Lelpo, B. (Benedetto)
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- Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review(2020) Pastor, E. (Enrique); Matanza, I.; Beltrán, M. (Miquel); Lelpo, B. (Benedetto); Arredondo, J. (Jorge); Simó, V. (Vicente); Magdaleno, M. C.; Notarnicola, M.; Castañón, C. B. (César Beltrán)Background Preoperative or neoadjuvant chemotherapy (NAC) has emerged as a novel alternative to treat locally advanced colon cancer (LACC), as in other gastrointestinal malignancies. However, evidence of its efficacy and safety has not yet been gathered in the literature. The aim of the present study was to perform an extensive review of the scientific evidence for NAC in patients with LACC. Methods PubMed, EMBASE, MEDLINE and Cochrane Library were searched for a systematic review of the literature from 2010 to 2019. Six eligible studies were included, with a total of 27,937 patients, 1232 of them (4.4%) treated with NAC. There were only one randomized controlled trial, three phase II non-randomized single arm studies and two retrospective studies. Results The baseline computed tomography scan showed that most of patients had a T3 tumor. The completion rate of the planned neoadjuvant treatment ranged from 52.5 to 93.8%. Between 97.2 and 100% of patients had the scheduled surgery. The median tumor volume reduction after NAC ranged from 62.5 to 63.7%. The anastomotic leak rate in the NAC group ranged from 0 to 7%, with no cases of postoperative mortality. There was major pathological tumor regression in 4–34.7% of cases. Between 84 and 100% of NAC patients had R0-surgery. Survival after NAC seems to be encouraging although significant improvement has only been proven in T4b tumours. Conclusions According to our systematic review, the NAC may be a safe and effective emerging therapeutic alternative for treating LACC. This approach, which is still being tested, increases the reliance on accurate radiological staging.
- Combined transanal minimally invasive surgery (TAMIS) and retroperitoneal laparoscopy for resection of lymph node recurrence of ovarian cancer(2018) Pastor, E. (Enrique); Fuentes, S. (Silvia); Diago, M. V.; Corona, A.; Lorenzo, E.; Villafañe, A. (Amaya); Padilla, L.; Lelpo, B. (Benedetto); Arredondo, J. (Jorge); Simó, V. (Vicente); Orille, V.To our knowledge no cases of transanal minimally invasive surgery (TAMIS) combined with retroperitoneal laparoscopy for resection of lymph node recurrence have been described in the literature. We report a case of resection of mesorectal and para-aortic lymph node recurrence of primary ovarian cancer performed with retroperitoneal laparoscopy and TAMIS. A 66-year-old female, diagnosed in December 2014 with stage IIa ovarian adenocarcinoma had cytoreductive surgery at that time, achieving a R0 resection (complete hysterectomy with bilateral ovariectomy, pelvic peritonectomy with standard lymphadenectomy and supramesocolic omentectomy). Surgery was followed by adjuvant treatment. On November 2017, a computed tomography scan revealed lymph node recurrence in the left para-aortic nodes (2.5 cm diameter on CT) and mesorectal space (2.8 cm diameter) at 10 cm from the anal verge. After a multidisciplinary session, both nodes were resected (see attached video). The para-aortic node was resected using retroperitoneal laparoscopy and the mesorectal node resected using a TAMIS approach [1,2,3]. The postoperative course was uneventful and the patient was discharged 5 days after surgery. Histopathological examination of the two nodes revealed undifferentiated serosal adenocarcinoma of the ovary. No recurrence was found at 1-year follow-up. Combination of different minimally invasive approaches is a safe alternative to conventional surgery for resection of lymph node recurrence that surgeons should be aware of.
- Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients(2019) Hernán, C. (Cristina); Pastor, E. (Enrique); Fernández, J. (Jesús); Villafañe, A. (Amaya); Lelpo, B. (Benedetto); Arredondo, J. (Jorge); Simó, V. (Vicente); Jiménez, L. M. (Luis Miguel)Introduction The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. Methods Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous versus non simultaneous abdominal-perineal surgery. Results Mean patient age was 67 years (56–75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9±1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262±40.7min; it was shorter in females (P<.001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5cm (0.5–2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P=.047). The mean number of retrieved lymph-nodes was 15.2±11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4–8). Morbidities occurred in 36% of cases, and one patient died. Conclusions According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature.