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1. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE

Author

Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, K, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Lang, H, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef K., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Lang H., Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F. M., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., Artigas C., Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, K, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Lang, H, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef K., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Lang H., Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F. M., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., and Artigas C.

Abstract

Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. Methods: This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. Results: Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term 'early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term 'late metachronous metastases' applies to those detected after 12 months. 'Disappearing metastases' applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusion: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

Published
2023

2. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE

Author

Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, C, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Hauke, L, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef C., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Hauke Lang, Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., Artigas C., Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, C, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Hauke, L, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef C., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Hauke Lang, Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., and Artigas C.

Abstract

Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. Methods: This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. Results: Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term “early metachronous metastases” applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with “late metachronous metastases” applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusions: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

Published
2023

3. Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members

Author

Martin, D., Mantziari, S., Demartines, N., Hubner, M., Bismuth, H., Sarr, M. G., Strasberg, S. M., Wexner, S. D., Adham, M., Altomare, D. F., Andersson, R., Bechstein, W., Biondo, S., Bockhorn, M., Bonavina, L., Rituerto, D. C., Clavien, P. -A., De Manzini, N., Decker, G., Dejong, C. H., Dervenis, C., Farges, O., Figueras, J., Fingerhut, A. L., Friess, H., Glehen, O., Gnant, M., Gutschow, C., Hahnloser, D., Hamberger, B., Hamming, J. F., Holscher, A. H., Izbicki, J. R., Jonas, S., Karamarkovic, A., Kehlet, H., Leppaniemi, A. K., Lerut, J., Line, P. -D., Lodge, J. P. A., Meakins, J. L., Montorsi, M., Nafteux, P., Naredi, P., Olah, A., Panis, Y., Pardo, F., Parks, R. W., Pedrazzoli, S., Pessaux, P., Marques, H. P., Poggioli, G., Popescu, I., Puolakkainen, P. A., Ramia Angel, J. M., Rasanen, J., Reynolds, J. V., Rosati, R., Saeger, H. -D., Schneeberger, S., Schneider, P. M., Soreide, K., Stippel, D., Toso, C., Tuech, J. -J., Tukiainen, E. J., Van Hillegersberg, R., Wijnhoven, B., Winter, D. C., Zaninotto, G., Surgery, Martin, D., Mantziari, S., Demartines, N., Hubner, M., Bismuth, H., Sarr, M. G., Strasberg, S. M., Wexner, S. D., Adham, M., Altomare, D. F., Andersson, R., Bechstein, W., Biondo, S., Bockhorn, M., Bonavina, L., Rituerto, D. C., Clavien, P. -A., De Manzini, N., Decker, G., Dejong, C. H., Dervenis, C., Farges, O., Figueras, J., Fingerhut, A. L., Friess, H., Glehen, O., Gnant, M., Gutschow, C., Hahnloser, D., Hamberger, B., Hamming, J. F., Holscher, A. H., Izbicki, J. R., Jonas, S., Karamarkovic, A., Kehlet, H., Leppaniemi, A. K., Lerut, J., Line, P. -D., Lodge, J. P. A., Meakins, J. L., Montorsi, M., Nafteux, P., Naredi, P., Olah, A., Panis, Y., Pardo, F., Parks, R. W., Pedrazzoli, S., Pessaux, P., Marques, H. P., Poggioli, G., Popescu, I., Puolakkainen, P. A., Ramia Angel, J. M., Rasanen, J., Reynolds, J. V., Rosati, R., Saeger, H. -D., Schneeberger, S., Schneider, P. M., Soreide, K., Stippel, D., Toso, C., Tuech, J. -J., Tukiainen, E. J., Van Hillegersberg, R., Wijnhoven, B., Winter, D. C., Zaninotto, G., Martin D., Mantziari S., Demartines N., Hubner M., Bismuth H., Sarr M.G., Strasberg S.M., Wexner S.D., Adham M., Altomare D.F., Andersson R., Bechstein W., Biondo S., Bockhorn M., Bonavina L., Rituerto D.C., Clavien P.-A., De Manzini N., Decker G., Dejong C.H., Dervenis C., Farges O., Figueras J., Fingerhut A.L., Friess H., Glehen O., Gnant M., Gutschow C., Hahnloser D., Hamberger B., Hamming J.F., Holscher A.H., Izbicki J.R., Jonas S., Karamarkovic A., Kehlet H., Leppaniemi A.K., Lerut J., Line P.-D., Lodge J.P.A., Meakins J.L., Montorsi M., Nafteux P., Naredi P., Olah A., Panis Y., Pardo F., Parks R.W., Pedrazzoli S., Pessaux P., Marques H.P., Poggioli G., Popescu I., Puolakkainen P.A., Ramia Angel J.M., Rasanen J., Reynolds J.V., Rosati R., Saeger H.-D., Schneeberger S., Schneider P.M., Soreide K., Stippel D., Toso C., Tuech J.-J., Tukiainen E.J., Van Hillegersberg R., Wijnhoven B., Winter D.C., Zaninotto G., ESA Study Group, Sarr, M.G., Strasberg, S.M., Wexner, S.D., Altomare, D.F., Rituerto, D.C., Clavien, P.A., Dejong, C.H., Fingerhut, A.L., Hamming, J.F., Hölscher, A.H., Izbicki, J.R., Leppäniemi, A.K., Line, P.D., Lodge, JPA, Meakins, J.L., Oláh, A., Parks, R.W., Marques, H.P., Puolakkainen, P.A., Ramia Angel, J.M., Reynolds, J.V., Saeger, H.D., Schneider, P.M., Søreide, K., Tuech, J.J., Tukiainen, E.J., Winter, D.C., Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Zurich, Demartines, Nicolas, and Toso, Christian

