Browsing by Author "Norero, Enrique"
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- ItemAcute abdomen due to pancreatic pseudocyst with splenic extension and rupture(2021) Navarro, Francisco; Leiva, Lissette; Norero, EnriquePancreatic pseudocyst is a common complication of acute and chronic pancreatitis. However, spleen involvement in pancreatitis is rare. We present a patient with a pancreatic tail pseudocyst with splenic extension and rupture. Due to initial stability, conservative management was decided. However, he developed tachycardia with severe abdominal pain associated with signs of peritoneal irritation, requiring an emergency laparotomy. A large pancreatic tail pseudocyst was identified in addition to a ruptured spleen. Splenectomy and double layer hand-sewn gastrocystic anastomosis were performed. The patient had a satisfactory recovery and was discharged on the 11th postoperative day. Conservative management is an option in stable patients but with a high rate of failure. Surgery remains the standard choice in these cases.
- ItemDisección endoscópica submucosa para el tratamiento de neoplasias incipientes del tubo digestivo: experiencia en un centro universitario de alto volumen(2021) Mejía, Ricardo; Sáez, Josefina; Briones, Pamela; Norero, Enrique; Ceroni, Marco; Díaz, Alfonso; Sharp, AllanBackground: Endoscopic submucosal dissection (ESD) allows en-bloc resection of early gastro-intestinal neoplasms (EGIN) with healing potential. Aim: To describe the results of patients treated with ESD for EGIN by our team. Patients and Methods: Descriptive study of patients with EGIN who underwent ESD with curative intention between January 2008 and March 2020. Results: One hundred thirty-two ESD were performed in 127 patients. 77% were gastric lesions, 14% colorectal, 8% esophageal and 1% duodenal. En-bloc resection was achieved in 98.4% of ESDs. Eighty eight percent of patients met curative standards. Overall, cancer-specific, and recurrence-free survival were 95%, 100% and 98% respectively. Conclusions: ESD allows en-bloc resections with curative potential in selected patients, but with a significant reduction in morbidity and mortality and less impact on quality of life. Our results suggest the feasibility to perform ESD in our country with results comparable to those reported in the literature.
- ItemImpact of Adjuvant FOLFOX on Quality of Life and Peripheral Neuropathy Incidence in Patients With Gastric Cancer: A Prospective Cohort Study(Elsevier Inc., 2023) Mondaca Contreras, Sebastián Patricio; Pinto, Mauricio P.; Briones Carvajal, Juan Rodrigo; Caire, Nicole; Peña Prado, José Tomas; Koch Hein, Erica Cristina; Muñiz Muñoz, Maria Sabrina; Herrera, María Elisa; Sanchez Rojel, Cesar Giovanni; Galindo Aranibar, Héctor Gonzalo; Pizarro Brito, Gonzalo Ignacio; Acevedo Claros, Francisco Nicolas; Ibáñez Cáceres, Carolina; Balmaceda Araque, Carlos Felipe; Norero, Enrique; Duran, Doris; Garrido Salvo, Marcelo Adán; Nervi Nattero, BrunoObjectives: Perioperative and adjuvant chemotherapy have demonstrated clinical benefits in localized gastric cancer. Nevertheless, the reports on their effects on patient's health-related quality of life (HRQoL) are scarce. Here, we prospectively assessed quality of life and the incidence of chemotherapy-induced peripheral neuropathy (CIPN) in a cohort of patients treated with adjuvant FOLFOX. Methods: Localized stomach or gastroesophageal junction adenocarcinoma patients who underwent curative resection were recruited at a single center. All patients received adjuvant FOLFOX6, and HRQoL and CIPN were assessed using the European organization for research and treatment of cancer quality life (EORTC) C30 and the EORTC CIPN20 questionnaires, respectively. Clinically significant deterioration of HRQoL was also assessed as a coprimary outcome in a longitudinal analysis. Results: We recruited a total of 63 patients. Median age was 62.5 years, and 75% had stomach tumors. Twenty-four weeks after the start of treatment, the probability of being free from HRQoL deterioration and CIPN was 29% (95% confidence interval [CI] 18%-42%) and 6% (95% CI 2%-17%), respectively. Five-year disease-free survival was 45% (95% CI 24%-64%) and 5-year overall survival was 63% (95% CI 48%-76%). Conclusions: Adjuvant FOLFOX is associated with a high rate of long-term survival in localized gastric cancer; nevertheless, it has detrimental effects on patients’ quality of life.
- ItemLaparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database(2021) Trastulli, Stefano; Desiderio, Jacopo; Lin, Jian-Xian; Reim, Daniel; Zheng, Chao-Hui; Borghi, Felice; Cianchi, Fabio; Norero, Enrique; Nguyen, Ninh T.; Qi, Feng; Coratti, Andrea; Cesari, Maurizio; Bazzocchi, Francesca; Alimoglu, Orhan; Brower, Steven T.; Pernazza, Graziano; D'Imporzano, Simone; Azagra, Juan-Santiago; Zhou, Yan-Bing; Cao, Shou-Gen; Garofoli, Eleonora; Mosillo, Claudia; Guerra, Francesco; Liu, Tong; Arcuri, Giacomo; Gonzalez, Paulina; Staderini, Fabio; Marano, Alessandra; Terrenato, Irene; D'Andrea, Vito; Bracarda, Sergio; Huang, Chang-Ming; Parisi, AmilcareSimple Summary:Gastric resection with D2 lymphadenectomy is considered the gold standard for the treatment of both advanced and early gastric cancer with lymph node metastasis. The performance of D2 lymphadenectomy is technically challenging and represents a key factor in improving patients' survival. For these reasons, the execution of gastrectomy with D2 lymphadenectomy using the traditional open surgical technique still represents the most widespread approach and, based on current international guidelines, the indication for laparoscopic surgery is limited to early gastric cancer that does not require a D2 lymphadenectomy. The present study aimed to investigate the use of laparoscopic versus open surgical approaches in performing gastrectomy with D2 lymphadenectomy for cancer in terms of intraoperative and postoperative outcomes and long-term survival. The study was conducted using the data collected in the International study group on Minimally Invasive surgery for Gastric Cancer (IMIGASTRIC) international database.
- ItemLong-term Results of Endoscopic Submucosal Dissection (ESD) for the Treatment of Early Gastric Cancer (EGC) in a High-volume Latin American Center(2021) Mejía, Ricardo; Sáez, Josefina; Norero, Enrique; Briones, Pamela; Ceroni, Marco; Martínez, Cristian; Díaz, Alfonso; Calvo, Alfonso; Sharp, AllanBackground: Gastric cancer is the second leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and benefits over gastrectomy for the treatment of early gastric cancer (EGC). The aim of this study is to present the results of ESD for EGC in a high-volume center in Chile. Materials and Methods: Retrospective descriptive study of patients who underwent ESD for EGC at the Doctor Sótero del Río Hospital. Results: A total of 100 ESDs were performed in 96 patients between 2008 and 2020. Fifty-five percent were female patients, the average age was 68 years (range, 45 to 89 y). En bloc resection was achieved in 98% of cases and the rate of complications Clavien grade III or higher was 8.3%. There were no cases of perioperative mortality. Ninety-three percent of the dissections were classified as R0 and 83% met curative standards according to expanded criteria. The mean follow-up was 42 months (range, 1 to 144 mo). Overall survival was 97%. Cancer-specific survival was 100% and recurrence-free survival was 97%. Conclusions: The present study describes the largest series of ESD for the treatment of EGC reported in Latin America. Our results support the feasibility of implementing ESD in Chile and indicate good oncological outcomes comparable to those reported in the large Asian series published to date.
