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)

Ectopic insulinoma: a systematic review.

Knowledge of ectopic insulinomas comes from single cases. We performed a systematic review through PubMed, Web of Science, Embase, eLibrary and ScienceDirect of all cases reported in the last four decades. We also describe one unreported patient. From 28 patients with ectopic insulinoma, 78.6% were female and mean age was 55.7 ± 19.2 years. Hypoglycaemia was the first symptom in 85.7% while 14.3% complained of abdominal pain or genital symptoms. Median tumour diameter was 27.5 [15-52.5] mm and it was localised by CT (73.1%), MRI (88.9%), [68Ga]Ga-DOTA-exedin-4 PET/CT (100%), 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC (100%), somatostatin receptor scintigraphy (40%) and endoscopic ultrasound (50%). Ectopic insulinomas were located at duodenum (n = 3), jejunum (n = 2), and one respectively at stomach, liver, appendix, rectum, mesentery, ligament of Treitz, gastrosplenic ligament, hepatoduodenal ligament and splenic hilum. Seven insulinomas were affecting the female reproductive organs: ovary (n = 5), cervix (n = 2) and remaining tumours were at retroperitoneum (n = 3), kidney (n = 2), spleen (n = 1) and pelvis (n = 1). 89.3% underwent surgery (66.7% surgery vs. 33.3% laparoscopy) and 16% underwent an ineffective pancreatectomy. 85.7% had localized disease at diagnosis and 14.3% developed distant metastasis. Median follow-up time was 14.5 [4.5-35.5] months and mortality was reported in 28.6% with median time until death of 60 [5-144] months. In conclusion, ectopic insulinomas are presented as hypoglycaemia with female preponderance. Functional imaging [68Ga]Ga-DOTA-exedin-4 PET/CT and 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC have very high sensitivity. Clinicians should be alert to the possibility of extra-pancreatic insulinomas when classic diagnostic tests and intraoperative pancreas exploration failed to locate the tumour.

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)

Colangiocarcinoma intrahepático: factores pronósticos de recidiva y supervivencia en una serie de 67 pacientes tratados quirúrgicamente en un solo centro / Intrahepatic cholangiocarcinoma: Prognostic factors for recurrence and survival in a series of 67 patients treated surgically at a single center

Introducción: El colangiocarcinoma intrahepático es una neoplasia primaria hepática de mal pronóstico, cuyo único tratamiento curativo es la cirugía. El objetivo de este trabajo ha sido determinar los factores pronósticos de supervivencia del colangiocarcinoma intrahepático tratado quirúrgicamente con intención curativa. Métodos: Se ha recogido una serie de 67 pacientes intervenidos quirúrgicamente de esta neoplasia en el Hospital Universitario de Bellvitge entre 1996 y 2017. Se han analizado los datos epidemiológicos, clínicos, quirúrgicos, anatomopatológicos, de morbilidad, de mortalidad y de supervivencia. Resultados: La morbilidad postoperatoria ha sido del 47,76% y la mortalidad postoperatoria de 1,5%. La linfadenectomía se ha asociado a mayor morbilidad. La supervivencia global ha sido de 91%; 49,2% y 39,8% a los 12, 36 y 60 meses, respectivamente, y la supervivencia libre de enfermedad de 67,2%; 32,8% y 22,4%. La morbilidad postoperatoria en forma de reintervención quirúrgica, la invasión vascular y la quimioterapia adyuvante han demostrado ser factores de mal pronóstico. La invasión vascular en el estudio anatomopatológico fue el factor de riesgo de mayor importancia en la supervivencia. Conclusiones: Este estudio recoge la experiencia de nuestro centro en el tratamiento quirúrgico del colangiocarcinoma intrahepático durante un periodo de 21 años. La linfadenectomía se ha asociado a mayor morbilidad y la afectación vascular en el estudio anatomopatológico ha sido el factor de riesgo más importante en cuanto a la supervivencia. (AU)

Introduction: Intrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. Methods: Sixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. Results: Postoperative morbidity was 47.76%, and postoperative mortality was 1.5%. Lymphadenectomy was associated with increased morbidity. Overall survival was 91%, 49.2% and 39.8% after 12, 36 and 60 months, respectively, and disease-free survival was 67.2%, 32.8% and 22.4%. Postoperative morbidity (reoperation, vascular invasion, adjuvant chemotherapy) were shown to be factors for a poor prognosis. Vascular invasion in the pathological study was the most important risk factor in the survival analysis. Conclusions: This study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis. (AU)

Intrahepatic cholangiocarcinoma: Prognostic factors for recurrence and survival in a series of 67 patients treated surgically at a single center.

