Revistas
Revista:
SURGICAL LAPAROSCOPY ENDOSCOPY AND PERCUTANEOUS TECHNIQUES
ISSN 1530-4515
Vol. 32
N° 1
Año 2022
Págs.28 - 34
Background: Laparoscopic resection is the treatment of choice for colorectal cancer. Rates of conversion to open surgery range between 7% and 30% and controversy exists as to the effect of this on oncologic outcomes. The objective of this study was to analyze what factors are predictive of conversion and what effect they have on oncologic outcomes. Methods: From a prospective database of patients undergoing laparoscopic surgery between 2000 and 2018 a univariate and multivariate analyses were made of demographic, pathologic, and surgical variables together with complementary treatments comparing purely laparoscopic resection with conversions to open surgery. Overall and disease-free survival were compared using the Kaplan-Meier method. Results: Of a total of 829 patients, 43 (5.18%) converted to open surgery. In the univariate analysis, 12 variables were significantly associated with conversion, of which left-sided resection [odds ratio (OR): 2.908; P=0.02], resection of the rectum (OR: 4.749, P=0.014), and local invasion of the tumor (OR: 6.905, P<0.01) were independently predictive factors in the multiple logistic regression. Female sex was associated with fewer conversions (OR: 0.375, P=0.012). The incidence and pattern of relapses were similar in both groups and there were no significant differences between overall and disease-free survival. Conclusions: Left-sided resections, resections of the rectum and tumor invasion of neighboring structures are associated with higher rates of conversion. Female sex is associated with fewer conversions. Conversion to open surgery does not compromise oncologic outcomes at 5 and 10 years.
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 39
N° 15
Año 2021
Revista:
SURGICAL LAPAROSCOPY ENDOSCOPY AND PERCUTANEOUS TECHNIQUES
ISSN 1530-4515
Vol. 31
N° 5
Año 2021
Págs.558 - 564
Background: Laparoscopic resection is the ideal treatment of colon cancer. The aim of the study was to analyze the predictive factors for postoperative complications and their impact on oncologic outcomes in laparoscopic resections in colon cancer.
Materials and Methods: In all patients undergoing elective laparoscopic surgery the number and degree of severity of postoperative complications were recorded and classified according to Clavien-Dindo. A univariate analysis was made of the demographic, surgical, and oncologic variables of patients with and without complications. The statistically significant variables were then entered into a multivariate model. In both groups overall and disease-free survival were analyzed using Kaplan-Meier estimates.
Results: Of 524 patients, 138 (26.3%) experienced some type of complication, 110 less severe (79.7%) and 28 (20.4%) severe. Twenty-nine conversions to open surgery occurred (5.5%) and hospital mortality was 0.2%. In the multivariate analysis, use of corticosteroids [odds ratio (OR): 3.619], oral anticoagulants (OR: 3.49), blood transfusions (OR: 4.30), and conversion to open surgery (OR: 3.93) were significantly associated with the development of complications. However, sigmoid resections were associated with fewer complications (OR: 0.45). Overall 5-year and 10-year survival in both groups, was 83.3%, 74.1%, 76.0%, and 67.1%, respectively (P = 0.18). Disease-free survival at 5 and 10 years, excluding stage IV tumors, was 88.6% and 90.4%, respectively (P = 0.881).
Conclusions: The use of corticosteroids, oral anticoagulants, blood transfusions, and conversion to open surgery are all independent predictive factors of postoperative complications. Sigmoid resections are associated with fewer complications. In laparoscopic resections of the colon, complications do not negatively affect long-term oncologic outcomes.
Revista:
WORLD JOURNAL OF SURGERY
ISSN 0364-2313
Vol. 44
N° 6
Año 2020
Págs.1798 - 1806
BACKGROUND:
Latero-lateral duodenojejunostomy is the treatment of choice for superior mesenteric artery syndrome (SMAS). The present study analyzes the long-term outcomes in 13 patients undergoing laparoscopic surgery for SMAS.
MATERIALS AND METHODS:
A retrospective study of 10 females and three males undergoing surgery between 2001 and 2013 was performed. Demographic, clinical and radiologic data and long-term surgical outcomes were recorded. In 12 patients latero-lateral duodenojejunostomy and in one patient distal laparoscopic gastrectomy with Roux-en-Y reconstruction were performed. The median age was 24 years (20-28), and the median duration of symptoms was 24 months (5-24). The most frequent symptoms were abdominal pain (n¿=¿11; 92.3%), nausea and vomiting (n¿=¿10; 77%) and weight loss (n¿=¿9; 69.2%). The median operating time was 98 min (86-138) and hospital stay was 3 days (1-14).
RESULTS:
No reconversions occurred, and one patient experienced gastric emptying delay in the immediate postoperative period with spontaneous resolution. In four patients, SMAS was associated with severe stenosis of the celiac trunk which was treated in the same operation, and four patients presented stenosis of the left renal vein (the "nutcracker" phenomenon). With a median follow-up of 94 months (SD 65.3), eight patients (61.5%) had excellent results. One patient had a relapse of symptoms 4 years after surgery requiring distal gastrectomy, two patients presented delay in gastric emptying following temporary improvement and one patient experienced no improvement.
CONCLUSIONS:
Latero-lateral duodenojejunostomy yields good results in SMAS although it requires other gastric motility disorders to be ruled out for appropriate treatment to be established.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 112
N° 1
Año 2020
Págs.16 - 22
Background: the standard treatment for locally advanced rectal cancer is neoadjuvant chemo-radiotherapy, surgery and adjuvant chemotherapy. Only 50% of patients receive the adjuvant treatment due to the surgical complications and toxicity of radiotherapy. Recently, neoadjuvant chemotherapy has been investigated in the locally advanced rectal cancer setting, with the aim of guaranteeing an uninterrupted systemic treatment. The objective of the present study was to assess the safety and efficacy of neoadjuvant chemotherapy in locally advanced rectal cancer.
Methods and patients: patients treated with neoadjuvant chemotherapy and surgery were identified from a prospective database of patients with rectal cancer (cII-III). The primary outcomes were the assessment of the number of R0 resections, the degree of pathologic response, patterns of recurrence and overall and disease-free survival. Treatment schedule: patients received 6-8 cycles of oxaliplatin and fluoropyrimides based chemotherapy.
Results: twenty-seven patients who received neoadjuvant chemotherapy were identified. Twenty-six anterior resections and one Hartmann intervention were performed. An R0 resection was performed in 27 (100%) patients and no involvement of the circumferential margin was observed. Complete pathologic response (ypT0N0) was confirmed in four (14.8%) patients.The median follow-up was 35 months (range: 10-81) and four distant recurrences were recorded. Overall and disease-free survival at five years was 85% and 84.7%, respectively. Twenty-seven (100%) patients received all the cycles of chemotherapy, with a mean of six cycles (range 5-8) per patient.
Conclusions: neoadjuvant chemotherapy is a promising alternative in the locally advanced rectal cancer setting and further phase III clinical trials are clearly warranted.
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 38
N° 15 Supl.
Año 2020
Págs.4104
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 112
N° 8
Año 2020
Págs.609 - 614
Background: the prognostic value of the number of lymph nodes isolated (< 12 versus >= 12) in the surgical specimen continues to be controversial. In this study, the impact of isolating fewer or more than 12 lymph nodes in stage II colon cancer with a high-risk biologic phenotype was analyzed, such as the presence of perineural invasion.
Methods: all cases of stage II disease (T3-4N0M0) with perineural invasion (PNI+) were retrospectively identified from a prospective database of patients undergoing surgery for colon cancer. The cohort was divided into two groups depending on the number of lymph nodes isolated (< 12 vs >= 12). Apart from clinical and surgical data, the patterns of recurrence, overall (OS) and disease-free survival (DFS) at five and ten years were analyzed.
Results: sixty patients met the inclusion criteria, 31.7 % had < 12 lymph nodes isolated and 68.3 % had more than 12 isolated. There were no clinical or surgical differences between the two groups. OS at five and ten years was significantly lower in the patients with < 12 lymph nodes isolated (84.2 %, 62.7 % vs 94.6 % and 91.6 %, p = 0.01). DFS at five and ten years was 51 % vs 86.5 %, respectively (p = 0.005).
Conclusion: the number of lymph nodes isolated (with a cutoff of 12) in stage II colon cancer with PNI+ has prognostic value and should therefore be borne in mind when planning adjuvant chemotherapy.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 111
N° 2
Año 2019
Págs.87 - 93
Background: the aim of the present study was to analyze the clinicopathological features of patients undergoing pancreatic surgical resections due to cystic neoplasms of the pancreas. Material and methods: demographic data, form of presentation, radiologic images and location of the tumors within the pancreas were analyzed. Data was also collected on the type of surgery (open/laparoscopic), postoperative complications and their severity and oncologic outcomes. Results: eighty-two pancreatic resections were performed. The mean age of patients was 57 years and 49 (59%) were female. Forty-one tumors (50%) were incidental and the most frequent symptoms in the group of symptomatic patients were abdominal pain (63.4%) and weight loss (36.5%). Thirty-two tumors (39%) were located in the tail of the pancreas, 25 (30.5%) in the head and 20 (24.4%) in the body. Thirty-nine (47.5%) distal pancreatectomies, 16 central, ten duodenal pancreatectomies and one enucleation were performed; 40 (48.5%) were carried out laparoscopically. Mean hospital stay was ten days and eight patients (7%) experienced severe complications, one was a pancreatic fistula. Sixty-six tumors (80.5%) were recorded as non-invasive and 16 (19.5%) as invasive: seven intraductal mucinous papillary tumors, one cystic mucinous tumor, four solid pseudopapillary tumors and four cystic neuroendocrine tumors. There was a median follow-up of 64 months; disease-free survival at five and ten years was 97.4% in the patients with non-invasive tumors and 84.6% and 70.5% in the invasive tumors group (p < 0.01). Conclusions: fifty percent of cystic neoplasms of the pancreas are incidental. Two phenotypes exist, invasive and non-invasive.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972
Vol. 49
N° Supl. 1
Año 2019
Págs.150
Revista:
PLOS ONE
ISSN 1932-6203
Vol. 14
N° 5
Año 2019
Págs.e0215970
Background Perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced gastric (GC) or gastroesophageal junction cancer (GEJC) has been shown to improve survival compared to an exclusive surgical approach. However, most patients retain a poor prognosis due to important relapse rates. Population pharmacokinetic-pharma-codynamic (PK/PD) modeling may allow identifying at risk-patients. We aimed to develop a mechanistic PK/PD model to characterize the relationship between the type of neoadjuvant therapy, histopathologic response and survival times in locally advanced GC and GEJC patients. Methods Patients with locally advanced GC and GEJC treated with neoadjuvant CT with or without preoperative CRT were analyzed. Clinical response was assessed by CT-scan and EUS. Pathologic response was defined as a reduction on pTNM stage compared to baseline cTNM. Metastasis development risk and overall survival (OS) were described using the population approach with NONMEM 7.3. Model evaluation was performed through predictive checks. Results A low correlation was observed between clinical and pathologic TNM stage for both T (R = 0.32) and N (R = 0.19) categories. A low correlation between clinical and pathologic response was noticed (R = -0.29). The OS model adequately described the observed survival rates. Disease recurrence, cTNM stage >= 3 and linitis plastica absence, were correlated to a higher risk of death. Conclusion Our model adequately described clinical response profiles, though pathologic response could not be predicted. Although the risk of disease recurrence and survival were linked, the identification of alternative approaches aimed to tailor therapeutic strategies to the individual patient risk warrants further research.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972
Vol. 48
N° Supl 1
Año 2018
Págs.202
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 110
N° 3
Año 2018
Págs.138 - 144
Purpose: The objective of the study was to analyze the clinico-pathological differences and the oncologic outcomes between right and left-sided colon cancer. Patients and methods: The patients cohort was identified from a prospective register of colon cancer, 950 patients underwent surgery (stages I, II and III), of which 431 had right-sided colon cancer and 519 had left-sided colon cancer. Results: More laparoscopic resections were performed (101 vs 191; p < 0.001) and operating times were longer (146 min vs 165 min; p < 0.001) in the left-sided colon group. Patients with right-sided colon cancer more frequently received transfusions (18.8% vs 11.3%; p < 0.001) and experienced a greater number of complications (28.5% vs 20.9%, p = 0.004), although severity and operative mortality were similar in both groups (1.2% vs 0.2%). Mucinous adenocarcinomas and undifferentiated tumors were more frequent in the right-sided group (12% vs 6.5%; p < 0.001). Early stage was predominant in the left-sided colon tumors (28.2% vs 34.5%, p = 0.02). There were no differences in disease-free survival (DFS) in stages I and II after a median follow-up of 103 months. However, a greater survival at five and ten years in left-sided, stage III tumors was observed, with a trend towards statistical significance (p = 0.06). No differences were found with regard to the patterns of recurrence. Conclusions: Right-sided colon cancer exhibits phenotypical differences with regard to left-sided colon cancer. In stage III disease, left-sided colon cancer has a greater survival with a trend towards statistical significance. Overall, tumor location is a variable that should be taken into consideration in clinical studies of colon cancer.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972
Vol. 48
N° Supl. 1
Año 2018
Págs.191
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN 1699-048X
Vol. 20
N° 5
Año 2018
Págs.658 - 665
Synchronous liver metastases (LM) from gastric (GC) or esophagogastric junction (EGJ) adenocarcinoma are a rare events. Several trials have evaluated the role of liver surgery in this setting, but the impact of preoperative therapy remains undetermined. Patients with synchronous LM from GC/EGJ adenocarcinoma who achieved disease control after induction chemotherapy (ICT) and were subsequently scheduled to chemoradiotherapy (CRT) to the primary tumor and surgery assessment were retrospectively analyzed. Pathological response, patterns of relapse, progression-free survival (PFS), and overall survival (OS) were calculated. From July 2002 to September 2012, 16 patients fulfilling the inclusion criteria were identified. Primary tumor site was GC (nine patients) or EGJ (seven patients). LM were considered technically unresectable in nine patients. Radiological response to the whole neoadjuvant program was achieved in 13 patients. Eight patients underwent surgical resection of the primary tumor; in five of these LM were resected. A complete pathological response in the primary or in the LM was found in four and three patients, respectively. The most frequent site of relapse/progression was systemic (eight patients). Local and liver-only relapses were observed in two patients each. After a median follow-up of 91 months, the median OS and PFS were 23.0 (95% CI 13.2-32.8) and 17.0 months (95% CI 11.7-22.3). 5-year actuarial PFS is 17.6%. Our results suggest that an intensified approach using ICT followed by CRT in synchronous LM from GC/EGJ adenocarcinoma is feasible and may translate into prolonged survival times in selected patients.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 110
N° 12
Año 2018
Págs.768 - 774
Objective: the objective of this study was to analyze the anatomical and clinical features and long-term oncologic outcomes of 25 patients that underwent surgery due to intraductal papillary mucinous neoplasm of the pancreas.