- ItemOpen vs robotic gastrectomy with D2 lymphadenectomy: a propensity score-matched analysis on 1469 patients from the IMIGASTRIC prospective database(2023) Trastulli, Stefano; Desiderio, Jacopo; Lin, Jian-Xian; Reim, Daniel; Zheng, Chao-Hui; Borghi, Felice; Cianchi, Fabio; Norero, Enrique; Nguyen, Ninh T. T.; Qi, Feng; Coratti, Andrea; Cesari, Maurizio; Bazzocchi, Francesca; Alimoglu, Orhan; Brower, Steven T. T.; Pernazza, Graziano; D'Imporzano, Simone; Azagra, Juan-Santiago; Zhou, Yan-Bing; Cao, Shou-Gen; Guerra, Francesco; Liu, Tong; Arcuri, Giacomo; Gonzalez, Paulina; Staderini, Fabio; Marano, Alessandra; Di Nardo, Domenico; Parisi, Amilcare; Huang, Chang-Ming; Tebala, Giovanni DomenicoBackgroundComparative data on D2-robotic gastrectomy (RG) vs D2-open gastrectomy (OG) are lacking in the Literature. Aim of this paper is to compare RG to OG with a focus on D2-lymphadenectomy.Study designData of patients undergoing D2-OG or RG for gastric cancer were retrieved from the international IMIGASTRIC prospective database and compared.ResultsA total of 1469 patients were selected for inclusion in the study. After 1:1 propensity score matching, a total of 580 patients were matched and included in the final analysis, 290 in each group, RG vs OG. RG had longer operation time (210 vs 330 min, p < 0.0001), reduced intraoperative blood loss (155 vs 119.7 ml, p < 0.0001), time to liquid diet (4.4 vs 3 days, p < 0.0001) and to peristalsis (2.4 vs 2 days, p < 0.0001), and length of postoperative stay (11 vs 8 days, p < 0.0001). Morbidity rate was higher in OG (24.1% vs 16.2%, p = 0.017).ConclusionRG significantly expedites recovery and reduces the risk of complications compared to OG. However, long-term survival is similar.
- ItemReconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer(2024) Schneider, Marcel Andre; Kim, Jeesun; Berlth, Felix; Sugita, Yutaka; Grimminger, Peter P.; Wijnhoven, Bas P. L.; Overtoom, Hidde; Gockel, Ines; Thieme, Rene; Griffiths, Ewen A.; Butterworth, William; Nienhuser, Henrik; Mueller, Beat; Crnovrsanin, Nerma; Gero, Daniel; Nickel, Felix; Gisbertz, Suzanne; van Berge Henegouwen, Mark I.; Pucher, Philip H.; Khan, Kashuf; Chaudry, Asif; Patel, Pranav H.; Pera, Manuel; Dal Cero, Mariagiulia; Garcia, Carlos; Martinez Salinas, Guillermo; Kassab, Paulo; Prado Castro, Osvaldo Antonio; Norero, Enrique; Wisniowski, Paul; Putnam, Luke Randall; Lombardi, Pietro Maria; Ferrari, Giovanni; Gudaityte, Rita; Maleckas, Almantas; Prodehl, Leanne; Castaldi, Antonio; Prudhomme, Michel; Lee, Hyuk-Joon; Sano, Takeshi; Baiocchi, Gian Luca; De Manzoni, Giovanni; Giacopuzzi, Simone; Bencivenga, Maria; Rosati, Riccardo; Puccetti, Francesco; D'Ugo, Domenico; Nunobe, Souya; Yang, Han-Kwang; Gutschow, Christian AlexanderObjective/Background:Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied.Methods:MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.Results:Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction.Conclusions:In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference.
- ItemSURVIVAL AND PERIOPERATIVE MORBIDITY OF TOTALLY LAPAROSCOPIC VERSUS OPEN GASTRECTOMY FOR EARLY GASTRIC CANCER: ANALYSIS FROM A SINGLE LATIN AMERICAN CENTRE(2019) Norero, Enrique; Vargas, Catalina; Achurra, Pablo; Ceroni, Marco; Mejia, Ricardo; Martinez, Cristian; Munoz, Rodrigo; Gonzalez, Paulina; Calvo, Alfonso; Diaz, AlfonsoBackground: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and RO resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p= 0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and RO resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=020) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.