INTRODUCTION: Intrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. METHODS: Sixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. RESULTS: Postoperative study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis. CONCLUSIONS: This study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis.

Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement.

BACKGROUND: There are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy. METHODS: Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy. RESULTS: We included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third + fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n = 13), adenocarcinoma (n = 4), neuroendocrine tumor (n = 3), duodenal adenoma (n = 1), and adenomatous duodenal polyposis (n = 1); scenario 2: retroperitoneal desmoid tumor (n = 2), recurrence of liposarcoma (n = 2), retroperitoneal paraganglioma (n = 1), neuroendocrine tumor in pancreatic uncinate process (n = 1), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n = 1); and scenario 3: aortoenteric fistula (n = 3), duodenal trauma (n = 1), erosive duodenitis (n = 1), and biliopancreatic limb ischemia (n = 1). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35). CONCLUSIONS: Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Resultados a largo plazo sobre la resección de la cabeza pancreática por pancreatitis crónica: ¿duodenopancreatectomía cefálica o pancreatectomía cefálica con preservación duodenal? / Long-term results of resection of the head of the pancreas due to chronic pancreatitis: Pancreaticoduodenectomy or duodenum-preserving cephalic pancreatectomy?

INTRODUCCIÓN: El dolor crónico en la pancreatitis crónica es de difícil manejo. El objetivo de nuestro trabajo es la valoración del control del dolor refractario al tratamiento médico en pacientes afectos de masa inflamatoria en la cabeza pancreática, así como comparar dos técnicas quirúrgicas realizadas. MÉTODOS: Estudio retrospectivo sobre pacientes intervenidos entre 1989 y 2011 refractarios al tratamiento médico con predominio inflamatorio en la cabeza pancreática. Se realizó un estudio comparativo a corto y a largo plazo entre los pacientes intervenidos mediante duodenopancreatectomía cefálica (DPC) y/o pancreatectomía cefálica con preservación duodenal (PCPD). RESULTADOS: Se realizaron 22 DPC y 12 PCPD. En el 44% de los casos se presentaron complicaciones posquirúrgicas, siendo las más frecuentes el vaciamiento gástrico retardado (14,7%) y la fístula pancreática (11,7%). No se evidenciaron diferencias estadísticamente significativas según la técnica quirúrgica. Se consiguió el control del dolor de forma satisfactoria en el 85% de los pacientes, hubo un 43% de diabetes mellitus de novo, y la reincorporación a la actividad laboral fue del 88%. Catorce pacientes fallecieron durante el seguimiento; de ellos, 7 a causa de neoplasias, algunas de ellas relacionadas con el consumo de tabaco y alcohol. La supervivencia global a 5 y 10 años fue del 88 y del 75%, respectivamente. CONCLUSIÓN: La resección cefálica en pacientes con dolor intratable en la pancreatitis crónica es una terapéutica eficaz, con buenos resultados a largo plazo en términos de control del dolor y sin diferencias significativas entre ambas técnicas quirúrgicas. Los pacientes con pancreatitis crónica presentan una elevada mortalidad asociada a neoplasias de novo

INTRODUCTION: Chronic pain in chronic pancreatitis is difficult to manage. The objective of our study is to assess the control of pain that is refractory to medical treatment in patients with an inflammatory mass in the head of the pancreas, as well as to compare the two surgical techniques. METHODS: A retrospective study included patients treated surgically between 1989 and 2011 who had been refractory to medical treatment with inflammation of the head of the pancreas. An analysis of the short and long-term results was done to compare patients who had undergone pancreaticoduodenectomy (PD) and/or resection of the head of the pancreas with duodenal preservation (RHPDP). RESULTS: 22 PD and 12 RHPDP were performed. Postoperative complications were observed in 14% of patients, the most frequent being delayed gastric emptying (14.7%) and pancreatic fistula (11.7%). No statistically significant differences were found in terms of surgical technique. Pain control was satisfactory in 85% of patients, 43% presented de novo diabetes mellitus, and 88% returned to their work activities. Fourteen patients died during follow-up, 7 due to malignancies, and some were related to tobacco use and alcohol consumption. The overall 5 and 10 year survival rates were 88% and 75% respectively. CONCLUSIÓN: Cephalic resection in patients with intractable pain in chronic pancreatitis is an effective therapy that provides good long-term results in terms of pain control, with no significant differences between the two surgical techniques. Patients with chronic pancreatitis have a high mortality rate associated with de novo malignancies

