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Article ; Online: Critical appraisal of surgical margins according to KRAS status in liver resection for colorectal liver metastases: Should surgical strategy be influenced by tumor biology?

Rhaiem, Rami / Duramé, Adrien / Primavesi, Florian / Dorcaratto, Dimitri / Syn, Nicholas / Rodríguez, Ángela de la Hoz / Dupré, Aurélien / Piardi, Tullio / Fernández, Gerardo Blanco / Villaverde, Arancha Prada / Rodríguez Sanjuán, Juan C / Santiago, Roberto Fernández / Fernández-Moreno, María-Carmen / Ferret, Georgina / Ben, Santiago López / Suárez Muñoz, Miguel Á / Perez-Alonso, Alejandro J / Koh, Ye-Xin / Jones, Robert /

Martín-Pérez, Elena / Kianmanesh, Reza / Di Martino, Marcello

Surgery

2024

Abstract: Background: KRAS mutation is a negative prognostic factor for colorectal liver metastases. Several studies have investigated the resection margins according to KRAS status, with conflicting results. The aim of the study was to assess the oncologic ... ...

Abstract	Background: KRAS mutation is a negative prognostic factor for colorectal liver metastases. Several studies have investigated the resection margins according to KRAS status, with conflicting results. The aim of the study was to assess the oncologic outcomes of R0 and R1 resections for colorectal liver metastases according to KRAS status. Methods: All patients who underwent resection for colorectal liver metastases between 2010 and 2015 with available KRAS status were enrolled in this multicentric international cohort study. Logistic regression models were used to investigate the outcomes of R0 and R1 colorectal liver metastases resections according to KRAS status: wild type versus mutated. The primary outcomes were overall survival and disease-free survival. Results: The analysis included 593 patients. KRAS mutation was associated with shorter overall survival (40 vs 60 months; P = .0012) and disease-free survival (15 vs 21 months; P = .003). In KRAS-mutated tumors, the resection margin did not influence oncologic outcomes. In multivariable analysis, the only predictor of disease-free survival and overall survival was primary tumor location (P = .03 and P = .03, respectively). In KRAS wild-type tumors, R0 resection was associated with prolonged overall survival (74 vs 45 months, P < .001) and disease-free survival (30 vs 17 months, P < .001). The multivariable model confirmed that R0 resection margin was associated with prolonged overall survival (hazard ratio = 1.43, 95% confidence interval: 1.01-2.03) and disease-free survival (hazard ratio = 1.42; 95% confidence interval: 1.06-1.91). Conclusions: KRAS-mutated colorectal liver metastases showed more aggressive tumor biology with inferior overall survival and disease-free survival after liver resection. Although R0 resection was not associated with improved oncologic outcomes in the KRAS-mutated tumors group, it seems to be of paramount importance for achieving prolonged long-term survival in KRAS wild-type tumors.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2024.02.008
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Article ; Online: Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions.

Rodríguez-Sanjuán, Juan C / Gómez-Ruiz, Marcos / Trugeda-Carrera, Soledad / Manuel-Palazuelos, Carlos / López-Useros, Antonio / Gómez-Fleitas, Manuel

World journal of gastroenterology

2016 Volume 22, Issue 6, Page(s) 1975–2004

Abstract: Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric ... ...

Abstract	Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
MeSH term(s)	Diffusion of Innovation ; Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Digestive System Surgical Procedures/trends ; Evidence-Based Medicine ; Forecasting ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/trends ; Postoperative Complications/etiology ; Risk Factors ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/trends ; Treatment Outcome
Language	English
Publishing date	2016-01-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v22.i6.1975
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Article ; Online: Perioperative chemotherapy versus surgery alone for resectable colorectal liver metastases: an international multicentre propensity score matched analysis on long-term outcomes according to established prognostic risk scores.

Di Martino, Marcello / Primavesi, Florian / Syn, Nicholas / Dorcaratto, Dimitri / de la Hoz Rodríguez, Ángela / Dupré, Aurélien / Piardi, Tullio / Rhaiem, Rami / Blanco Fernández, Gerardo / Prada Villaverde, Arancha / Rodríguez Sanjuán, Juan C / Fernández Santiago, Roberto / Fernández-Moreno, María-Carmen / Ferret, Georgina / López Ben, Santiago / Suárez Muñoz, Miguel Á / Perez-Alonso, Alejandro J / Koh, Ye-Xin / Jones, Robert /

Martín-Pérez, Elena

HPB : the official journal of the International Hepato Pancreato Biliary Association

2021 Volume 23, Issue 12, Page(s) 1873–1885

Abstract: Background: There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence.: Methods: Multicentre retrospective ... ...

