93 results on '"Alejandro Serrablo"'
Search Results
2. Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort studyResearch in context
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Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Asif Jah, Harry V.M. Spiers, Shibojit Talukder, Jack L. Martin, Paul Gibbs, Simon J.F. Harper, Emmanuel L. Huguet, Vasilis Kosmoliaptsis, Siong S. Liau, Raaj K. Praseedom, Bristi Basu, Xavier de Aretxabala, Javier Lendoire, Shishir Maithel, Alejandro Branes, Bodil Andersson, Alejandro Serrablo, Volkan Adsay, Tomoyuki Abe, Moh'd Abu Hilal, Maria del Mar Achalandabaso Boira, Mustapha Adham, Mohamed Adam, Maryam Ahmad, Bilal Al-Sarireh, Maite Albiol, Nassir Alhaboob, Adnan Alseidi, Houssem Ammar, Akshay Anand, Pantelis Antonakis, Veronica Araya, Stanley W. Ashley, Georgi Atanasov, Fabio Ausania, Ricardo Balestri, Abhirup Banerjee, Simon Banting, Giedrius Barauskas, Fabian Bartsch, Andrea Belli, Simona Beretta, Frederik Berrevoet, Gerardo Blanco Fernandez, Louisa Bolm, Mathieu Bonal, Emre Bozkurt, Andries E. Braat, Luke Bradshaw, Lyle Burdine, Matthew Byrne, Maria Caceres, Maria Jesus Castro Santiago, Benjamin Chan, Lynn Chong, Ahmet Çoker, Maria Conde Rodriguez, Daniel Croagh, Alyn Crutchley, Carmen Cutolo, Mathieu D'Hondt, Daniel D'Souza, Freek Daams, Raffaele Dalla Valle, José Davide, Mario de Bellis, Marieke de Boer, Celine de Meyere, Philip de Reuver, Matthew Dixon, Panagiotis Dorovinis, Gabriela Echeverría Bauer, Maria Eduarda, Hasan Eker, Joris Erdmann, Mert Erkan, Evangelos Felekouras, Emanuele Felli, Eduardo Fernandes, Eduardo Figueroa Rivera, Andras Fulop, Daniel Galun, Michael Gerhards, Poya Ghorbani, Fabio Giannone, Luis Gil, Emmanouil Giorgakis, Mario Giuffrida, Felice Giuliante, Ioannis Gkekas, Miguel Gomez Bravo, Bas Groot Koerkamp, Oscar Guevara, Alfredo Guglielmi, Aiste Gulla, Rahul Gupta, Amit Gupta, Marta Gutiérrez, Abu Bakar Hafeez Bhatti, Jeroen Hagendoorn, Zain Hajee, Abdul Rahman Hakeem, Hytham Hamid, Sayed Hassen, Stefan Heinrich, Ryota Higuchi, Daniel Hoffman, David Holroyd, Daniel Hughes, Arpad Ivanecz, Satheesh Iype, Isabel Jaen Torrejimeno, Shantanu Joglekar, Robert Jones, Klaus Kaczirek, Harsh Kanhere, Ambareen Kausar, Zhanyi Kee, Jessica Keilson, Jorg Kleef, Johannes Klose, Brett Knowles, Jun Kit Koong, Nagappan Kumar, Supreeth Kunnuru, Paleswan Joshi Lakhey, Andrea Laurenzi, Yeong Sing Lee, Felipe Leon, Voon Meng Leow, Jean-Baptiste Lequeu, Mickael Lesurtel, Elisabeth Lo, Stefan Löb, Elizabeth Lockie, Peter Lodge, Dolores López Garnica, Victor Lopez Lopez, Linda Lundgren, Nikolaos Machairas, Dhiresh Maharjan, Deep Malde, Guillaume Martel, Julie Martin, Michele Mazzola, Arianeb Mehrabi, Ricardo Memeo, Flavio Milana, George Molina, Leah Monette, Haluk Morgul, Dimitrios Moris, Antonios Morsi-Yeroyannis, Nicholas Mowbray, Francesk Mulita, Edoardo Maria Muttillo, Malith Nandasena, Pueya Rashid Nashidengo, Arash Nickkholgh, Colin Byron Noel, Masayuki Ohtsuka, Arturs Ozolins, Sanjay Pandanaboyana, Nikolaos Pararas, Alessandro Parente, June Peng, Arkaitz Perfecto Valero, Julie Perinel, Konstatinos Perivoliotis, Teresa Perra, Patrick Pessaux, Natalie Petruch, Gaetano Piccolo, Laszlo Piros, Alberto Porcu, Viswakumar Prabakaran, Raj Prasad, Mikel Prieto Calvo, Florian Primavesi, Eva Maria Pueyo Periz, Alberto Quaglia, Jose M. Ramia Angel, Ashwin Rammohan, Francisco Razionale, Ricardo Robles Campos, Manas Roy, Sophie Rozwadowski, Luis Ruffolo, Natalia Ruiz, Andrea Ruzzenante, Lily Saadat, Mohamed Amine Said, Edoardo Saladino, Gabriel Saliba, Per Sandstrom, Carlo Alberto Schena, Anthony Scholer, Cristoph Schwartz, Lorenzo Serafini, Pablo Serrano, Deepak Sharma, Aali Sheen, Vishwanath Siddagangaiah, Michael Silva, Saurabh Singh, Ajith Siriwardena, Michal Skalski, Mante Smig, Faris Soliman, Donzília Sousa Silva, Ernesto Sparrelid, Parthi Srinivasan, Malin Sternby Eilard, Oliver Strobel, Urban Stupan, Miguel Angel Suarez-Munoz, Manisekar Subramaniam, Teiichi Sugiura, Robert Sutcliffe, Hilko Swank, Lillian Taylor, Prabin Bikram Thapa, Catherine The, Asara Thepbunchonchai, Caman Thieu, Navneet Tiwari, Guido Torzilli, Chutwichai Tovikkai, Blaz Trotovsek, Savvas Tsaramanidis, Georgios Tsoulfas, Katsuhiko Uesaka, Garzali Umar, Lucio Urbani, Michail Vailas, Ronald van Dam, Peter van de Boezem, Stijn van Laarhoven, Tomas Vanagas, Mike Van Dooren, Manon Viannet, Luca Vigano, Aarathi Vijayashanker, Celia Villodre, Toshifumi Wakai, Aklile Workneh, Li Xu, Masakazu Yamamoto, Zhiying Yang, Robert Young, and Marko Zivanovic
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Gallbladder cancer ,Liver resection ,Surgical outcomes ,Cholangiocarcinoma ,Medicine (General) ,R5-920 - Abstract
Summary: Background: Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC). Methods: The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity. Findings: On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84–1.29], p = 0.711 and HR 1.18 [0.95–1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79–1.17], p = 0.67 and HR 1.48 [1.16–1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02–1.74], p = 0.037) and OS (HR 1.26 [1.03–1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3–3.52], p
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- 2023
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3. How Donor and Surgical Factors Affect the Viability and Functionality of Human Hepatocytes Isolated From Liver Resections
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Estela Solanas, Nieves Sanchez-Fuentes, Alejandro Serrablo, Alberto Lue, Sara Lorente, Luis Cortés, Angel Lanas, Pedro M. Baptista, and M. Trinidad Serrano
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humans ,liver ,hepatocytes ,hepatectomy ,cell separation ,warm ischemia ,Medicine (General) ,R5-920 - Abstract
Liver resections are a significant source of primary human hepatocytes used mainly in artificial liver devices and pharmacological and biomedical studies. However, it is not well known how patient-donor and surgery-dependent factors influence isolated hepatocytes’ yield, viability, and function. Hence, we aimed to analyze the impact of all these elements on the outcome of human hepatocyte isolation.Patients and methodsHepatocytes were isolated from liver tissue from patients undergoing partial hepatectomy using a two-step collagenase method. Hepatocyte viability, cell yield, adhesion, and functionality were measured. In addition, clinical and analytical patient variables were collected and the use or absence of vascular clamping and its type (continuous or intermittent) plus the ischemia times during surgery.ResultsMalignant disease, previous chemotherapy, and male gender were associated with lower hepatocyte viability and isolation cell yields. The previous increase in transaminases was also associated with lower yields on isolation and lower albumin production. Furthermore, ischemia secondary to vascular clamping during surgery was inversely correlated with the isolated hepatocyte viability. An ischemia time higher than 15 min was related to adverse effects on viability.ConclusionSeveral factors correlated with the patient and the surgery directly influence the success of human hepatocyte isolation from patients undergoing liver resection.
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- 2022
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4. Association between preoperative levels of 25-hydroxyvitamin D and hospital-acquired infections after hepatobiliary surgery: A prospective study in a third-level hospital.
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Estefania Laviano, Maria Sanchez Rubio, Maria Teresa González-Nicolás, María Pilar Palacian, Javier López, Yolanda Gilaberte, Pilar Calmarza, Antonio Rezusta, and Alejandro Serrablo
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Medicine ,Science - Abstract
IntroductionEvidence implicates vitamin D deficiency in poorer outcomes and increased susceptibility to hospital-acquired infections (HAIs). This study examined the association between serum vitamin D levels and HAIs in a population of hepatobiliary surgery patients.MethodsParticipants in this prospective analytical observational study were patients who underwent hepatobiliary surgery in a tertiary hospital in Aragon, Spain, between February 2018 and March 2019. Vitamin D concentrations were measured at admission and all nosocomial infections during hospitalization and after discharge were recorded.ResultsThe mean 25-hydroxyvitamin D concentration of the study population (n = 301) was 38.56 nmol/L, which corresponds to vitamin D deficiency. Higher vitamin D concentrations were associated with a decreased likelihood of developing a HAI in general (p = 0.014), and in particularly surgical site infection (p = 0.026). The risk of HAI decreased by 34% with each 26.2-nmol/L increase in serum vitamin D levels.ConclusionsVitamin D levels may constitute a modifiable risk factor for postoperative nosocomial infections in hepatobiliary surgery patients.