Long-term results of resection of the head of the pancreas due to chronic pancreatitis: Pancreaticoduodenectomy or duodenum-preserving cephalic pancreatectomy? / Resultados a largo plazo sobre la resección de la cabeza pancreática por pancreatitis crónica: ¿duodenopancreatectomía cefálica o pancreatectomía cefálica con preservación duodenal?

INTRODUCTION: Chronic pain in chronic pancreatitis is difficult to manage. The objective of our study is to assess the control of pain that is refractory to medical treatment in patients with an inflammatory mass in the head of the pancreas, as well as to compare the two surgical techniques. METHODS: A retrospective study included patients treated surgically between 1989 and 2011 who had been refractory to medical treatment with inflammation of the head of the pancreas. An analysis of the short and long-term results was done to compare patients who had undergone pancreaticoduodenectomy (PD) and/or resection of the head of the pancreas with duodenal preservation (RHPDP). RESULTS: 22 PD and 12 RHPDP were performed. Postoperative complications were observed in 14% of patients, the most frequent being delayed gastric emptying (14.7%) and pancreatic fistula (11.7%). No statistically significant differences were found in terms of surgical technique. Pain control was satisfactory in 85% of patients, 43% presented de novo diabetes mellitus, and 88% returned to their work activities. Fourteen patients died during follow-up, 7 due to malignancies, and some were related to tobacco use and alcohol consumption. The overall 5 and 10 year survival rates were 88% and 75% respectively. CONCLUSION: Cephalic resection in patients with intractable pain in chronic pancreatitis is an effective therapy that provides good long-term results in terms of pain control, with no significant differences between the two surgical techniques. Patients with chronic pancreatitis have a high mortality rate associated with de novo malignancies.

Adenocarcinoma duodenal: resultados del tratamiento quirúrgico de una serie unicéntrica de 27 pacientes / Duodenal adenocarcinoma: Surgical results of 27 patients treated at a single center

Introducción: El adenocarcinoma de duodeno es una neoplasia poco frecuente, sobre la que existen pocas experiencias publicadas de los resultados tras su resección. El objetivo es analizar los resultados obtenidos en nuestro centro tras la resección curativa del adenocarcinoma duodenal (AD). Métodos: Estudio retrospectivo de los pacientes intervenidos con resección curativa por AD entre 1990 y 2017 en nuestro hospital. Resultados: Se intervino a 27 pacientes. En 23 casos (85%) se realizó duodenopancreatectomía cefálica (DPC) y en 4 casos (15%) con localización en la 3.ª-4.ª porción duodenal se realizó duodenectomía (DD) segmentaria. La morbilidad postoperatoria global fue del 67% (18 pacientes). La mortalidad postoperatoria global fue 7% (2 pacientes), sin embargo, la mortalidad postoperatoria relacionada con la cirugía fue de 4% (un paciente). El estudio anatomopatológico evidenció resección con márgenes libres en todos los casos intervenidos. La mediana de adenopatías resecadas fue 18 (0 a 38), siendo 1 (0 a 8) las adenopatías afectadas. Tras una mediana de seguimiento de 23 (9-69,7) meses, la supervivencia actuarial fue de 62,2 (25,2 a 99,1) meses y la supervivencia actuarial libre de enfermedad fue de 49 (0 a 133) meses. Conclusiones: La resección quirúrgica del AD comporta una elevada morbilidad postoperatoria, sin embargo, consigue una supervivencia prolongada. Dependiendo de la localización y en ausencia de infiltración pancreática, la DD segmentaria con márgenes libres es una alternativa a la DPC

Introduction: Duodenal adenocarcinoma is a rare malignancy. Given the rarity of the disease, there is limited data related to resection results. The objective is to analyze results at our hospital after the curative resection of duodenal adenocarcinoma (DA). Methods: The variables were retrospectively collected from patients operated on between 1990 and 2017 at our hospital. Results: A total of 27 patients were treated. Twenty-three patients (85%) underwent pancreaticoduodenectomy, and 4 patients (15%) with tumors located in the third and fourth portions of the duodenum underwent segmental duodenal resection. The overall postoperative morbidity was 67% (18 patients). Postoperative mortality was 7% (2 patients); however, postoperative mortality related to surgery was 4% (1 patient). All patients had negative resection margins. A median of 18 lymph nodes (range, 0-38) were retrieved and evaluated, with a median of 1 involved node (range, 0-8). Median follow up was 23 (9-69.7) months. Actuarial overall survival was 62.2 (25.2-99.1) months. Actuarial disease-free survival was 49 (0-133) months. Conclusions: The surgical treatment of duodenal adenocarcinoma is associated with a high morbidity, although it achieves considerable survival. Depending on the tumor location and if there is no pancreatic infiltration, segmental duodenal resection with negative margins is an alternative to cephalic pancreaticoduodenectomy

Duodenal adenocarcinoma: Surgical results of 27 patients treated at a single center. / Adenocarcinoma duodenal: resultados del tratamiento quirúrgico de una serie unicéntrica de 27 pacientes.

INTRODUCTION: Duodenal adenocarcinoma is a rare malignancy. Given the rarity of the disease, there is limited data related to resection results. The objective is to analyze results at our hospital after the curative resection of duodenal adenocarcinoma (DA). METHODS: The variables were retrospectively collected from patients operated on between 1990 and 2017 at our hospital. RESULTS: A total of 27 patients were treated. Twenty-three patients (85%) underwent pancreaticoduodenectomy, and 4 patients (15%) with tumors located in the third and fourth portions of the duodenum underwent segmental duodenal resection. The overall postoperative morbidity was 67% (18 patients). Postoperative mortality was 7% (2 patients); however, postoperative mortality related to surgery was 4% (1 patient). All patients had negative resection margins. A median of 18 lymph nodes (range, 0-38) were retrieved and evaluated, with a median of 1 involved node (range, 0-8). Median follow up was 23 (9-69.7) months. Actuarial overall survival was 62.2 (25.2-99.1) months. Actuarial disease-free survival was 49 (0-133) months. CONCLUSIONS: The surgical treatment of duodenal adenocarcinoma is associated with a high morbidity, although it achieves considerable survival. Depending on the tumor location and if there is no pancreatic infiltration, segmental duodenal resection with negative margins is an alternative to cephalic pancreaticoduodenectomy.

Short- and long-term outcomes of arterial reconstruction on recipient splenic artery in adult liver transplantation. Single-center prospective study 25 years after first description.

Several techniques have been proposed for liver transplantation with inadequate hepatic artery (HA) anastomosis. We aimed to analyze outcomes of arterial reconstruction with the splenic artery (SA). This was a prospective study of our experience with recipients who underwent arterial anastomosis on the SA compared with patients who underwent standard HA. We included 54 patients in the SA group and 1405 in the HA group. Patients in SA group were more frequently retransplantation (31% vs. 8%; P = 0.001), required more transfusion (11 ± 12 vs. 6 ± 9.9 PRC; P = 0.001), had longer surgeries (424 ± 95 vs. 394 ± 102 min; P = 0.03), and longer hospital stays (28 ± 29 vs. 20 ± 18 days; P = 0.002). There were no differences in vascular and biliary complications (15% and 7%; P = 0.18; and 32% and 23%; P = 0.32), primary dysfunction (11% and 9%; P = 0.74), reoperation (12% and 10%; P = 0.61), postoperative mortality (13% and 7%; P = 0.12) and 5 years survival (66% vs. 63%; P = 0.71). Following primary transplantation, there were no differences. The outcomes of arterial reconstruction using the recipients' SA in adult liver transplantation are comparable to those for standard HA reconstruction after a first transplant.

Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study.