Abstract	Background: There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence. Methods: Multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010-2015. Patients were divided into two groups according to whether they received perioperative CTx or not and were compared using propensity score matching (PSM) analysis. Then, they were stratified according to prognostic risk scores, including: Clinical Risk Score (CRS), Tumour Burden Score (TBS) and Genetic And Morphological Evaluation (GAME) score. Results: The study included 967 patients with a median follow-up of 68 months. After PSM analysis, patients with perioperative CTx presented prolonged overall survival (OS) in comparison with the surgery alone group (82.8 vs 52.5 months, p = 0.017). On multivariable analysis perioperative CTx was an independent predictor of increased OS (HR 0.705, 95%CI 0.705-0.516, p = 0.029). The benefits of perioperative CTx on survival were confirmed in patients with CRS and TBS scores ≤2 (p = 0.022 and p = 0.020, respectively) and in patients with a GAME score ≤1 (p = 0.006). Conclusion: Perioperative CTx demonstrated an increase in OS in patients with CRLM. Patients with a low-risk of recurrence seem to benefit from systemic treatment.
MeSH term(s)	Colorectal Neoplasms/surgery ; Hepatectomy/adverse effects ; Humans ; Liver Neoplasms/surgery ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Propensity Score ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-05-15
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2021.04.026
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Article ; Online: Radiofrequency ablation must be assessed by pathological methods.

Rodríguez-Sanjuán, Juan C / González, Francisco / Gómez-Fleitas, Manuel

Hepatology (Baltimore, Md.)

2010 Volume 51, Issue 2, Page(s) 723; author reply 723–4

MeSH term(s)	Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery ; Catheter Ablation ; Humans ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery
Language	English
Publishing date	2010-02
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	604603-4
ISSN	1527-3350 ; 0270-9139
ISSN (online)	1527-3350
ISSN	0270-9139
DOI	10.1002/hep.23454
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Zs.A 1660: Show issues

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Article ; Online: How long is antibiotic therapy necessary after urgent cholecystectomy for acute cholecystitis?

Rodríguez-Sanjuán, Juan C / Casella, Giovanni / Antolín, Francisco / Castillo, Federico / Fernández-Santiago, Roberto / Riaño, María / Herrera, Luis A / Gómez-Fleitas, Manuel

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2013 Volume 17, Issue 11, Page(s) 1947–1952

Abstract: Objective: The objective of the study was to analyze surgical site infection (SSI) frequency with different duration antibiotic courses to establish the minimum necessary duration.: Methods: This is an observational study of prospective surveillance ... ...

Abstract	Objective: The objective of the study was to analyze surgical site infection (SSI) frequency with different duration antibiotic courses to establish the minimum necessary duration. Methods: This is an observational study of prospective surveillance of 287 consecutive patients (mean age 67.8 years) operated on for acute cholecystitis of grade II severity in the first 72 h. Postoperative antibiotics had been withdrawn before diagnosis of any infection as an inclusion criterion. Patients were classified into three groups, according to therapy duration: group 1 (0-4 days, n = 45, 15.7 %); group 2 (5-7 days, n = 75, 26.1 %); and group 3 (>7 days, n = 167, 58.2 %). A multivariable analysis of risk infection was performed. Results: Overall SSI frequency in groups 1, 2, and 3 was 2.2, 10.7, and 9 %, respectively. Risk analysis showed an increase in both crude and adjusted relative risks of overall infection in group 2 (crude relative risk (RR): 4.80 (0.62-37.13); adjusted RR, 2.03 (0.20-20.91)) and in group 3 (crude RR, 4.04 (0.55-29.79); adjusted RR, 2.35 (0.28-20.05)) by comparison with group 1, although without statistical significance. As a result, treatment lasting 4 days or less was not associated with overall surgical site infection incidence higher than longer treatment. Conclusion: Antibiotic treatment over 4 days after early cholecystectomy provides no advantage in decreasing surgical site infection incidence.
MeSH term(s)	Aged ; Amoxicillin-Potassium Clavulanate Combination/therapeutic use ; Anti-Bacterial Agents/administration & dosage ; Antibiotic Prophylaxis/methods ; Cholecystectomy/adverse effects ; Cholecystitis, Acute/surgery ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Penicillanic Acid/analogs & derivatives ; Penicillanic Acid/therapeutic use ; Piperacillin/therapeutic use ; Piperacillin, Tazobactam Drug Combination ; Postoperative Care ; Prospective Studies ; Risk Assessment ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/prevention & control ; Time Factors
Chemical Substances	Anti-Bacterial Agents ; Piperacillin, Tazobactam Drug Combination (157044-21-8) ; Amoxicillin-Potassium Clavulanate Combination (74469-00-4) ; Penicillanic Acid (87-53-6) ; Piperacillin (X00B0D5O0E)
Language	English
Publishing date	2013-08-22
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-013-2321-3
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis.

