Cattel and Blumgart Anastomosis: Comparison of Pancreatojejunostomy Techniques in Patients with Pancreatic Cancer.

BACKROUND: Pancreaticojejunal anastomosis has a high risk of pancreatic leakage, which several surgical techniques have been described. Our main objective is to determine what is the association of postoperative pancreatic leakage in patients undergoing pancreaticoduodenectomy according to the pancreaticojejunal anastomosis technique used (Cattel vs Blumgart)? MATERIAL AND METHODS: Historical cohort, all cancer patients undergoing pancreaticoduodenectomy were included. From April 2020 to May 2021, Cattel technique was used; from June 2021 to June 2022, Blumgart technique was used. All procedures were performed by a single board-certified surgical oncologist at Oncology Hospital. RESULTS: 24 patients (11 men and 13 women). The first 9 procedures were performed with the Cattel technique, starting from procedure 10, the Blumgart technique was used. No differences were observed regarding the consistency of the pancreas (p=0.28) or the size of the duct (p=0.51) between the two groups. Pancreatic leakage was observed in 100% with the Cattel technique and in 6.7% with the Blumgart technique (p= 0.0001). An amylase value was observed in the left drainage at 6 days > 200 U/L with the Cattel technique and < 200 U/L with Blumgart (p=0.0001). Intraoperative bleeding (Cattel 1200 ml vs. Blumgart 400 ml, p= 0.03) and 90-day mortality (Cattel 33.3% vs. Blumgart 0%, Log-Rank: 0.022) also showed a difference in favor of Blumgart technique. Blumgart technique is a protective factor for the presence of pancreatic leakage (RR 0.06, 95% CI 0.01-0.44, p=0.0001). DISCUSSION: A lower risk of pancreatic leakage was found using the Blumgart technique, compared to the Cattel technique.

Human papillomavirus in men / Virus del papiloma humano en hombres

Objective: To describe the clinical behavior of human papillomavirus in men. Materials and methods: Current international literature was reviewed to describe the clinical behavior of human papillomavirus in men. Results: Internationally, the overall prevalence of HPV DNA is 50.8%, HPV considered high risk are 14 types. Prevalence of HPV DNA in invasive penile cancer ranges from 33.1% to 47%. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). Positive HPV is described as an independent prognostic factor for cancer-specific survival. Conclusion: It is not clear why HPV infection has a predilection in specific areas of the genital tract. However, it is important to note that there are factors that increase the risk of HPV infection. (AU)

Objetivo: Describir el comportamiento clínico del virus del papiloma humano en hombres. Materiales y métodos: Se revisó la literatura internacional actual para describir el comportamiento clínico del virus del papiloma humano en los hombres. Resultados: En el ámbito internacional, la prevalencia general del ADN del VPH es del 50,8%. Los VPH considerados de alto riesgo son 14 tipos. La prevalencia del ADN del VPH en el cáncer de pene invasivo oscila entre el 33,1% y el 47%, siendo el VPH-16 el más frecuente (68,3%), seguido del VPH-6 (8,1%) y del VPH-18 (6,9%). El VPH positivo se describe como un factor pronóstico independiente para la supervivencia específica del cáncer. Conclusión: No está claro por qué la infección por VPH muestra predilección por áreas específicas del tracto genital. Sin embargo, es importante tener en cuenta que existen factores que aumentan el riesgo de infección por VPH. (AU)

Human papillomavirus in men.

OBJECTIVE: To describe the clinical behavior of human papillomavirus in men. MATERIALS AND METHODS: Current international literature was reviewed to describe the clinical behavior of human papillomavirus in men. RESULTS: Internationally, the overall prevalence of HPV DNA is 50.8%, HPV considered high risk are 14 types. Prevalence of HPV DNA in invasive penile cancer ranges from 33.1% to 47%. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). Positive HPV is described as an independent prognostic factor for cancer-specific survival. CONCLUSION: It is not clear why HPV infection has a predilection in specific areas of the genital tract. However, it is important to note that there are factors that increase the risk of HPV infection.

Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery.

INTRODUCTION: Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. METHODS: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. RESULTS: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. CONCLUSIONS: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.

Surgical margins in gastric cancer T2 and T3 and its relationship with recurrence and overall survival at 5 years.

INTRODUCTION: Surgical resection is the potentially curative treatment in gastric cancer. However, definitive surgical margins are controversial. MATERIAL AND METHODS: We conducted a retrospective, observational study. All patients with gastric cancer treated with surgery of T2 and T3, tumors without involvement of the esophagogastric junction and without neoadjuvant treatment were included. RESULTS: A total of 70 patients were included. 44 men (62.9%) and 26 women (37.1%). In multivariate analysis, depth of the invasion (T2 vs T3), lymphadenectomy and more than 5 positive nodes were independent factors for recurrence at 5 years. Depth of the invasion (T2 vs T3), intra-abdominal metastases and recurrence were independent factors of overall survival at 5 years. ROC analysis did not show a definitive surgical margin with better 5-year overall survival and lower recurrence. CONCLUSIONS: In patients with gastric cancer T2 and T3, surgical margin did not affect 5-year overall survival or recurrence rate. Other factors are associated with recurrence and 5-year overall survival at 5 years, regardless of the distance from the tumor to the margin.