Material and methods: patients undergoing surgery for intraductal papillary mucinous neoplasm of the pancreas were identified from a prospective database of pancreatic resections. Demographic data, symptoms, type of surgery and type of lesion (branch type, main duct or mixed) were recorded. The lesions were classified into invasive (high grade dysplasia and carcinoma) and noninvasive (low- or intermediate-grade dysplasia). Postoperative complications were analyzed as well as the pattern of recurrence and disease-free survival at five and ten years.
Results: the most common symptoms in the 25 patients (14 males and eleven females) were abdominal pain and weight loss. Eight (32%) cases were diagnosed incidentally. Twelve (48%) of the lesions were of the branch type, three affected the main duct and ten (40%) were mixed. Twelve cephalic duodenopancreatectomies and seven total pancreatectomies were performed; three were central; two, distal; and one, enucleation. Seven cases (32%) had an invasive phenotype. Three patients had locoregional and distant recurrence at six, 16 and 46 months after surgery with a median follow-up of 7.7 years. Disease-free survival at five and ten years for the noninvasive type was 94% and 57% for invasive phenotypes (p < 0.05).
Conclusions: intraductal papillary mucinous neoplasm is a heterogeneous entity with well differentiated phenotypes, which requires a tailored strategy and treatment, as established in the current consensus guidelines due to its malignant potential.
Revista:
JOURNAL OF GASTROINTESTINAL SURGERY
ISSN 1091-255X
Vol. 22
N° 4
Año 2018
Págs.713 - 721
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. 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. 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. 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.
Revista:
FRONTIERS IN IMMUNOLOGY
ISSN 1664-3224
Vol. 9
Año 2018
Págs.2918
Emerging evidence reveals that adipose tissue-associated inflammation is a main mechanism whereby obesity promotes colorectal cancer risk and progression. Increased inflammasome activity in adipose tissue has been proposed as an important mediator of obesity-induced inflammation and insulin resistance development. Chronic inflammation in tumor microenvironments has a great impact on tumor development and immunity, representing a key factor in the response to therapy. In this context, the inflammasomes, main components of the innate immune system, play an important role in cancer development showing tumor promoting or tumor suppressive actions depending on the type of tumor, the specific inflammasome involved, and the downstream effector molecules. The inflammasomes are large multiprotein complexes with the capacity to regulate the activation of caspase-1. In turn, caspase-1 enhances the proteolytic cleavage and the secretion of the inflammatory cytokines interleukin (IL)-1 beta and IL-18, leading to infiltration of more immune cells and resulting in the generation and maintenance of an inflammatory microenvironment surrounding cancer cells. The inflammasomes also regulate pyroptosis, a rapid and inflammation-associated form of cell death. Recent studies indicate that the inflammasomes can be activated by fatty acids and high glucose levels linking metabolic danger signals to the activation of inflammation and cancer development. These data suggest that activation of the inflammasomes may represent a crucial step in the obesity-associated cancer development. This review will also focus on the potential of inflammasome-activated pathways to develop new therapeutic strategies for the prevention and treatment of obesity-associated colorectal cancer development.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 110
N° 11
Año 2018
Págs.684 - 690
Purpose: the aim of this study was to compare overall and disease-free survival among patients with colorectal cancer detected via a screening program as compared to those with symptomatic cancer.
Material and methods: patients diagnosed via colonoscopy (screening group) and those with clinical symptoms (non-screening) were identified from 1995 to 2014. Demographic, clinical, surgical and pathologic variables were recorded. Stage I, II and III cancers were included. Overall and disease-free survival were calculated at five and ten years after tumor resection and survival was calculated by matching both groups for cancers at stage I, II and III.
Results: two hundred and fifty patients were identified as a result of screening procedures and 1,330 patients presented with symptomatic cancers.There were no significant differences in the baseline characteristics between the two groups. Pathologic stage, degree of differentiation, perineural invasion and lymphovascular invasion were lower in the screening group (p < 0.01). Overall and disease-free survival at five and ten years were higher in the screening group (p < 0.01). However, when the subjects were matched for pathologic stage, significant differences were found between the two groups with regard to stage I and III tumors. Disease-free survival in stage III at five years (79.1 vs 61.7%; p < 0.001) and ten years (79.1% vs 58.5%; p < 0.001) were significantly higher in the screening group.
Conclusions: patients with stage I and III tumors that were diagnosed via a screening program have a higher overall and disease-free survival at five and ten years.
Revista:
INTERNATIONAL JOURNAL OF SURGERY
ISSN 1743-9191
Vol. 52
Año 2018
Págs.303 - 308
Purpose: The objective is to analyze the impact of severe postoperative complications in patients undergoing curative surgery for colon cancer. Material and methods: From a prospective database, we identified patients with stage I-III disease (AJCC) who underwent surgery between 2000 and 2014. Patients were selected with major complications (IIIb on the Clavien-Dindo classification) and with no major complications. Variables were analyzed in both groups. Local, peritoneal and distant recurrence together with overall survival and disease-free survival were analyzed. Results: Of a total of 950 patients, 51 (5.3%) experienced major complications. Operative mortality was 2.6%. Age, ASA grade, urgent surgery, pre-operative hemoglobin, right-sided location, operative time, transfusion, conversion to open surgery, were all associated with major complications (all P < 0.05). With a median follow-up of 84.8 and 40 months in both groups, there was greater incidence of local recurrences in patients experiencing complications (2.4% vs 7.8%; P=0.03 OR 3.39, 95% CI 1.12-10.24), being more marked in stage III patients (4.2% vs 21%; P=0.005, OR 6.13 95% CI 1.74-21.56). In the stage III group, peritoneal recurrence was significantly greater in patients with complications (13.6% vs 31.6%; P=0.04 OR 2.92 95% CI 1.04-8.18). Patients with major complications had a significantly lower overall survival (P=0.024) than patients with no complications both at 5 years (78.9% vs 68.8%) and 10 years (74.6% vs 32.1%). The same trend was observed for disease-free survival (71.6% vs 48.3% and 69.8% vs 32.2%; P=0.013). Conclusion: The development of major complications following colectomy for colon cancer has a negative impact on long-term oncologic outcomes, especially in stage III disease.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 109
N° 11
Año 2017
Págs.778 - 787
Cystic pancreatic neuroendocrine tumors represent 13% of all neuroendocrine tumors. The aim of this study is to analyze the phenotype and biologic behavior of resected cystic neuroendocrine tumors. A systematic review and meta-analysis were conducted until September 2016 using a search in Medline, Scopus, and EMBASE with the terms "cystic pancreatic endocrine neoplasm", "cystic islets tumors" and "cystic islets neoplasms". From the 795 citations recovered 80 studies reporting on 431 patients were selected. 87.1% (n = 387) were sporadic tumors and 10.3% (n = 40) corresponded to multiple endocrine neoplasia type 1. Were diagnosed incidentally 44.6% (n = 135). Cytology was found to have a sensitivity of 78.5%. Were non-functional tumors 85% (n = 338), and among the functional tumors, insulinoma was the most frequent. According to the European Neuroendocrine Tumor Society staging, 87.8% were limited to the pancreas (I-IIb), and 12.2% were advanced (III-IV). Disease-free survival at 5 years in stages (I-IIIa) and (IIIb-IV) was 91.5% and 54.2%, respectively; and was significantly lower (p = 0.0001) in functional tumors. In patients with multiple endocrine neoplasia there was a higher incidence of functional (62.5%) and multifocal (28.1%) tumors. Disease-free survival at 5 and 10 years was 60%. Cystic pancreatic neuroendocrine tumors exhibit phenotypical characteristics which are different to those of solid neuroendocrine tumors.
