The involvement of the hepatic artery is a risk factor for unresectability after neoadjuvant treatment in borderline pancreatic adenocarcinoma.

INTRODUCTION: Borderline Resectable Pancreatic Ductal Adenocarcinoma (BR-PDAC) benefits from neoadjuvant treatment (NAT) with the intent of surgical salvage in the absence of disease progression during chemotherapy (CT) or chemoradiotherapy (CRT). Scarce literature exists about prognostic factors of resectability at the time of diagnosis or during neoadjuvant treatment, especially regarding vascular relationships. MATERIALS: We reviewed our prospective BR-PDAC cohort to determine resectability predictors. We collected data about clinical baseline characteristics, vessels' involvement, type of NAT, CA19-9 evolution, and radiological outcome. We performed a descriptive analysis and a logistic regression model to define resectability predictors; we finally compared overall survival (OS) and progression-free survival (PFS) for those predictors. RESULTS: One hundred patients started NAT, with a resection rate of 44 % (40 pancreaticoduodenectomies, 4 distal pancreatectomies). The most frequent vessel relationship was the abutment of the superior mesenteric artery (44 %), and 26 patients had ≥2 vessels involved. Prognostic factors of resectability were CA19-9 response >10 % (OR 3.07, p = 0.016) and Hepatic Artery involvement (OR 0.21, p = 0.026). Median overall survival was better for CA19-9 responders than for non-responders (20.9 months and 11.8 months respectively, p < 0.001), and similar to normalized CA19-9 (25.0 months, p = 0.48). There were no differences in terms of OS or PFS with the involvement of the HA (17.7 vs 17.1 months, p = 0.367; and 8.7 vs 12.0 months, p = 0.267). CONCLUSION: The involvement of the Hepatic Artery seems to confer a worse prognosis regarding resectability. A decrease of only >10 % of CA19-9 is a predictive factor for resectability and better overall and progression-free survival.

Prognostic risk factors in 113 patients undergoing cephalic duodenopancreatectomy for distal cholangiocarcinoma. / Factores de mal pronóstico en 113 pacientes sometidos a duodenopancreatectomía cefálica por colangiocarcinoma distal.

INTRODUCTION: Distal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. OBJECTIVE: To analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. MATERIALS AND METHODS: A single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. RESULTS: One hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76-124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan-Meier curves. CONCLUSIONS: The presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies.

Análisis de factores de riesgo de vaciamiento gástrico lento tras la duodenopancreatectomía cefálica / Study of risk factors for delayed gastric emptying after partial pancreatoduodenectomy

Introducción: El vaciamiento gástrico lento (VGL) es una de las complicaciones más frecuentes tras la duodenopancreatectomía cefálica. El objetivo del actual estudio es analizar los factores de riesgo de su aparición. Métodos: Análisis de factores de riesgo de VGL sobre una base de datos prospectiva de 390 pacientes intervenidos entre 2013 y 2021. Se realizó un estudio retrospectivo comparativo entre pacientes con y sin VGL y posteriormente un estudio de factores de riesgo de VGL mediante modelos de regresión logística univariante y multivariante. Resultados: La incidencia de VGL en el global de la serie fue del 28%. Un 63% de los pacientes presentaron alguna complicación y la mortalidad postoperatoria fue del 3,1%. Se evidenció que la edad mediana (73 años vs. 68 años, p<0,001) y la creatinina preoperatorias (75 vs. 68.5, p<0,001) eran superiores en el grupo VGL. El estudio de factores de riesgo evidenció que la edad superior a 60 años (p=0,002) y la fístula pancreática (p<0,001) eran factores de riesgo de VGL. Conclusiones: La presencia de fístula pancreática se confirma como factores de riesgo de VGL tras la duodenopancreatectomía. Además, se demuestra que la edad superior a 60 años es un factor de riesgo de VGL. (AU)

Introduction: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. Methods: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. Results: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63% and postoperative mortality was 3.1%. Focusing in delayed gastric emptying, it was shown that the median age (73 years vs. 68 years, p<0.001) and preoperative creatinine (75 vs. 65.5, p<0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (p=0.002) and pancreatic fistula (p<0.001) were risk factors for delayed gastric emptying. Conclusions: The presence of pancreatic fistula is confirmed as risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying. (AU)

