Left renal vein graft and in situ hepatic perfusion in hepatectomy for complete tumor invasion of hepatic veins: hemodynamic optimization and surgical technique.

PURPOSE: Assessing hepatic vein reconstruction using a left renal vein graft and in situ hypothermic liver perfusion in an extended liver resection. METHODS: Patients included in this study were those with liver tumors undergoing curative surgery with resection and reconstruction of hepatic veins. Hepatic vein was reconstructed using a left renal vein graft. We describe the technical aspects of liver resection and vascular reconstruction, the key aspects of hemodynamic management, and the use of in situ hypothermic liver preservations during liver transection (prior to and during vascular clamping). RESULTS: The right hepatic vein was reconstructed with a median left renal venal graft length of 4.5 cm (IQR, 3.1-5.2). Creatinine levels remained within normal limits in the immediate postoperative phase and during follow-up. Median blood loss was 500 ml (IQR, 300-1500) and in situ perfusion with cold ischemia was 67 min (IQR, 60.5-77.5). The grafts remained patent during the follow-up with no signs of thrombosis. No major postoperative complications were observed. CONCLUSION: Left renal vein graft for the reconstruction of a hepatic vein and in situ hypothermic liver perfusion are feasible during extended liver resection.

Fulminant liver failure secondary to submassive hepatic necrosis in a patient treated with Orlistat. A case report.

Orlistat is an intestinal lipase inhibitor drug that is recommended in obese patients along with a hypocaloric diet. Although the most frequent secondary effect is steatorrhea, fulminant liver failure has also been associated with this drug, which has required liver transplantation in 3 patients. We present the case of a 42-year-old obese male.

Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID).

BACKGROUND AND OBJECTIVES: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID).

BACKGROUND: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.

Impact of Catholicism on the Attitude Toward the Donation of Organs Among African Residents in Spain.

INTRODUCTION: The African population is one of the largest immigrant groups in Europe. Religious beliefs are deeply rooted in most African societies and condition their attitude toward organ donation. OBJECTIVE: We sought to analyze the influence of Catholicism in the attitude toward organ donation among Africans residing in Spain. MATERIALS AND METHODS: Study participants were born in Africa and were residents in Spain. Data were obtained from the database of the International Donor Collaborative Project, which includes a sample of the population for 15 years, stratified by those who were born in Africa, as well as age and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Ríos). RESULTS: Of the population under study, 13% are Catholics (n = 475) and 80% (n = 2896) are Muslims. The favorable attitude toward the donation of cadaver organs is 53.7% (n = 255) among Catholics compared with 25.6% (n = 742) among Muslims (P < .001). On the contrary, 17.7% of Catholics have an unfavorable opinion (n = 84), while 45.5% (n = 1280) of Muslims have an unfavorable opinion; 28.6% of Catholics and 29.2% of Muslims are undecided. In addition, among Catholics who believe that their doctrine accepts organ donation and transplantation, 70.6% (n = 132) are in favor of donating a corpse compared to those who believe that Catholic doctrine is against (P < .001 ), with only 35% (n = 7) in favor of the donation. CONCLUSIONS: Africans who have converted to Catholicism have a more favorable attitude toward donating their own organs than those who continue in Islam.

Analysis of the Socio-Personal Profile of Latin Americans Living in Spain and the United States: Does It Justify the Differences in Attitude Toward Organ Donation?

INTRODUCTION: There are differences in the attitude toward organ donation between Latin Americans living in Spain and those living in the United States. OBJECTIVE: We sought to analyze the socio-personal factors that can condition the difference in attitude toward donation between Latin Americans living in the United States and those living in Spain. MATERIALS AND METHODS: Participants in the study were Latin Americans living in Spain (group A; n=1237) and the United States (Florida) (group B; n=1450), extracted from the database of the International Collaborative Donor Project (PCID). Inclusion criteria were a sample population stratified by area, country of birth, age, and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Rios.) Participants were randomly selected to be surveyed according to stratification. RESULTS: The attitude in favor of Latin Americans residing in Spain (group A) was 60% (n=745) vs 33% (n=485) of residents in the United States (group B) (P < .001). The socio-personal profile of the Latin Americans in Spain compared with those in the United States indicates that they are mainly women (63.5% vs 43.7%, respectively), younger (31.78 vs 37.31 years, respectively), have more secondary education (21.2% vs 16.3%, respectively) and university studies (11% vs 6%, respectively), are of South American origin vs those who are Mexican and Central American, respectively, and there is a higher percentage of atheists/agnostics (8.1% vs 3.7%). However, the personal profile toward donation is similar in both groups, both for and against organ donation. CONCLUSIONS: The personal social profile of the Latin American resident in Spain is different from that of the resident in the United States. However, the psycho-social profile for and against organ donation is similar in both countries.

Differences in Attitude Toward Organ Donation in the Three Main Cities of Cuba.

BACKGROUND: Cuba is one of the Latin American countries with the highest rates of organ donation. Social and cultural differences among the population throughout the country may also affect attitudes toward donation. Knowledge of these characteristics would facilitate awareness of the population most reluctant to donate and transplant. OBJECTIVE: We sought to analyze the differences in attitudes toward organ donation among Cubans living in the main capitals of Cuba. MATERIALS AND METHODS: Study population. The study group was the Cuban population living in the cities of Cienfuegos (n=636), Havana (n=920), and Santiago de Cuba (n=455), extracted from the database of the International Collaborative Donor Project. Sample of the population. Participants were older than 15 years, and data were stratified by geographic area, age, and sex. Assessment instrument. We used a validated questionnaire of attitude toward organ donation for transplant (PCID-DTO-Ríos), anonymously filled in and self-administered. STATISTICS: Student t test was applied together with the χ2 test, complemented by an analysis of the remainders. RESULTS: The favorable attitude among inhabitants in Cienfuegos was 71.2% (n=453), 68.3% (n=628) among those in Havana, and 69.5% (n=316) among those in Santiago de Cuba (P < .05). The psycho-social profile of respondents favoring organ donation was similar in the 3 cities. CONCLUSIONS: The attitude toward organ donation among the population of the main cities of Cuba was favorable and similar in all of them. The psycho-social profile toward organ donation was similar in the 3 cities.