Revista:
JOURNAL OF MEDICAL CASE REPORTS
ISSN 1752-1947
Vol. 11
N° 1
Año 2017
Págs.115
BACKGROUND:
Chemotherapy is considered the most appropriate treatment for metastatic uterine sarcoma, despite its limited efficacy. No other treatment has been conclusively proved to be a real alternative, but some reports suggest that anti-hormonal therapy could be active in a small subset of patients. We report the case of a patient with metastatic uterine carcinosarcoma with positive hormonal receptors and a complete pathological response.
CASE PRESENTATION:
A 54-year-old white woman presented to our emergency room with hypovolemic shock and serious vaginal bleeding. After stabilization, she was diagnosed as having a locally advanced uterine carcinosarcoma with lymph nodes and bone metastatic disease. In order to control the bleeding, palliative radiotherapy was administered. Based on the fact that positive hormone receptors were found in the biopsy, non-steroidal aromatase inhibitor therapy with letrozole was started. In the following weeks, her general status improved and restaging imaging tests demonstrated a partial response of the primary tumor. Ten months after initiating aromatase inhibitor therapy, she underwent a radical hysterectomy and the pathological report showed a complete response. After completing 5 years of treatment, aromatase inhibitor therapy was stopped. She currently continues free of disease, without further therapy, and maintains a normal and active life.
CONCLUSIONS:
This case shows that patients with uterine carcinosarcoma and positive hormone receptors may benefit from aromatase inhibitor therapy. A multidisciplinary strategy that includes local therapies such as radiation and/or surgery should be considered the mainstay of treatment. Systemic therapies such as hormone inhibitors should be taken into consideration and deserve further clinical research in the era of precision medicine.
Revista:
ONCOIMMUNOLOGY
ISSN 2162-402X
Vol. 6
N° 7
Año 2017
Págs.e1328338
Growing evidence indicates that adipose tissue inflammation is an important mechanism whereby obesity promotes cancer risk and progression. Since IL-32 is an important inflammatory and remodeling factor in obesity and is also related to colon cancer (CC) development, the aim of this study was to explore whether IL-32 could function as an inflammatory factor in human obesity-associated CC promoting a microenvironment favorable for tumor growth. Samples obtained from 84 subjects [27 lean (LN) and 57 obese (OB)] were used in the study. Enrolled subjects were further subclassified according to the established diagnostic protocol for CC (49 without CC and 35 with CC). We show, for the first time, that obesity (p = 0.009) and CC (p = 0.026) increase circulating concentrations of IL-32¿. Consistently, we further showed that gene (p < 0.05) and protein (p < 0.01) expression levels of IL-32¿ were upregulated in VAT from obese patients with CC. Additionally, we revealed that IL32 expression levels are enhanced by hypoxia and inflammation-related factors in HT-29 CC cells as well as that IL-32¿ is involved in the upregulation of inflammation (IL8, TNF, and CCL2) and extracellular matrix (ECM) remodeling (SPP1 and MMP9) genes in HT-29 cancer cells. Additionally, we also demonstrate that the adipocyte-conditioned medium obtained from obese patients stimulates (p < 0.05) the expression of IL32 in human CC cells. These findings provide evidence of the potential involvement of IL-32 in the development of obesity-associated CC as a pro-inflammatory and ECM remodeling cytokine.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN 1699-048X
Vol. 19
N° 3
Año 2017
Págs.379 - 385
Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery. Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied. Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65-82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8-79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2-63.7 %) (p < 0.005) of SUVmax (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p (25)-p (75): 27.3-57.8) 3-5 year actuarial RFS was 88.9-85.6 %, respectively. Five-year actuarial OS was 95.3 %. Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.
Revista:
ANNALS OF SURGICAL ONCOLOGY
ISSN 1068-9265
Vol. 24
N° 4
Año 2017
Págs.1077 - 1084
Background. Perineural invasion (PNI) in colon cancer (CC) has been associated with poorer prognosis even in stage II disease (T3-4 N0 M0). The aim of this study is to analyze prognostic histopathologic factors in stage II colon cancer in patients treated with curative surgery as established in National Comprehensive Cancer Network guidelines. Methods. From a prospective database of CC cases, 507 patients with stage I-II disease who had undergone curative resection from January 2000 and December 2012 were identified. Of these patients, 17 % received 5-flurouracil-based adjuvant chemotherapy. Together with demographic and anatomic variables, we also studied perineural and lymphovascular invasion, degree of differentiation, and their correlation with disease-free survival. Results. Perineural invasion was identified in 57 patients (11.2 %) and lymphovascular invasion (LVI) in 82 (16.2 %) of the 507 patients. Perineural invasion was associated with LVI, the depth of invasion of the wall of the colon, and location of the tumor. Overall and disease-free survival of the complete series at 5 and 10 years was 89.5, 85.2, 83.2 and 81.6 %, respectively. In the PNI positive patients, disease-free survival at 5 years was significantly lower than in those without PNI (73.5 vs 88.6 %; p = 0.02). Multivariate analysis showed the presence of PNI to be a significant independent prognostic factor for disease-free survival (p = 0.025). Adjuvant chemotherapy reversed the impact of PNI on 5-to 10-year disease-free survival. Conclusions. PNI a major prognostic and predictive factor in stage II colon cancer, and our results support the use of adjuvant chemotherapy in patients with PNI.
Revista:
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN 0930-2794
Vol. 31
N° 10
Año 2017
Págs.3847 - 3857
Laparoscopic organ-sparing pancreatectomy (LOSP) is an ideal therapeutic option in selected cases of pancreatic neuroendocrine tumors (PNETs). Nevertheless, given the low frequency of PNETs, there is scarce evidence regarding short and particularly long-term outcomes of LOSP in this clinical setting. All patients with PNETs who underwent surgery (under a LOSP policy) were retrospectively reviewed from a prospective database maintained at our center. Preoperative characteristics, operative data, pathological features and postoperative outcomes were analyzed. Between December 2003 and December 2015, 36 patients with PNETs underwent laparoscopic resections. Ten were functional tumors, 26 non-functional and 16 were "incidental" cases. The following procedures were performed: one enucleation, eight central pancreatectomies (LCP), one resection of the uncinate process and 26 distal pancreatectomies (DP) (15 of them laparoscopic vessels-preserving). There were no conversions to open surgery, and no drains were routinely left. Mean operative time was 288 min (SD 99). Hospital stay was 6 days. Eighteen patients (50%) experienced some complication of which most were mild (Clavien-Dindo I/II). Three postoperative bleedings occurred: two grade B/one grade C; two required laparoscopic reoperation. Thirteen (36.1%) patients developed peripancreatic fluid collections: two were symptomatic and were managed with transgastric drainage (one presented post-puncture abscesification requiring surgical drainage and splenectomy). Four patients (11%)-one DP and three LCP-developed new-onset pancreatogenic diabetes mellitus (NODM) in the long term. According to the European Neuroendocrine Tumor Society, 19 cases were stage I, seven IIA, two IIIA, one IIIB and seven stage IV. Over a mean follow-up of 51 months, two patients died, one due to recurrence of the tumor and another due to cirrhosis. The existing different surgical options must be individually considered according to the location and particular characteristics of every tumor. Results from this single-center study document the effectiveness of LOSP in selected cases of PNETs.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 109
N° 11
Año 2017
Págs.802 - 802
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 108
N° 11
Año 2016
Págs.689 - 696
Background: Pancreatic neuroendocrine tumors (pNETs) comprise a heterogeneous group of tumors with a varied biological behavior. In the present study, we analyzed the experience of 79 pNETs resected between 1993 and 2015. The pathologic prognostic factors (European Neuroendocrine Tumor Society, ENETS; and AJCC) classification, vascular invasion (VI), proliferation index (ki-67) and the presence of necrosis were retrospectively reviewed. Methods: The clinical data of 79 patients with pNETs who underwent surgery were retrospectively analyzed. Mortality rates and Kaplan-Meier estimates were used to evaluate survival over time for pathologic stages, tumor functionality, and vascular invasion. Cox proportional hazards models were used to calculate the hazard ratio regarding ENETS, AJCC staging, sex, tumor functionality and vascular invasion. Results: The male: female ratio was 40: 39. Twenty-one patients (26%) had functional tumors and 58 (73.4%) had nonfunctional tumors, of which 35 (44.3%) were diagnosed incidentally. Seventeen Whipple procedures, 46 distal pancreatectomies (including 26 laparoscopic and 20 open procedures), 8 laparoscopic central pancreatectomies, 1 laparoscopic resection of the uncinated process and 7 enucleations (one laparoscopic) were performed. Vascular invasion and necrosis were observed in 29 of 75 cases (38.6%) and in 16 cases (29%), respectively. The comparison between survivor functions of ENETS staging categories showed statistically significant differences (p = 0.042). Mortality rate was higher in patients with non-functioning tumors compared with hormonally functioning tumors (p = 0.052) and in those with vascular invasion (p = 0.186). Conclusions: In spite of the heterogeneity of pNETs, the ENETS TNM classification efficiently predicts long-term prognosis. The non-functioning tumors and the presence of vascular invasion are associated with poor prognosis.