BACKGROUND: The aim of this study was to evaluate whether the placement of a coaxial double-pigtail plastic stent (DPS) within a lumen-apposing metal stent (LAMS) may improve the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). METHODS: This was a retrospective cohort study including patients with PFCs and an indication for transmural drainage. Two strategies (LAMS alone or LAMS plus DPS) were used at the endoscopist's discretion. RESULTS: A total of 41 patients were treated (21 LAMS alone; 20 LAMS plus DPS). The characteristics of the PFCs, and the technical and clinical success rates did not differ between groups. The LAMS alone group had a significantly higher rate of adverse events than the LAMS plus DPS group (42.9 % vs. 10.0 %; P = 0.04). Bleeding was the most frequent adverse event observed. CONCLUSIONS: The addition of a coaxial DPS to LAMS was associated with a lower rate of adverse events in EUS-guided drainage of PFCs.

Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study / Fluoroscopia vs no fluoroscopia en el drenaje transmural de colecciones pancreáticas guiado por ecoendoscopia: estudio comparativo

Introduction: The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. Aims: The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). Methods: This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. Results: Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). Conclusions: Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups (AU)

Introducción: La necesidad de la ayuda de fluoroscopia en pacientes que se les realiza un drenaje transmural guiada por ecoendoscopia (USE) de colecciones pancreáticas (CP) no está claro. Objetivo: El objetivo de este estudio fue comparar los resultados generales del drenaje transmural de CP con ayuda de fluoroscopia (F) versus sin fluoroscopia (SF). Métodos: Estudio comparativo, análisis retrospectivo, con inclusión prospectiva y consecutiva en una base de datos específica. Estudio realizado en un centro universitario terciario, en el periodo entre 2009 y 2015. Todos los pacientes fueron seudoquistes (PSQ) o colecciones pancreáticas necróticas encapsuladas (CPN) con clínica asociada. Se asignaron 2 grupos dependiendo de la disponibilidad de la fluoroscopia. Grupos heterogéneos respecto a sus características demográficas, CP y procedimientos. El estudio analizó el éxito técnico, el éxito clínico, las incidencias, los eventos adversos y el seguimiento. Resultados: Cincuenta drenajes transmurales guiados por USE de CP, de un total de 86 drenajes por USE, fueron incluidos durante el periodo del estudio. El grupo F incluyó 26 procedimientos, PSC 69,2%, CPN 30,8%, prótesis metálicas 61,5% (46,1% prótesis de aposición luminal) y plásticas 38,5%. El grupo SF incluyó 24 procedimientos, PSQ 37,5%, CPN 62,5% y prótesis metálicas 95,8% (prótesis de aposición luminal). Éxito técnico del 100% en ambos grupos, éxito clínico clínico similar (F 88,5%, FL 87,5%). Incidencias técnicas y eventos adversos intraprocedimiento: solo descritos en grupo F (7,6% y 11.5%, respectivamente) y ninguna en el grupo SF. Tiempo del procedimiento menor en grupo SF (8min, p=0.0341). Conclusiones: El drenaje transmural de CP sin ayuda de fluoroscopia no comportó mayor número de incidencias técnicas o eventos adversos intraprocedimiento. Los éxitos técnico y clínico fueron similares en ambos grupos (AU)

Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study.

INTRODUCTION: The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. AIMS: The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). METHODS: This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. RESULTS: Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). CONCLUSIONS: Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups.

Tratamiento quirúrgico de los tumores neuroendocrinos no funcionantes de páncreas basado en 3 escenarios clínicos / Surgical treatment of non-functioning pancreatic neuroendocrine tumours based on three clinical scenarios