Subjects
Male, medicine.medical_specialty, Blood transfusion, Consensus, Delphi Technique, medicine.medical_treatment, Delphi method, 610 Medicine & health, Consensu, Likert scale, 03 medical and health sciences, Surgeon, 0302 clinical medicine, Aged, Europe, Humans, Middle Aged, Societies, Medical, Surgeons, Surgical Procedures, Operative/methods, Medical, major surgery, Delphi consensus definition, medicine, Operative / methods, 10217 Clinic for Visceral and Transplantation Surgery, Surgical Procedures, ddc:617, business.industry, Perioperative, Vascular surgery, 2746 Surgery, 3. Good health, Cardiac surgery, Surgery, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Surgical Procedures, Operative, 030211 gastroenterology & hepatology, Societies, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Abdominal surgery, Human
Abstract

Background: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). Methods: A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Results: Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.

Published
2020
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5. Pancreas-Preserving Total Duodenectomy: A Systematic Review

Author

Cantalejo-Diaz M, Ramia-Angel J, Palomares-Cano A, and Serradilla-Martin M

Subjects
Familial adenomatous polyposis, Pancreas-sparing, Total duodenectomy, Pancreas-preserving, Pancreatic trauma
Abstract

Background: The management of the pancreas in patients with duodenal trauma or duodenal tumors remains a controversial issue. Pancreas-preserving total duodenectomy (PPTD) requires a meticulous surgical technique. The most common indication is familial duodenal adenomatous polyposis (FAP). The aims of this study are to carry out a systematic review of the literature on the indications for PPTD and to highlight the risks and benefits compared with other more aggressive procedures. Summary: A systematic literature review was performed following PRISMA recommendations of studies published in PubMed, Embase, and Cochrane library until May 2019. Thirty articles describing 211 patients were chosen. The mean age was 48 years. The surgical indication in 75% of patients was FAP. The mean operating time was 329 min and mean intraoperative bleeding 412 mL. Postoperative morbidity rate was 49.7% (76% Clavien-Dindo 97.8%. Key Messages: PPTD is indicated for patients with benign and premalignant duodenal lesions without involvement of the pancreatic head. It is a feasible procedure offering an alternative to other more aggressive procedures in selected patients. Mortality is below 1.5%.

Published
2021

6. Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol

Author

Rodriguez-Laiz G, Melgar-Requena P, Alcazar-Lopez C, Franco-Campello M, Villodre-Tudela C, Pascual-Bartolome S, Bellot-Garcia P, Rodriguez-Soler M, Miralles-Macia C, Mas-Serrano P, Navarro-Martinez J, Martinez-Adsuar F, Gomez-Salinas L, Jaime-Sanchez F, Perdiguero-Gil M, Diaz-Cuevas M, Palazon-Azorin J, Such-Ronda J, Lluis-Casajuana F, and Ramia-Angel J

