Blanco, N. (Nuria)
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- ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal(Springer, 2023) Pastor, E. (Enrique); Pastor, C. (Carlos); Baixauli-Fons, J. (Jorge); Oliva, I. (I.); Blanco, N. (Nuria); Arredondo, J. (Jorge); Tejedor, P. (P.); Alvarellos, A. (Alicia)Purpose A protective loop ileostomy is the most useful method to reduce sequelae in the event of an anastomotic leakage (AL) after rectal cancer surgery. However, it requires an additional stoma reversal surgery with its own potential complications. Postoperative ileus (POI) remains the most common complication after ileostomy reversal, which leads to an increase in morbidity, length of hospital stay (LOS) and overall healthcare costs. Several retrospective studies carried out in this feld have concluded that there are insufcient evidence-based recommendations about the routine application of preoperative bowel stimulation in clinical practice. Here we discuss whether stimulation of the eferent limb before ileostomy reversal might reduce POI and improve postoperative outcomes. Methods This is a multicentre randomised controlled trial to determine whether mechanical stimulation of the eferent limb during the 2 weeks before the ileostomy reversal would help to reduce the development of POI after surgery. This study was registered on Clinicaltrials.gov (NCT05302557). Stimulation will consist of infusing a solution of 500 ml of saline chloride solution mixed with a thickening agent (Resource©, Nestlé Health Science; 6.4 g sachet) into the distal limb of the ileostomy loop. This will be performed within the 2 weeks before ileostomy reversal, in an outpatient clinic under the supervision of a trained stoma nurse. Conclusion The results of this study could provide some insights into the preoperative management of these patients.
- Never discard enucleation as a possibility: successful enucleation of a neuroendocrine tumor in the pancreatic neck in long and close proximity to the main pancreatic duct(Elsevier, 2024) Rotellar, F. (Fernando); Blanco, N. (Nuria); Aliseda, D. (Daniel)Parenchyma-sparing surgery includes enucleation. Enucleation is not used very often, partly because of its technical complexity, and is usually reserved for anatomically favorable cases (> 3 mm from the duct of Wirsung) with benign etiology. We present a case demonstrating that it is always worth exploring the possibility of performing a more con- servative surgery even in difficult anatomic locations.
- 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.
- 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.
- Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials(Oxford University Press, 2024) Chopitea, A. (Ana); Rotellar, F. (Fernando); Rodriguez, J. (Javier); Pardo, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Castañón-Álvarez, E. (Eduardo); Ponz-Sarvise, M. (Mariano); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)Background: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. Methods: A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan–Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Results: Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. −1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Conclusion: Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.
- Anatomical left hepatectomy extended to caudate lobe due to colorectal metastasis with intrabiliary growth: securing optimal margins with a laennec’s capsule approach and vein‐guided resection(Springer, 2024) Rotellar, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Lapuente, F. (Fernando); Blanco, N. (Nuria); Sabatella, L. (Lucas); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)Metastases of colorectal cancer (CRLM) present in up to 15% of cases an intrabiliary growth pattern (IGP) resembling cholangiocarcinoma behavior. An appropriate diagnosis is paramount, as IGP modifes the surgical strategy.
- Short-term outcomes of minimally invasive retromuscular ventral hernia repair using an enhanced view totally extraperitoneal (eTEP) approach: systematic review and meta-analysis(2022) Rotellar, F. (Fernando); Almeida, A. (Ana); Luján-Colás, J. (Juan); Zozaya-Larequi, G. (Gabriel); Sanchez-Justicia, C. (C.); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)Background The enhanced view totally extraperitoneal (eTEP) approach is becoming increasingly more widely accepted as a promising technique in the treatment of ventral hernia. However, evidence is still lacking regarding the perioperative, postoperative and long-term outcomes of this technique. The aim of this meta-analysis is to summarize the current available evidence regarding the perioperative and short-term outcomes of ventral hernia repair using eTEP. Study design A systematic search was performed of PubMed, EMBASE, Cochrane Library and Web of Science electronic databases to identify studies on the laparoscopic or robotic-enhanced view totally extraperitoneal (eTEP) approach for the treatment of ventral hernia. A pooled meta-analysis was performed. The primary end point was focused on short-term outcomes regarding perioperative characteristics and postoperative parameters. Results A total of 13 studies were identified involving 918 patients. Minimally invasive eTEP resulted in a rate of surgical site infection of 0% [95% CI 0.0-1.0%], a rate of seroma of 5% [95% CI 2.0-8.0%] and a rate of major complications (Clavien-Dindo III-IV) of 1% [95% CI 0.0-3.0%]. The rate of intraoperative complications was 2% [95% CI 0.0-4.0%] with a conversion rate of 1.0% [95% CI 0.0-3.0%]. Mean hospital length of stay was 1.77 days [95% CI 1.21-2.24]. After a median follow-up of 6.6 months (1-24), the rate of recurrence was 1% [95% CI 0.0-1.0%]. Conclusion Minimally invasive eTEP is a safe and effective approach for ventral hernia repair, with low reported intraoperative complications and good outcomes.