Revista:
COLORECTAL DISEASE
ISSN 1462-8910
Vol. 18
N° Supl. 1
Año 2016
Págs.24
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN 1699-048X
Vol. 18
N° 7
Año 2016
Págs.714-721
Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.
Revista:
OBESITY SURGERY
ISSN 0960-8923
Vol. 26
N° 2
Año 2016
Págs.282 - 288
Background: Current evidence suggests that local anesthetic wound infiltration should be employed as part of multimodal postoperative pain management. There is scarce data concerning the benefits of this anesthetic modality in laparoscopic weight loss surgery. Therefore, we analyzed the influence of trocar site infiltration with bupivacaine on the management of postoperative pain in laparoscopic bariatric surgery.
Methods: This retrospective randomized study included 47 patients undergoing primary obesity surgery between January and September 2014. Laparoscopic gastric bypass was performed in 39 cases and sleeve gastrectomy in 8 cases. Patients were stratified into two groups depending on whether preincisional infiltration with bupivacaine and epinephrine was performed (study group, 27 patients) or not (control group, 20 patients). Visual analogue scale (VAS), International Pain Outcomes questionnaire, and rescue medication records were reviewed to assess postoperative pain.
Results: VAS scores in the study group and sleeve gastrectomy group were lower than those in the control and gastric bypass groups in the first 4 h postoperatively without reaching statistical significance (p > 0.05). VAS scores did not differ in any other period of time. No statistically significant differences in pain perception were registered according to the patient's pain outcomes questionnaire or the need for rescue medication.
Conclusions: The present study did not conclusively prove the efficacy of bupivacaine infiltration by any of the three evaluation methods analyzed. Nevertheless, preincisional infiltration provides good level of comfort in the immediate postoperative period when analgesia is most urgent.
Revista:
PLOS ONE
ISSN 1932-6203
Vol. 11
N° 9
Año 2016
Págs.e0162189
To our knowledge, we herein show for the first time that obese patients with CC exhibit increased circulating levels of OPN, YKL-40 and TNC providing further evidence for the influence of obesity on CC development via ECM proteins, representing promising diagnostic biomarkers or target molecules for therapeutics.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN 1699-048X
Vol. 18
N° 9
Año 2016
Págs.909-914
Combined treatment for LARC obtains a 5-year OS rounding 90 %. Follow-up based on thoracic-abdominal CT scan allows an early diagnosis of metastatic lesions. Surgical resection of metastases, regardless of their location, greatly increases the patient's survival rate.
Revista:
BRITISH JOURNAL OF CANCER
ISSN 0007-0920
Vol. 115
N° 6
Año 2016
Págs.655 - 663
Background: The degree of histopathological response after neoadjuvant therapy in locally advanced gastric cancer (GC) is a key determinant of patients' long-term outcome. We aimed to assess the pattern of histopathological regression after two neoadjuvant approaches and its impact on survival times.
Methods: Regression grade of the primary tumour (Becker criteria) and the degree of nodal response by a 4-point scale (grades A-D) were assessed. Grade A-true negative lymph nodes (LNs); grade B and C-infiltrated LNs with any or little evidence of nodal response; and grade D-complete pathological response in a previously infiltrated LN. A favourable pathological response was defined as Becker Ia-b and grade D.
Results: From 2004 to 2014, 80 patients with GC (cT3-4/N + by CT-scan/EUS) were treated with either preoperative chemotherapy (ChT, n = 34) or chemoradiation (CRT, n = 46). Patients in the CRT group had a higher likelihood of achieving a Becker Ia-b response (58 vs 32%, P = 0.001), a grade D nodal regression (30 vs 6%, P = 0.009) and a favourable pathological response (23 vs 3%; P = 0.019). Patients with a grade D nodal response had a longer 5-year PFS and OS compared with those with a grade B or C response. Patients with a baseline negative LN status had similar outcomes irrespective of the preoperative therapy received (5-year OS; ChT vs CRT, 58 vs 51%, P = 0.92).
Conclusions: Preoperative chemoradiation increases the likelihood of achieving favourable ...
Revista:
ENDOSCOPY
ISSN 0013-726X
Vol. 48
N° Supl. 1
Año 2016
Págs.E346 - E347
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 33
N° 3 S
Año 2015
Págs.744
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 33
N° 3 S
Año 2015
Págs.718
Revista:
ANNALS OF SURGICAL ONCOLOGY
ISSN 1068-9265
Vol. 22
N° 3
Año 2015
Págs.916-923
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.
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 33
N° 3 S
Año 2015
Págs.695
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 93
N° 3
Año 2015
Págs.207 - 208
Como señalan García-Granero et al.3, tras 30 años de progresos técnicos en el tratamiento del CRLA, además de la cirugía correcta, debemos tratar la enfermedad sistémica ¿micrometástasis, células tumorales circulantes¿ precozmente en los casos de alto riesgo, como es el tercio distal del recto
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 107
N° 6
Año 2015
Págs.340-346
With a mean follow-up of 70.06 months, local recurrence was 4.8% and distant recurrence 25.5%. No differences were found in the histopathologic prognostic factors across the three groups studied depending on distance (cm) from the anal margin. Involvement of the circumferential resection margin (CRM+) was significantly greater in tumors in the distal third of the rectum (8.5%; p = 0.04). 67 patients (13.4%) showed a complete pathologic response. DSF at 5 and 10 years was significantly lower in patients with tumors affecting the distal third as compared to the middle third of the rectum (61.9% vs. 57.7%; p = 0.04). Tumors at this distal location resulted in a significantly higher incidence of lung metastases (p = 0.016).
