Diego López-Guerra

El contenido completo estará disponible en breve. ¡Gracias por tu paciencia!

Background: The use of livers from donors with expanded criteria, where monitoring the degree of hepatic steatosis (HS) is crucial, has increased in recent years to address the shortage of available grafts. The aim of this study is to evaluate the utility of monitoring regional hepatic oxygen saturation (rSO2) using the INVOS somatic oximeter in the assessment of liver donors. Methods: An observational, longitudinal, and prospective study was conducted of adult patients undergoing liver transplantation at our center between 08/01/2020 and 06/01/2022. We measured rSO2 by placing the sensor on the donor skin and on the liver surface. Results: The rSO2 measurements on the donor skin were obtained in 27 patients (93.1%), while the measurements on the donor liver were taken in 18 patients (62.1%). We found a statistically significant relationship between the rSO2 values measured on the donor liver and the degree of steatosis ( p = 0.001). rSO2 values > 57% measured on the donor liver were associated with HS < 30% (S: 92%; E: 75%). Donors with lower preoperative GOT values had statistically significantly higher rSO2 values measured on the skin ( p = 0.046). Conclusions: Hepatic rSO2 measurements obtained with the NIRS device in liver donors were associated with relevant donor graft characteristics, particularly the degree of HS.

Introduction: A positive surgical margin (R1 resection) is a relevant risk factor for local recurrence in patients with pancreatic ductal adenocarcinoma of the pancreas (PDAC). An intraoperative liquid biopsy (ILB) based on tumor cell mobilization could help to detect R1 resection intraoperatively. Objective: To evaluate the potential role of the intraoperative circulating tumor cells (CTCs) and cluster mobilization on the R0/R1 detection. Methods: Sixty-three patients with resectable PDAC of the head of the pancreas were prospective enrolled under the CETUPANC trial. Open pancreaticoduodenectomy (PD) was done in all patients. Intraoperative CTCs and clusters were determined during PD. Results: The overall rate of R1 resection was 34.9% (22/63 patients). Multivariate analysis showed that factors associated with R1 resection (AUC=0.920) were the presence of undifferentiated G3 tumor (P=0.017), microscopic vascular invasion (P=0.016), and the intraoperative increase of both free CTCs and clusters in portal vein determination from the beginning to the end of the surgery (P=0.002 and P=0.005, respectively). A specific logistic regression model, including delta end to baseline CTCs and cluster mobilization to achieve a combined cut-off to detect R1 detection was calculated (AUC=0.799). The obtained R1-index based on ILB had 84% of sensitivity and 68% of specificity to detect R1 resection. Conclusions: The ILB based on the intraoperative mobilization of CTCs and clusters from the beginning to the end of the PD was a predictive factor to detect R1 resection in patients with PDAC.

Background: The involvement of the inferior vena cava in advanced abdominal tumors is a surgical challenge, given the high postoperative morbidity and poor long-term prognosis. Our goal was to analyze our experience, perioperative management, and results. Methods: We retrospectively evaluated short and long-term results of surgical resections of tumors with associated inferior vena cava resection performed in our facilities between 2012 and 2023. Results: A total of 25 patients were selected for our retrospective study: 3 with renal carcinoma, 5 with sarcoma, 12 with metastatic lesions, 2 with adrenal tumors, 1 pancreatic tumor, 1 extra-adrenal paraganglioma and 1 with hepatocellular carcinoma. Postoperative severe complications (Dindo-Clavien score ≥ IIIa) affected 36% of patients and the mortality rate was 8%. Partial resection with primary repair was performed in 13 patients (52%), with patch reconstruction in 6 (24%), and vascular reconstruction with prosthesis in 6 patients (24%). The mean disease-free survival was 7 months (IQR 2.5–11.5). Graft thrombosis occurred in 2 patients during follow-up. Conclusions: In selected patients, the resection of the inferior vena cava is a complex surgery with an assumable morbimortality and relative survival improvement.