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- 2020
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5. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas
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Alba, Manuel-Vázquez, Anita, Balakrishnan, Paul, Agami, Bodil, Andersson, Frederik, Berrevoet, Marc G, Besselink, Ugo, Boggi, Damiano, Caputo, Alberto, Carabias, Lucia, Carrion-Alvarez, Carmen Cepeda, Franco, Alessandro, Coppola, Bobby V M, Dasari, Sherley, Diaz-Mercedes, Michail, Feretis, Constantino, Fondevila, Giuseppe Kito, Fusai, Giuseppe, Garcea, Victor, Gonzabay, Miguel Ángel Gómez, Bravo, Myrte, Gorris, Bart, Hendrikx, Camila, Hidalgo-Salinas, Prashant, Kadam, Dimitrios, Karavias, Emanuele, Kauffmann, Amar, Kourdouli, Vincenzo, La Vaccara, Stijn, van Laarhoven, James, Leighton, Mike S L, Liem, Nikolaos, Machairas, Dimitris, Magouliotis, Adel, Mahmoud, Marco V, Marino, Marco, Massani, Paola Melgar, Requena, Keno, Mentor, Niccolò, Napoli, Jorieke H T, Nijhuis, Andrej, Nikov, Cristina, Nistri, Victor, Nunes, Eduardo Ortiz, Ruiz, Sanjay, Pandanaboyana, Baltasar Pérez, Saborido, Radek, Pohnán, Mariuca, Popa, Belinda Sánchez, Pérez, Francisco Sánchez, Bueno, Alejandro, Serrablo, Mario, Serradilla-Martín, James R A, Skipworth, Kjetil, Soreide, Dimitris, Symeonidis, Dimitris, Zacharoulis, Piotr, Zelga, Daniel, Aliseda, María Jesús Castro, Santiago, Carlos Fernández, Mancilla, Raquel Latorre, Fragua, Daniel Llwyd, Hughes, Carmen Payá, Llorente, Mickaël, Lesurtel, Tom, Gallagher, José Manuel, Ramia, Surgery, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, and Graduate School
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Intraductal papillary mucinous neoplasm ,Pancreatic Intraductal Neoplasms ,Score ,Malignancy ,Preoperative diagnosis ,Adenocarcinoma, Mucinous ,intraductal papillary mucinous neoplasm ,malignancy ,pancreatic neoplasm ,preoperative diagnosis ,score ,Pancreatic Neoplasms ,Humans ,Surgery ,Pancreatic neoplasm ,Pancreas ,Carcinoma, Pancreatic Ductal ,Retrospective Studies - Abstract
Purpose A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. Methods An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. Results A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score >= 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. Conclusion Patients with a Shin score
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- 2022
6. Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study
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Thomas B. Russell, Peter L. Labib, Fabio Ausania, Elizabeth Pando, Keith J. Roberts, Ambareen Kausar, Vasileios K. Mavroeidis, Gabriele Marangoni, Sarah C. Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R. Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal S. Shah, Zaed Z.R. Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori, Adam Streeter, Jemimah Denson, Mark Puckett, Shang-Ming Zhou, Matthew Browning, Keith Roberts, Sarah Thomasset, Adam Frampton, Andrew Smith, Brian Davidson, Ricky Bhogal, Michael Silva, Nehal Sureshkumar Shah, Zaed Hamady, Carolina Gonzalez-Abos, Nair Fernandes, Elsa Garcia Moller, Cristina Dopazo Taboada, Rupaly Pande, Jameel Alfarah, Samik Bandyopadhyay, Ahmed Abdelrahim, Ayesha Khan, Caitlin Jordan, Jonathan R.E. Rees, Harry Blege, William Cambridge, Olga White, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Daniel Field, Mohammed Gouda, Ruben Bellotti, Hytham K.S. Hamid, Hassan Ahmed, Catherine Moriarty, Louise White, Mark Priestley, Kerry Bode, Judith Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Stephanos Pericleous, Krishna Patel, Conrad Shaw, Nolitha Morare, Mohamad Khish Zaban, Joseph Doyle, Alan Guerrero, Andre Moguel, Carlos Chan, Michael Jones, Edward Buckley, Nasreen Akter, Kyle Treherne, Gregory Gordon, Daniel Hughes, Tomas Urbonas, Gioia Brachini, Roberto Caronna, Piero Chirletti, Teresa Perra, Nurul Nadhirah Abd Kahar, Thomas Hall, Nabeegh Nadeem, Shoura Karar, Ali Arshad, Adam Yarwood, Mohammed Hammoda, Maria Artigas, and Sandra Paterna-López
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Oncology ,Surgery ,General Medicine - Published
- 2023
7. Polyethylene glycol-coated haemostatic patch for prevention of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: randomized clinical trial
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Mario Serradilla-Martín, Sandra Paterna-López, Ana Palomares-Cano, Miguel Cantalejo-Díaz, Teresa Abadía-Forcén, Marta L Gutiérrez-Díez, Consuelo Artigas-Marco, and Alejandro Serrablo-Requejo
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General Medicine - Abstract
Background The potential of haemostatic patches to reduce the rate of postoperative pancreatic fistula remains unclear. The aim of this trial was to evaluate the impact of a polyethylene glycol-coated haemostatic patch on the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. Methods In this randomized, single-centre, clinical trial, patients undergoing pancreatoduodenectomy were randomized 1 : 1 to receive pancreatojejunostomy reinforced with two polyethylene glycol-coated haemostatic patches (patch group) or without any reinforcement (control group). The primary outcome was clinically relevant postoperative pancreatic fistula, defined as grade B/C according to International Study Group of Pancreatic Surgery criteria, within 90 days. Key secondary outcomes were length of hospital stay, total rate of postoperative pancreatic fistula, and overall complication rate. Results From 15 May 2018 to 22 June 2020, 72 patients were randomized, and 64 were included in the analyses (31 in the patch group and 33 in the control group). The risk of clinically relevant postoperative pancreatic fistula was reduced by 90 per cent (OR 0.10, 95 per cent c.i. 0.01 to 0.89, P = 0.039). Moreover, the use of the polyethylene glycol-coated patch retained its protective effect on clinically relevant postoperative pancreatic fistula in a multivariable regression model, significantly reducing the risk of clinically relevant postoperative pancreatic fistula by 93 per cent (OR 0.07, 95 per cent c.i. 0.01 to 0.67, P = 0.021), regardless of patient age, sex, or fistula risk score. The incidence of secondary outcomes did not significantly differ between the groups. One patient died within 90 days in the patch group versus three patients in the control group. Conclusions A polyethylene glycol-coated haemostatic patch reduced the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. Registration number NCT03419676 (http://www.clinicaltrials.gov).
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- 2023
8. Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study
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Thomas B. Russell, Peter L. Labib, Jemimah Denson, Fabio Ausania, Elizabeth Pando, Keith J. Roberts, Ambareen Kausar, Vasileios K. Mavroeidis, Gabriele Marangoni, Sarah C. Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R. Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal S. Shah, Zaed Z.R. Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori, Adam Streeter, Mark Puckett, Matthew G. Browning, Carolina González-Abós, Nair Fernandes, Elsa G. Moller, Cristina D. Taboada, Rupaly Pande, Jameel Alfarah, Samik Bandyopadhyay, Ahmed Abdelrahim, Ayesha Khan, Caitlin Jordan, Jonathan R.E. Rees, Collaborator: Harry Blege, Sarah Thomasset, William Cambridge, Olga White, Adam Frampton, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Daniel Field, Mohammed Gouda, Ruben Bellotti, Hytham K.S. Hamid, Hassan Ahmed, Andrew Smith, Catherine Moriarty, Louise White, Mark Priestley, Kerry Bode, Judith Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Brian Davidson, Stephanos Pericleous, null Krishna Patel, Conrad Shaw, Nolitha Morare, Mohamad K. Zaban, Ricky Bhogal, Joseph Doyle, Alan Guerrero, Andre Moguel, Carlos Chan, Michael Jones, Edward Buckley, Nasreen Akter, Kyle Treherne, Gregory Gordon, Michael Silva, Daniel Hughes, Tomas Urbonas, Gioia Brachini, Roberto Caronna, Piero Chirletti, Teresa Perra, Nurul N. Abd Kahar, Thomas Hall, Nabeegh Nadeem, Zaed Hamady, Shoura Karar, Ali Arshad, Adam Yarwood, Mohammed Hammoda, Maria Artigas, and Sandra Paterna-López
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Hepatology ,Gastroenterology - Published
- 2023
9. Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study
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Florence E.M. de Rijk, Charlotte L. van Veldhuisen, Marc G. Besselink, Jeanin E. van Hooft, Hjalmar C. van Santvoort, Erwin J.M. van Geenen, Peter Hegyi, J-Matthias Löhr, Juan E. Dominguez-Munoz, Pieter Jan F. de Jonge, Marco J. Bruno, Robert C. Verdonk, Massimo Falconi, Wen-Bin Zou, Trond Engjom, Chee Y. Ooi, Robert Sutton, Luca Frulloni, John Neoptolemos, Charles Wilcox, Vujasinovic Miroslav, Guru Trikudanathan, Zhuan Liao, Truls Hauge, Joachim Mössner, Chantal Hoge, Paul Fockens, Sven Mieog, Gabriele Capurso, Yunfeng Cui, Enrique de Madaria, Marius Distler, Ali Aghdassi, David C. Whitcomb, Kylie Russell, Georg Beyer, Lumír Kunovsky, Wilhelmus Kwanten, Andrea Kazemi Nava, Kevin Conlon, A.K. Siriwardena, Salvatore Paiella, Felipe Alconchel, Marco Vito Marino, Vincent E. de Meijer, Carlos Domingo, Jorg Kleeff, Aarti Lakshmanan, Michael Jen Lie Chu, Stefan Bouwense, Pueya Rashid Nashidengo, Perivoliotis Konstantinos, Edoardo Maria Muttillo, Garzali Ibrahim Umar, Maria Jesus Castro Santiago, Victor Lopez-Lopez, Francesco Torri, Moritz Schmelzle, Povilas Ignatavicius, Dennis Wicherts, Antonio Gomes, Nikolaos A. Machairas, Panagiotis I. Dorovinis, Alejandro Serrablo, Kjetil Soreide, Mohammad Rahbari, Michael Jen Jie Chu, Margarita Ptasnuka, Marius Petrulionis, Colin Byron Noel, Ernest Castro, Marcello Di Martino, Alfonso Recordare, Stefan Stättner, Fabio Ausania, Vera Hartman, Geert Roeyen, Viacheslav Egorov, Tomas Vanagas, Mohamed Ebrahim, Elena Arabadzhieva, Giuseppe Malleo, Liang Li, David Adams, Grzegorz Oracz, Reddy D. Nageshwar, Alexander Waldthaler, Atsushi Masamune, Asbjorn Mohr Drewes, Antonio Amodio, Temel Tirkes, Anshu Srivastava, Gregory J. Beilman, Zoltan Berger, Bjorn Lindkvist, Giulia Martina Cavestro, Cheryl Gariepy, Laszlo Czakó, Milena Di Leo, Vishal Sharma, Sundeep Lakhtakia, Surinder Singh Rana, Sinaed N. Duggan, Chang-Il Kwon, Anna Evans Phillips, Christopher E. Forsmark, Ferga C. Gleeson, Glen A. Lehman, William Greenhalf, Guido Costamagna, Christopher M. Halloran, Helmut Friess, Henrik Hojgaard Rasmussen, Tsukasa Ikeura, Ingfrid S. Haldorsen, Takao Itoi, Jacob R. Izbicki, John Windsor, Jakob Lykke Poulsen, Jens Brondum Frokjaer, Jose Larino-Noia, Dan Wang, Julio Iglesias Garcia, Evangelos Kalaitzakis, Kararzyna Wertheim-Tysarowska, Kensuke Kubota, Jessica Larusch, Markus M. Lerch, Liang-Hao Hu, Mert Erkan, Jorg D. Machicado, Marianna Arvanitakis, Markus W. Buchler, Marlon F. Levy, Melvin B. Heyman, Camilla Nojgaard, Mouen A. Khashab, Myriam Delhaye, Takeshi Ogura, Kazuichi Okazaki, Paula Ghaneh, Peter A. Banks, Pankaj Gupta, Georgios I. Papachristou, Patrick Michl, Philippe Levy, Aldis Pukitis, Raffaele Pezzilli, Ryan D. Baron, Stephen T. Amann, Sarah Jane Schwarzenberg, Shuiji Isaji, Soren Schou Olesen, Srdan Novovic, Steven J. Hughes, Steven L. Werlin, Tanja Gonska, Timothy B. Gardner, Mark D. Topazian, Frank Ulrich Weiss, Venakata S. Akshintala, Veronique D. Morinville, Vinciane Rebours, Aron Vincze, Vikesh K. Singh, Naiqiang Cui, Hong Zhang, Zhao-shen Li, Integrated Research on Energy, Environment & Socie, Molecular Active Systems, Gastroenterology and hepatology, Gastroenterology & Hepatology, Graduate School, Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Gastroenterology and Hepatology
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Pancreatic enzyme replacement therapy ,Hepatology ,Endocrinology, Diabetes and Metabolism ,Clinical Decision-Making ,Exocrine pancreatic insufficiency ,Gastroenterology ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Steatorrhea ,SDG 3 - Good Health and Well-being ,Expert opinion ,Pancreatitis, Chronic ,Humans ,HaPanEU-guidelines ,Pancreas ,Chronic pancreatitis - Abstract
IntroductionDespite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency.MethodsAn online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years.ResultsOverall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency.ConclusionThis survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence. Introduction: Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency. Methods: An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years. Results: Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency. Conclusion: This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence.
