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Research Interests: Surgery, Medicine, Humans, Male, Middle Aged, and 5 moreLIPOMA, Laparoscopy, Vomiting, Gastrectomy, and Stomach neoplasms
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BACKGROUND Conflicting data exists whether non-oncologic index cholecystectomy (IC) leading to discovery of incidental gallbladder cancer (IGBC) negatively impacts survival. This study aimed to determine whether a subgroup of patients... more
BACKGROUND Conflicting data exists whether non-oncologic index cholecystectomy (IC) leading to discovery of incidental gallbladder cancer (IGBC) negatively impacts survival. This study aimed to determine whether a subgroup of patients derives a disadvantage from IC. METHODS Patients with IGBC and non-IGBC treated at an academic USA and Chilean center during 1999-2016 were compared. Patients with T1, T4 tumor or preoperative jaundice were excluded. T2 disease was classified into T2a (peritoneal-side tumor) and T2b (hepatic-side tumor). Disease-specific survival (DSS) and its predictors were analyzed. RESULTS Of the 196 patients included, 151 (77%) had IGBC. One hundred thirty-six (90%) patients of whom 118 (87%) had IGBC had T2 disease. Three-year DSS rates were similar between IGBC and non-IGBC for all patients. However, for T2b patients, 3-year survival rate was worse for IGBC (31% vs 85%; p = 0.019). In multivariate analysis of T2 patients, predictors of poor DSS were hepatic-side tumor hazard ratio [HR], 2.9; 95% CI, 1.6-5.4; p = 0.001) and N1 status (HR, 2.4; 95% CI, 1.6-3.6; p < 0.001). CONCLUSIONS Patients with T2b gallbladder cancer specifically benefit from a single operation. These patients should be identified preoperatively and referred to hepatobiliary center.
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Research Interests: Medicine, Disease, Clinical Sciences, Gallbladder, Elsevier, and 3 moreGallbladder Cancer, Resection, and hpb
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We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus... more
We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required. The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999-2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed. One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 6...
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Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound... more
Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.
Research Interests: Medicine, Humans, Male, Middle Aged, LIPOMA, and 4 moreLaparoscopy, Vomiting, Gastrectomy, and Stomach neoplasms
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e16717 Background: Human gallbladder cancer research lacks in vitro models that can recapitulate the pathophysiology of the original tumor and normal epithelia. Organoids cultures emulate the tumor heterogeneity and have been successively... more
e16717 Background: Human gallbladder cancer research lacks in vitro models that can recapitulate the pathophysiology of the original tumor and normal epithelia. Organoids cultures emulate the tumor heterogeneity and have been successively used as translational models to evaluate clinical response to anticancer drug. Here, we established and characterized patients derived organoids culture (PDOs) from human gallbladder cancer patients. Methods: Fresh tissues obtained from gallbladder cancer patients who underwent cholecystectomy were digested with Collagenase/Dispase, filtered and then suspension cells were mixed with Matrigel (1:1) for organoids establishment. Cultures were maintained at 37°C and 5% CO2. The organoids were characterized through histopathology evaluation, immunohistochemistry, and ultra-deed targeted sequencing (TruSeq protocol, Illumina, TSACP; 25 genes). In addition, we evaluated the response of organoids to gemcitabine, cisplatin and Fluorouracil (5-FU), using the...
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Gallbladder cancer is an aggressive disease with late diagnosis and no efficacious treatment. The Hippo-Yes-associated protein 1 (YAP1) signaling pathway has emerged as a target for the development of new therapeutic interventions in... more
Gallbladder cancer is an aggressive disease with late diagnosis and no efficacious treatment. The Hippo-Yes-associated protein 1 (YAP1) signaling pathway has emerged as a target for the development of new therapeutic interventions in cancers. However, the role of the Hippo-targeted therapy has not been addressed in advanced gallbladder cancer (GBC). This study aimed to evaluate the expression of the major Hippo pathway components mammalian Ste20-like protein kinase 1 (MST1), YAP1 and transcriptional coactivator with PDZ-binding motif (TAZ) and examined the effects of Verteporfin (VP), a small molecular inhibitor of YAP1-TEA domain transcription factor (TEAD) protein interaction, in metastatic GBC cell lines and patient-derived organoids (PDOs). Immunohistochemical analysis revealed that advanced GBC patients had high nuclear expression of YAP1. High nuclear expression of YAP1 was associated with poor survival in GBC patients with subserosal invasion (pT2). Additionally, advanced GBC...
