Laparoscopic staged colon-first resection for metastatic colorectal cancer: Perioperative and midterm outcomes from a single-center experience.

INTRODUCTION: The present study aimed to evaluate the short- and mid-term outcomes of laparoscopic colon-first staged resection for colorectal cancer (CRC) and colorectal cancer liver metastases (CRCLM). METHODS: This study included patients with metastatic CRC who underwent laparoscopic surgical staged resection for the primary tumor and CRCLM between June 2013 and December 2018. Data collection included the baseline patient's and tumor features, the perioperative and histopathologic outcomes from both surgical procedures, and the oncologic follow-up. RESULTS: Twenty-five patients were eligible for the study. Three major and 22 minor laparoscopic liver resections were performed following laparoscopic CRC surgery. Five patients required conversion to laparotomy during CRCLM resection, but no conversion was needed for the colorectal procedures. The rate of severe intraoperative complications (CLASSIC grade III-IV) was 8% and 16% during CRC and CRCLM resection, respectively. Three patients (12%) developed major postoperative complications (Clavien-Dindo grade > III) after both interventions, including one death due to intraoperative bleeding. During a median follow-up of 30 months, 15 patients were diagnosed with disease recurrence. The 3-year disease-free survival and overall survival were 33.3% and 73.9%, respectively. CONCLUSIONS: Laparoscopic staged resection for CRC and CRCLM is safe, feasible, and offers acceptable midterm oncological outcomes in patients with metastatic colorectal cancer.

Abordaje laparoscópico del páncreas izquierdo / Laparoscopic approach of the left side of the páncreas

Introducción: La pancreatectomía izquierda laparoscópica (PIL) es una técnica quirúrgica cada vez más utilizada para el tratamiento de lesiones benignas y malignas del páncreas izquierdo. Analizamos los resultados de nuestra serie de PIL para el tratamiento de las lesiones primarias de cuerpo y cola pancreáticos. Métodos: Desde noviembre de 2011 a noviembre de 2017 se han intervenido 18 pacientes por lesiones primarias del páncreas realizándose una pancreatectomía distal laparoscópica. En todos los casos se dejó un drenaje intraabdominal y se siguieron las recomendaciones del International Study Group for Pancreatic Fistula (ISGPF). Resultados: La mediana de edad fue de 66,5 años (RIQ 46-74). De las 18 pancreatectomías izquierdas, cuatro se realizaron con preservación esplénica, una de ellas una pancreatectomía central. Hubo dos conversiones. La mediana del tiempo operatorio fue de 247,5 min (RIQ242-275). La mediana de estancia hospitalaria fue de 7 días (RIQ6-8). A los 90 días se detectaron complicaciones en cinco pacientes: tres grado II, una grado III y una grado V según la clasificación modificada de Clavien-Dindo. Hubo una fístula pancreática grado B y cuatro pacientes reingresaron por colecciones peripancreáticas. La anatomía patológica evidenció malignidad en el 38,9% de los casos, presentando todos ellos márgenes negativos. Conclusiones: La PIL puede ser considerada técnica de elección para el tratamiento de las lesiones pancreáticas benignas y una alternativa al abordaje abierto para pacientes seleccionados diagnosticados de neoplasias malignas, siempre que la realicen cirujanos con experiencia en cirugía pancreática y laparoscópica avanzada

Introduction: Laparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. Methods: From November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. Results: The mean age was 66.5 years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5 minutes (IQR 242-275). The median postoperative hospital stay was 7 days (IQR 6-8). After 90 days, complications were detected in five patients: three grade II, one grade III and one grade V according to the modified Clavien-Dindo classification. There was one grade B pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. Conclusions: LLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions

Laparoscopic approach of the left side of the pancreas. / Abordaje laparoscópico del páncreas izquierdo.

INTRODUCTION: Laparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. METHODS: From November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. RESULTS: The mean age was 66.5years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5minutes (IQR 242-275). The median postoperative hospital stay was 7days (IQR 6-8). After 90days, complications were detected in five patients: three gradeII, one gradeIII and one gradeV according to the modified Clavien-Dindo classification. There was one gradeB pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. CONCLUSIONS: LLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions.

Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction.

BACKGROUND: We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate. METHODS: We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker's classification) and survival were analyzed. RESULTS: Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 - 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively. CONCLUSIONS: The percentage of major responder tumors after preoperative chemotherapy was low. Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.

Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose homeostasis, lipid profiles, and comorbidities in morbidly obese patients.

Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery, 83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004). High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.

Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women.

BACKGROUND: Despite routine supplementation of vitamins and minerals after bariatric surgery, an important number of patients suffer from deficiencies. Little is still known about the novel restrictive procedure, sleeve gastrectomy. METHODS: A retrospective study of 30 morbidly obese patients undergoing a laparoscopic sleeve gastrectomy, between May 2008 and September 2010, was performed. Baseline albumin, ferritin, iron, zinc, calcium, vitamin D, parathormone (PTH), vitamin B12, and folic acid were obtained before operation and postoperative determinations 1, 3, 6, 9, 12, 18, and 24 months after surgery. RESULTS: Before surgery, 96.7% of the patients presented vitamin D deficiency, 20% had elevated PTH, 3.3% hypoalbuminemia, and 3.3% folic acid deficiency. One year after surgery, only one patient (3.3%) presented vitamin D deficiency and had elevated PTH. The rest of parameters were within normal range. The second year after surgery, the results remain similar. A significant difference was obtained when comparing preoperative vitamin D values and postoperative determinations 12 months after surgery (increase of 51.9 ng/dl, 95% confidence interval (CI) (41.8-61.3); p < 0.001). A significant difference was determined when comparing preoperative PTH values and postoperative determinations 3 months after surgery (decrease of 16.6 pg/ml, 95% CI (2.6-30.6); p = 0.03). A significant inverse correlation was observed between weight loss and vitamin D increase at the third month after surgery (Pearson correlation coefficient -0.948; p = 0.033). CONCLUSIONS: Postoperative values of vitamin D show a progressive increase, while PTH ones present a significant reduction, without any impact on serum calcium levels. We have demonstrated an inverse correlation between weight loss and vitamin D increase at the third month after surgery.