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- 2022
10. Variations in the type of nutritional support provided after pancreatoduodenectomy: results from an international multicentre retrospective cohort study
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Thomas Russell, Peter Labib, Paula Murphy, Fabio Ausania, Elizabeth Pando, Keith Roberts, Ambareen Kausar, Vasileios Mavroeidis, Gabriele Marangoni, Sarah Thomasset, Adam Frampton, Pavlos Lykoudis, Mauel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew Smith, Duncan Spalding, Parthi Sriniva, Brian Davidson, Ricky Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal Shah, Zaed Hammady, Bilal Al-Sarrieh, Alejandro Serrablo, and Somaiah Aroori
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Background/Objectives: An early oral diet is recommended after pancreatoduodenectomy (PD), however, the nutritional management of PD patients is known to be highly variable, and some centres still provide postoperative parenteral nutrition (PN) routinely. A proportion of patients who receive PN experience clinically significant complications underscoring its judicious use. Using a multicentre cohort, this study aimed to determine the proportion of PD patients that received postoperative nutritional support (NS), describe the variations in this support, and investigate whether receiving PN correlated with morbidity. Subjects/Methods: Data was extracted from the Recurrence After Whipple’s (RAW) study database, a retrospective study of patients undergoing PD for histologically confirmed pancreatic, ampullary or distal bile duct malignancy. Results: 1323 patients (89.2%) had data on their postoperative NS status available. Of these, 45.4% received postoperative NS. This was “enteral only”, “parenteral only”, and “enteral and parenteral” in 44.3%, 35.2% and 20.5% of cases, respectively. Body mass index 2 (p=0.03), absence of preoperative biliary stenting (p=0.009) and serum albumin Conclusion: Being underweight, not undergoing preoperative biliary stenting and having a low preoperative serum albumin all correlated with receiving postoperative NS. A considerable number of patients who had an uneventful recovery received PN; this should be reserved for those who are unable to take an oral diet.
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- 2022
11. Mucinous cystic liver neoplasm with invasive component and sarcomatous differentiation
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Daniel Aparicio-López, Ana Palomares-Cano, Carlos Hörndler-Algarate, Alejandro Serrablo-Requejo, and Mario Serradilla-Martín
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Surgery ,General Medicine - Abstract
Hepatobiliary mucinous cystic neoplasms (MCN) harbor an invasive carcinoma in 16% of the cases, mainly tubular type, but occasionally sarcomatoid or undifferentiated, these entities being frankly rare.We present the case of a liver MCN with an invasive component and sarcomatous degeneration.The patient was treated surgically with subsequent adjuvant chemotherapy (capecitabine), presenting tumor progression after three months with peritoneal carcinomatosis and liver recurrence. The patient died due to liver failure 4 months after surgery.MCN with an invasive component and sarcomatous degeneration are very rare, present advanced stages, show aggressive behavior, and have a poor prognosis.
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- 2022
12. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis
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Roberto Hernandez-Alejandro, Luis I. Ruffolo, Alejandro Serrablo, Orlando Jorge M Torres, Bergthor Björnsson, and Ruslan Alikhanov
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medicine.medical_specialty ,medicine.medical_treatment ,Portal vein ligation ,030230 surgery ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Ligation ,Portal Vein ,business.industry ,Liver Neoplasms ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,Treatment Outcome ,Liver ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Risk stratification ,Colorectal Neoplasms ,business - Abstract
Since first described, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has garnered boisterous praise and fervent criticism. Its rapid adoption and employment for a variety of indications resulted in high perioperative morbidity and mortality. However recent risk stratification, refinement of technique to reduce the impact of stage I and progression along the learning curve have resulted in improved outcomes. The first randomized trial comparing ALPPS to two stage hepatectomy (TSH) for colorectal liver metastases (CRLM) was recently published demonstrating comparable perioperative morbidity and mortality with improved resectability and survival following ALPPS. In this review, as ALPPS enters the thirteenth year since conception, the current status of this contentious two stage technique is presented and best practices for deployment in the treatment of CRLM is codified.
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- 2020
13. Extended liver surgery for gallbladder cancer revisited: Is there a role for hepatopancreatoduodenectomy?
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Jun Li, Alejandro Serrablo, Orlando Jorge M Torres, Albert C. Y. Chan, Eduardo Fernandes, and Ruslan Alikhanov
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Pancreaticoduodenectomy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Bile Ducts, Extrahepatic ,law ,medicine ,Hepatectomy ,Humans ,Gallbladder cancer ,Pancreas ,Aged ,Bile duct ,business.industry ,Mortality rate ,Cancer ,Hepatoduodenal ligament ,General Medicine ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,medicine.anatomical_structure ,Liver ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Female ,Gallbladder Neoplasms ,Lymphadenectomy ,business - Abstract
Gallbladder cancer (GBCA) is a rare and fatal disease and the majority of patients presents with advanced stage. Surgical resection associated with lymphadenectomy is the only chance for cure. For patients in stages III and IV, extended resection is the only treatment to achieve R0 margins. For GBCA invading the hepatoduodenal ligament and pancreatoduodenal region, the resection of extrahepatic bile duct and pancreas is necessary. Hepatopancreatoduodenectomy (HPD) represents the most complex and challenging procedure in the hepatopancreatobiliary region. Kuno at the Cancer Institute Hospital Tokyo performed the first HPD in Japan in 1974 and in 1980 Takasaki presented five cases and the 30-day mortality was 60%. After that, other countries started to perform the procedure including United States and Brazil. The main complications are liver failure and pancreatic fistula. Advancements in perioperative care, surgical technique, medical instruments and postoperative at intensive care unit have resulted in reduction in morbidity and mortality. The use of portal vein embolization is indicated to increase the liver volume in patients with insufficient remnant. Preoperative biliary drainage can prevent cholangitis and improve hepatic function. This procedure should be recommended before extended HPD in jaundiced patients. Operative results with mortality rates below 5% at high volume centers suggest that HPD should be performed at centers with expertise in hepatopancreatobiliary surgery.
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- 2020
14. Infección del sitio quirúrgico en cirugía hepatobiliopancreática y su relación con la concentración sérica de vitamina D
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Antonio Rezusta, Javier E. López, María Teresa González-Nicolás, Estefania Laviano, María Pilar Palacian, Yolanda Gilaberte, Pilar Calmarza, María Sanchez, and Alejandro Serrablo
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,Surgery ,030230 surgery ,business ,Humanities - Abstract
Introducción La relación entre las infecciones nosocomiales en pacientes quirúrgicos y la vitamina D ha sido estudiada por algunos autores. Sin embargo, hasta la fecha no existe ningún estudio realizado sobre pacientes de cirugía hepatobiliar. El objetivo de nuestro trabajo es estudiar la infección del sitio quirúrgico (ISQ) en la unidad de cirugía hepatobiliar, y valorar su relación con la concentración sérica de vitamina D. Métodos Se llevó a cabo un estudio analítico observacional de pacientes sucesivos intervenidos en la unidad de cirugía hepatobiliar de nuestro centro durante un año. Se incluyeron las intervenciones relativas a enfermedad biliar, pancreática y hepática. Se determinaron los niveles de vitamina D al ingreso, así como las ISQ de tipo superficial, profunda y órgano-cavitaria diagnosticadas durante el estudio. El seguimiento del paciente se realizó durante al menos un mes tras la cirugía, dependiendo de la enfermedad. La estadística se realizó mediante el programa estadístico R v.3.1.3. Resultados La muestra quedó constituida por 321 pacientes, de los cuales el 25, 8% presentó ISQ a expensas fundamentalmente de las infecciones órgano-cavitarias que presentaron una incidencia del 24, 3%. Concentraciones séricas superiores a 33, 5 nmol/l demostraron reducir en un 50% el riesgo de ISQ. Conclusiones Las concentraciones elevadas de vitamina D en sangre demostraron ser un factor protector frente a las ISQ (OR: 0, 99). Nuestros resultados sugieren una relación directa entre la concentración sérica de vitamina D y la ISQ, justificando la realización de nuevos estudios prospectivos. Introduction: While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. Methods: Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. Results: Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. Conclusions: High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.
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- 2020
15. Surgical site infection in hepatobiliary surgery patients and its relationship with serum vitamin D concentration
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María Sanchez, Estefania Laviano, María Teresa González-Nicolás, Pilar Calmarza, Antonio Rezusta, Yolanda Gilaberte, Javier E. López, Alejandro Serrablo, and María Pilar Palacian
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Male ,medicine.medical_specialty ,Exploratory laparotomy ,Digestive System Diseases ,medicine.medical_treatment ,030230 surgery ,Logistic regression ,Gastroenterology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Surgical Wound Infection ,Prospective Studies ,Vitamin D ,Prospective cohort study ,Digestive System Surgical Procedures ,Aged ,Cross Infection ,business.industry ,Incidence ,Incidence (epidemiology) ,General Engineering ,Middle Aged ,Protective Factors ,Pancreaticoduodenectomy ,Logistic Models ,Female ,Cholecystectomy ,Hepatectomy ,business - Abstract
Introduction While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. Methods Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. Results Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. Conclusions High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.
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- 2020
16. Hepatopancreatoduodenectomy -a controversial treatment for bile duct and gallbladder cancer from a European perspective
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Lotte C. Franken, Frederik J H Hoogwater, J. Peter A. Lodge, Nadia Russolillo, Alessandro Ferrero, Thomas M. van Gulik, Philipp Kron, Rajiv P Lahiri, E-Ahpba scientific, Mickael Lesurtel, Ronald M. van Dam, Tom M. Gallagher, N. Chatzizacharias, Nariman D. Karanjia, Jun Li, Bertrand Le Roy, Olivier Soubrane, Serena Langella, Bobby V.M. Dasari, Rosa Jorba, Camila Hidalgo Salinas, Erini Martinou, Valentinus T. Valdimarsson, Jeroen Hagendoorn, Alfredo Guglielmi, Alejandro Serrablo, Tommaso Campagnaro, Mathieu D'Hondt, Ignasi Poves, Wolfram T. Knoefel, A Nikov, Nadja Lehwald-Tywuschik, Fadi Rassam, Melroy A D'souza, I. Q. Molenaar, Giuseppe Fusai, François Cauchy, Stefan Stättner, Christian Sturesson, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Heelkunde (9), Graduate School, CCA - Cancer Treatment and Quality of Life, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, and Surgery
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medicine.medical_specialty ,RESECTION ,LIVER ,PERIHILAR CHOLANGIOCARCINOMA ,INTERNATIONAL STUDY-GROUP ,Improved survival ,030230 surgery ,BILIARY ,Gastroenterology ,Bile duct cancer ,03 medical and health sciences ,0302 clinical medicine ,MAJOR HEPATECTOMY ,Internal medicine ,medicine ,Hepatectomy ,Humans ,In patient ,Gallbladder cancer ,Hepatology ,Bile duct ,business.industry ,PANCREATIC FISTULA ,Mortality rate ,Perioperative ,medicine.disease ,RISK SCORE ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,DEFINITION ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,PANCREATICODUODENECTOMY ,Gallbladder Neoplasms ,Bile Ducts ,business - Abstract
BACKGROUND: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers.METHOD: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed.RESULTS: In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival.CONCLUSION: HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.
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- 2020
17. Radio-Pathological Correlations in Patients with Liver Metastases for Colorectal Cancer
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Daniel Azoulay, Luis Sarría, Luis Tejedor, Alejandro Serrablo, Leyre Serrablo, Carlos Paradisi, Panagiotis Paliogiannis, and Carlos Horndler
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Male ,medicine.medical_specialty ,Necrosis ,Hepatic resection ,Colorectal cancer ,Gastroenterology ,Fibrosis ,Internal medicine ,medicine ,Hepatectomy ,Humans ,In patient ,Gastrointestinal cancer ,Pathological ,Aged ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Tumor Burden ,Female ,Surgery ,medicine.symptom ,Colorectal Neoplasms ,Tomography, X-Ray Computed ,business - Abstract
Background:Colorectal cancer (CRC) is the most frequent gastrointestinal cancer. The liver is the organ most commonly affected by CRC metastases. Synchronous CRC liver metastases (CRCLM) are present in 15–25% at diagnosis, and metastases are confined to the liver in 70–80% of these cases. The aim of the present study was to investigate the existence of significant correlations between the pathological features and computed tomography scan morpho-densitometric findings. Summary:A retrospective study of prospectively collected data has been performed; all patients underwent curative-intent hepatic resection from January 2004 to December 2012 and had histologically confirmed CRCLM. Key Messages: Thirty-four (57%) patients were males; the mean age was 64.4 (±10.2) years. Statistically significant differences have been found with the percentages of intra-tumoral fibrosis (p = 0.038) and necrosis (p = 0.007); the values of fibrosis are higher in the absence of a peri-lesional ring, while those of necrosis are higher in the presence of a peri-lesional ring.There was a correlation between the histopathological response to treatments and the global attenuation levels observed in the computed tomography scan of CRCLM. Furthermore, the presence of a radiologically evidenced peripheral ring was associated with the amount of viable tumor cells in the periphery of the tumor, and with responses predominated by necrosis. More studies are needed to clarify the radiological and histological correlation and to be able to better select patients who are going to undergo surgery.