Experiencia en la resección del proceso uncinado del páncreas: indicaciones y resultados. Revisión de la literatura / Experience in the resection of the uncinate process of the pancreas: Indications and results. Literature review

Introducción: El objetivo de nuestro trabajo es evaluar la experiencia acumulada en el empleo de la uncinectomía (UC) como técnica de pancreatectomía conservadora de parénquima. Método: Estudio observacional y descriptivo que incluye retrospectivamente todos los pacientes intervenidos mediante la técnica de UC en Hospital Universitari de Bellvitge (HUB), y revisión exhaustiva de los casos descritos en la literatura inglesa hasta la actualidad. Resultados: Desde el 2003 hasta el 2019 han sido intervenidos siete pacientes mediante UC en el HUB con orientación diagnóstica de lesión pancreática considerada premaligna. Todos los pacientes han presentado morbilidad, fundamentalmente en forma de fístula pancreática postoperatoria y ninguno de ellos ha presentado insuficiencia pancreática endocrina ni exocrina. Actualmente todos los pacientes se encuentran vivos y sin recidiva de enfermedad neoplásica. Otros 29 casos han sido descritos en la literatura. Del total de los casos (36 pacientes), el abordaje ha sido mínimamente invasivo (laparoscópico o robotizado) en seis pacientes (16,7%), conllevando una estancia hospitalaria inferior. La incidencia global de fístula pancreática es del 50% comportando una tasa de reingreso inferior al 10%, pero sin necesitar reintervención. Conclusión: La UC es una técnica infrecuente y poco estandarizada para la resección de lesiones benignas o de bajo potencial de malignidad localizadas en el proceso uncinado del páncreas. Aunque se asocia a una morbilidad igual o superior a las técnicas de resección estandarizadas, ofrece una preservación excelente de la función endocrina y exocrina pancreática, con el consiguiente beneficio en la calidad de vida de los pacientes a largo plazo. (AU)

Introduction: The aim of our study is to assess the accumulated experience in the use of uncinatectomy (UC) as a parenchymal-sparing pancreatectomy technique. Method: We have carried out a observational and descriptive study including restrospectively all the patients undergoing UC at Hospital Universitary de Bellvitge (HUB) and an exhaustive review of the cases described in the english literature. Results: From 2003 to 2019, seven patients have been operated by UC in the HUB with a diagnostic orientation of pancreatic lesion considered premalignant. All patients have presented morbidity, mainly in the form of postoperative pancreatic fistula, and none of them have presented endocrine or exocrine pancreatic insufficiency. Currently, all patients are alive and without recurrence of neoplastic disease. Another 29 cases have been described in the literature. Of all the cases (36 patients), the approach was minimally invasive (laparoscopic or robotic) in 6 patients (16.7%), leading to a shorter hospital stay. The global incidence of pancreatic fistula is 50%, with a re-admission rate of less than 10%, but without requiring re-intervention. Conclusion: UC is an infrequent and poorly standardized technique for the resection of benign lesions or those with low potential for malignancy located in the uncinate process of the pancreas. Although it is associated with equal or greater morbidity than standardized resection techniques, it offers excellent preservation of endocrine and exocrine pancreatic function, with the consequent long-term benefit in the patients life quality. (AU)

Home monitoring vs hospitalization for mild acute pancreatitis. A pilot randomized controlled clinical trials.

INTRODUCTION: Acute pancreatitis is a high-incidence benign disease. In 2009, it was the second highest cause of total hospital stays, the largest contributor to aggregate costs (approximately US$ 7000.00 per hospitalization), and the fifth leading cause of in-hospital deaths in the United States. Although almost 80% of acute pancreatitis cases are mild (usually requiring short-term hospitalization and without further complications), severe cases can be quite challenging.Classifications, scores, and radiological criteria have been developed to predict disease severity and outcome accurately; however, in-hospital care remains of widespread use, regardless of disease severity. A recent Turkish study reported that mild acute pancreatitis can be effectively and safely managed with home monitoring. Although the optimal timing for oral refeeding remains controversial and could cast some doubt on the feasibility of home monitoring, some guidelines already advocate for starting it within 24 hours.The present clinical trial aims to assess whether home monitoring is effective, safe and non-inferior to hospitalization for managing mild acute pancreatitis. METHODS: This will be a multicenter open-label randomized (1:1) controlled clinical trial to assess the efficacy and safety of home monitoring compared to in-hospital care for mild acute pancreatitis. All patients coming to the emergency department with suspected acute pancreatitis will be screened for enrollment. The main variable will be treatment failure (Yes/No) within the first 7 days after randomization. DISCUSSION: Acute pancreatitis implies a high economic burden in healthcare systems worldwide. Recent evidence suggests that mild disease can be safely and effectively treated with home monitoring. This approach may produce considerable cost savings and positively impact patients' quality of life. We expect the results to show that home monitoring is effective and not inferior to hospitalization for managing mild acute pancreatitis and that the economic costs are lower, kickstarting similar trials throughout the world, optimizing the use of limited healthcare budgets, and improving patients' quality of life.