Sánchez-Carrasco, Miguel / Rodríguez-Sanjuán, Juan C / Martín-Acebes, Fernando / Llorca-Díaz, Francisco J / Gómez-Fleitas, Manuel / Zambrano Muñoz, Rocío / Sánchez-Manuel, F Javier

HPB surgery : a world journal of hepatic, pancreatic and biliary surgery

2016 Volume 2016, Page(s) 4614096

Abstract: ... ...

Abstract	Objective
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025964-8
ISSN	1607-8462 ; 0894-8569
ISSN (online)	1607-8462
ISSN	0894-8569
DOI	10.1155/2016/4614096
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Article ; Online: Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy?

Rodríguez-Sanjuán, Juan C / Arruabarrena, Arantxa / Sánchez-Moreno, Laura / González-Sánchez, Francisco / Herrera, Luis A / Gómez-Fleitas, Manuel

American journal of surgery

2012 Volume 204, Issue 1, Page(s) 54–59

Abstract: Background: Percutaneous cholecystostomy (PC) is an alternative treatment in acute cholecystitis (AC) in high-risk or elderly patients although its advantage over emergency cholecystectomy has not yet been established.: Study design: AC prospective ... ...

Abstract	Background: Percutaneous cholecystostomy (PC) is an alternative treatment in acute cholecystitis (AC) in high-risk or elderly patients although its advantage over emergency cholecystectomy has not yet been established. Study design: AC prospective database analysis in high-risk patients treated by PC (group 1, 29 patients) or emergency cholecystectomy (group 2, 32 patients). Surgical risk was estimated by physiological POSSUM, Charlson, Apache II, and American Society of Anesthesiologists (ASA) scores. Results: The groups showed homogeneity concerning age and surgical risk. PC allowed AC resolution in 19 patients (70.4%), but 8 (29.6%) needed emergency cholecystectomy. Morbidity and mortality rates were 31% and 17.2%, respectively. Mortality was significantly associated with ASA IV (P = .01). In group 2, the morbidity rate was 28.1% without mortality. There was no statistical difference in morbidity (P = .6) although mortality was significantly higher in group 1 (P = .02). Conclusions: PC seems of little benefit and ought to be left for those very old patients with surgical contraindication.
MeSH term(s)	Aged ; Aged, 80 and over ; Cholecystectomy/adverse effects ; Cholecystectomy/mortality ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystitis, Acute/surgery ; Cholecystostomy/adverse effects ; Cholecystostomy/methods ; Cholecystostomy/mortality ; Confounding Factors (Epidemiology) ; Databases, Factual ; Emergencies ; Emergency Treatment/methods ; Female ; Humans ; Male ; Patient Selection ; Prospective Studies ; Research Design ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Treatment Failure ; Treatment Outcome
Language	English
Publishing date	2012-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2011.05.013
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Article: Sutura simple y erradicación de Helicobacter pylori en la úlcera perforada.

Rodríguez-Sanjuán, Juan C / García-Díaz, Rosa A / Trugeda-Carrera, Soledad / Gómez-Fleitas, Manuel

Medicina clinica

2006 Volume 126, Issue 5, Page(s) 197; author reply 197–8

Title translation	Simple closure and Helicobacter pylori eradication in perforated ulcer.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Helicobacter Infections/drug therapy ; Helicobacter pylori ; Humans ; Peptic Ulcer Perforation/microbiology ; Peptic Ulcer Perforation/surgery
Chemical Substances	Anti-Bacterial Agents ; Anti-Ulcer Agents
Language	Spanish
Publishing date	2006-01-31
Publishing country	Spain
Document type	Comment ; Letter
ZDB-ID	411607-0
ISSN	1578-8989 ; 0025-7753
ISSN (online)	1578-8989
ISSN	0025-7753
DOI	10.1157/13084542
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Article ; Online: Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss.

