Rotellar, F. (Fernando)
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- Cirugía bariátrica laparoscópica: bypass gástrico proximal(Gobierno de Navarra. Departamento de Salud, 2005) Valenti, V. (Víctor); Pastor, C. (Carlos); Rotellar, F. (Fernando); Poveda, I. (Ignacio); Baixauli-Fons, J. (Jorge); Gil, A. (Aurora); Marti-Cruchaga, P. (Pablo)The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP) seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (>70% of the excess), surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg/m2; for BMI >60 Kg/m2 the GBP employed is denominated distal. Between October 2003 and November 2005, our centre performed 55 laparoscopic proximal Roux-en-Y gastric bypasses via laparoscopy. These involved 42 women and 13 males with an average age of 44 years. The average BMI was 43.5 (35-55.8). The average basal weight was 116.15 Kg. There was no peroperative mortality, nor reinterventions. The BMI after 12 months was 28.4. The average basal weight was 74.2 Kg. Laparoscopic Roux-en-Y proximal gastric bypass is a safe and efficient technique for the treatment of morbid obesity.
- Comparison Between Two Warm Ischemic Models in Experimental Liver Transplantation in Pigs(Elsevier, 2003) Rotellar, F. (Fernando); Espi, A. (A.); Martinez-Regueira, F. (Fernando); Baixauli-Fons, J. (Jorge); Pardo, F. (Fernando); Olea, J. (J.); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Nwose, P. (P.)Experimental models of warm ischemia in liver transplantation have been employed to study the mechanisms and treatment of ischemia reperfusion injury. METHODS: We compared a control group without (group A, n = 10) versus two models of warm ischemia of liver transplants in pigs: namely, occlusion of the hepatic artery and portal vein for 30 minutes (group B, n = 23) and extraction of the liver 60 minutes after cardiac arrest (group C, n = 5). Liver function tests, coagulation studies, and liver biopsies were performed during the first 24 hours post-liver transplant. RESULTS: Clamping of the hepatic vasculature in group B produced a significant liver injury compared with the control group: elevation of the ALT and an abnormal 1-hour post-revascularization biopsy similar to that observed in the cardiac arrest group C. The transaminase levels were lower among group A animals (P <.05). But the hepatic synthetic functions as reflected in the protrombin time (PT) were not affected in group B versus group A. The alteration in PT with respect to the initial value was similar among group A and group B animals, which were significantly less than that in group C (P <.05). CONCLUSIONS: Occlusion of the hepatic artery and portal vein, a simple surgical maneuver, causes moderate damage to a liver graft but less alteration of hepatic synthetic function. Clamping of the hepatic vasculture obtains more long-term survivors after OLT than cardiac arrest.
- Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases(2023) Goh, B.K.P. (Brian K. P.); Park, J.O. (James O.); Sutcliffe, R.P. (Robert P.); Kingham, T.P. (T. Peter); Wakabayashi, G. (Go); Herman, P. (Paulo); D'Hondt, M. (Mathieu); Lee, J.H. (Jae Hoon); Rotellar, F. (Fernando); Chiow, A.K.H. (Adrian K. H.); Cipriani, F. (Federica); Giuliante, F. (Felice); Fuks, D. (David); Aghayan, D.L. (Davit L.); Choi, G. (Gi-Hong); Troisi, R.I. (Roberto I.); Mejía, A. (Alejandro); Cheung, T.T. (Tan To); Di-Benedetto, F. (Fabrizio); Cherqui, D. (Daniel); Tang, C. N. (Chung-Ngai); Edwin, B. (Bjorn); Efanov, M. (Mikhail); Robles-Campos, R. (Ricardo); Scatton, O. (Oliver); Wang, X. (Xiaoying); Chen, K. (KuoHsin); Ferrero, A. (Alessandro); Abu-Hilal, M. (Mohammed); Chong, C.C.N (Charing C. N.); Fondevila, C. (Constantino); Choi, S.H. (Sung Hoon); López-Ben, S. (Santiago); Aldrighetti, L. (Luca); Marino, M.V. (Marco V.); Ruzzenente, A. (Andrea); Sucandy, I. (Iswanto); Han, H.S. (Ho-Seong); Liu, R. (Rong); Pratschke, J. (J.); Syn, N.L. (Nicholas L.); Mazzaferro, V. (Vicenzo); Sugioka, A. (Atsushi); Gastaca, M. (Mikel); Long, T.C.D. (Tran Cong Duy)Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours >_10 cm. Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (>_10 cm) tumors at 42 international centers between 2002-2020. Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs. 21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs. 6 days, P=0.435). Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.