Surgical options for the treatment of neuroendocrine neoplasms of the ampulla of Vater: a reference centre experience.

INTRODUCTION: The main objective of this study was to analyse the results of the surgical treatment of ampullary neuroendocrine tumours (NET) based on transduodenal ampullectomy and pancreatoduodenectomy, in a reference centre in hepatobiliopancreatic pathology. METHOD: Retrospective, observational study, including all patients operated on for pancreatic and/or duodenal NET in a reference unit of hepatobiliopancreatic pathology and prospectively registered between January 1st, 1993 and September 30th, 2021. For those parameters not present, retrospective research was performed. Demographic, clinical, analytical and pathological data were analysed. A descriptive study was carried out. Overall and disease-free survival was calculated using Kaplan-Meier curves and the Log-Rank test. RESULTS: Of 181 patients operated on for pancreatic and/or duodenal NET, only 9 were located in the ampulla of Vater, which represents 4.9% of all pancreatic and/or duodenal NET. Pancreatoduodenectomy (PD) was performed in 6 patients, while 3 patients underwent transduodenal ampullectomy (TDA). Longer surgical time and more postoperative complications were observed in the PD group. There were no differences in hospital stay. Overall and disease-free survival at 5 years in the PD group compared to ATD was 83.3% vs. 100% and 50% vs. 100%, respectively. CONCLUSIONS: Ampullary NET without locoregional involvement or risk factors, can be treated by conservative surgeries such as transduodenal ampullectomy.

Experience in the resection of the uncinate process of the pancreas: Indications and results. Literature review.

INTRODUCTION: The aim of our study is to assess the accumulated experience in the use of uncinatectomy (UC) as a parenchymal-sparing pancreatectomy technique. METHOD: We have carried out a observational and descriptive study including restrospectively all the patients undergoing UC at Hospital Universitary de Bellvitge (HUB) and an exhaustive review of the cases described in the english literature. RESULTS: From 2003 to 2019, seven patients have been operated by UC in the HUB with a diagnostic orientation of pancreatic lesion considered premalignant. All patients have presented morbidity, mainly in the form of postoperative pancreatic fistula, and none of them have presented endocrine or exocrine pancreatic insufficiency. Currently, all patients are alive and without recurrence of neoplastic disease. Another 29 cases have been described in the literature. Of all the cases (36 patients), the approach was minimally invasive (laparoscopic or robotic) in 6 patients (16.7%), leading to a shorter hospital stay. The global incidence of pancreatic fistula is 50%, with a re-admission rate of less than 10%, but without requiring re-intervention. CONCLUSIONS: UC is an infrequent and poorly standardized technique for the resection of benign lesions or those with low potential for malignancy located in the uncinate process of the pancreas. Although it is associated with equal or greater morbidity than standardized resection techniques, it offers excellent preservation of endocrine and exocrine pancreatic function, with the consequent long-term benefit in the patients life quality.

Opciones en el tratamiento quirúrgico de la neoplasia neuroendocrina de la ampolla de Váter: experiencia en un centro de referencia / Surgical options for the treatment of neuroendocrine neoplasms of the ampulla of Vater: a reference centre experience