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- 2020
18. Current indications of ex-situ liver resection: A systematic review
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Alejandro Serrablo, Teresa Giménez-Maurel, Alejandra Utrilla Fornals, Leyre Serrablo, and Daniel Azoulay
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Liver Neoplasms ,Hepatectomy ,Humans ,Surgery ,Transplantation, Autologous ,Liver Failure ,Liver Transplantation - Abstract
Ex situ liver resection and autotransplantation, a surgical technique introduced for managing advanced and unresectable malignant tumors, never became a popular surgical procedure, due mainly to the high incidence of adverse events and postoperative recurrences. This study aims to assess the clinical outcomes of ex situ liver resection and autotransplantation in the currently available literature.The PubMed electronic database was used to retrieve studies that meet the inclusion criteria for the topic.Twenty-nine studies were included. The mean (range) 90-day mortality rate was 11.6% (0%-50%) and the mean overall survival was 55.8% (12.5%-100.0%). R0 resection was achieved in 100% of cases. In the overall study sample, the maximum tumor size was found to be positively correlated with the 90-day mortality rate (P = .047) and negatively correlated with the overall survival (P = .048). The mean number of total resected segments appeared to be positively correlated with the length of hospital stay (P = .039). In the malignant tumor sample, there was a significant relationship between the maximum tumor size and postoperative liver failure, 90-day mortality rate (P = .027 and P = .034, respectively), and between the mean length of anhepatic phase and mean length of hospital stay (P = .0092).The ex situ liver resection and autotransplantation appears to be a valuable option in selected patients with conventionally unresectable hepatic tumors and normal liver function. However, it was not possible to provide clear and unequivocal recommendations about this procedure. To rectify this, an international database to help surgeons in their decision-making process ought to be established.
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- 2022
19. Pancreatic mucinous cystic neoplasms located in the distal pancreas: a multicenter study
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Jose M. Ramia, Juan del Rio Martín, Gerardo Blanco-Fernández, Miguel Cantalejo-Diaz, Fernando Pardo, Elena Muñoz-Forner, Alberto Carabias, Alba Manuel-Vazquez, Pedro J. Hernández-Rivera, Isabel Jaén-Torrejimeno, Helga K. Kälviäinen-Mejia, Fernando Rotellar-Sastre, Marina Garcés-Albir, Raquel Latorre, Texell Longoria-Dubocq, Noelia De Armas-Conde, Alejandro Serrablo-Requejo, Sara Esteban Gordillo, Luis Sabater, and Mario Serradilla-Martín
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Distal pancreatectomy ,Cystadenocarcinoma ,Malignancy ,Definition ,Ovarian-type stroma ,Management ,Cystic ,International study-group ,Original Article ,Mucinous ,Surgery ,Pancreas ,Cancer - Abstract
BACKGROUND: Mucinous cysts of the pancreas (MCN) are infrequent, usually unilocular tumors which occur in postmenopausal women and are located in the pancreatic body/tail. The risk of malignancy is low. The objective is to define preoperative risk factors of malignancy in pancreatic MCN and to assess the feasibility of the laparoscopic approach. METHODS: Retrospective multicenter observational study of prospectively recorded data regarding distal pancreatectomies was carried out at seven hepatopancreatobiliary (HPB) Units between 01/01/08 and 31/12/18 (the ERPANDIS Project). RESULTS: Four hundred and forty-four distal pancreatectomies were recorded including 47 MCN (10.6%). Thirty-five were non-invasive tumors (74.5%). In all, 93% of patients were female, and 60% were ASA (American Society of Anaesthesiology) II. The mean preoperative size was 46 mm. Patients with invasive tumors were older (54 vs. 63 years). Invasive tumors were larger (6 vs. 4 cm), although the difference was not significant (P=0.287). Sixty percent was operated via laparoscopic approach, which was used in 74.6% of non-invasive tumors and in 16.7% of the invasive ones. The spleen was not preserved in 93.6% of the patients. R0 resection was obtained in all patients. Two patients with invasive tumors died. CONCLUSIONS: In our surgical series of MCN, patients with malignancy were older and presented larger tumors, although the difference was not statistically significant. Laparoscopy is a safe and feasible approach for MCN. Prospective studies are now needed to define risk factors that can guide the decision whether to administer conservative treatment or to operate.
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- 2022
20. Heterogeneity of management practices surrounding operable gallbladder cancer – results of the OMEGA-S international HPB surgical survey
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Anita Balakrishnan, Asif Jah, Mickael Lesurtel, Bodil Andersson, Paul Gibbs, Simon J.F. Harper, Emmanuel L. Huguet, Vasilis Kosmoliaptsis, Siong S. Liau, Raaj K. Praseedom, Jose M. Ramia, Alejandro Branes, Javier Lendoire, Shishir Maithel, Alejandro Serrablo, T. Abe, M. Achalandabaso, M. Adham, A. Ahmet, B. Al-Sarireh, M. Albiol Quer, F. Alconchel, M. Alsammani, A. Alseidi, A. Anand, A. Anselmo, P. Antonakis, E. Arabadzhieva, X. de Aretxabala, S. Aroori, S. Ashley, F. Ausania, A. Banerjee, M. Barabino, A. Bartlett, F. Bartsch, A. Belli, J. Beristain-Hernandez, F. Berrevoet, A.B.H. Bhatti, R. Bhojwani, B. Bjornsson, T. Blaz, M. Byrne, M.P. Calvo, J. Castellanos, M.J. Castro, D. Cavallucci, D. Chang, G. Christodoulis, O. Ciacio, P.A. Clavien, A. Coker, M. Conde-Rodriguez, F.E. D'Amico, M. D'Hondt, F. Daams, B.V.M. Dasari, M. De Bellis, V.E. de Meijer, K. Dede, G. Deiro, F.J.B. Delgado, G. Desai, A. Di Gioia, M. Di Martino, M. Dixon, P. Dorovinis, T. Dumitrascu, T. Ebata, M.S. Eilard, J. Erdmann, M. Erkan, S. Famularo, E. Felli, M. Fergadi, G.B. Fernandez, A. Fox, S. Galodha, D. Galun, S. Ganandha, R.J.R. Garcia, G. Gemenetzis, F. Giannone, L. Gil, E. Giorgakis, F. Giovinazzo, M. Giuffrida, T. Giuliani, F. Giuliante, I. Gkekas, M. Goel, B.K. Goh, A. Gomes, T. Gruenberger, O. Guevara, A. Gulla, A. Gupta, R. Gupta, A.R. Hakeem, H.K.S. Hamid, S. Heinrich, S. Helton, R. Hernandez-Alejandro, A. Heumann, R. Higuchi, D. Hughes, B.C. Inarejos, A. Ivanecz, Y. Iwao, S. Iype, I. Jaen, M.J. Jie, R. Jones, K. Kacirek, R. Kalayarasan, A. Kaldarov, L. Kaman, H. Kanhere, V.K. Kapoor, P. Karanicolas, A. Karayiannakis, A. Kausar, Z.A. Khan, D.-S. Kim, J. Klose, B. Knowles, P.S. Koh, P. Kolodziejczyk, A.L. Komorowski, J.K. Koong, I. Kozyrin, A. Krishna, P. Kron, N. Kumar, S. van Laarhoven, P.J. Lakhey, J. Lanari, A. Laurenzi, V.M. Leow, Y. Limbu, Y.-B. Liu, S. Lob, E. Lolis, V. Lopez-Lopez, R.C. Lozano, L. Lundgren, N. Machairas, D. Magouliotis, A. Mahamid, D. Malde, A. Malek, H. Malik, G. Malleo, M.V. Marino, S.C. Mayo, M. Mazzola, R. Memeo, K. Menon, R. Menzulin, R. Mohan, H. Morgul, D. Moris, F. Mulita, E.M. Muttillo, C. Nahm, M. Nandasena, P.R. Nashidengo, A. Nickkholgh, A. Nikov, C. Noel, D. O'Reilly, T. O'Rourke, M. Ohtsuka, J.A.O. Omoshoro-Jones, S. Pandanaboyana, N. Pararas, R. Patel, S. Patkar, J.S. Peng, A. Perfecto, J. Perinel, K. Perivoliotis, T. Perra, M.T. Phan, G. Piccolo, A. Porcu, F. Primavesi, J. Primrose, E. Pueyo-Periz, D. Radenkovic, A. Rammohan, A. Rowcroft, J. Sakata, E. Saladino, C.A. Schena, A. Scholer, C. Schwarz, P. Serrano, M. Silva, K. Soreide, E. Sparrelid, S. Stattner, C. Sturesson, T. Sugiura, M. Sumo, R. Sutcliffe, C. Teh, J.Y. Teo, K. Tepetes, P.B. Thapa, A. Thepbunchonchai, J.B.P. Torres, O.J.M. Torres, G. Torzili, C. Tovikkai, A. Troncoso, G. Tsoulfas, A. Tuzuher, G. Tzimas, G.I. Umar, L. Urbani, T. Vanagas, null Varga, V. Velayutham, L. Vigano, T. Wakai, Z. Yang, V. Yip, D. Zacharoulis, E.A. Zakharov, G. Zimmitti, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism
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Surgeons ,Common Bile Duct ,Hepatology ,Surveys and Questionnaires ,Gastroenterology ,Humans ,Hepatectomy ,Gallbladder Neoplasms - Abstract
Background: Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. Methods: A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia–Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. Results: Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. Conclusion: Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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- 2022
21. Hepatocarcinoma en hígado no cirrótico: serie bicéntrica de 19 casos
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Mario Serradilla Martín, Cristina Vallejo Berna, Ana Palomares Cano, José Manuel Ramia Ángel, Roberto de la Plaza Llamas, Alejandro Serrablo Requejo, Aylhin Joana López Marcano, and José R. Oliver Guillén
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medicine.medical_specialty ,Abdominal pain ,Cirrhosis ,business.industry ,Cancer ,Perioperative ,medicine.disease ,Chronic liver disease ,Gastroenterology ,Internal medicine ,Hepatocellular carcinoma ,medicine ,Surgery ,Liver function ,medicine.symptom ,Risk factor ,business - Abstract
Background: Hepatocellular carcinoma is the most common type of primary liver cancer and is the third cause of cancer related deaths; 80% of the HCC are associated with cirrhotic livers or chronic liver diseases, which constitute the main risk factor. Chronic inflammation, necrosis and regeneration due to these conditions produce genetic mutation and development of tumor cells. Yet, 10% develop in non-cirrhotic healthy livers without precipitating factors. Material and methods: We conducted a retrospective analysis of the characteristics and survival of patients with diagnosis of hepatocellular carcinoma in non-cirrhotic liver and absence of a history of liver cirrhosis or chronic liver disease undergoing surgery in two hepato-pancreato-biliary units between January 2007 and January 2016. Results: Mean age was 65 years and 13 patients were men. Abdominal pain was the most common clinical presentation. Liver panel was normal in 60% of the cases and alpha-fetoprotein was elevated in only 16%. The diagnosis was made by imaging tests in 61% of the cases. Mean tumor size was 110.6 cm. All the patients underwent surgery. Complications were observed in 36.8% of the patients and survival at 5 years was 62.3%. Conclusion: hepatocellular carcinoma is usually diagnosed as a large lesion in imaging tests ordered due to abdominal pain. Surgery provides curative treatment, and large resections can be safely performed, with low perioperative morbidity and mortality and low incidence of postoperative liver failure,since the liver remnant is healthy and liver function is maintained.