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Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, including an increasing number of reports of radical cholecystectomy with hepatectomy, lymphadenectomy and excision of the extrahepatic biliary... more
Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, including an increasing number of reports of radical cholecystectomy with hepatectomy, lymphadenectomy and excision of the extrahepatic biliary tree, but continues to be controversial. Here, we highlight these controversies and review the management of incidental GBC, and the MIS management of early and advanced nonincidental GBC. While initial results are promising, and are likely to improve, adequate long-term survival data are lacking and for now MIS for GBC should be limited to high-volume centers with adequate expertise in both MIS and hepatobiliary surgery.
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The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for... more
The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), had a lower rate of multiple organ resection (21% versus 39%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and had less postoperative complications (14% versus 32%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.
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... Preparation of the patient for liver transplantation. Eduardo F Viñuela ,; Darius F Mirza: Affiliations. Correspondence: Dr. Darius F Mirza,. email address. Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham,... more
... Preparation of the patient for liver transplantation. Eduardo F Viñuela ,; Darius F Mirza: Affiliations. Correspondence: Dr. Darius F Mirza,. email address. Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, United Kingdom. ...
Acute appendicitis is the most common non obstetric surgical emergency during pregnancy. To asses our experience in the diagnosis and management of acute appendicitis occurring during pregnancy. Data from all pregnant patients who were... more
Acute appendicitis is the most common non obstetric surgical emergency during pregnancy. To asses our experience in the diagnosis and management of acute appendicitis occurring during pregnancy. Data from all pregnant patients who were subjected to an appendectomy for a suspected acute appendicitis from January 1998 to December 2002, were retrospectively analyzed. All pathological, surgical, clinical records and the delivery outcome registry of each patient were reviewed. Among 47,322 deliveries, 46 pregnant women aged 29+/-9 years and with a gestational age of 21+/-7 weeks, were operated because of a presumptive acute appendicitis. Forty (87%) had a histopathologically proven appendicitis; ten (25%) cases had a perforated appendix and 30 (75%) had a non-perforated appendicitis. Five (10.9%) patients had a negative laparotomy and one had a necrotic ovarian tumor. Patients with perforated and non perforated appendices had a similar lapse from the onset of symptoms to operation (69+/-...
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1 Departamento de Cirugía Digestiva Hospital Clínico Universidad Católica, 2 Servicio de Cirugía, Hospital Dr. Sótero del Rio, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile. ... Introducción: La cirugía... more
1 Departamento de Cirugía Digestiva Hospital Clínico Universidad Católica, 2 Servicio de Cirugía, Hospital Dr. Sótero del Rio, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile. ... Introducción: La cirugía laparoscópica ha sido incorporada ...
1 Servicios de Cirugía, 2 Gineco-Obstetricia, 3 Anatomía Patológica y 4 Centro de Diagnóstico y Estudios Perinatales (CEDIP), Hospital Doctor Sótero del Río. 5 Unidad Docente Asociada, Facultad de Medicina, Pontificia Universidad Católica... more
1 Servicios de Cirugía, 2 Gineco-Obstetricia, 3 Anatomía Patológica y 4 Centro de Diagnóstico y Estudios Perinatales (CEDIP), Hospital Doctor Sótero del Río. 5 Unidad Docente Asociada, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago de ...
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1 Servicios de Cirugía, 2 Gineco-Obstetricia, 3 Anatomía Patológica y 4 Centro de Diagnóstico y Estudios Perinatales (CEDIP), Hospital Doctor Sótero del Río. 5 Unidad Docente Asociada, Facultad de Medicina, Pontificia Universidad Católica... more
1 Servicios de Cirugía, 2 Gineco-Obstetricia, 3 Anatomía Patológica y 4 Centro de Diagnóstico y Estudios Perinatales (CEDIP), Hospital Doctor Sótero del Río. 5 Unidad Docente Asociada, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago de ...
La colelitiasis es una patología altamente prevalente en nuestro medio. Estudios epidemiológicos recientes comunican cifras de prevalencia de hasta 20% en la población adulta masculina y entre 40 y 50% en la población femenina 1,2 .... more
La colelitiasis es una patología altamente prevalente en nuestro medio. Estudios epidemiológicos recientes comunican cifras de prevalencia de hasta 20% en la población adulta masculina y entre 40 y 50% en la población femenina 1,2 . Además, se estima, que en nuestro país, ...