Introducción: El objetivo del estudio fue analizar los resultados del tratamiento quirúrgico de las neoplasias neuroendocrinas (NNE) ampulares mediante Ampulectomía transduodenal (ATD) y duodenopancreatectomía cefálica (DPC), en un centro de referencia en patología hepatobiliopancreática. Método: Estudio retrospectivo, observacional, incluyendo los pacientes intervenidos de NNE de páncreas y/o duodenales en una unidad de referencia en patología hepatobilipancreática y registrados prospectivamente entre el 1 de enero de 1993 y el 30 de septiembre de 2021. Para aquellos parámetros no presentes, se realizó una búsqueda retrospectiva. Se analizaron datos demográficos, clínicos, analíticos y anatomopatológicos. Se realizó un análisis descriptivo. La supervivencia global y libre de enfermedad se calculó mediante curvas de Kaplan-Meier y el test de log-rank. Resultados: De 181 pacientes intervenidos de NNE de páncreas y/o duodenales, solo nueve se localizaban en la ampolla de Váter, lo que representa 4,9% de todos los NNE pancreáticos y/o duodenales. Se realizó DPC en seis pacientes, mientras que a tres se les practicó ATD. Se observó mayor tiempo quirúrgico y más complicaciones en el grupo DPC. No hubo diferencias en la estancia hospitalaria. La supervivencia global y libre de enfermedad a cinco años del grupo DPC respecto a la ATD fue de 83,3 vs. 100% y del 50 vs. 100%, respectivamente. Conclusiones: Las NNE ampulares sin afectación locorregional ni factores de riesgo, pueden ser tratadas mediante cirugías preservadoras como la ATD. (AU)

Introduction: The main objective of this study was to analyse the results of the surgical treatment of ampullary neuroendocrine tumours (NET) based on transduodenal ampullectomy and pancreatoduodenectomy, in a reference centre in hepatobiliopancreatic pathology. Method: Retrospective, observational study, including all patients operated on for pancreatic and/or duodenal NET in a reference unit of hepatobiliopancreatic pathology and prospectively registered between January 1st, 1993 and September 30th,2021. For those parameters not present, retrospective research was performed. Demographic, clinical, analytical and pathological data were analysed. A descriptive study was carried out. Overall and disease-free survival was calculated using Kaplan-Meier curves and the Log-Rank test. Results: Of 181 patients operated on for pancreatic and/or duodenal NET, only 9 were located in the ampulla of Vater, which represents 4.9% of all pancreatic and/or duodenal NET. Pancreatoduodenectomy (PD) was performed in 6 patients, while 3 patients underwent transduodenal ampullectomy (TDA). Longer surgical time and more postoperative complications were observed in the PD group. There were no differences in hospital stay. Overall and disease-free survival at 5 years in the PD group compared to ATD was 83.3% vs. 100% and 50% vs. 100%, respectively. Conclusions: Ampullary NET without locorregional involvement or risk factors, can be treated by conservative surgeries such as transduodenal ampullectomy. (AU)

Predictive factors for resection and survival in type A borderline resectable pancreatic ductal adenocarcinoma patients after neoadjuvant therapy: A retrospective cohort study.

INTRODUCTION: Pancreatic cancer is the seventh leading cause of cancer-related death worldwide, and surgical resection with radical intent remains the only potentially curative treatment option today. However, borderline resectable pancreatic ductal adenocarcinomas (BR-PDAC) stand in the gray area between the resectable and unresectable disease since they are technically resectable but have a high probability of incomplete exeresis. Neoadjuvant treatment (NAT) plays an important role in ensuring resection success.Different survival prognostic factors for BR-PDAC have been well described, but evidence on the predictive factors associated with resection after NAT is scarce. This study aims to study if CA 19-9 plasmatic levels and the tumor anatomical relationship with neighboring vascular structures are prognostic factors for resection and survival (both Overall Survival and Progression-Free Survival) in patients with type A BR-PDAC. METHODS: This will be a retrospective cohort study using data from type A BR-PDAC patients who received NAT in the Bellvitge University Hospital. The observation period is from January 2010 until December 2019; patients must have a minimum 12-month follow-up. Patients will be classified according to the MD Anderson Cancer Center criteria for BR-PDAC. DISCUSSION: Patients with BR-PDAC have a high risk for a margin-positive resection. Serum Carbohydrate Antigen 19-9 plasmatic levels and vascular involvement stand out as disease-related prognostic factors.This study will provide valuable information on the prognostic factors associated with resection. We will exclude locally advanced tumors and expect this approach to provide more realistic resection rates without selecting those patients that undergo surgical exploration. However, focusing on an anatomical definition may limit the results' generalizability.