INTRODUCCIÓN: El tratamiento de los tumores neuroendocrinos pancreáticos no funcionantes (TNEPNF) es la resección en caso de enfermedad localizada o metástasis hepáticas resecables. Existe controversia en metástasis hepáticas irresecables. MÉTODOS: Analizamos los datos perioperatorios y de supervivencia de 63 pacientes resecados por TNEPNF entre 1993 y 2012, dividiéndolos en 3 escenarios: A, resección pancreática (44 pacientes); B, resección pancreática y hepática por metástasis hepáticas sincrónicas (12 pacientes), y C, resección pancreática en presencia de metástasis hepáticas irresecables (6 pacientes). Se estudiaron factores pronósticos de supervivencia y recidiva. RESULTADOS: Las cirugías más frecuentes fueron, pancreatectomía corporocaudal (51%) y duodenopancreatectomía cefálica (38%). El 44% de los pacientes requirieron una cirugía asociada, resecando sincrónicamente páncreas e hígado en 9. Dos pacientes recibieron un trasplante hepático durante el seguimiento. Según la clasificación de la OMS, se distribuyeron en G1: 10 (16%), G2: 45 (71%) y G3: 8 (13%). La morbimortalidad postoperatoria fue del 49 y del 1,6%, respectivamente. Al cierre del estudio, 43 (68%) seguían vivos, con una supervivencia actuarial media de 9,6 años. La clasificación de la OMS y la recidiva fueron factores de riesgo de mortalidad en el estudio multivariante. La supervivencia actuarial mediana por escenarios fue de 131 meses (A), 102 meses (B) y 75 meses (C), sin diferencias estadísticamente significativas. CONCLUSIONES: El tratamiento del TNEPNF sin enfermedad a distancia es la resección. Las metástasis hepáticas resecables en los tumores bien diferenciados deben resecarse. La resección del tumor pancreático con metástasis hepáticas sincrónicas irresecables debe considerarse en TNEPNF bien diferenciados. El grado de clasificación de la OMS y la recidiva son factores de riesgo de mortalidad a largo plazo

INTRODUCTION: The treatment of patients with non-functioning pancreatic neuroendocrine tumours (NFPNET) is resection in locally pancreatic disease, or with resectable liver metastases. There is controversy about unresectable liver disease. METHODS: We analysed the perioperative data and survival outcome of 63 patients who underwent resection of NFPNET between 1993 and 2012. They were divided into 3 scenarios: A, pancreatic resection (44 patients); B, pancreatic and liver resection in synchronous resectable liver metastases (12 patients); and C, pancreatic resection in synchronous unresectable liver metastases (6 patients). The prognostic factors for survival and recurrence were studied. RESULTS: Distal pancreatectomy (51%) and pancreaticoduodenectomy (38%) were more frequently performed. Associated surgery was required in 44% of patients, including synchronous liver resections in 9 patients. Two patients received a liver transplant during follow-up. According to the WHO classification they were distributed into G1: 10 (16%), G2: 45 (71%), and G3: 8 (13%). The median hospital stay was 11 days. Postoperative morbidity and mortality were 49% and 1.6%, respectively. At the closure of the study, 43 (68%) patients were still alive, with a mean actuarial survival of 9.6 years. The WHO classification and tumour recurrence were risk factors of mortality in the multivariate analysis. The median actuarial survival by scenarios was 131 months (A), 102 months (B), and 75 months (C) without statistically significant differences. CONCLUSIONS: Surgical resection is the treatment for NFPNET without distant disease. Resectable liver metastases in well-differentiated tumours must be resected. The resection of the pancreatic tumour with unresectable synchronous liver metastasis must be considered in well-differentiated NFPNET. The WHO classification grade and recurrence are risk factors of long-term mortality

¿Es la duodenopancreatectomía cefálica una intervención segura en el paciente cirrótico? / Is pancreaticoduodenectomy a safe procedure in the cirrhotic patient?