Revista:
RADIOTHERAPY AND ONCOLOGY
ISSN 0167-8140
Vol. 116
N° 2
Año 2015
Págs.316 - 322
Purpose To evaluate the influence of equivalent dose (EQD2) in clinical outcomes of patients with isolated locally recurrent tumors (ILRT), treated with salvage surgery and intra-operative electron beam radiation therapy (IOERT). Methods and materials We retrospectively reviewed 128 patients with non-metastatic ILRT of different tissues (soft tissue sarcomas, head and neck, uterine, and colorectal). Patients had received salvage surgery (R0/R1/R2) and IOERT. Previously not irradiated patients had received additional external beam radiation therapy (EBRT). Results IOERT was delivered at a median dose of 15 Gy (range, 5-25 Gy). Seventy-five patients (60.9%) received additional EBRT of 46 Gy. Median EQD2 of salvage program was 62 Gy and median EQD2 of exclusive IORT was 31.2 Gy. Median follow-up was 19.2 months (range: 1.3-220). Thirty-one patients (24.2%) developed severe (grade 3-5) complications. New locoregional recurrence was documented in 86 (67.2%) of the 123 cases. Five-year rates were 31% for locoregional control, 57% for distant metastasis-free and 31% for overall survival. On multivariate analysis, R0-1 vs. R2 resection (HR 2.2, 95 CI: 1.2-4.1) was statistically significant for locoregional recurrence and EQD2 ¿62 Gy for survival (HR 2.2, 95 CI: 1.1-4.1). Conclusions Surgical radicality (gross macroscopic resection) and radiation dose (EQD2 ¿62 Gy in radiation salvage program) are the dominant prognostic factors beside ILRT histology. Modest rates of long-term disease control are expected when both factors are fulfilled.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° Supl. 1
Año 2014
Págs.113
Revista:
JOURNAL OF GASTROINTESTINAL ONCOLOGY
ISSN 2078-6891
Vol. 5
N° 2
Año 2014
Págs.148-153
Neoadjuvant chemotherapy as a systemic treatment for stage IV colon cancer does not indicate surgery contraindication nor increases postoperative morbimortality by a significant amount.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° Supl. 1
Año 2014
Págs.26
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 92
N° Especial Congreso
Año 2014
Págs.371
Objetivos: La respuesta patológica del cáncer de recto localmente avanzado (CRLA) a la quimio-radioterapia neoadyuvante es hoy día el método más fiable para valorar la respuesta a la CRT, aunque existen controversias sobre su significación pronóstica. En el presente trabajo se analiza la presencia de respuesta coloide y su significación pronóstica en un programa de CRT preoperatoria en el CRLA.
Métodos: De un total de 621 pacientes con cáncer de recto, 324 con CRLA fueron tratados con CRT preoperatoria: durante 5 semanas asociado a 5-FU. En 44 pacientes (13,6%) el tumor estaba en el tercio superior, en 135 (41,7%) en el tercio medio y en 145 (44,8%) en el tercio distal. La mediana de la dosis de radioterapia (cGy) y del tiempo hasta la cirugía fueron de 4.680 cGY (P25-P75: 4.500-5.040) y 34 (P25-P75: 33-42) días respectivamente. En la pieza quirúrgica se valoró el grado de respuesta tumoral, TNM, invasión linfovascular, infiltración perineural y la presencia de respuesta coloide con y sin presencia de células.
Resultados: Se objetivó respuesta coloide en 134 (41,3%); de los cuales en 86 (64%) fue coloide acelular y en 48 (36%) con presencia de células. Se objetivó mayor respuesta coloide sin células en los tumores proximales vs distales (42,8% vs 31,1%). No hubo relación entre la repuesta coloide y el estadio clínico TNM (c TNM). Por el contrario, se observó relación significativa entre la disminución del estadio tumoral y la presencia de respuesta coloide acelular. Con una mediana de seguimiento de 79 meses (rango 3-250), la supervivencia libre de enfermedad (DFS) a los 5 y 10 años fue del 75,1% y del 71,4. Los pacientes con respuesta coloide con células tuvieron una disminución del 20% en la DFS a los 5 (60,4%) frente a los que presentaban respuesta coloide acelular, 79,4% (p < 0,0225). La respuesta coloide con células incrementaba en 2,5 las posibilidades de fallecimiento respecto a los de respuesta coloide acelular (HR = 2,5 (1,1-5,76) p = 0,028, cox univariante).
Conclusiones: La presencia de respuesta coloide tiene significación pronóstica en el CRLA, tratado con CRT neoadyuvante y debe incluirse en el estudio patológico con el fin de establecer pautas de tratamiento adyuvante.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° Supl. 1
Año 2014
Págs.18
Revista:
SURGERY TODAY
ISSN 0941-1291
Vol. 44
N° 12
Año 2014
Págs.2318-2323
If longer-term follow-up is achieved, definitive conclusions may be obtained. However, the present results suggest that the cleft lift procedure may become the gold standard technique for the surgical management of non-acute pilonidal disease.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° 3
Año 2014
Págs.171 - 194
Liver regeneration (LR) is one of the most amazing tissue injury response. Given its therapeutic significance has been deeply studied in the last decades.LR is an extraordinary complex process, strictly regulated, which accomplishes the characteristics of the most evolutionary biologic systems (robustness) and explains the difficulties of reshaping it with therapeutic goals.TH reproduces the physiological tissue damage response pattern, with a first phase of priming of the hepatocytes-cell-cycle transition G0-G1¿, and a second phase of proliferation ¿cell-cycleS/M phases¿ which ends with the liver mass recovering. This process has been related with the tissue injury response regulators as: complement system, platelets, inflammatory cytokines(TNF-a, IL-1b, IL-6), growth factors (HGF, EGF, VGF) and anti-inflammatory factors (IL-10, TGF-b).Given its complexity and strict regulation, illustrates the unique alternative to liver failure is liver transplantation.The recent induced pluripotential cells (iPS) description and the mesenchymal stem cell (CD133+) plastic capability have aroused new prospects in the cellular therapy field. Those works have assured the cooperation between mesenchymal and epithelial cells. Herein, we review the physiologic mechanisms of liver regeneration.
Revista:
ANNALS OF ONCOLOGY
ISSN 0923-7534
Vol. 25
N° 2
Año 2014
Págs.83 - 84
Introduction: Preoperative chemotherapy remains an experimental approach in patients (pts) with locally advanced colon cancer (LACC) that is being actively tested in ongoing randomised trials. We assessed the feasibility and preliminary evidence of activity of incorporating a direct monitoring of 5-FU levels based on pharmacokinetic-(PK) guided dose adjustments.
Methods: Radiologically-staged LACC pts (T4 or T3 with >5mm invasion beyond the muscularis propia), were planned to receive 4 cycles of Oxaliplatin (85mg/m2), Leucovorin (400 mg/m2), bolus 5-FU (400 mg/m2) and infusional 5-FU (initial dose of 2400mg/m2 in 46h and subsequent cycles tailored according to PK monitoring in order to reach a target 5-FU area under the curve (AUC) between 20-30 mg·h·L-1) on a biweekly basis. Surgery was scheduled 4 to 6 weeks after the completion of chemotherapy treatment. All pts were staged at baseline and before surgery. Pathological tumor regression was graded according to the MSKCC classification. Toxicity was reported according to the NCI-CTCAE 4.0.
Results: From March 2011 to August 2013, 19 pts (M/F: 13/6; median age 60) with LACC were evaluated. Median dose of 5-FU was 5000 mg. 78.9% of the pts required a 5-FU dose increase to reach the target AUC. Median 5-FU plasma clearance was 199,58 L/h. Side effects profile included G3 neutropenia (6 pts), G2 diarrhea (5 pts), G2 nausea (3 pts) and G2 asthenia (5 pts). Neoadjuvant treatment was discontinued in 2 pts due to small bowel obstruction requiring surgery. No progressive disease was observed during preoperative chemotherapy. A radiological dowstaging was achieved in 11 pts (58%). All pts underwent surgery (laparoscopy-assisted 50%) with an R0 resection rate of 89.47%. There were no treatment-related deaths. Pathological responses (MSKCC score) included grades 4, 3+ and 3 in 10.5%, 15.78% and 21% of pts, respectively. Median number of harvested nodes was 23 (7-51) with a ypN0 rate of 79%. Median time to hospital discharge was 9 days. After a median follow-up of 15 months (6-35), the 12-month actuarial PFS and OS were 76.5% and 97.4%, respectively.
