Surgery of Colorectal Liver Metastases Involving the Inferior Vena Cava: A Systematic Review.

Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30-40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible.

Polyethylene glycol-coated haemostatic patch for prevention of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: randomized clinical trial.

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).

Mucinous cystic liver neoplasm with invasive component and sarcomatous differentiation.

BACKGROUND: 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. METHODS: We present the case of a liver MCN with an invasive component and sarcomatous degeneration. RESULTS: 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. CONCLUSION: MCN with an invasive component and sarcomatous degeneration are very rare, present advanced stages, show aggressive behavior, and have a poor prognosis.

Pancreas-Preserving Total Duodenectomy: A Systematic Review.

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%.

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population.

BACKGROUND: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single- and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population. METHODS: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant. RESULTS: Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting single-gland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%. CONCLUSIONS: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

Top 100. Revisión de los artículos más citados sobre cirugía laparoscópica del páncreas / The top 100. Review of the most cited articles on pancreas and laparoscopy

INTRODUCCIÓN: El número de citas se considera un indicador indirecto del mérito de un artículo, revista o investigador, aunque no es un método infalible para determinar la calidad científica. Nuestro objetivo es determinar las características de los artículos más citados sobre páncreas y laparoscopia. MÉTODOS: Realizamos una búsqueda de todos los artículos publicados en cualquier revista sobre páncreas y laparoscopia hasta septiembre de 2019 y seleccionamos los 100 artículos más citados. Registramos el número de citas, la revista, el año de publicación, el cuartil, el factor de impacto, la institución, el país, el tipo de artículo de los autores, el tipo de cirugía, el tema y el área. RESULTADOS: El top 100 suma 10.970 citas. La revista con más artículos es Surgical Endoscopy y 2007 es el año con el mayor número de artículos en el top 100. El porcentaje de publicaciones de América y Europa es similar. Las series de casos son el tipo de artículo más frecuente, los resultados/morbilidad es el tema más discutido y la pancreatectomía distal es el tipo de cirugía más frecuente. CONCLUSIONES: Este estudio bibliométrico sobre páncreas y laparoscopia está condicionado por el factor tiempo, ya que la laparoscopia ha llegado más tarde a la cirugía pancreática, probablemente debido a la morbimortalidad asociada a la cirugía pancreática y a la necesidad de una alta especialización en este campo. La literatura es reciente y escasa. Se necesitan más estudios y de mayor calidad en este campo

INTRODUCTION: The number of citations is considered as an indirect indicator of the merit of an article, journal or researcher, although it is not an infallible method to determine scientific quality. Our goal is to determine the characteristics of the articles most cited about pancreas and laparoscopy. METHODS: We performed a search of all articles published in any journal about pancreas and laparoscopy until September 2019 and selected the 100 most cited papers. We recorded number of citations, journal, year of publication, quartil, impact factor, institution, country, authors type of paper, type of surgery, topic and area. RESULTS: The top 100 citations account 10,970 citations in total. The journal with the most articles is Surgical Endoscopy and 2007 is the year with the highest number of articles in the top 100 citations. The percentage of publications from America and Europe are similar. Case series is the most frequently paper, outcomes/morbidity is the most frequently discussed topic, and distal pancreatectomy is the most frequently type of surgery. CONCLUSIONS: This bibliometric study on pancreas and laparoscopy is conditioned by the time factor, since laparoscopy has arrived later at pancreatic surgery, probably due to the morbidity and mortality associated with pancreatic surgery and the need for a high specialization in this field. The literature is recent and scarce. More and better-quality studies are needed in this field

The top 100. Review of the most cited articles on pancreas and laparoscopy. / Top 100. Revisión de los artículos más citados sobre cirugía laparoscópica del páncreas.

INTRODUCTION: The number of citations is considered as an indirect indicator of the merit of an article, journal or researcher, although it is not an infallible method to determine scientific quality. Our goal is to determine the characteristics of the articles most cited about pancreas and laparoscopy. METHODS: We performed a search of all articles published in any journal about pancreas and laparoscopy until September 2019 and selected the 100 most cited papers. We recorded number of citations, journal, year of publication, quartil, impact factor, institution, country, authors type of paper, type of surgery, topic and area. RESULTS: The top 100 citations account 10,970 citations in total. The journal with the most articles is Surgical Endoscopy and 2007 is the year with the highest number of articles in the top 100 citations. The percentage of publications from America and Europe are similar. Case series is the most frequently paper, outcomes/morbidity is the most frequently discussed topic, and distal pancreatectomy is the most frequently type of surgery. CONCLUSIONS: This bibliometric study on pancreas and laparoscopy is conditioned by the time factor, since laparoscopy has arrived later at pancreatic surgery, probably due to the morbidity and mortality associated with pancreatic surgery and the need for a high specialization in this field. The literature is recent and scarce. More and better-quality studies are needed in this field.

Metabolic syndrome, non-alcoholic fatty liver disease and hepatocarcinoma.