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- 2019
22. Vascular Resection in Perihilar Cholangiocarcinoma
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Leyre Serrablo, Ruslan Alikhanov, Luis Tejedor, and Alejandro Serrablo
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Cancer Research ,medicine.medical_specialty ,Right hepatic artery ,Surgical approach ,business.industry ,Mortality rate ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,surgery in vascular involvement ,Review ,Liver resections ,Resection ,medicine_pharmacology_other ,vascular invasion in perihilar cholangiocarcinoma ,Oncology ,medicine ,Radiology ,Vascular resection ,Perihilar Cholangiocarcinoma ,business ,Survival rate ,perihilar cholangiocarcinoma ,RC254-282 ,biliary carcinoma - Abstract
Simple Summary In perihilar cholangiocarcinoma with vascular involvement, vascular resection to achieve margin-free status is being performed with increasing frequency despite controversial results. Morbidity, mortality, and overall survival are widely variable throughout the world. Vascular resections can include the portal vein alone, the hepatic artery alone, or combined resections. In some cases of locally advance disease, extended resections, such as hepatopancreatoduodenectomy or liver transplant, may be performed to achieve R0 status or a change to cure. The neoadjuvant treatment could help to achieve it. This article reviews and updates all treatment options in this setting. Abstract Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.
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- 2021
23. Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey Analysis
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Pasquale F. Innominato, Valérie Cailliez, Marc-Antoine Allard, Santiago Lopez-Ben, Alessandro Ferrero, Hugo Marques, Catherine Hubert, Felice Giuliante, Fernando Pereira, Esteban Cugat, Darius F. Mirza, Jose Costa-Maia, Alejandro Serrablo, Real Lapointe, Cristina Dopazo, Jose Tralhao, Gernot Kaiser, Jinn-Shiun Chen, Francisco Garcia-Borobia, Jean-Marc Regimbeau, Oleg Skipenko, Jen-Kou Lin, Christophe Laurent, Enrico Opocher, Yuichi Goto, Benoist Chibaudel, Aimery de Gramont, René Adam, Institut Català de la Salut, [Innominato PF] Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK. Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry, UK. UPR 'Chronotherapy, Cancers and Transplantation', Faculty of Medicine, Paris-Saclay University, Villejuif, France. [Cailliez V, Allard MA] AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Research Unit Chronotherapy, Cancers and Transplantation, University Paris Saclay, Villejuif, France. [Lopez-Ben S] Hospital Josep Trueta, Girona, Spain. [Ferrero A] Ospedale Mauriziano Umberto I, Torino, Italy. [Marques H] Hospital de Curry Cabral, Lisboa, Portugal. [Dopazo C] Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, and UCL - (SLuc) Service de chirurgie et transplantation abdominale
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Cancer Research ,colorectal cancer ,liver metastases ,hepatectomy ,neo-adjuvant chemotherapy ,preoperative chemotherapy ,onco-surgical approach ,liver resection ,LiverMetSurvey ,real-world evidence ,downsizing ,irresectable hepatic metastases ,Medizin ,Fetge - Càncer - Cirurgia ,Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Liver Neoplasms [DISEASES] ,intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::hepatectomía [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Intestinal Neoplasms::Colorectal Neoplasms [DISEASES] ,Còlon - Càncer - Cirurgia ,Surgical Procedures, Operative::Digestive System Surgical Procedures::Hepatectomy [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Otros calificadores::Otros calificadores::/cirugía [Otros calificadores] ,neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias hepáticas [ENFERMEDADES] ,neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias gastrointestinales::neoplasias intestinales::neoplasias colorrectales [ENFERMEDADES] ,Other subheadings::Other subheadings::/surgery [Other subheadings] ,Oncology ,Avaluació de resultats (Assistència sanitària) - Abstract
Simple Summary The features of preoperative systemic anticancer therapy associated with best outcomes after resection of initially-irresectable liver metastases from colorectal cancer are yet to be identified. We harnessed data from a prospective international surgical database (LiverMetSurvey) to explore the duration and modalities of preoperative systemic anticancer therapy associated with longer overall survival in this clinical setting. Our study included 2793 patients having undergone liver surgery after preoperative systemic anticancer treatment for initially irresectable disease. We found that short (
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- 2022
24. Multicentric Study on Total Pancreatectomies
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Jose M. Ramia, Elena Martin-Perez, Ignasi Poves, Joan Fabregat-Prous, Javier Larrea y Olea, Francisco Sanchez-Bueno, Francisco Botello-Martinez, Javier Briceño, Alberto Miyar-de León, Mario Serradilla, Angel Moya-Herraiz, Joan Fabregat Prous, Lluis Secanella, Javier Larrea, null Olea, Francisco Sanchez Bueno, Francisco Botello Martinez, Alejandro Serrablo, Joana Ferrer Fabrega, S. Sanchez Cabús, Miguel Angel Gómez Bravo, Javier Padillo, Laia Blanco, J. Balcells, Esteban Cugat, Maribel García Domingo, Luis Muñoz Bellvis, Maria Dolores Perez Diaz, Julio Santoyo Santoyo, Belinda Sanchez, Trinidad Villegas, Silvino Pacho, Luis Díez Valladares, Jose Rebollar, Miguel Ángel Suárez Muñoz, Elías Domínguez, Elena Martín Perez, Laia Falgueras, Vicenç Artigas, Luis Sabater, Agustin Garcia Gil, Jose Ignacio Miota de Llama, Gerardo Manzanet, Jose Carlos Pino, Juan Carlos Rodríguez Sanjuán, F. Lluis, Fabio Ausania, Maialen Alkorta Zuloaga, Jorge Escartín, Manel Salas, Carlos Domingo, Enrique Artigues Sánchez de Rojas, José Antonio Barreras Mateos, José María Fernández Cebrián, Beatriz Pérez Cabrera, D. Padilla Valverde, Alfonso Sanjuanbenito, Ignacio Iturburu Belmonte, Natalia Bejarano, F. García Borobia, Pablo Toral Guinea, Aylhin Lopez Marcano, Francisco Asencio Arana, Evaristo Varo, Rafael Esteban, Juan L. Blas, José M. Jover Navalón, Cristina Fernández Martínez, Enrique Daban Collado, Antonio Calvo Duran, J.C. Vicens, J. Romero, J.M. Badía, Raquel Sánchez, Ricardo de Miguel Ibáñez, Fernando Pardoc, Carlos Francos von Hunefeld, Fernando Pereira, Francisco Garcia Molina, Ignacio Rodríguez Prieto, Alfredo Alonso Poza, Carlos Gilsanz, Jose Miguel Martínez Albert, Miguel Angel Morcillo, Sagrario Martínez Cortijo, José Martín Fernández, Jesús Baquedano, José Castell, Javier Aguiló, and Juan Carlos Bernal
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medicine.medical_specialty ,Intraductal papillary mucinous neoplasm ,business.industry ,medicine.medical_treatment ,General Engineering ,medicine.disease ,Pancreaticoduodenectomy ,Surgery ,medicine.anatomical_structure ,Pancreatic cancer ,Radiological weapon ,medicine ,Adenocarcinoma ,Pancreatitis ,Pancreas ,business ,Artery - Abstract
Introduction Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature. Methods A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1–December 31, 2015. Results 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was “mesentery artery first” (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3 most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. Conclusions This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.
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- 2019
25. Estudio multicéntrico nacional sobre pancreatectomías totales
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Jose M. Ramia, Elena Martin-Perez, Ignasi Poves, Joan Fabregat-Prous, Javier Larrea y Olea, Francisco Sanchez-Bueno, Francisco Botello-Martinez, Javier Briceño, Alberto Miyar-de León, Mario Serradilla, Angel Moya-Herraiz, Joan Fabregat Prous, Lluis Secanella, Francisco Sanchez Bueno, Francisco Botello Martinez, Alejandro Serrablo, Joana Ferrer Fabrega, S. Sanchez Cabús, Miguel Angel Gómez Bravo, Javier Padillo, Laia Blanco, J. Balcells, Esteban Cugat, Maribel García Domingo, Luis Muñoz Bellvis, Maria Dolores Perez Diaz, Julio Santoyo Santoyo, Belinda Sanchez, Trinidad Villegas, Silvino Pacho, Luis Díez Valladares, Jose Rebollar, Miguel Ángel Suárez Muñoz, Elías Domínguez, Elena Martín Perez, Laia Falgueras, Vicenç Artigas, Luis Sabater, Agustin Garcia Gil, Jose Ignacio Miota de Llama, Gerardo Manzanet, Jose Carlos Pino, Juan Carlos Rodríguez Sanjuán, F. Lluis, Fabio Ausania, Maialen Alkorta Zuloaga, Jorge Escartín, Manel Salas, Carlos Domingo, Enrique Artigues Sánchez de Rojas, José Antonio Barreras Mateos, José María Fernández Cebrián, Beatriz Pérez Cabrera, D. Padilla Valverde, Alfonso Sanjuanbenito, Ignacio Iturburu Belmonte, Natalia Bejarano, F. García Borobia, Pablo Toral Guinea, Aylhin Lopez Marcano, Francisco Asencio Arana, Evaristo Varo, Rafael Esteban, Juan Laaa Blas, José M. Jover Navalón, Cristina Fernández Martínez, Enrique Daban Collado, Antonio Calvo Duran, J.C. Vicens, J. Romero, J.M. Badía, Raquel Sánchez, Ricardo de Miguel Ibáñez, Fernando Pardoc, Carlos Francos von Hunefeld, Fernando Pereira, Francisco Garcia Molina, Ignacio Rodríguez Prieto, Alfredo Alonso Poza, Carlos Gilsanz, Jose Miguel Martínez Albert, Miguel Angel Morcillo, Sagrario Martínez Cortijo, José Martín Fernández, Jesús Baquedano, José Castell, Javier Aguiló, and Juan Carlos Bernal
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,medicine ,Surgery ,030230 surgery ,business - Abstract
Resumen Introduccion La pancreatectomia total (PT) es una intervencion infrecuente, con unas indicaciones no claramente definidas y unos resultados postoperatorios no estandarizados. Presentamos un estudio multicentrico nacional sobre PT y una comparacion con la literatura existente. Metodos Estudio prospectivo observacional realizado mediante el registro nacional de pacientes operados de duodenopancreatectomia cefalica y PT realizadas por cualquier indicacion durante el periodo comprendido entre el 1 enero y el 31 diciembre del 2015. Resultados Se incluyo a 1.016 pacientes, pertenecientes a 73 centros; de ellos, 112 correspondian a PT. El porcentaje de PT/numero total de casos es del 11%. La edad media fue 63,5 anos y eran varones un 57,2%. El diagnostico radiologico de sospecha mas frecuente fue cancer de pancreas (58/112 casos). La tecnica de la PT mas habitual fue «arteria mesenterica primero» (43/112 casos). Se efectuaron resecciones venosas en 23 pacientes (20,5%). El porcentaje de complicaciones postoperatorias a 90 dias fue 50%, pero las complicaciones mayores (> IIIA) solo el 20,7%. La mortalidad global a 90 dias fue del 8% (9 pacientes). La estancia media fue 20,7 dias. Los 3 diagnosticos histologicos definitivos mas frecuentes fueron: adenocarcinoma de pancreas, neoplasia mucinosa papilar intraductal y pancreatitis cronica. La tasa de R0 fue del 67,8%. Conclusiones Este estudio demuestra que los resultados de morbimortalidad de la PT en Espana son similares o superiores a los publicados previamente. Es necesario un estudio mas especifico sobre PT centrado en complicaciones especificas, como la insuficiencia endocrina.