We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical intervention and immediate postoperative period; and post-surgical follow-up information, such as recurrence, overall survival (OS), and disease-free survival (DFS). A total of 32 patients underwent surgery. The median age was 69.74 years (IQR 60.47–79.09) and the male/female distribution was 3:1. The surgeries performed were: pancreaticoduodenectomy (PD) in 16 (50%) patients, segmental resection in 13 (40.6%), and the local excision of the lesion in three (9.4%). The R0 rate was higher in PD (86.7% vs. 42.9%; p = 0.013). The OS and DFS rate at one, three and five years was 95%, 70%, and 60% and 86%, 55%, and 48%, respectively. There was a greater trend towards recurrence in patients who did not undergo PD (53.8% vs. 25%; p = 0.14) and conservative surgery seemed to be associated with more local recurrence than PD (57.1% vs. 33.3%; p = 0.49). PD and limited resection are both valid options in the cases of non-ampullary duodenal adenocarcinoma, although PD presented lower rates of loco-regional recurrence.

Several types of cancers have been reported to metastasize to the pancreas. Lung cancer with isolated pancreatic metastasis is extremely rare. In selected patients, surgery is advocated. The aim of our study is to carry out a systematic review of the articles published on the surgical treatment of these patients. Our goal was to realize a systematic review in accordance with PRISMA guidelines. We conducted a literature search using MEDLINE (PubMed), EMBASE and SCOPUS databases to identify all studies published from 1967 to 2020 reporting patients with pancreatic resection for metastatic lung cancer to the pancreas. The data of the articles finally selected were represented in tables. The median age of included patients was calculated as well as the median survival. The proportion of patients was calculated according to sex, type of surgery performed and location of the lesion. 3150 articles were included at the beginning. After the screening process, 20 articles were selected for the systematic review. These articles reported data on 23 patients. Presentation was mainly metachronous, with a disease-free interval of 10 (0–54) months. Of these patients, 43.5% were symptomatic at diagnosis and 34.8% had extrapancreatic metastases. Mean overall survival was 17.65 (± 14.56) months. Based in this review, there is limited evidence on the treatment due to the small number of published articles, most of them being case report. Surgical resection of pancreatic metastases from lung cancer could be a safe procedure and it could improve survival rates in selected patients.

Background information Pancreatic stellate cells play a key role in the fibrosis that develops in diseases such as pancreatic cancer. In the growing tumour, a hypoxia condition develops under which cancer cells are able to proliferate. The growth of fibrotic tissue contributes to hypoxia. In this study, the effect of hypoxia (1% O₂) on pancreatic stellate cells physiology was investigated. Changes in intracellular free‐Ca²⁺ concentration, mitochondrial free‐Ca²⁺ concentration and mitochondrial membrane potential were studied by fluorescence techniques. The status of enzymes responsible for the cellular oxidative state was analyzed by quantitative reverse transcription‐polymerase chain reaction, high‐performance liquid chromatography, spectrophotometric and fluorimetric methods and by Western blotting analysis. Cell viability and proliferation were studied by crystal violet test, 5‐bromo‐2‐deoxyuridine cell proliferation test and Western blotting analysis. Finally, cell migration was studied employing the wound healing assay. Results Hypoxia induced an increase in intracellular and mitochondrial free‐Ca²⁺ concentration, whereas mitochondrial membrane potential was decreased. An increase in mitochondrial reactive oxygen species production was observed. Additionally, an increase in the oxidation of proteins and lipids was detected. Moreover, cellular total antioxidant capacity was decreased. Increases in the expression of superoxide dismutase 1 and 2 were observed and superoxide dismutase activity was augmented. Hypoxia evoked a decrease in the oxidized/reduced glutathione ratio. An increase in the phosphorylation of nuclear factor erythroid 2–related factor and in expression of the antioxidant enzymes catalytic subunit of glutamate‐cysteine ligase, catalase, NAD(P)H‐quinone oxidoreductase 1 and heme oxygenase‐1 were detected. The expression of cyclin A was decreased, whereas expression of cyclin D and the content of 5‐bromo‐2‐deoxyuridine were increased. This was accompanied by an increase in cell viability. The phosphorylation state of c‐Jun NH₂‐terminal kinase was increased, whereas that of p44/42 and p38 was decreased. Finally, cells subjected to hypoxia maintained migration ability. Conclusions and Significance Hypoxia creates pro‐oxidant conditions in pancreatic stellate cells to which cells adapt and leads to increased viability and proliferation.