Abstract

Introduction Enhanced recovery after surgery (ERAS) has been shown to facilitate discharge, decrease length of stay, improve outcomes and reduce costs. We used this concept to design a comprehensive fast-track pathway (OR-to-discharge) before starting our liver transplant activity and then applied this protocol prospectively to every patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our first six years results. Patients and methods Prospective cohort study of all the liver transplants performed at our institution for the first six years. Balanced general anesthesia, fluid restriction, thromboelastometry, inferior vena cava preservation and temporary portocaval shunt were strategies common to all cases. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early. Results A total of 240 transplants were performed in 236 patients (191 male/45 female) over 74 months, mean age 56.3 +/- 9.6 years, raw MELD score 15.5 +/- 7.7. Predominant etiologies were alcohol (n = 136) and HCV (n = 82), with hepatocellular carcinoma present in 129 (54.7%). Nine patients received combined liver and kidney transplants. The mean operating time was 315 +/- 64 min with cold ischemia times of 279 +/- 88 min. Thirty-one patients (13.1%) were transfused in the OR (2.4 +/- 1.2 units of PRBC). Extubation was immediate (< 30 min) in all but four patients. Median ICU length of stay was 12.7 hours, and median post-transplant hospital stay was 4 days (2-76) with 30 patients (13.8%) going home by day 2, 87 (39.9%) by day 3, and 133 (61%) by day 4, defining our fast-track group. Thirty-day-readmission rate (34.9%) was significantly lower (28.6% vs. 44.7% p=0.015) in the fast-track group. Patient survival was 86.8% at 1 year and 78.6% at five years. Conclusion Fast-Tracking of Liver Transplant patients is feasible and can be applied as the standard of care

Published
2021

8. Short-term clinical outcomes after total pancreatectomy: a prospective multicenter pan-European snapshot study

Author

Latenstein, A., primary, Scholten, L., additional, Al-Saffar H., Ahmad, additional, Bjornsson, B., additional, Butturini, G., additional, Capretti, G., additional, Chatzizacharias, N., additional, Frigerio, I., additional, Gallagher, T., additional, Gasteiger, S., additional, Halimi, A., additional, Labori, K., additional, Montagnini, G., additional, Muñoz-Bellvis, L., additional, Nappo, G., additional, Nikov, A., additional, Pando, E., additional, De Pastena, M., additional, La Peña-Moral J., De, additional, Roberts, K., additional, Salvia, R., additional, Sanchez-Bueno, F., additional, Scandavini, C., additional, Serradilla-Martin, M., additional, Dervenis, C., additional, Radenkovic, D., additional, Stättner, S., additional, Tomazic, A., additional, Varga, M., additional, Zavrtanik, H., additional, Zerbi, A., additional, Erkan, M., additional, Kleeff, J., additional, Lesurtel, M., additional, Besselink, M., additional, and Ramia-Angel, J., additional

Published
2020
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9. Soft-tissue images. Retroperitoneal venous angioma

Author

Martín-Fernández, J., López-Péréz, R., Ramia-Angel, J. M., David Padilla, López-Buenadicha, A., and Hernández-Calvo, J.

Subjects
Adult, Surgical Images, Humans, Retroperitoneal Neoplasms, Hemangioma, Tomography, X-Ray Computed
Published
2001

11. [Acute hydatid pancreatitis].

Author

Ramia Angel JM, Sancho Calatrava E, Veguillas Redondo P, Santos Blanco JM, and García-Parreño Jofré J

Subjects
Acute Disease, Adolescent, Aged, Anthelmintics therapeutic use, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Cholestasis, Extrahepatic complications, Cholestasis, Extrahepatic parasitology, Combined Modality Therapy, Drainage, Echinococcosis diagnostic imaging, Echinococcosis surgery, Echinococcosis, Hepatic complications, Echinococcosis, Hepatic diagnosis, Echinococcosis, Hepatic drug therapy, Echinococcosis, Hepatic surgery, Female, Humans, Male, Pancreatitis diagnosis, Pancreatitis diagnostic imaging, Pancreatitis etiology, Pancreatitis surgery, Radiography, Interventional, Sphincterotomy, Endoscopic, Echinococcosis diagnosis, Pancreatitis parasitology
Published
2008
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13. [Esophageal polypoid neoplasm. Carcinosarcoma].

Author

Villegas Herrera MT, Alvarez Martín MJ, Ramia Angel JM, Villar del Moral JM, Garrote Lara D, and Ferron Orihuela JA

Subjects
Adult, Humans, Male, Polyps diagnosis, Polyps surgery, Carcinosarcoma diagnosis, Carcinosarcoma surgery, Esophageal Neoplasms diagnosis, Esophageal Neoplasms surgery
Published
2002

14. [Symptomatic subcapsular hepatic hematoma after renal extracorporeal shock wave lithotripsy].