Análisis de los criterios del profesional de Enfermería sobre la aplicación de los dispositivos de ostomía en cada momento del proceso asistencial / Analysis of the criteria by Nursing professionals regarding the application of ostomy devices at each moment of the care process

Objetivo: analizar la opinión y los criterios de los profesionales de Enfermería sobre la aplicación de los dispositivos de ostomía en cada momento del proceso asistencial teniendo en cuenta las características de la ostomía y del paciente. Método: estudio descriptivo transversal multicéntrico a partir de una encuesta nacional realizada a profesionales de Enfermería implicados en el cuidado a pacientes ostomizados. Resultados: a pesar de la disponibilidad de todo tipo de dispositivos de ostomías en la mayoría de los centros, a partir del ingreso en hospitalización, se instruye al paciente habitualmente en el manejo de dispositivos de dos piezas, lo que explicaría su mayor frecuencia de uso. Discusión y conclusiones: se han encontrado exposiciones de casos clínicos o investigaciones promovidas por la industria en los que no se justifica el uso de los dispositivos empleados, sino las características de estos mismos. Realizar una encuesta de ámbito nacional ofrece una visión global de los criterios que siguen los profesionales de Enfermería en el cuidado y manejo del paciente ostomizado y en la elección y/o el cambio de dispositivo de ostomía.(AU)

Objective: to analyse the opinion and criteria by Nursing professionals regarding the application of ostomy devices at each moment of the care process, considering the characteristics of the ostomy and the patient. Method: a multicentre cross-sectional descriptive study based on a national survey conducted on Nursing professionals involved in care for ostomized patients. Results: regardless of the availability of all type of devices in most centres, patients are usually trained from their admission to hospital in the use of two-piece devices, which would explain their higher frequency of use. Discussion and conclusions: there have been clinical case reports or research studies promoted by the industry with the characteristics of the devices but no justification for their use. A nationwide survey offers an overall view of the criteria followed by Nursing professionals for the care and management of ostomized patients and their choice and/or replacement of ostomy devices.(AU)

Experience in biliopancreatic diversion with duodenal switch: Results at 2, 5 and 10 years.

INTRODUCTION: Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS: Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS: The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20] kg and 49.8 [5] kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS: Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.

Experiencia en la derivación biliopancreática tipo cruce duodenal: resultados a 2, 5 y 10 años / Experience in biliopancreatic diversion with duodenal switch: results at 2, 5 and 10 years

El cruce duodenal (CD) se considera una de las técnicas más efectivas para lograr la pérdida de peso y disminuir las comorbilidades en pacientes con obesidad mórbida.Material y métodosEstudio descriptivo unicéntrico en el que se analizaron 224 pacientes intervenidos de CD directo con ligadura de la arteria gástrica derecha laparoscópico. El objetivo fue describir los resultados ponderales, resolución de comorbilidades, suplementación nutricional y complicaciones postquirúrgicas a dos, cinco y 10 años.ResultadosLa edad media de la cohorte fue de 49,3 (23-65) años, el peso e índice de masa corporal (IMC) medio fueron de 131,8(20)kg y 49,8(5)kg/m2. El porcentaje de exceso de peso perdido a dos, cinco y 10 años fue de 80,6(15)%, 69,3(18)%, 67,4(18)%, respectivamente. La remisión completa de la diabetes a dos y cinco años se evidenció en 35 (85,4%) y 27 (70,4%) pacientes. En el postoperatorio inmediato, la tasa de complicaciones Clavien-Dindo ≥ III fue en 15 pacientes (6,7%) y la mortalidad a 30 y 90 días fue de uno (0,4%) y dos (0,9%) pacientes. La necesidad de cirugía revisional se realizó en dos pacientes (0,9%). El 80% de los pacientes requirió en algún momento suplementación nutricional extra a partir de los dos años de la cirugía ConclusionesEl CD directo es una técnica con un bajo índice de complicaciones quirúrgicas en pacientes con un IMC entre 45 y 55 kg/m2. El control metabólico y la pérdida ponderal es sostenida con un bajo índice de cirugía revisional. Aún así, conlleva la necesidad de un seguimiento postquirúrgico estrecho para la valoración de suplementación nutricional(AU)

IntroductionDuodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity.Material and methodsDescriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years.ResultsThe mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20]kg and 49.8 [5]kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery.ConclusionsDirect DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation(AU)

Combined endoscopic-laparoscopic surgery (CELS) can avoid segmental colectomy in endoscopically unremovable colonic polyps: a cohort study over 10 years.