- Minimally invasive liver surgery for hepatocellular carcinoma in patients with portal hypertension(Oxford University Press, 2023) Rotellar, F. (Fernando); Almeida, A. (Ana); Luján-Colás, J. (Juan); Zozaya-Larequi, G. (Gabriel); Sangro, B. (Bruno); Blanco, N. (Nuria); Sabatella, L. (Lucas); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)For patients with early stage hepatocellular carcinoma (HCC), liver resection is a mainstay of curative treatment. Patients with a solitary tumour, Child–Pugh A cirrhosis and serum bilirubin of 1 mg/dl are considered ideal candidates for liver resection1,2 . For patients with portal hypertension, current guidelines recommend careful consideration of liver resection based on the hierarchical interaction of portal hypertension, liver function and resection extent1,3 . Open liver resection has been used in the majority of published studies on liver resection and portal hypertension. Although there is limited published experience of minimally invasive liver resection (MILR), using MILR in these patients appears to be associated with favourable outcomes4 . Particularly in patients with Child–Pugh A cirrhosis, but also in patients with more advanced cirrhosis5 , MILR offers significant advantages in the surgical treatment of HCC including reduced intraoperative bleeding, fewer complications and minimized surgical aggression, which improves recovery6,7 . If these benefits are also found in patients with portal hypertension, MILR may represent a step forward in the surgical treatment of patients with HCC and portal hypertension. This systematic review and meta-analysis aimed to summarize the intraoperative, postoperative and survival outcomes of MILR in patients with HCC and portal hypertension.
- Increased adipose tissue expression of lipocalin-2 in obesity is related to inflammation and matrix metalloproteinase-2 and metalloproteinase-9 activities in humans(Elsevier Scientific Pub, 2009) Rotellar, F. (Fernando); Ramirez, B. (Beatriz); Catalan, V. (Victoria); Álvarez-Cienfuegos, J. (Javier); Frühbeck, G. (Gema); Silva, C. (Camilo); Gomez-Ambrosi, J. (Javier); Salvador, J. (Javier); Rodriguez, A. (Amaia); Gil, M.J. (María José)Abstract Lipocalin-2 (LCN2) is a novel adipokine with potential roles in obesity, insulin resistance, and inflammation. The aim of the present work was to evaluate the effect of obesity on circulating concentrations and gene and protein expression levels of LCN2 in human visceral adipose tissue (VAT) as well as its involvement in inflammation. VAT biopsies from 47 subjects were used in the study. Real-time PCR and Western-blot analyses were performed to quantify levels of LCN2 in VAT as well as the association with other genes implicated in inflammatory pathways. Forty-four serum samples were used to analyze the circulating concentrations of LCN2. Zymography analysis was used to determine the activity of matrix metalloproteinase (MMP) in VAT. Obese patients exhibited increased mRNA (p<0.0001) and protein (p=0.017) expression levels of LCN2 compared to lean subjects. Although no differences in plasma LCN2 concentrations were observed, increased circulating LCN2/MMP-9 complex levels were found (p=0.038) in the obese group. Moreover, obese individuals showed increased (p<0.01) activity of MMP-2 and MMP-9/LCN2 complex, while a positive correlation (p<0.01) between MMP-2 and MMP-9 activities and BMI was observed. Gene and protein expression levels of LCN2 in VAT were positively associated with inflammatory markers (p<0.01). These findings represent the first observation that mRNA and protein levels of LCN2 are increased in human VAT of obese subjects. Furthermore, LCN2 is associated with MMP-2 and MMP-9 activities as well as with proinflammatory markers suggesting its potential involvement in the low-grade chronic inflammation accompanying obesity.
- Pancreatectomía central en tumores benignos del cuello del páncreas(Elsevier España, 2005) Valenti, V. (Víctor); Pastor, C. (Carlos); Rotellar, F. (Fernando); Poveda, I. (Ignacio); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Beunza, J.J. (Juan José); Gil, A. (Aurora); Cervera, M. (María)The surgical treatment of benign tumors of the neck of the pancreas usually consists of enucleation or formal pancreatectomy. Central pancreatectomy has been put forward because it has fewer major complications and can preserve endocrine and exocrine function. Between January 1999 and march 2003, three patients with benign tumors of the neck of the pancreas underwent central pancreatectomy. all patients underwent computed tomography scans, intraoperative ultrasound and frozen-section analysis. pathologic examination showed two mucinous cystadenomas and one serous cystadenoma. after a mean follow-up of 34 months, none of the patients has shown major complications or local recurrence, or has developed diabetes. In conclusion, central pancreatectomy is a useful technique for selected benign or low-grade malignant pancreatic tumors of the neck of the pancreas.
- Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: A systematic seview and meta-analysis from propensity-score matched studies(Springer, 2023) Goh, B.K.P. (Brian K. P.); Rotellar, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Sapisochin, G. (Gonzalo); Aliseda, D. (Daniel)Background: Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC). Methods: A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model. Results: Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]). Conclusions: This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.
- Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis(Oxford University Press, 2024) Pastor, C. (Carlos); Rotellar, F. (Fernando); Matos, I. (Ignacio); Baixauli-Fons, J. (Jorge); Rodriguez, J. (Javier); Sanchez-Justicia, C. (C.); Arredondo, J. (Jorge); Aliseda, D. (Daniel); Alvarellos, A. (A.)Background: Neoadjuvant chemotherapy is increasingly used to treat locally advanced (T3-4 Nx-2 M0) colon cancer due to its potential advantages over the standard approach of upfront surgery. The primary objective of this systematic review and meta-analysis was to analyse data from comparative studies to assess the impact of neoadjuvant chemotherapy on oncological outcomes. Methods: A systematic review was conducted by searching the MEDLINE and Scopus databases. The search encompassed RCTs, propensity score-matched studies, and controlled prospective studies published up to 1 April 2023. As a primary objective, overall survival and disease-free survival were compared. As a secondary objective, perioperative morbidity, mortality, and complete resection were compared using the DerSimonian and Laird models. Results: A total of seven studies comprising a total of 2120 patients were included. Neoadjuvant chemotherapy was associated with a reduction in the hazard of recurrence (HR 0.73, 95% c.i. 0.59 to 0.90; P = 0.003) and death (HR 0.67, 95% c.i. 0.54 to 0.83; P < 0.001) compared with upfront surgery. Additionally, neoadjuvant chemotherapy was significantly associated with higher 5-year overall survival (79.9% versus 72.6%; P < 0.001) and disease-free survival (73.1% versus 64.5%; P = 0.028) rates. No significant differences were observed in perioperative mortality (OR 0.97, 95% c.i. 0.28 to 3.33), overall complications (OR 0.95, 95% c.i. 0.77 to 1.16), or anastomotic leakage/intra-abdominal abscess (OR 0.88, 95% c.i. 0.60 to 1.29). However, neoadjuvant chemotherapy was associated with a lower risk of incomplete resection (OR 0.70, 95% c.i. 0.49 to 0.99). Conclusion: Neoadjuvant chemotherapy is associated with a reduced hazard of recurrence and death, as well as improved overall survival and disease-free survival rates, compared with upfront surgery in patients with locally advanced colon cancer.
- Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors(Elsevier, 2018) Estévez, M.G. (Mateo G.); Valenti, V. (Víctor); Rotellar, F. (Fernando); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Bilbao, J.I. (José I.); Vivas, I. (Isabel); Ruiz-Canela, M. (Miguel); Marti-Cruchaga, P. (Pablo)Background: Laparoscopic arcuate ligament release has been demonstrated a valid therapeutic option for arcuate ligament syndrome. Nevertheless, long-term follow-up and predictive factors have not been described for this treatment. Methods: Clinical and surgical data and short- and long-term outcomes together with the impact of the degree of stenosis of the celiac trunk were analyzed in 13 consecutive patients who underwent laparoscopic arcuate ligament release between 2001 and 2013. Results: Thirteen patients (12 F/1 M) underwent surgery. The median age was 32 years old, and their mean body mass index was 20.7 (range 14.7-25). The 13 patients presented with intense postprandial abdominal pain. Ten cases were associated with weight loss. The median duration of symptoms was 24 months (range 2-240). Three patients presented symptoms associated with superior mesenteric artery syndrome. Median operative time was 120 min (range 90-240), and there were no conversions to open surgery. Median hospital stay was 3 days (range 2-14). Over a median follow-up of 117 months (range 45-185), nine patients had excellent results although two required endovascular procedures at 70 and 24 months after surgery. Four patients (30.7%) experienced poor outcomes. When we analyzed the impact of the degree of occlusion of the celiac trunk, we observed that in patients with severe occlusion (> 70%), better results were obtained, with complete resolution of symptoms in 71% of cases. Conclusion: Laparoscopic arcuate ligament release constitutes an excellent treatment for arcuate ligament syndrome. The degree of occlusion of the celiac trunk may be a factor predictive of long-term outcomes.
- Impact of Perineural and Lymphovascular Invasion on Oncological Outcomes in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Surgery(2015) Pastor, C. (Carlos); Rotellar, F. (Fernando); Baixauli-Fons, J. (Jorge); Arbea, L. (Luis); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Arredondo, J. (Jorge); Beorlegui, C. (Carmen); Sola, J.J. (Jesús Javier)Background The prognostic significance of perineural and/or lymphovascular invasion (PLVI) and its relationship with tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT) and surgery. Methods A total of 324 patients with LARC were treated with CRT and operated on between January 1992 and June 2007. Tumors were graded using a quantitative 5-grade TRG classification and the presence of PLVI was histologically studied. Results At a median follow-up of 79.0 months (range 3–250 months), a total of 80 patients (24.7 %) relapsed. The observed 5- and 10-year overall survival (OS) was 83.2 and 74.9 %, respectively. The 5- and 10-year disease-free survival (DFS) was 75.1 and 71.4 %, respectively. A significant correlation was found between the TRG and survival (log rank, p < 0.001). The 10-year OS was 32.7 % for grade 1, 63.8 % for grade 2, 75.0 % for grade 3, 90.4 % for grade 3+, and 96.0 %,for grade 4. The 10-year DFS was 31.8 % for grade 1, 58.6 % for grade 2, 70.4 % for grade 3, 88.4 % for grade 3+, and 97.1 % for grade 4. In patients with PLVI, the TRG had no impact on survival. When excluding patients with PLVI, the TRG was an independent prognostic factor for OS and DFS. Conclusions The presence of PLVI is a more powerful prognostic factor than TRG in LARC patients treated with neoadjuvant CRT followed by surgery. PLVI denotes an aggressive phenotype, suggesting that these patients may benefit from adjuvant systemic therapy.