Author

Padilla Valverde D, Ladrón C, Ramia Angel JM, Cubo Cintas T, Martín Fernández J, Pardo García R, López Buenadicha A, Ortega Pérez G, and Hernández Calvo J

Subjects
Adult, Humans, Male, Hematoma etiology, Lithotripsy adverse effects, Liver Diseases etiology
Abstract

The presentation of a hepatic subcapsular hematoma as a complication following the carrying out of an extracorporeal renal shock wave lithotripsy is fairly uncommon. We would like to describe the case of a patient who showed after extracorporeal renal post-lithotripsy intense abdominal symptoms and in which the presence of any prior hepatic pathology was ruled out, alterations in the blood coagulation system as well as anomalies in the execution of the extracorporeal lithotripsy as etiological mechanisms. We carried out a bibliographical review due to the rarity of the process described.

Published
2001
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15. Soft-tissue images. Retroperitoneal venous angioma.

Author

Martín-Fernández J, López-Péréz R, Ramia-Angel JM, Padilla-Valverde D, López-Buenadicha A, and Hernández-Calvo J

Subjects
Adult, Hemangioma pathology, Humans, Retroperitoneal Neoplasms pathology, Tomography, X-Ray Computed, Hemangioma diagnostic imaging, Retroperitoneal Neoplasms diagnostic imaging
Published
2001

16. [Adrenal pseudocysts. Therapeutic attitude].

Author

Martín Fernández J, Delgado Portela M, Ladrón Gil C, Casanueva Luis T, Ramia Angel JM, Cubo Cintas T, and Hernández Calvo J

Subjects
Adult, Female, Humans, Middle Aged, Adrenal Gland Diseases diagnosis, Adrenal Gland Diseases surgery, Cysts diagnosis, Cysts surgery
Abstract

Objective: Cystic tumors of the adrenal gland are uncommon, but are being increasingly more frequently diagnosed during routine radiological evaluation as "incidentalomas". We discuss the differential diagnosis, therapeutic approach and the existing controversies concerning the management of this tumor type., Methods: Two additional cases of adrenal pseudocyst in two women aged 47 and 38 years are presented. In one case the tumor was discovered incidentally, whereas the other case presented with acute pain arising from intracystic hemorrhage., Results: The fist patient had a cystic tumor of 8 cm with some inner walls. Fine needle aspiration biopsy revealed a benign cystic lesion of the right adrenal gland. At laparotomy, an 8.5 x 4.5 cm multiloculated cystic lesion was excised. The second patient presented with abdominal pain due to intracystic hemorrhage. A Doppler US did not disclose any vessel inside the lesion. We performed a lumbotomy and excised a 7.5 x 6 cm cystic tumor located in the right adrenal gland. Both lesions were diagnosed as adrenal pseudocyst; the second case was a hemorrhagic one., Conclusions: The therapeutic approach in adrenal cystic tumors can be based upon the radiological and cytological findings since malignant cystic tumors are uncommon. A clear liquid and a negative cytology practically discard malignant tumors. Furthermore, cystic adenocarcinomas are usually large and the cystic liquid is cloudy with abundant cellularity. Surgical treatment is justified in the symptomatic, big or complex tumors (mixed, non-homogeneous).

Published
1998

17. [Cecal ulcer associated with acetyl salicylic acid].

Author

Martín Fernández J, García Rojo M, Rodríguez Sánchez E, Ramia Angel JM, Cubo Cintas T, and Hernández Calvo J

Subjects
Adult, Female, Humans, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Aspirin adverse effects, Cecal Diseases chemically induced, Ulcer chemically induced
Published
1998

18. [Hepatic adenoma and focal nodular hyperplasia: difficult differential diagnosis. Presentation of a case of focal nodular hyperplasia].

Author

Rodríguez Dapena S, Sánchez López JD, Ramia Angel JM, Villeta Plaza R, Ibarra Peláez A, Alcalde Escribano J, Morales Gutiérrez C, Abad Barahona A, and Ballesteros Sáez D

Subjects
Adult, Diagnosis, Differential, Female, Humans, Hyperplasia pathology, Adenoma pathology, Liver pathology, Liver Neoplasms pathology
Abstract

Hepatic adenoma and focal nodular hyperplasia are unfrequent benign lesions of the liver with individual histologic characteristics, but not always clinically distinguishable. The main difference is the intratumoral or intraperitoneal bleeding risk (high in adenoma and virtually zero in focal nodular hyperplasia). Surgery is the elective treatment for the first, while a more conservative attitude is allowed for the second. We present the case of a woman with an hepatic mass that clinically and radiologically seemed to be an adenoma. An atypical hepatectomy was done uneventfully. The examination of the specimen showed shaw focal nodular hyperplasia. We review the diagnostic and therapeutic controversy between these entities, because only the histologic examination of the entire surgical specimen could demonstrate the real nature of the lesion.

Published
1996

19. [Small cell anaplastic carcinoma of the colon].

Author

Villeta Plaza R, Alcalde Escribano J, Rodríguez Dapena S, Sánchez López D, Ramia Angel JM, Novo O, Ibarra Peláez A, Morales Gutiérrez C, and Abad Barahona A

Subjects
Colectomy, Colon pathology, Humans, Immunohistochemistry, Male, Middle Aged, Carcinoma, Small Cell pathology, Carcinoma, Small Cell surgery, Colonic Neoplasms pathology, Colonic Neoplasms surgery
Abstract

Small-cell anaplastic carcinoma of the colon is a very infrequent tumour (less than 1% of all colorectal neoplasms). Thirty-two cases have been described in the international literature up to 1992. A case, in a 54 year-old patient who underwent successful resection is presented. The importance of this tumour is due to its great aggressivity, and its great tendency to produce early hematogenous and lymph node metastases. It implies a bad prognosis and a survival of around 0% at one year. Because of these facts, treatment must include, beside surgical resection, an aggressive systemic protocol.

Published
1996

20. [Colonic carcinoma with epidermoid differentiation].

Author

Villeta Plaza R, Alcalde Escribano J, Ibarra Peláez A, Sánchez López D, Rodríguez Dapena S, Novo O, Ramia Angel JM, Morales Gutiérrez A, Abad Barahona A, and Ballesteros Saez D

Subjects
Carcinoma, Adenosquamous secondary, Carcinoma, Adenosquamous surgery, Colon, Sigmoid pathology, Colorectal Neoplasms surgery, Female, Humans, Liver Neoplasms pathology, Liver Neoplasms secondary, Male, Middle Aged, Rectum pathology, Sigmoid Neoplasms surgery, Carcinoma, Adenosquamous pathology, Colorectal Neoplasms pathology, Sigmoid Neoplasms pathology
Published
1995

21. [Jejunal adenocarcinoma].

Author

Sánchez López JD, Villate Plaza R, Ramia Angel JM, Rodríguez Dapena S, Alcalde Escribano J, Morales Gutiérrez C, and Abad Barahona A

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Adenocarcinoma diagnosis, Adenocarcinoma surgery, Jejunal Neoplasms diagnosis, Jejunal Neoplasms surgery
Published
1994

22. [Congenital hypertrophy of retinal pigment epithelium in familial colonic polyposis. Study of a family].

Author

Ramia Angel JM, Montero Rodríguez M, Ramírez Fe C, Sáenz Regalado D, Villeta Plaza R, Alcalde Escribano J, Morales Gutiérrez C, and Abad Barahona A

Subjects
Adolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Hypertrophy congenital, Male, Pedigree, Adenomatous Polyposis Coli complications, Adenomatous Polyposis Coli genetics, Pigment Epithelium of Eye pathology
Abstract

In the last years the relationship between congenital hypertrophy of retinal pigment epithelium (CHPRE) and familial adenomatous polyposis (FAP) has been described. It has been said that ophthalmoscopy would be a good screening method for following up the relatives of patients with FAP. We present an ophthalmoscopic study of 14 member of a family with FAP. Four members with FAP were operated on in our department. Only a six years-old child, to this date without FAP, presented CHPRE. We review the relationship between FAP and CHPRE, and emphasize the importance of follow-up in FAP specially when CHPRE is present.

Published
1993

23. [Cecal hernia through the Winslow's hiatus].

Author

Sáenz Regalado D, Morales Gutiérrez C, Villeta Plaza R, Ramia Angel JM, López López A, and Abad Barahona A

Subjects
Aged, Female, Hernia diagnostic imaging, Humans, Peritoneum, Radiography, Cecal Diseases diagnostic imaging
Abstract

A new case of cecal herniation through the foramen of Winslow is reported in a 67 year-old woman, preoperatively diagnosed by water-soluble contrast enema. Herniation through Winslow's foramen is an uncommon variety of internal hernias. Of 144 cases reported up to 1991 in the world literature, the cecum was involved in only 25-30%; and less than 10% of these were radiologically diagnosed before surgery.

Published
1993

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