Conclusion: Preoperative PK-adjusted FOLFOX in LACC pts is safe and well tolerated, achieving major pathological responses in almost 50% the pts and a remarkable R0 resection rate. This strategy may be an alternative in the management of patients with LACC but further research seems warranted. Almost 80% of the patients required a dose increase to achieve target dose levels.
Revista:
JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X
Vol. 32
N° Supl. 3
Año 2014
Págs.579
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° 3
Año 2014
Págs.171-194
Liver regeneration (LR) is one of the most amazing tissue injury response. Given its therapeutic significance has been deeply studied in the last decades.LR is an extraordinary complex process, strictly regulated, which accomplishes the characteristics of the most evolutionary biologic systems (robustness) and explains the difficulties of reshaping it with therapeutic goals.TH reproduces the physiological tissue damage response pattern, with a first phase of priming of the hepatocytes-cell-cycle transition G0-G1¿, and a second phase of proliferation ¿cell-cycleS/M phases¿ which ends with the liver mass recovering. This process has been related with the tissue injury response regulators as: complement system, platelets, inflammatory cytokines(TNF-a, IL-1b, IL-6), growth factors (HGF, EGF, VGF) and anti-inflammatory factors (IL-10, TGF-b).Given its complexity and strict regulation, illustrates the unique alternative to liver failure is liver transplantation.The recent induced pluripotential cells (iPS) description and the mesenchymal stem cell (CD133+) plastic capability have aroused new prospects in the cellular therapy field. Those works have assured the cooperation between mesenchymal and epithelial cells. Herein, we review the physiologic mechanisms of liver regeneratio
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 92
N° Especial Congreso
Año 2014
Págs.97
Objetivos: La asociación de quimio-radioterapia preoperatoria (CRT) y la extirpación completa del mesorrecto (TME) representa el tratamiento estándar del cáncer de recto localmente avanzado (CRLA) (estadios II y III). El objetivo del presente trabajo es exponer los resultados oncológicos a largo plazo de 356 pacientes con CRLA, tratados en un periodo de 25 años.
Métodos: De un total de 621 se analizan 356 pacientes con CRLA. En 55 (15,4%) el tumor estaba localizada en el tercio superior, en 120 (33,7%) en el tercio medio y en 181 (50,8%) en el tercio inferior. La mediana de la dosis de radioterapia para los tres grupos osciló entre 47,5 Gy y 48,52. La quimioterapia concomitante fue: 5-fluoroacilo (5-FU) o capecitabina en combinación con oxaliplatino. Se analizó el tipo de cirugía, el grado de respuesta patológico, la afectación del margen circunferencial, respuesta coloide, la presencia de invasión linfovascular, la recurrencia local y a distancia y la supervivencia global y libre de enfermedad.
Resultados: La mediana del intervalo entre la CRT y la cirugía fue de 40 días (rango 24-104). Se realizaron 52 resecciones anteriores de recto (LAR) en el tercio superior (94,5%), 112 (93,3%) en el tercio medio y 92 (50,8%) en el tercio inferior; con 4 (3,3%) amputación en el tercio medio y 72 (39,8%) en el tercio distal. No se encontraron diferencias significativas en los tres grupos en el número de ganglios aislados, en el índice ganglionar, en la invasión venosa, invasión perineural, ni en el grado de respuesta tumoral al CRT. Se objetivó respuesta patológica completa (pCR) en 5 pacientes (9,1%) del tercio superior, en 12 (10,0%) del tercio inferior y en 32 (17,7%) del tercio inferior. Con un seguimiento medio de 187 meses; la supervivencia libre de enfermedad a los 5 y a los 10 años en los 3 grupos fue del 75%, 76% y 69% y del 75%, 71% y 66%, respectivamente. La recidiva local fue del 3,6%, 4,2% y 6,1% en los tres grupos. La recurrencia a distancia más frecuente fue en pulmón - 10,9%, 16,7%, 23,8%- con diferencias casi significativas (p < 0,007) en el tercio distal.
Conclusiones: A pesar del buen control local con CRT y TME en el CRLA, la recidiva a distancia especialmente en el tercio inferior, plantea la necesidad de nuevas estrategias terapéuticas, dirigidas a la enfermedad sistémica.
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 92
N° Especial Congreso
Año 2014
Págs.98
Objetivos: El tratamiento estándar del cáncer de recto localmente avanzado (CRLA) (estadios II y III) es quimio-radioterapia (CRT) preoperatoria y proctectomía con extirpación completa del mesorrecto (TME). Hoy día existen controversias sobre la relación entre la respuesta patológica (RP) y la supervivencia global (OS) y libre de enfermedad (DFS). El objetivo del presente trabajo es analizar la relación entre los hallazgos patológicos y los resultados oncológicos a largo plazo.
Métodos: Entre 1992 y 2007, se trataron 324 pacientes con CRLA, con CRT preoperatoria y cirugía con TME. El grado de respuesta patológica se evaluó según criterios de Ruo en 5 categorías: desde mínima respuesta grado 1 hasta respuesta completa (pCR) o grado 4 sin células tumorales visibles. Además del TNM, se valoró margen circunferencial y la invasión linfovascular (LVI) y perineural.
Resultados: Con una mediana de seguimiento de 79 meses (rango 3-250), la supervivencia global a los 5 y 10 años fue del 83,2% y del 79% y la libre de enfermedad del 75,1% y del 71,4% respectivamente. Se observó recurrencia local en 8 pts. (2,5%) y recidiva a distancia en 69 (21,3%). Se observó una correlación significativa entre los 5 grados de respuesta patológica y la supervivencia a los 5 y 10 años (log rank, p < 0,001). La DFS en los casos de menor respuesta -grados 1 y 2- fue del 31,8% y del 58,6% respectivamente; mientras que los grados de respuesta casi completa y completa era del 88,4% y del 96,0%. Curiosamente en los pacientes con invasión linfovascular y perineural en el análisis univariante, dichas variables perdían significación estadística, quedando la afectación ganglionar y la localización en el tercio distal como factores de mal pronóstico. Por el contrario, en los pacientes sin Infiltración linfovascular (ILV), los grados de respuesta patológica se relacionaban con supervivencia.
Conclusiones: A pesar de los resultados obtenidos con CRT neoadyuvante seguida de cirugía (TME) y la correlación entre los grados de respuesta patológica y la supervivencia, existen factores de riesgo, como la invasión linfovascular y afectación ganglionar, que deben plantear otras medidas terapéuticas con el fin de evitar las recurrencias a distancia: adelantar e intensificar preoperatoria la quimioterapia y/o la quimioterapia adyuvante o la búsqueda de marcadores moleculares de la respuesta al tratamiento y comportamiento biológico.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 106
N° 7
Año 2014
Págs.497 - 499
A 36-year-old woman without previous medical history presented at the emergency room with recent onset of diffuse, continuous abdominal pain associated to nausea without vomiting.On examination, her abdomen was soft, very distended and tender with guarding over the left iliac fossa.