BACKGROUND: Combined-Endoscopic-Laparoscopic-Surgery (CELS) was developed for benign colonic polyps, endoscopically unresectable, to avoid segmental colectomy. This observational study aims to compare surgical outcomes of endoscopically unresectable colonic polyps treated laparoscopically before and since the institutional introduction of CELS. Primary endpoint was postoperative morbidity and mortality; secondary endpoints were time of hospitalization and histopathological findings. METHODS: Charts of all patients with preoperative diagnosis of benign colonic tumors, treated laparoscopically at our institution from 1/2010 to 2/2020 were reviewed. Patients with polyps (1) affecting ileocecal valve, (2) occupying > 50% of the circumference, (3) ≥ 3 endoscopically unresectable polyps, (4) inflammatory bowel disease, (5) polyps within diverticular area post diverticulitis, (6) rectal polyps (7) foreseen impossibility of laparoscopy (8) preoperatively biopsy proven invasive adenocarcinoma were excluded. Group I consists of all patients potentially treatable by CELS but operated by laparoscopic colonic resection as CELS was not yet institutionally established. Group II includes all patients treated with CELS (since 11/2017). RESULTS: One hundred-fifteen consecutive patients were reviewed. Applying exclusion criteria, twenty-three patients form group I and twenty-three group II (female 30.4%, median age 68 years). Groups distributed homogenously for age, BMI (body mass index) and polyps´ localization with most polyps (60.4%) localized in right colon; group II patients had significantly higher American Society of Anesthesiologists (ASA) score. Median operating time, hospital stay and morbidity were significantly less in group II. Postoperative morbidity occurred overall in 14 patients (30.4%), mostly Clavien-Dindo class I-II (26.1%) and significantly less in group II (p = 0.017), Clavien-Dindo III-IV distributed equally (one patient each group) without postoperative mortality. Definitive histopathology showed invasive adenocarcinoma in 8.3% without differences between groups. Two patients with invasive adenocarcinoma after CELS were advised for oncological resection. CONCLUSION: CELS is safe and efficient to treat complex, benign colonic polyps by a complete minimal invasive laparoscopic approach. CELS showed better surgical outcomes with less morbidity, no mortality and appropriate pathological results avoiding unnecessary laparoscopic surgery with intestinal anastomosis.

Salud oral y neoplasia gastrointestinal. Revisión narrativa / Oral health and gastrointestinal neoplasia: Narrative review

La cavidad oral constituye la puerta de entrada al complejo sistema digestivo, por lo que el conocimiento de los mecanismos que los vinculan es de vital importancia. En los últimos años la patología dental y oral ha sido analizada como potencial factor de riesgo de enfermedades vinculadas al estilo de vida y, por tanto, se está considerando como una posible interesante vía de prevención. Realizamos una revisión narrativa con búsqueda bibliográfica exhaustiva en las bases de datos MEDLINE y SCOPUS, incluyendo artículos internacionales que relacionan la salud oral con neoplasias del tracto digestivo, publicados entre 2015 y 2020. El objetivo de esta revisión es analizar la evidencia existente sobre la potencial asociación entre salud bucodental y procesos carcinogénicos del tracto gastrointestinal, proporcionando una posible futura vía de prevención a nivel odontológico. Como objetivo secundario, se fomenta concienciar sobre la importancia de la salud oral como nuevo paradigma y variable de estudio en el ámbito de la investigación médico-sanitaria. (AU)

The oral cavity represents the gateway to the complex digestive system, so the knowledge of the exact mechanisms that link them is vitally important. Recently, oral and dental pathologies have been studied as potential risk factors for pathologies linked to lifestyle habits. Therefore, it could be considered as an interesting preventive way. We conducted a narrative review with a thorough bibliographic search on MEDLINE and SCOPUS, including international studies related to oral healthcare and gastrointestinal neoplasms, published between 2015 and 2020. The primary aim of this revision is to analyze the association between oral healthcare and carcinogenic gastrointestinal processes, providing a possible future preventive strategy for dental care. Moreover, we intend to raise awareness about the importance of oral healthcare as a new paradigm and study variable in the global health care system. (AU)

Oral health and gastrointestinal neoplasia: Narrative review.