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- 2019
26. National Survey on Pancreatic Surgery Units
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José Manuel Ramia, Grupo Español de Cirugía Pancreática Aec Ce Ihpba, Alejandro Serrablo, and Miguel Ángel Gómez Bravo
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Encuesta ,Revisión ,medicine.medical_specialty ,Técnica ,Review ,Total population ,030230 surgery ,Pancreatic surgery ,03 medical and health sciences ,0302 clinical medicine ,Transplant surgery ,Cirugía ,medicine ,Humans ,Survey ,Pancreas ,Digestive System Surgical Procedures ,business.industry ,Drain tube ,General surgery ,General Engineering ,Pancreatic Diseases ,Professional Practice ,Treatment characteristics ,Spanish population ,Páncreas ,Spain ,Health Care Surveys ,Technique ,Surgery ,business ,Hospital Units - Abstract
Introduction The technical, human, scientific and treatment characteristics of the Units that manage complex pathologies have not been studied in depth. Methods Multi-institutional descriptive study (survey) developed jointly by the Hepatobiliary-Pancreatic Division of the Spanish Association of Surgeons and the Spanish Chapter of the IHPBA (International Hepatopancreatobiliary Association) on the characteristics of the Units where pancreatic surgery is performed in Spain. Results 82 surveys were sent. 69 medical centers responded (84%), belonging to 16 autonomous regions of Spain. The total population of these regions was 23 183 262 (50% of the Spanish population). The average number of beds per hospital was 673. The unit that performs pancreatic surgery is a Hepatobiliary-Pancreatic Surgery Unit or HPB and Liver Transplant Surgery Unit in 56 hospitals (77%). The average number of surgeons is 4.5 per Unit. Fifty-five Units (80%) lack specific anesthetists. The number of pancreatectomies performed during 2017 at the hospitals surveyed was 1315 pancreaticoduodenectomies (PD), 566 distal pancreatectomies (DP) and 178 total pancreaticoduodenectomies (TPD). The mean per hospital was 19.1 PD, 8.2 DP and 2.6 TPD. PD was usually performed using a classic approach, with pancreatojejunostomy, single-loop technique, antecolic gastrojejunostomy and using two drain tubes. Only 7 units performed PD laparoscopically and only 13 units did not perform laparoscopic DP. Conclusions This survey provides updated information about the majority of the Units where pancreatic surgery is performed in Spain and could also serve as a starting point for prospective multicenter studies.
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- 2019
27. National survey on pancreatic surgery units
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Alejandro Serrablo, José Manuel Ramia, and Miguel Ángel Gómez Bravo
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Encuesta ,Revisión ,Técnica ,business.industry ,education ,Review ,respiratory system ,030230 surgery ,03 medical and health sciences ,Páncreas ,0302 clinical medicine ,Cirugía ,Technique ,Medicine ,Surgery ,Survey ,business ,Pancreas ,Humanities - Abstract
Spanish Pancreatic Surgery Group (AEC CE-IHPBA)., [EN]: [Introduction] The technical, human, scientific and treatment characteristics of the Units that manage complex pathologies have not been studied in depth. [Methods] Multi-institutional descriptive study (survey) developed jointly by the Hepatobiliary-Pancreatic Division of the Spanish Association of Surgeons and the Spanish Chapter of the IHPBA (International Hepatopancreatobiliary Association) on the characteristics of the Units where pancreatic surgery is performed in Spain. [Results] 82 surveys were sent. 69 medical centers responded (84%), belonging to 16 autonomous regions of Spain. The total population of these regions was 23183262 (50% of the Spanish population). The average number of beds per hospital was 673. The unit that performs pancreatic surgery is a Hepatobiliary-Pancreatic Surgery Unit or HPB and Liver Transplant Surgery Unit in 56 hospitals (77%). The average number of surgeons is 4.5 per Unit. Fifty-five Units (80%) lack specific anesthetists. The number of pancreatectomies performed during 2017 at the hospitals surveyed was 1315 pancreaticoduodenectomies (PD), 566 distal pancreatectomies (DP) and 178 total pancreaticoduodenectomies (TPD). The mean per hospital was 19.1 PD, 8.2 DP and 2.6 TPD. PD was usually performed using a classic approach, with pancreatojejunostomy, single-loop technique, antecolic gastrojejunostomy and using two drain tubes. Only 7 units performed PD laparoscopically and only 13 units did not perform laparoscopic DP. [Conclusions] This survey provides updated information about the majority of the Units where pancreatic surgery is performed in Spain and could also serve as a starting point for prospective multicenter studies., [ES]: [Introducción] Las características técnicas, humanas, científicas y asistenciales de las Unidades que atienden una patología compleja son poco estudiadas y conocidas. [Métodos] Estudio descriptivo multiinstitucional (encuesta) desarrollado conjuntamente por la sección Hepatobiliopancreática de la Asociación Española de Cirujanos y el capítulo español de la IHPBA (Asociación Internacional Hepatopancreatobiliar) sobre las características de las Unidades donde se realiza cirugía pancreática en España. [Resultados]Se enviaron 82 encuestas. Respondieron 69 centros (84%) pertenecientes a 16 comunidades autónomas. La suma de habitantes de las áreas propias fue 23.183.262. El número medio de camas por hospital fue 673. La Unidad que realiza la cirugía pancreática es la Unidad de Cirugía Hepatobiliopancreática o Cirugía HPB y Trasplante Hepático en 56 hospitales (77%). El número medio de cirujanos es 4,5 por Unidad. Cincuenta y cinco Unidades (80%) carecen de anestesistas específicos. El número de pancreatectomías realizadas durante 2017 en los centros encuestados fue 1.315 duodenopancreatectomías cefálicas (DPC), 566 pancreatectomías distales (PD) y 178 duodenopancreatectomías totales (DPT). La media por centro fueron 19,1 DPC, 8,2 PD y 2,6 DPT. La DPC más habitual se realiza mediante abordaje clásico, con pancreatoyeyunostomía, montaje en un asa, con gastroyeyunostomía antecólica y 2 drenajes. Solo 7 Unidades efectúan la DPC por laparoscopia y solamente 13 Unidades no realizan PD laparoscópica. [Conclusiones]Esta encuesta proporciona información actualizada del trabajo asistencial y científico de un gran porcentaje de las Unidades donde se realiza cirugía pancreática en España, y además puede servir de punto de partida a trabajos multicéntricos prospectivos.
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- 2019
28. Evidence Map of Pancreatic Surgery–A living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS)
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Vincent Landré, Charles M. Vollmer, Carlos Fernandez-del Castillo, Jakob R. Izbicki, Helmut Friess, Markus W. Büchler, Felix J Hüttner, Olivier R. Busch, Faik G. Uzunoglu, Parul J. Shukla, Rüdiger Kretschmer, Dejan Radenkovic, Kevin C. Conlon, Keith D. Lillemoe, John P. Neoptolemos, Mohammed Abu Hilal, Marc G. Besselink, Christopher Halloran, Jürgen Weitz, Yi Miao, Giuseppe Fusai, Ömer Meydan, Luca Gianotti, Alejandro Serrablo, Ajith K. Siriwardena, Marta Sandini, Oliver Strobel, Pascal Probst, Maximillian Bockhorn, Dezső Kelemen, Shailesh V. Shrikhande, Mustapha Adham, Christos Dervenis, Eva Kalkum, Markus K. Diener, Roberto Salvia, Alessandro Zerbi, Savio G. Barreto, Thilo Hackert, Giovanni Marchegiani, André L. Mihaljevic, Claudio Bassi, Christopher L. Wolfgang, Marco Del Chiaro, Hannes Kenngott, Probst, P, Huttner, F, Meydan, O, Abu Hilal, M, Adham, M, Barreto, S, Besselink, M, Busch, O, Bockhorn, M, Del Chiaro, M, Conlon, K, Castillo, C, Friess, H, Fusai, G, Gianotti, L, Hackert, T, Halloran, C, Izbicki, J, Kalkum, E, Kelemen, D, Kenngott, H, Kretschmer, R, Landre, V, Lillemoe, K, Miao, Y, Marchegiani, G, Mihaljevic, A, Radenkovich, D, Salvia, R, Sandini, M, Serrablo, A, Shrikhande, S, Shukla, P, Siriwardena, A, Strobel, O, Uzunoglu, F, Vollmer, C, Weitz, J, Wolfgang, C, Zerbi, A, Bassi, C, Dervenis, C, Neoptolemos, J, Buchler, M, Diener, M, Surgery, CCA - Cancer Treatment and Quality of Life, and Amsterdam Gastroenterology Endocrinology Metabolism
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medicine.medical_specialty ,MEDLINE ,030230 surgery ,Pancreatic surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,Pancreas ,Digestive System Surgical Procedures ,Pancreatic Surgery ,Evidence-Based Medicine ,business.industry ,General surgery ,Evidence-based medicine ,Confidence interval ,ddc ,3. Good health ,Clinical research ,Systematic review ,030220 oncology & carcinogenesis ,Surgery ,Distal pancreatectomy ,business - Abstract
Background: Pancreatic surgery is associated with considerable morbidity and, consequently, offers a large and complex field for research. To prioritize relevant future scientific projects, it is of utmost importance to identify existing evidence and uncover research gaps. Thus, the aim of this project was to create a systematic and living Evidence Map of Pancreatic Surgery. Methods: PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for all randomized controlled trials and systematic reviews on pancreatic surgery. Outcomes from every existing randomized controlled trial were extracted, and trial quality was assessed. Systematic reviews were used to identify an absence of randomized controlled trials. Randomized controlled trials and systematic reviews on identical subjects were grouped according to research topics. A web-based evidence map modeled after a mind map was created to visualize existing evidence. Meta-analyses of specific outcomes of pancreatic surgery were performed for all research topics with more than 3 randomized controlled trials. For partial pancreatoduodenectomy and distal pancreatectomy, pooled benchmarks for outcomes were calculated with a 99% confidence interval. The evidence map undergoes regular updates. Results: Out of 30, 860 articles reviewed, 328 randomized controlled trials on 35, 600 patients and 332 systematic reviews were included and grouped into 76 research topics. Most randomized controlled trials were from Europe (46%) and most systematic reviews were from Asia (51%). A living meta-analysis of 21 out of 76 research topics (28%) was performed and included in the web-based evidence map. Evidence gaps were identified in 11 out of 76 research topics (14%). The benchmark for mortality was 2% (99% confidence interval: 1%–2%) for partial pancreatoduodenectomy and
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- 2021
29. Pancreatic head cancer overall survival after pancreaticoduodenectomy with total mesopancreas excision
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Alejandro Serrablo-Requejo, Sandra Paterna-López, Marta Gutiérrez-Díez, María Teresa Abadía-Forcen, Mario Serradilla-Martín, Pablo Sancho-Pardo, and Consuelo Artigas-Marco
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Surgery ,General Medicine - Published
- 2022
30. Is multivisceral resection added to duodenopancreatectomy justified? Analysis of postoperative morbimortality and long-term survival
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Alejandro Serrablo, Pablo Sancho, Sandra Paterna, Sef Saudi, and Maria Espinosa
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Surgery ,General Medicine - Published
- 2022
31. Total mesopancreas excision in pancreaticoduodenectomy for pancreatic head cancer. Impact on the superior mesenteric artery margin status
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Alejandro Serrablo-Requejo, Sandra Paterna-López, Marta Gutiérrez-Díez, María Teresa Abadía, Mario Serradilla-Martín, Pablo Sancho-Pardo, and Consuelo Artigas-Marco
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Surgery ,General Medicine - Published
- 2022
32. Postoperative complications on pancreaticoduodenectomy with total mesopancreas excision in pancreatic head cancer
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Alejandro Serrablo-Requejo, Sandra Paterna-López, Marta Gutiérrez-Díez, María Teresa Abadía-Forcén, Mario Serradilla-Requejo, Pablo Sancho-Pardo, and Consuelo Artigas-Marco
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Surgery ,General Medicine - Published
- 2022
33. Impact of total mesopancreas excision on postoperative tumor recurrence
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Alejandro Serrablo-Requejo, Sandra Paterna-López, Marta Gutiérrez-Díez, María Teresa Abadía-Forcén, Mario Serradilla-Martín, Pablo Sancho-Pardo, and Consuelo Artigas-Marco
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Surgery ,General Medicine - Published
