Sierra, A. (Alejandro)

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    Role of the extended lymphadenectomy in gastric cancer surgery: experience
    (Springer Verlag, 2003) Martinez-Gonzalez, M.A. (Miguel Ángel); Martinez-Regueira, F. (Fernando); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Sierra, A. (Alejandro)
    Although curative resection is the treatment of choice for gastric cancer, controversy exists about the adequate extent of lymph node dissection when resection is performed. METHODS: We retrospectively assessed 85 patients who underwent a limited lymphadenectomy (D1) and 71 who had an extended lymph node dissection (D2) in a single institution between 1990 and 1998 (median follow-up, 37.3 months). Prognostic factors were assessed by Cox proportional hazard models adjusted for potential confounders. RESULTS: We found no significant difference in the length of hospital stay (median, 12.1 and 13.1 days), overall morbidity (48.2% and 53.5%), or operative mortality (2.3% and 0%) between D1 and D2, respectively. Five-year survival in the D2 group was longer (50.6%) than in the D1 group (41.4%) for tumor stages (tumor-node-metastasis) >I. In multivariate analysis, tumor-node-metastasis stage (hazard ratio for stages >I vs. 0-I, 11.6), the ratio between invaded and removed lymph nodes, the presence of distant metastases, Lauren classification, and the extent of lymphadenectomy (hazard ratio for D1 vs. D2, 2.3; 95% confidence interval, 1.25-4.30) were the only significant prognostic factors. CONCLUSIONS: Our experience shows that extended (D2) lymph node dissection improves survival in patients with resected gastric cancer.
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    Effect of treatment with tranexamic acid on complement activation and ischemia reperfusion in liver transplantation in pigs
    (Elsevier, 1999) Martinez-Regueira, F. (Fernando); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Sierra, A. (Alejandro); Diez-Caballero, A. (Alberto); Nwose, P. (P.)
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    Papel de la linfadenectomía ampliada tipo R2 en el tratamiento quirúrgico del cáncer gástrico resecable
    (The Spanish Society of Digestive Pathology, 1994) Martinez-Regueira, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Torramade, J. (J.); Sierra, A. (Alejandro); Diez-Caballero, A. (Alberto)
    The extended lymphadenectomy has been proposed as routine procedure in the surgical treatment of gastric cancer, although some controversies have been published. We present a retrospective analysis on the impact of extended lymph node dissection after total gastrectomy, in terms of post-operative course and histopathologic findings, in a group of 30 patients with R2 lymphadenectomy and in 16 patients with R1 lymphadenectomy. There were no significant differences in duration of operation, amount of blood trasfusion and length of hospital stay between the 2 groups. The only significant difference was found in the greater amount of drainage output after R2 lymphadenectomy as compared with R1. There were no mortalities in either group and morbidity rate was similar for both [43% in R1 and 40% in R2) mostly in the form of abdominal infections (18% in R1 and 16% in R2]). A significantly greater number of lymph nodes was identified after R2 gastrectomy. Fifty-three per cent of patients has positive lymph nodes, 12% of them being from the N2 echelon of nodes (including one case of early gastric cancer). Careful lymph node dissection in gastric cancer surgery allows a more precise staging of the tumor with no increase in postoperative morbidity
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    COSMIC project: consensus on the objectives of the metabolic syndrome in clinic
    (Taylor and Francis Group, 2018) Mostaza, J.M. (José M.); Valdivielso, P. (Pedro); Pedro-Botet, J. (Juan); Sierra, A. (Alejandro); Millán, J. (Jesús); Pérez-Martínez, P. (Pablo); Escalada, J. (Javier); Barrios, V. (V.); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Ascaso, F.J. (Francisco J.)
    Metabolic syndrome (MetS), a disorder with a high and growing prevalence, is a recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes. It is a constellation of clinical and metabolic risk factors that include abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. Unfortunately, MetS is typically underrecognized, and there is great heterogeneity in its management, which can hamper clinical decision-making and be a barrier to achieving the therapeutic goals of CVD and diabetes prevention. Although no single treatment for MetS as a whole currently exists, management should be targeted at treating the conditions contributing to it and possibly reversing the risk factors. All this justifies the need to develop recommendations that adapt existing knowledge to clinical practice in our healthcare system. In this regard, professionals from different scientific societies who are involved in the management of the different MetS components reviewed the available scientific evidence focused basically on therapeutic aspects of MetS and developed a consensus document to establish recommendations on therapeutic goals that facilitate their homogenization in clinical decision-making.