The oral cavity represents the gateway to the complex digestive system, so the knowledge of the exact mechanisms that link them is vitally important. Recently, oral and dental pathologies have been studied as potential risk factors for pathologies linked to lifestyle habits. Therefore, it could be considered as an interesting preventive way. We conducted a narrative review with a thorough bibliographic search on MEDLINE and SCOPUS, including international studies related to oral healthcare and gastrointestinal neoplasms, published between 2015 and 2020. The primary aim of this revision is to analyze the association between oral healthcare and carcinogenic gastrointestinal processes, providing a possible future preventive strategy for dental care. Moreover, we intend to raise awareness about the importance of oral healthcare as a new paradigm and study variable in the global health care system.

Cruce duodenal de una anastomosis (SADI-S) en uno o dos tiempos: análisis comparativo de 232 casos de un solo centro / Direct and two-step single anastomosis duoenal switch (SADI-S): Unicentric comparative analysis of 232 cases

Introducción: El cruce duodenal de una anastomosis (SADI-S) es una cirugía bariátrica concebida como una simplificación del cruce duodenal. El objetivo de este estudio es valorar su seguridad y eficacia, comparando los casos operados en uno o dos tiempos. Métodos: Estudio descriptivo unicéntrico que compara los resultados de pacientes intervenidos de SADI-S en uno o dos tiempos entre 2014 y 2019. Resultados: Se incluyeron a 232 pacientes, 192 operados directamente y 40 sometidos previamente a una gastrectomía vertical. La tasa de complicaciones Clavien-Dindo ≥ IIIA fue 7,8%, siendo las más frecuentes el hemoperitoneo y la fístula de muñón duodenal. Hubo un éxitus en los primeros 90 días del 0,4%. Los pacientes sometidos a SADI-S directo partieron de un índice de masa corporal (IMC) de 49,6 kg/m2 y los operados en dos tiempos de 56,2 kg/m2 (p < 0,001), siendo el exceso de peso perdido a los dos años de ambos grupos de 77,3% y 59,3% respectivamente (p < 0,05). La tasa de resolución de la diabetes, hipertensión arterial, dislipemia y síndrome de apnea obstructiva del sueño fue de 88,5, 73,0, 77,0 y 85,7% respectivamente, sin diferencias entre el SADI-S en uno o dos tiempos. Conclusión: El SADI-S es una técnica segura y eficaz a medio plazo para la pérdida de peso y control de comorbilidades. Los pacientes intervenidos en dos tiempos partieron de un IMC mayor y presentaron menor porcentaje de exceso de peso perdido que los operados directamente. (AU)

Introduction: The «Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy» (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure. Methods: Unicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019. Results: Two hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo ≥ IIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6 kg/m2 in comparison of 56.2 kg/m2 in the two-step SADI-S (p < 0.001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, p < 0.05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques. Conclusion: In medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S. (AU)

Direct and two-step single anastomosis duodenal switch (SADI-S): Unicentric comparative analysis of 232 cases.

INTRODUCTION: The "Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy" (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure. METHODS: Unicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019. RESULTS: Two hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo ≥ IIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6 kg/m2 in comparison of 56.2 kg/m2 in the two-step SADI-S (P < .001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, P < .05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques. CONCLUSION: In medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S.

Oral health and gastrointestinal neoplasia: Narrative review. / Salud oral y neoplasia gastrointestinal. Revisión narrativa.

The oral cavity represents the gateway to the complex digestive system, so the knowledge of the exact mechanisms that link them is vitally important. Recently, oral and dental pathologies have been studied as potential risk factors for pathologies linked to lifestyle habits. Therefore, it could be considered as an interesting preventive way. We conducted a narrative review with a thorough bibliographic search on MEDLINE and SCOPUS, including international studies related to oral healthcare and gastrointestinal neoplasms, published between 2015 and 2020. The primary aim of this revision is to analyze the association between oral healthcare and carcinogenic gastrointestinal processes, providing a possible future preventive strategy for dental care. Moreover, we intend to raise awareness about the importance of oral healthcare as a new paradigm and study variable in the global health care system.

Experience in biliopancreatic diversion with duodenal switch: results at 2, 5 and 10 years. / Experiencia en la derivación biliopancreática tipo cruce duodenal: resultados a 2, 5 y 10 años.

INTRODUCTION: Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS: Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS: The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20]kg and 49.8 [5]kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS: Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.