- 2022
34. Ex-situ liver resection and autotransplantation, a systematic review, can we get some clear ideas?
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Alejandro Serrablo, Teresa Gimenez-Maurel, Alejandra Utrillas, and Pablo Sancho
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Surgery ,General Medicine - Published
- 2022
35. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis
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Andreas A. Schnitzbauer, F. Heid, R. Van Dam, B. Olij, T Gimenez-Maurel, Marc H.A. Bemelmans, Daniel Heise, Jan Heil, Wolf O. Bechstein, Bergthor Björnsson, Per Sandström, A. Dili, R. Korenblik, Christoph A. Binkert, Laurent Gerard, Peter Metrakos, Robert F. Dondelinger, C. van der Leij, Erik Schadde, Sam G. Pappas, Boris Guiu, J. Tasse, John J. Klein, Alejandro Serrablo, Jennifer Kalil, A. Lakoma, Stefan Breitenstein, Olivier Detry, Ulf P. Neumann, Martin Hertl, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), MUMC+: DA BV Medisch Specialisten Radiologie (9), UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, and UCL - (MGD) Service de chirurgie
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Male ,medicine.medical_specialty ,RESECTION ,medicine.medical_treatment ,Portal vein ,LIVER VENOUS DEPRIVATION ,Hepatic Veins ,Preoperative care ,Resection ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,MAJOR HEPATECTOMY ,Preoperative Care ,medicine ,Hepatectomy ,Humans ,Embolization ,Vein ,HEPATOBILIARY SCINTIGRAPHY ,Aged ,Retrospective Studies ,LIGATION ,Receiver operating characteristic ,business.industry ,Portal Vein ,MORTALITY ,REMNANT LIVER ,Liver Neoplasms ,Middle Aged ,Embolization, Therapeutic ,Liver Regeneration ,Transplantation ,HYPERTROPHY ,medicine.anatomical_structure ,METASTASES ,Treatment Outcome ,030220 oncology & carcinogenesis ,VOLUME ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiology ,business ,Follow-Up Studies - Abstract
Background The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. Methods All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016–2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan–Meier analysis. Results In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. Conclusion PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
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- 2020
36. Asociación de la Concentración sérica de la vitamina D con las infecciones nosocomiales en pacientes de Cirugía Hepatobiliopancreática
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Laviano Martínez, Estefanía, Dr. Alejandro Serrablo Requejo, and Dr. Antonio Rezusta López
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cirugia abdominal ,microbiologia clinica ,enfermedades infecciosas ,vitaminas - Abstract
IntroducciónLa deficiencia de vitamina D, según la evidencia existente, está asociada a una mayor susceptibilidad a padecer infecciones nosocomiales. El objetivo de este estudio es examinar la asociación entre la concentración sérica de vitamina D y las infecciones nosocomiales en pacientes de cirugía hepatobiliopancreática.Material y métodosSe realizó un estudio prospectivo analítico observacional de pacientes sucesivos intervenidos tanto de forma urgente como programada en la Unidad de Cirugía Hepatobiliar de un hospital de tercer nivel en Aragón, desde febrero de 2018 hasta marzo de 2019. Las concentraciones de vitamina D se midieron al ingreso y todas las infecciones nosocomiales se documentaron tanto durante la hospitalización como durante el seguimiento en consultas externas.ResultadosLa media de 25-hidroxivitamina D en la población a estudio (n=301) fue de 38,56 nmol/l, correspondiendo estos valores a deficiencia. Los pacientes con mayores concentraciones de vitamina D asociaron un menor riesgo de padecer infecciones nosocomiales (p=0,014), sobre todo en el caso de la infección de sitio quirúrgico (p=0,026).El riesgo de padecer infecciones nosocomiales descendía un 34% por cada incremento en 26,2 nmol/l de la concentración sérica de vitamina D.DiscusiónLa concentración sérica de vitamina D constituye un factor de riesgo modificable que podría prevenir las infecciones nosocomiales en pacientes de Cirugía Hepatobiliar.
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- 2020
37. Current status of liver transplantation in Latin America
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Alan G. Contreras, Lucas McCormack, Wellington Andraus, Eduardo de Souza M Fernandes, Eduardo de Souza M. Fernandes, Alejandro Serrablo Requejo, Nicolás Jarufe, Martin Dib, Felix Carrasco, Martin Harguindeguy, Jose Pablo Garbanzo, Frans Serpa, Alejandro Gimenez, Ricardo Villaroel, and Alonso Vera
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Economic growth ,Latin Americans ,Tissue and Organ Procurement ,Waiting Lists ,medicine.medical_treatment ,Public policy ,Liver transplantation ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Social consciousness ,Organ donation ,Healthcare Disparities ,business.industry ,General Medicine ,Liver Transplantation ,Transplantation ,Organ procurement ,Latin America ,030220 oncology & carcinogenesis ,Donation ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
The lack of adequate financial coverage, education, and the organization has been the main limiting factor for the development of transplantation in Latin America. As occurred worldwide, the number of patients on liver waiting lists in Latin America grows disproportionately compared to the number of liver transplantations (LTs) performed. Although many law modifications have been made in the last year, most countries lack social awareness about the importance of donation and the irreversibility of brain death. The mechanisms and norms for organ procurement and infrastructure development, capable of supporting this high demand, are still in slow progress in most countries. Access to LT in the region is very heterogeneous. While some countries have no active LT programs so far, others are an international model of a public transplantation system (Brazil) or a national information system (Argentina). While some countries have only a few LT centers, others have too many LT centers performing an inadequate low number of LTs. Disparity to access transplantation remains the major challenge in the region. Cultural and educational efforts have to be accompanied by transparent public policies that will likely increase organ donation and activity in transplantation. The purpose of this article is to review the trends and current activity in LT within Latin America, based on prior publications and the information available in each country of the region.
- Published
- 2020
38. Liver resection in Cirrhotic liver: Are there any limits?
- Author
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Alfred Wei Chieh Kow, Albert C. Y. Chan, Fabrizio Di Benedetto, Alejandro Serrablo, and Taizo Hibi
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Liver Cirrhosis ,medicine.medical_specialty ,Surgical stress ,Cirrhosis ,medicine.medical_treatment ,030230 surgery ,Resection ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,business.industry ,General Medicine ,ALPPS ,Associating liver partition and portal vein ligation for staged heaptectomy ,Bile leakage ,Hepatocellular carcinoma ,ICG ,Liver failure ,Liver resection ,Portal vein embolization ,Robotic liver surgery ,Volumetry ,Liver ,Liver Regeneration ,Treatment Outcome ,medicine.disease ,Liver regeneration ,Surgery ,030220 oncology & carcinogenesis ,Liver function ,business ,Abdominal surgery - Abstract
Liver resection remains one of the most technically challenging surgical procedure in abdominal surgery due to the complex anatomical arrangement in the liver and its rich blood supply that constitutes about 20% of the cardiac output per cycle. The challenge for resection in cirrhotic livers is even higher because of the impact of surgical stress and trauma imposed on borderline liver function and the impaired ability for liver regeneration in cirrhotic livers. Nonetheless, evolution and advancement in surgical techniques as well as knowledge in perioperative management of liver resection has led to a substantial improvement in surgical outcome in recent decade. The objective of this article was to provide updated information on the recent developments in liver surgery, from preoperative evaluation, to technicality of resection, future liver remnant augmentation and finally, postoperative management of complications.
- Published
- 2020
39. Atypical epigastric pain: Case Report
- Author
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Fabio Pulighe, Alejandro Serrablo Requejo, and Gian Pietro Gusai
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,General Medicine ,business ,Epigastric pain ,Surgery - Published
- 2020
40. Resultados de una encuesta sobre el soporte nutricional perioperatorio en la cirugía pancreática y biliar en España
- Author
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Carmelo Loinaz, Federico Ochando Cerdan, Emilio Vicente López, Alejandro Serrablo Requejo, P. López Cillero, Gómez Bravo, Miguel Ángel, Joan Fabregat Prous, and Universidad de Sevilla. Departamento de Cirugía
- Subjects
Páncreas ,Cirugía ,Nutrición ,Biliary ,Surgery ,Pancreas ,Nutrition ,Biliar - Abstract
A survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (< 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country. Introducción: realizamos una encuesta sobre soporte nutricional perioperatorio en cirugía pancreática y biliar en hospitales españoles en 2007, que mostró que pocos grupos quirúrgicos seguían las guías de ESPEN 2006. Diez años después enviamos un cuestionario para comprobar la situación actual. Métodos: treinta y ocho centros recibieron un cuestionario con 21 preguntas sobre tiempo de ayunas antes y después de la cirugía, cribado nutricional, duración y tipo de soporte nutricional perioperatorio, y número de procedimientos. Resultados: respondieron 34 grupos. La mediana de pancreatectomías (cabeza/total) fue de 29,5 (IC 95 %: 23,0-35; rango, 5-68) (total, 1002), la de cirugías biliares malignas de 9,8 (IC 95 %: 7,3-12,4; rango, 2-30) y la de resecciones biliares por patología benigna de 10,4 (IC 95 %: 7,6-13,3; rango, 2-33). Solo el 41,2 % de los grupos utilizaban soporte nutricional antes de la cirugía (< 50 % habian efectuado un cribado nutricional). El tiempo medio de ayuno preoperatorio para sólidos fue de 9,3 h (rango, 6-24 h), y de 6,6 h para líquidos (rango, 2-12). Tras la pancreatectomía, el 29,4 % habían intentado administrar una dieta oral precoz, pero el 88,2 % de los grupos usaron algún tipo de soporte nutricional y el 26,5 % usaron NP en el 100 % de los casos. Los demás grupos usaron diferentes porcentajes de NP y NE en sus casos. En la cirugía biliar maligna, el 22,6 % utilizaron NP siempre y NE en el 19,3 % de los casos. Conclusiones: la NP es el soporte nutricional más utilizado tras la cirugía de cabeza pancreática. Solo el 29,4 % de las unidades usan nutrición oral precoz y el 32,3 % emplean la NE tras este tipo de cirugía. El 22,6 % de las instituciones usan NP habitualmente tras la cirugía de tumores biliares malignos. Las guías ESPEN 2006 no se siguen de forma habitual en nuestro país tras más de 10 años desde su publicación.
- Published
- 2020
41. Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons: A Throw of the Dice?
- Author
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Timothy M. Pawlik, Xabier de Aretxabala, Koo Jeong Kang, Ricardo Robles-Campos, Mohamed Rela, Hugo Pinto-Marques, Christian E. Oberkofler, Shimul A. Shah, Masakazu Yamamoto, Henrik Petrowsky, Christian Toso, René Adam, Kenneth K. Tanabe, Roberto Hernandez-Alejandro, Michelle L. DeOliveira, Karim Boudjema, Eduardo de Santibañes, Julia Braun, Cäcilia S. Reiner, Norihiro Kokudo, Olivier Soubrane, Orlando Jorge M Torres, Michael Linecker, Miguel Angel Mercado, Philipp Dutkowski, Yuman Fong, Povilas Ignatavicius, Hauke Lang, Ronald P. DeMatteo, Peter Lodge, Jiahong Dong, Albert C. Y. Chan, Jean Nicolas Vauthey, Ruslan Alikhanov, Giedrius Barauskas, Johnny C. Hong, Alejandro Serrablo, William C. Chapman, Bryan M. Clary, Luca Aldrighetti, Pål-Dag Line, Thomas A. Aloia, Michael I. D’Angelica, Antonio Daniele Pinna, Guido Torzilli, O. Andriani, Pierre-Alain Clavien, Ignatavicius, P., Oberkofler, C. E., Chapman, W. C., Dematteo, R. P., Clary, B. M., D'Angelica, M. I., Tanabe, K. K., Hong, J. C., Aloia, T. A., Pawlik, T. M., Hernandez-Alejandro, R., Shah, S. A., Vauthey, J. -N., Torzilli, G., Lang, H., Line, P. -D., Soubrane, O., Pinto-Marques, H., Robles-Campos, R., Boudjema, K., Lodge, P., Adam, R., Toso, C., Serrablo, A., Aldrighetti, L., Deoliveira, M. L., Dutkowski, P., Petrowsky, H., Linecker, M., Reiner, C. S., Braun, J., Alikhanov, R., Barauskas, G., Chan, A. C. Y., Dong, J., Kokudo, N., Yamamoto, M., Kang, K. J., Fong, Y., Rela, M., De Aretxabala, X., De Santibanes, E., Mercado, M. A., Andriani, O. C., Torres, O. J. M., Pinna, A. D., and Clavien, P. -A.
