasms/pathology , Survival RateABSTRACT
INTRODUCTION: Introduction: a survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (< 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country.
INTRODUCCIﾃ哲: Introducciﾃｳn: realizamos una encuesta sobre soporte nutricional perioperatorio en cirugﾃｭa pancreﾃ｡tica y biliar en hospitales espaﾃｱoles en 2007, que mostrﾃｳ que pocos grupos quirﾃｺrgicos seguﾃｭan las guﾃｭas de ESPEN 2006. Diez aﾃｱos despuﾃｩs enviamos un cuestionario para comprobar la situaciﾃｳn actual. Mﾃｩtodos: treinta y ocho centros recibieron un cuestionario con 21 preguntas sobre tiempo de ayunas antes y despuﾃｩs de la cirugﾃｭa, cribado nutricional, duraciﾃｳn y tipo de soporte nutricional perioperatorio, y nﾃｺmero de procedimientos. Resultados: respondieron 34 grupos. La mediana de pancreatectomﾃｭas (cabeza/total) fue de 29,5 (IC 95%: 23,0-35; rango, 5-68) (total, 1002), la de cirugﾃｭas biliares malignas de 9,8 (IC 95%: 7,3-12,4; rango, 2-30) y la de resecciones biliares por patologﾃｭa benigna de 10,4 (IC 95%: 7,6-13,3; rango, 2-33). Solo el 41,2% de los grupos utilizaban soporte nutricional antes de la cirugﾃｭa (< 50% habian efectuado un cribado nutricional). El tiempo medio de ayuno preoperatorio para sﾃｳlidos fue de 9,3 h (rango, 6-24 h), y de 6,6 h para lﾃｭquidos (rango, 2-12). Tras la pancreatectomﾃｭa, el 29,4% habﾃｭan intentado administrar una dieta oral precoz, pero el 88,2% de los grupos usaron algﾃｺn tipo de soporte nutricional y el 26,5% usaron NP en el 100% de los casos. Los demﾃ｡s grupos usaron diferentes porcentajes de NP y NE en sus casos. En la cirugﾃｭa biliar maligna, el 22,6% utilizaron NP siempre y NE en el 19,3% de los casos. Conclusiones: la NP es el soporte nutricional mﾃ｡s utilizado tras la cirugﾃｭa de cabeza pancreﾃ｡tica. Solo el 29,4% de las unidades usan nutriciﾃｳn oral precoz y el 32,3% emplean la NE tras este tipo de cirugﾃｭa. El 22,6% de las instituciones usan NP habitualmente tras la cirugﾃｭa de tumores biliares malignos. Las guﾃｭas ESPEN 2006 no se siguen de forma habitual en nuestro paﾃｭs tras mﾃ｡s de 10 aﾃｱos desde su publicaciﾃｳn.
Subject(s)
Nutritional Support/methods , Pancreatectomy/standards , Biliary Tract Surgical Procedures , Humans , Middle Aged , Nutritional Status , Pancreas , Spain , Surveys and QuestionnairesABSTRACT
BACKGROUND: In 2017, the WHO updated their 2010 classification of pancreatic neuroendocrine tumors, introducing a well-differentiated, highly proliferative grade 3 tumor, distinct from neuroendocrine carcinomas. The aim of this study was to investigate the clinical significance of this update in a large cohort of resected tumors. METHODS: Using a multicenter, international dataset of patients with pancreatic neuroendocrine lesions, patients were classified both according to the WHO 2010 and 2017 schema. Multivariable survival analyses were performed, and the models were evaluated for discrimination ability and goodness of fit. RESULTS: Excluding patients with a known germline MEN1 mutation and incomplete data, 544 patients were analyzed. The performance of the WHO 2010 and 2017 models was similar, however surgically resected grade 3 tumors behaved very similarly to neuroendocrine carcinomas. CONCLUSION: The addition of a grade 3 NET classification may be of limited utility in surgically resected patients, as these lesions have similar postoperative survival compared to carcinomas. While the addition may allow for a more granular evaluation of novel treatment strategies, surgical intervention for high grade tumors should be considered judiciously.
Subject(s)
Carcinoma, Neuroendocrine , Neuroendocrine Tumors , Pancreatic Neoplasms , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/surgery , Humans , Neoplasm Grading , Neoplasm Staging , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgery , Organic Chemicals , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , World Health OrganizationSubject(s)
Chemoradiotherapy, Adjuvant , Fluorodeoxyglucose F18 , Magnetic Resonance Imaging , Multimodal Imaging/methods , Positron-Emission Tomography , Radiopharmaceuticals , Rectal Neoplasms/diagnostic imaging , Antimetabolites, Antineoplastic/therapeutic use , Area Under Curve , Capecitabine/therapeutic use , Female , Humans , Male , Middle Aged , Neoplasm Staging , Prospective Studies , ROC Curve , Radiotherapy Dosage , Rectal Neoplasms/pathology , Rectal Neoplasms/therapyABSTRACT
Introducciﾃｳn. La disfunciﾃｳn primaria (DP) y su forma mﾃ｡s grave, el fallo primario (FP), siguen siendo un problema muy importante en los pacientes sometidos a un trasplante hepﾃ｡tico (TH), ya que se trata de una entidad de origen desconocido, con una incidencia elevada y con una gran repercusiﾃｳn en su evoluciﾃｳn. Los objetivos de nuestro estudio son conocer la incidencia de la DP y la capacidad de 20 caracterﾃｭsticas de los donantes para inducir este cuadro. Pacientes y mﾃｩtodo. Se han estudiado de forma prospectiva los 248 TH realizados consecutivamente durante 79 meses en el Hospital Ramﾃｳn y Cajal de Madrid en 206 pacientes. Los enfermos fueron clasificados en normofunciﾃｳn primaria y disfunciﾃｳn primaria, y en esta ﾃｺltima se reagruparon los casos de FP y funciﾃｳn primaria inadecuada. Se definiﾃｳ normofunciﾃｳn primaria o funciﾃｳn primaria inadecuada segﾃｺn si las cifras de transaminasas y la actividad de protrombina eran superiores o inferiores a 2.000 U/ml y al 50 por ciento, respectivamente, entre los dﾃｭas segundo y sﾃｩptimo tras el trasplante hepﾃ｡tico. Resultados. La incidencia de DP fue del 9,3 por ciento (23 trasplantes hepﾃ｡ticos), de los cuales 12 (4,8 por ciento) casos fueron un fallo primario. El anﾃ｡lisis univariable relacionﾃｳ significativamente la edad del donante y la causa de la muerte cerebral de ﾃｩl con una mayor frecuencia de DP. El estudio multivariable ﾃｺnicamente lo relacionﾃｳ con esta ﾃｺltima variable (p = 0,04), con una odds ratio (OR) de 4,25 (intervalo de confianza [IC] del 95 por ciento, 1,13-16,0). Conclusiones. La DP es una entidad clﾃｭnica con una incidencia importante. El ﾃｺnico factor que ha demostrado su influencia en el desarrollo de una DP es una causa de muerte cerebral diferente de un traumatismo craneoencefﾃ｡lico (AU)