INTRODUCCIÓN: La duodenopancreatectomía cefálica (DPC) es el tratamiento de elección de los tumores del área periampular. Esta intervención presenta una elevada morbilidad postoperatoria, y suele estar contraindicada en los pacientes con hepatopatía crónica (CH). Analizar los resultados de la DPC en pacientes cirróticos, y compararlos con los de pacientes no cirróticos. MÉTODOS: Entre abril de 1994 y noviembre de 2014 registramos de forma prospectiva a todos los pacientes a los que se les realizó una DPC por cáncer del área periampular en el Hospital Universitari de Bellvitge. Se recogieron de forma prospectiva variables preoperatorias, intraoperatorias y del postoperatorio inmediato. Se definió grupo de estudio a los pacientes tratados mediante DPC y afectos de cirrosis hepática (grupo CH), y grupo control a pacientes intervenidos sin cirrosis hepática (grupo NCH); se realizó un estudio caso/control (1/2). RESULTADOS: Registramos a 15 pacientes del grupo CH, todos ellos con una buena función hepática (Child A), y a 30 del grupo NCH. La causa de la hepatopatía fue VHC (60%) y enolismo (40%). En los 3 instantes estudiados, los pacientes del grupo CH presentaron una cifra de plaquetas en sangre inferior y una ratio de protrombina superior, respecto al grupo NCH. La morbilidad postoperatoria fue del 60%, con una estancia media de 25 ± 19 días; sin diferencias significativas en la incidencia de complicaciones entre el grupo CH y NCH (73 vs. 53%; p = 0,1). La presencia de ascitis durante el postoperatorio fue superior en el grupo CH respecto al NCH (28 vs. 0%; p < 0,001). No hubo diferencias entre ambos grupos en la aparición de complicaciones hemorrágicas, ni de fístula pancreática. Se reintervino a 4 pacientes del grupo CH y a 2 del grupo NCH (26,7 vs. 6,7%; p = 0,1). No hubo mortalidad postoperatoria. CONCLUSIONES: La DPC es una intervención segura entre los pacientes hepatópatas con buena función hepática preoperatoria, a pesar de comportar una elevada morbilidad

INTRODUCTION: Pancreaticoduodenectomy (PD) is usually contraindicated in chronic liver disease. The objective of the present study was to analyze PD results in cirrhotic patients, and compare them with non-cirrhotic ones. METHODS: Between 1994 and 2014 we prospectively collected all patients with a PD for periampullar neoplasms in Hospital Universitari de Bellvitge. We registered preoperative, intraoperative and postoperative variables. We defined patients undergoing PD with liver cirrhosis as the study group (CH group), and those without liver cirrhosis as the control group (NCH group). A case/control study was performed (1/2). RESULTS: We registered 15 patients in the CH group, all with good liver function (Child A), and included 30 patients in NCH group. The causes of hepatopathy were HCV (60%) and alcoholism (40%). For the 3 moments studied, the CH group had a lower blood platelet count and a higher prothrombin ratio, compared with NCH group. Postoperative morbidity was 60% and mean postoperative stay was 25 ± 19 days, with no differences in terms of complications between CH group and NCG group (73% vs. 53%, P=.1). Presence of ascites was higher in the CH group compared with NCH group (28 vs. 0%, P < .001). There were no differences in terms of hemorrhage or pancreatic fístula. Four patients of the CH group and 2 patients of the NCH group were reoperated on (26.7 vs. 6.7%, P = .1). There was no postoperative mortality. CONCLUSIONS: PD is a safe procedure in cirrhotic patients with good liver function although it presents high morbidity

Is pancreaticoduodenectomy a safe procedure in the cirrhotic patient? / ¿Es la duodenopancreatectomía cefálica una intervención segura en el paciente cirrótico?

INTRODUCTION: Pancreaticoduodenectomy (PD) is usually contraindicated in chronic liver disease. The objective of the present study was to analyze PD results in cirrhotic patients, and compare them with non-cirrhotic ones. METHODS: Between 1994 and 2014 we prospectively collected all patients with a PD for periampullar neoplasms in Hospital Universitari de Bellvitge. We registered preoperative, intraoperative and postoperative variables. We defined patients undergoing PD with liver cirrhosis as the study group (CH group), and those without liver cirrhosis as the control group (NCH group). A case/control study was performed (1/2). RESULTS: We registered 15 patients in the CH group, all with good liver function (Child A), and included 30 patients in NCH group. The causes of hepatopathy were HCV (60%) and alcoholism (40%). For the 3 moments studied, the CH group had a lower blood platelet count and a higher prothrombin ratio, compared with NCH group. Postoperative morbidity was 60% and mean postoperative stay was 25±19 days, with no differences in terms of complications between CH group and NCG group (73% vs. 53%, P=.1). Presence of ascites was higher in the CH group compared with NCH group (28 vs. 0%, P<.001). There were no differences in terms of hemorrhage or pancreatic fístula. Four patients of the CH group and 2 patients of the NCH group were reoperated on (26.7 vs. 6.7%, P=.1). There was no postoperative mortality. CONCLUSIONS: PD is a safe procedure in cirrhotic patients with good liver function although it presents high morbidity.