Hessheimer, Amelia J / de la Rosa, Gloria / Gastaca, Mikel / Ruíz, Patricia / Otero, Alejandra / Gómez, Manuel / Alconchel, Felipe / Ramírez, Pablo / Bosca, Andrea / López-Andújar, Rafael / Atutxa, Lánder / Royo-Villanova, Mario / Sánchez, Belinda / Santoyo, Julio / Marín, Luís M / Gómez-Bravo, Miguel Á / Mosteiro, Fernando / Villegas Herrera, María T / Villar Del Moral, Jesús /

González-Abos, Carolina / Vidal, Bárbara / López-Domínguez, Josefina / Lladó, Laura / Roldán, José / Justo, Iago / Jiménez, Carlos / López-Monclús, Javier / Sánchez-Turrión, Víctor / Rodríguez-Laíz, Gonzalo / Velasco Sánchez, Enrique / López-Baena, Jose Á / Caralt, Mireia / Charco, Ramón / Tomé, Santiago / Varo, Evaristo / Martí-Cruchaga, Pablo / Rotellar, Fernando / Varona, María A / Barrera, Manuel / Rodríguez-Sanjuan, Juan C / Briceño, Javier / López, Diego / Blanco, Gerardo / Nuño, Javier / Pacheco, David / Coll, Elisabeth / Domínguez-Gil, Beatriz / Fondevila, Constantino

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2021 Volume 22, Issue 4, Page(s) 1169–1181

Abstract: Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes ... ...

Abstract	Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p < .001), ischemic type biliary lesions (OR 0.112, 95% CI 0.042-0.299, p < .001), graft loss (HR 0.371, 95% CI 0.267-0.516, p < .001), and patient death (HR 0.540, 95% CI 0.373-0.781, p = .001). Cold ischemia time (HR 1.004, 95% CI 1.001-1.007, p = .021) and re-transplantation indication (HR 9.552, 95% CI 3.519-25.930, p < .001) were significant independent predictors for graft loss among cDCD livers with A-NRP. While use of A-NRP helps overcome traditional limitations in cDCD liver transplantation, opportunity for improvement remains for cases with prolonged cold ischemia and/or technically complex recipients, indicating a potential role for complimentary ex situ perfusion preservation techniques.
MeSH term(s)	Aged ; Death ; Graft Survival ; Humans ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Middle Aged ; Organ Preservation/methods ; Perfusion/methods ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Tissue and Organ Procurement
Language	English
Publishing date	2021-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16899
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Article: Radiological and pathological assessment of hepatocellular carcinoma response to radiofrequency. A study on removed liver after transplantation.

Rodríguez-Sanjuán, Juan C / González, Francisco / Juanco, Carlos / Herrera, Luis A / López-Bautista, Mercedes / González-Noriega, Mónica / García-Somacarrera, Elena / Figols, Javier / Gómez-Fleitas, Manuel / Silván, Martín

World journal of surgery

2008 Volume 32, Issue 7, Page(s) 1489–1494

Abstract: Background: The real efficacy of radiofrequency ablation (RFA) in destroying hepatocellular carcinoma is not completely known, nor is the ability of computed tomography (CT) to precisely assess response. Our aims were to analyze pathological response, ... ...

Abstract	Background: The real efficacy of radiofrequency ablation (RFA) in destroying hepatocellular carcinoma is not completely known, nor is the ability of computed tomography (CT) to precisely assess response. Our aims were to analyze pathological response, tumor size influence, and CT response evaluation. Materials and methods: This was a retrospective study of 30 hepatocellular carcinoma nodules treated by RFA before liver transplant (LT) in 28 patients. Pathological study of the whole removed liver was then performed and the tumor response was classified as complete, incomplete, or absent. The biggest nodule diameter was estimated by CT or ultrasound. The procedure was carried out percutaneously in all but 3 patients, and in those 3 it was done surgically. Results: The pathological response was complete in 14 nodules (46.7%) and incomplete in 16 (53.3%). The differences in mean preoperative diameter between cases with complete and incomplete response were not significant (p = 0.3). We found that small tumors were not always completely destroyed, whereas bigger tumors could be successfully deleted. There was no clear association between any location and better or poorer response. The detection of RFA incomplete response by means of CT scan had 50% sensitivity and 100% specificity. Conclusions: In our experience, RFA can achieve some degree of tumor destruction in every treated case of hepatocellular carcinoma, the complete response rate being slightly lower than half. We have not found any association of response with tumor size or interval RFA-transplant. Second, CT had not enough sensitivity to assess RFA response of hepatocellular carcinoma.
MeSH term(s)	Adult ; Aged ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/therapy ; Catheter Ablation ; Female ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver Neoplasms/diagnosis ; Liver Neoplasms/therapy ; Liver Transplantation ; Male ; Middle Aged ; Remission Induction ; Retrospective Studies ; Tomography, X-Ray Computed
Language	English
Publishing date	2008-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-008-9559-z
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