The term "metabolic syndrome" refers to a group of alterations comprising central obesity reduced high-density lipoprotein cholesterol concentrations, elevated triglyceride concentrations, arterial hypertension, and hyperglycemia. This syndrome has established itself as one of the epidemics of the 21st century. Among its causative agents are insulin resistance, leptin and adiponectin, changes in microbiota, and epigenetics. Its incidence in the European population is estimated to be around 25%. Non-alcoholic fatty liver disease is the hepatic manifestation of metabolic syndrome; its prevalence parallels that of obesity, and it has increased exponentially in recent decades. Recently, several publications have linked metabolic risk factors with the onset and development of hepatocarcinoma, and so it is essential to determine whether patients with non-alcoholic fatty liver disease should follow a protocol for hepatocarcinoma screening. At present, the worldwide incidence of hepatocarcinoma in patients with non-alcoholic fatty liver disease without cirrhosis is only 2.7%. Screening for hepatocarcinoma in patients with non-alcoholic fatty liver disease and cirrhosis is mandatory, but the low incidence of hepatocarcinoma in patients without cirrhosis does not justify the systematic monitoring of this patient population. Current efforts are based on identifying subgroups of patients with non-alcoholic fatty liver disease and a higher-than-average risk of developing hepatocarcinoma.

Síndrome metabólico, enfermedad hepática grasa no alcohólica y hepatocarcinoma / No disponible

El síndrome metabólico es un conjunto de alteraciones constituido por obesidad de distribución central, disminución de las concentraciones del colesterol unido a lipoproteínas de alta densidad, elevación de las concentraciones de triglicéridos, hipertensión arterial e hiperglucemia. Este síndrome se ha convertido en una de las epidemias del siglo XXI. Entre sus agentes causales se encuentran la resistencia a la insulina, la leptina y adiponectina, los cambios en la microbiota y la epigenética. Se estima una incidencia alrededor del 25% en la población europea. La enfermedad hepática grasa no alcohólica es la manifestación hepática del síndrome metabólico. Su prevalencia es paralela a la de la obesidad, aumentando de forma exponencial en las últimas décadas. Recientemente, diversas publicaciones han relacionado los factores de riesgo metabólicos con la aparición y el desarrollo de hepatocarcinoma. En este contexto, es primordial determinar si los pacientes con enfermedad hepática grasa no alcohólica deben de seguir un protocolo de cribado de hepatocarcinoma. Hasta la fecha, la incidencia mundial publicada de hepatocarcinoma en pacientes con enfermedad hepática grasa no alcohólica sin cirrosis es del 2,7% a los diez años. Aunque el screening de hepatocarcinoma en pacientes con enfermedad hepática grasa no alcohólica y cirrosis es obligatorio, la baja incidencia de hepatocarcinoma en pacientes sin cirrosis no justifica la vigilancia sistemática de esta población de pacientes. Los esfuerzos se basan en determinar los subgrupos de pacientes con enfermedad hepática grasa no alcohólica con mayor riesgo de desarrollar hepatocarcinoma

No disponible

Hepatocarcinoma en hígado no cirrótico: serie bicéntrica de 19 casos / Hepatocellular carcinoma in the non-cirrhotic liver: a two-center experience with 19 cases

Antecedentes: El carcinoma hepatocelular es la neoplasia hepática más frecuente; el 90% se desarrolla sobre hígado cirrótico o con hepatopatía crónica, constituyendo así el principal factor de riesgo; la inflamación crónica, la necrosis y regeneración que estas producen condiciona la aparición de mutaciones genéticas y el desarrollo de células tumorales. Sin embargo, el 10% se desarrolla sobre hígado sano, no cirrótico y sin factores desencadenantes. Material y métodos: Se realizó un análisis descriptivo y de la supervivencia de una serie de 19 pacientes con anatomía patológica de carcinoma hepatocelular y ausencia de antecedentes de cirrosis hepática o hepatopatía crónica intervenidos en dos Unidades HPB en el período enero 2007- enero 2016. Resultados: La serie incluyó 13 varones y 6 mujeres con una edad media de 65 años. La presentación clínica más frecuente fue dolor abdominal. El 60% registraba analítica normal y solo en el 16% se elevó la AFP. El 61% presentó prueba de imagen diagnóstica. El tamaño medio fue de 110,6 mm. A todos se los trató con cirugía. Ocurrieron complicaciones en el 36,8% de los pacientes y una supervivencia a los 5 años del 62,3%. Conclusión: el carcinoma hepatocelular suele diagnosticarse cuando es de gran tamaño por hallazgos en pruebas de imagen realizadas generalmente en el estudio del dolor abdominal. La cirugía ofrece tratamiento curativo, pudiendo realizarse grandes resecciones con un alto índice de seguridad, con morbimortalidad perioperatoria baja y con bajo índice de insuficiencia hepática, ya que el remanente hepático es sano y la función hepática se mantiene.

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.