- Subjects
Liver surgery ,Adult ,Male ,medicine.medical_specialty ,Consensus ,Decision Making ,MEDLINE ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Practice Patterns, Physicians' ,Therapeutic strategy ,ddc:617 ,business.industry ,General surgery ,Liver Neoplasms ,Middle Aged ,Test (assessment) ,Transplantation ,Current practice ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Colorectal Neoplasms - Abstract
Objective To test the degree of agreement in selecting therapeutic options for patients suffering from colorectal liver metastasis (CRLM) among surgical experts around the globe. Summary/background Only few areas in medicine have seen so many novel therapeutic options over the past decades as for liver tumors. Significant variations may therefore exist regarding the choices of treatment, even among experts, which may confuse both the medical community and patients. Methods Ten cases of CRLM with different levels of complexity were presented to 43 expert liver surgeons from 23 countries and 4 continents. Experts were defined as experienced surgeons with academic contributions to the field of liver tumors. Experts provided information on their medical education and current practice in liver surgery and transplantation. Using an online platform, they chose their strategy in treating each case from defined multiple choices with added comments. Inter-rater agreement among experts and cases was calculated using free-marginal multirater kappa methodology. A similar, but adjusted survey was presented to 60 general surgeons from Asia, Europe, and North America to test their attitude in treating or referring complex patients to expert centers. Results Thirty-eight (88%) experts completed the evaluation. Most of them are in leading positions (92%) with a median clinical experience of 25 years. Agreement on therapeutic strategies among them was none to minimal in more than half of the cases with kappa varying from 0.00 to 0.39. Many general surgeons may not refer the complex cases to expert centers, including in Europe, where they also engage in complex liver surgeries. Conclusions Considerable inconsistencies of decision-making exist among expert surgeons when choosing a therapeutic strategy for CRLM. This might confuse both patients and referring physicians and indicate that an international high-level consensus statements and widely accepted guidelines are needed.
- Published
- 2020
42. Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain
- Author
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Universidad de Sevilla. Departamento de Cirugía, Carmelo Loinaz, Federico Ochando Cerdan, Emilio Vicente López, Alejandro Serrablo Requejo, P. López Cillero, Gómez Bravo, Miguel Ángel, Joan Fabregat Prous, Universidad de Sevilla. Departamento de Cirugía, Carmelo Loinaz, Federico Ochando Cerdan, Emilio Vicente López, Alejandro Serrablo Requejo, P. López Cillero, Gómez Bravo, Miguel Ángel, and Joan Fabregat Prous
- Abstract
A survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (< 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country., Introducción: realizamos una encuesta sobre soporte nutricional perioperatorio en cirugía pancreática y biliar en hospitales españoles en 2007, que mostró que pocos grupos quirúrgicos seguían las guías de ESPEN 2006. Diez años después enviamos un cuestionario para comprobar la situación actual. Métodos: treinta y ocho centros recibieron un cuestionario con 21 preguntas sobre tiempo de ayunas antes y después de la cirugía, cribado nutricional, duración y tipo de soporte nutricional perioperatorio, y número de procedimientos. Resultados: respondieron 34 grupos. La mediana de pancreatectomías (cabeza/total) fue de 29,5 (IC 95 %: 23,0-35; rango, 5-68) (total, 1002), la de cirugías biliares malignas de 9,8 (IC 95 %: 7,3-12,4; rango, 2-30) y la de resecciones biliares por patología benigna de 10,4 (IC 95 %: 7,6-13,3; rango, 2-33). Solo el 41,2 % de los grupos utilizaban soporte nutricional antes de la cirugía (< 50 % habian efectuado un cribado nutricional). El tiempo medio de ayuno preoperatorio para sólidos fue de 9,3 h (rango, 6-24 h), y de 6,6 h para líquidos (rango, 2-12). Tras la pancreatectomía, el 29,4 % habían intentado administrar una dieta oral precoz, pero el 88,2 % de los grupos usaron algún tipo de soporte nutricional y el 26,5 % usaron NP en el 100 % de los casos. Los demás grupos usaron diferentes porcentajes de NP y NE en sus casos. En la cirugía biliar maligna, el 22,6 % utilizaron NP siempre y NE en el 19,3 % de los casos. Conclusiones: la NP es el soporte nutricional más utilizado tras la cirugía de cabeza pancreática. Solo el 29,4 % de las unidades usan nutrición oral precoz y el 32,3 % emplean la NE tras este tipo de cirugía. El 22,6 % de las instituciones usan NP habitualmente tras la cirugía de tumores biliares malignos. Las guías ESPEN 2006 no se siguen de forma habitual en nuestro país tras más de 10 años desde su publicación.
- Published
- 2020
43. Vascular Resection for Intrahepatic Cholangiocarcinoma: Current Considerations
- Author
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Anna Dudareva, Miguel Ángel Trigo, Ruslan Alikhanov, and Alejandro Serrablo
- Subjects
Liver surgery ,Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Review ,General Medicine ,survival ,Resection ,Aggressive surgery ,Surgery ,Radiation therapy ,vascular resection ,intrahepatic cholangiocarcinoma ,liver resection ,Referral centre ,medicine ,Medicine ,Vascular resection ,cholangiocarcinoma ,business ,Intrahepatic Cholangiocarcinoma - Abstract
Intrahepatic cholangiocarcinoma (iCCA) accounts for approximately 10% of all primary liver cancers. Surgery is the only potentially curative treatment, even in cases of macrovascular invasion. Since resection offers the only curative chance, even extended liver resection combined with complex vascular or biliary reconstruction of the surrounding organs seems justified to achieve complete tumour removal. In selected cases, the major vascular resection is the only change to try getting the cure. The best results are achieved by the referral centre with a wide experience in complex liver surgery, such as ALPPS procedure, IVC resection, and ante-situ and ex-situ resections. However, despite aggressive surgery, tumour recurrence occurs frequently and long-term oncological results are very poor. This suggests that significant progress in prognosis cannot be expected by surgery alone. Instead, multimodal treatment including neoadjuvant chemotherapy, radiotherapy, and subsequent adjuvant treatment for iCCA seem to be necessary to improve results.
- Published
- 2021
44. Current status of liver transplantation in Latin America
- Author
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Contreras, Alan G., primary, McCormack, Lucas, additional, Andraus, Wellington, additional, de Souza M Fernandes, Eduardo, additional, Contreras, Alan G., additional, Fernandes, Eduardo de Souza M., additional, Requejo, Alejandro Serrablo, additional, Jarufe, Nicolás, additional, Dib, Martin, additional, Carrasco, Felix, additional, Harguindeguy, Martin, additional, Garbanzo, Jose Pablo, additional, Serpa, Frans, additional, Gimenez, Alejandro, additional, Villaroel, Ricardo, additional, and Vera, Alonso, additional
- Published
- 2020
- Full Text
- View/download PDF
45. Urgent Surgery for Giant Pancreatic Neuroendocrine Tumor: A Case Report
- Author
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Maurel Teresa, Gimenez, primary, Fornals Alejandra, Utrilla, additional, Casaña Leyre, Serrablo, additional, Gómez Miguel Angel, Trigo, additional, and Requejo Alejandro, Serrablo, additional
- Published
- 2020
- Full Text
- View/download PDF
46. Protocolo de actuación quirúrgica en casos confirmados o sospechosos de enfermedad por Ébola y otras enfermedades víricas altamente transmisibles
- Author
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Alejandro Serrablo, Josep M. Badia, Ines Rubio-Perez, Xavier Guirao Garriga, Javier Arias Díaz, and José María Jover Navalón
- Subjects
03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,Surgery ,030212 general & internal medicine ,030230 surgery ,business ,Humanities - Abstract
Resumen Las epidemias por virus altamente transmisibles como la enfermedad por virus del Ebola (EVE) pueden generar casos importados a Europa y America. Aunque la probabilidad de actuacion quirurgica en ellas es baja, la Asociacion Espanola de Cirujanos ha elaborado un protocolo de actuacion quirurgica. Indicacion No esta indicada la cirugia electiva. Puede necesitarse cirugia urgente en: personas en observacion, casos probables y casos confirmados en fase precoz. En algunas condiciones de habitual tratamiento quirurgico puede instaurarse una terapia medica conservadora con intencion de evitar la intervencion. Hospitales y equipos Los casos deben concentrarse en hospitales de alta especializacion, unicos centros en los que se practique una eventual intervencion quirurgica. Estos deben garantizar la seguridad de los profesionales. Los equipos quirurgicos han de recibir extensa formacion mediante simulacion. Protocolo quirurgico Las recomendaciones se basan en protocolos de uso del equipo de proteccion individual, guias clinicas de otras sociedades y recomendaciones especificas para el area quirurgica.
- Published
- 2016
47. Does distal laparoscopic pancreatectomy decrease morbidity and mortality? A multicentre study (ERPANDIS)
- Author
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Miguel Cantalejo, Elena Muñoz, Luis Sabater, María Sánchez-Rubio, Gerardo Blanco, Texell Longoria-Dubocq, Helga Kälviäinen, Pedro Hernández, M. Garcés, Alejandro Serrablo, Juan Vicente Del Rio, Alberto Carabias, Juan José Díaz, José Manuel Ramia, Fernando Pardo, Mario Serradilla, Sandra Paterna, Sara Esteban, Fernando Rotellar, and A. Manuel
- Subjects
medicine.medical_specialty ,business.industry ,Laparoscopic pancreatectomy ,Medicine ,Surgery ,General Medicine ,business - Published
- 2020
48. Vitamin D levels and nosocomial infections in HPB surgery
- Author
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Alejandro Serrablo, Javier López-Coscojuela, Helga Kälviäinen, Estefania Laviano, Yolanda Gilaberte, Pilar Palacian, María Sánchez-Rubio, Teresa González-Nicolás, and Antonio Rezusta
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Vitamin D and neurology ,Surgery ,General Medicine ,business ,Gastroenterology - Published
- 2020
49. Liver venous deprivation (LVD) for primarily unresectable liver tumors induces more kinetic liver growth than portal vein embolization alone
- Author
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Erik Schadde, Christoph A. Binkert, Alejandro Serrablo, F. Heid, T. Giménez Maurel, Stefan Breitenstein, and S. Gloor
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Portal vein embolization ,Gastroenterology ,Urology ,medicine ,business - Published
- 2020
50. Major hepatectomies in liver cystic echinococcosis: A bi-centric experience. Retrospective cohort study
- Author
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A. Lopez-Marcano, José Manuel Ramia, Alejandro Serrablo, A. Palomares, Roberto de la Plaza, and M. Serradilla
- Subjects
Adult ,Male ,medicine.medical_specialty ,Echinococcosis, Hepatic ,medicine.medical_treatment ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Medicine ,Animals ,Hepatectomy ,Humans ,Cyst ,Radical surgery ,Echinococcus granulosus ,Aged ,Retrospective Studies ,biology ,business.industry ,Cysts ,Mortality rate ,Retrospective cohort study ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,biology.organism_classification ,Echinococcosis ,Surgery ,Treatment Outcome ,Feasibility Studies ,030211 gastroenterology & hepatology ,Female ,Morbidity ,business - Abstract
Surgical treatment of liver cystic echinococcosis (LCE) could be conservative or radical. Radical surgery includes liver resection, but usually are minor hepatectomy in favourable segments. Experience in major hepatectomy (MH) for LCE is limited. Methods Retrospective study. Period: January 2007–December 2014. Inclusion criteria: liver infestation with Echinococcus granulosus causing active or complicated cysts. Epidemiological, clinical, radiological and surgical data were studied. Results 145 patients underwent surgery for LCE. MH was performed in 49 patients (34%) with 81 cysts. 51% of patients were women. Mean age: 56 years. Sixteen patients (32.7%) had recurrent disease. The mean diameter cyst was 9.9 cm. The MH performed were right hepatectomy (n = 15), left hepatectomy (6) and others (n = 28). The reason for MH was occupation of the entire lobe (14), severe vascular or biliary involvement (17), or a combination of the two (18). Major morbidity (Clavien III-V) was 26%. Mortality was 2%. Mean hospital stay: 15.3 days. At follow-up (mean: 31 months) the rate of liver recurrence after MH was 0%. Conclusions MH is feasible in LCE, with a major morbidity rate of (26%), and zero recurrence. Indications of MH are occupation of an entire lobe, extreme biliary or vascular involvement or recurrent cysts.
- Published
- 2018
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