Her blood tests were normal apart from a white cell count of 17,2x109/L. Abdominal radiograph findings showed suggestive images of CV, confirmed on computerized tomography (CT) (Fig. 1). We decided to perform a colonoscopy to decompress the colon before surgery. After that, her abdomen became non-distended and was taken to the operating room.Under laparoscopic approach (three 5 mm trocars), we found a soft but not dilated ascending colon that lacked retroperitoneal fixation. It was fixed in its proper place with three running sutures
Revista:
JOURNAL OF GASTROINTESTINAL ONCOLOGY
ISSN 2078-6891
Vol. 5
N° 2
Año 2014
Págs.104-111
Oxaliplatin/fluorpyrimidine neoadjuvant chemotherapy induces major tumour shrinkage at both the pathological and radiological levels. The CT scan shows a high accuracy and a low overstaged rate in LACC patients treated by means of a neoadjuvant approach.
Revista:
REVISTA ESPAÑOLA DE MEDICINA NUCLEAR E IMAGEN MOLECULAR
ISSN 2253-8089
Vol. 33
N° 2
Año 2014
Págs.79 - 86
Objetivo Diseñar una técnica novedosa de adquisición ex-vivo para establecer un marco común de validación de diferentes técnicas de segmentación para imágenes PET oncológicas. Evaluar sobre estas imágenes el funcionamiento de varios algoritmos de segmentación automática.
Material y métodos En 15 pacientes oncológicos se realizaron estudios PET ex-vivo de las piezas quirúrgicas extraídas durante la cirugía, previa inyección de 18F-FDG, adquiriéndose imágenes en 2 tomógrafos: un PET/CT clínico y un tomógrafo PET de alta resolución. Se determinó el volumen tumoral real en cada paciente, generándose una imagen de referencia para la segmentación de cada tumor. Las imágenes se segmentaron con 12 algoritmos automáticos y con un método estándar para PET (umbral relativo del 42%) y se evaluaron los resultados mediante parámetros cuantitativos.
Resultados La segmentación de imágenes PET de piezas quirúrgicas ha demostrado que para imágenes PET de alta resolución 8 de las 12 técnicas de segmentación evaluadas superan al método estándar del 42%. Sin embargo, ninguno de los algoritmos superó al método estándar en las imágenes procedentes del PET/CT clínico. Debido al gran interés de este conjunto de imágenes PET, todos los estudios se han publicado a través de Internet con el fin de servir de marco común de validación y comparación de diferentes técnicas de segmentación.
Conclusiones Se ha propuesto una técnica novedosa para validar técnicas de segmentación para imágenes PET oncológicas, adquiriéndose estudios ex-vivo de piezas quirúrgicas. Se ha demostrado la utilidad de este conjunto de imágenes PET mediante la evaluación de varios algoritmos automáticos.
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 91
N° Especial Congreso 2
Año 2013
Págs.784
Revista:
COLORECTAL DISEASE
ISSN 1462-8910
Vol. 15
N° 5
Año 2013
Págs.552-27
Neoadjuvant chemotherapy followed by surgery and chemotherapy for LACC is safe without apparent increase of early and medium-term complications
Revista:
DISEASES OF THE COLON AND RECTUM
ISSN 0012-3706
Vol. 56
N° 4
Año 2013
Págs.416-421
Patients with low third locally advanced rectal cancer with a poor response to neoadjuvant chemoradiotherapy (high y-pathological stage or low tumor regression grade) are at high risk of recurrence. Intense surveillance and the design of alternative therapeutic approaches aimed to lower the distant failure rate seem warranted.
Revista:
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
ISSN 0179-1958
Vol. 28
N° 5
Año 2013
Págs.671 - 677
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 91
N° Especial Congreso 2
Año 2013
Págs.33
Objetivos: Evaluar la respuesta tumoral a nivel radiológico, metabólico y patológico del tratamiento del cáncer de colon localmente avanzado (CCLA) tratado preoperatoriamente con oxaliplatino y capecitabina.
Métodos: Se incluyeron 44 paciente con diagnóstico de CCLA que recibieron tratamiento neoadyuvante y cirugía de colon. Se realizó un análisis retrospectivo. Todos os pacientes fueron estadificados en el momento del diagnóstico y tras recibir la quimioterapia preoperatoria. El diagnóstico clínico se basó en examen físico, endoscopia con toma de biopsia y TAC. En casos seleccionados se empleó PET/TAC. Se evaluó la precisión y la correlación entre los hallazgos descritos por TAC y los referidos en el análisis patológico final a nivel de estadio T, N y TN.
Resultados: Tras la quimioterapia se observó una reducción significativa del volumen tumoral medido por TAC del 62.5% (p < 0,001; test Wilcoxon) y del SUV max medido por PET del 38,9% (p = 0,004). No hubo ningún caso de progresión tumoral durante el tratamiento neoadyuvante. La precisión para el estadio T y N fue del 62% y 87%, respectivamente. La precisión para el estadio TN fue del 77%, con un 13.6% y un 9.1% de los pacientes con infra y sobreestadificación, respectivamente.
Conclusiones: La quimioterapia preoperatoria basada en oxaliplatino y capecitabina induce una respuesta tumoral mayor a nivel radiológico, metabólico y patológico. La alta precisión y la escasa sobreestadificación hallada en el TAC son de valor a la hora de seleccionar al grupo de pacientes con CCLA que más se podrían beneficiar de un tratamiento neoadyuvante.
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 90
N° Especial Congreso
Año 2012
Págs.193-194
Revista:
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN 0360-3016
Vol. 83
N° 2
Año 2012
Págs.587-593
PURPOSE:
To validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer.
METHODS AND MATERIALS:
Patients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m(2) b.i.d., Monday to Friday) and oxaliplatin (60 mg/m(2) on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed.
RESULTS:
A total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9% of the patients. Grade 3 proctitis in 18% of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4% thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13% of the patients, major response (96-100% of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97% of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively.
CONCLUSIONS:
Preoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible
Revista:
ENDOSCOPY
ISSN 0013-726X
Vol. 44
N° Suppl. 2
Año 2012
Págs.UCTN:E366-7
Revista:
ENDOSCOPY
ISSN 0013-726X
Vol. 44
N° Supl. 2
Año 2012
Págs.E366 - E367
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 90
N° Especial Congreso
Año 2012
Págs.194-194
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN 1130-0108
Vol. 104
N° 8
Año 2012
Págs.436-439
the duodenal defect repair with a patch of the remant antrum, represents a valid alternative in similar circumstances. To our knowledge, it appears to be the first clinical description of this technique.
Revista:
OBESITY SURGERY
ISSN 0960-8923
Vol. 22
N° 8
Año 2012
Págs.1196
Revista:
DISEASES OF THE COLON AND RECTUM
ISSN 0012-3706
Vol. 54
N° 9
Año 2011
Págs.1141 -6
Endoscopic ultrasound allows prediction of involved lymph nodes in 75% of the cases; however, 1 in 5 patients are missclassified as uN0 after neoadjuvant treatment. In our point of view, this percentage is too high to rely only on this diagnostic modality
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 89
N° 1
Año 2011
Págs.24-30
La anastomosis intracorpórea frente a la extracorpórea en la hemicolectomía derecha laparoscópica permite obtener un mayor número de ganglios resecados y un inicio más precoz de la tolerancia oral y del tránsito intestinal.
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN 0210-5705
Vol. 34
N° 5
Año 2011
Págs.333 - 336
Revista:
COLORECTAL DISEASE
ISSN 1462-8910
Vol. 13
N° Supl. 1
Año 2011
Págs.46
Revista:
International Journal of Gynecolgical Cancer
ISSN 1048-891X
Vol. 21
N° 2
Año 2011
Págs.397 - 402
Revista:
JOURNAL OF SURGICAL ONCOLOGY
ISSN 0022-4790
Vol. 104
N° 2
Año 2011
Págs.124-129
Background: Significant tumor downstaging has been achieved in patients with localized gastric adenocarcinoma by preoperative chemoradiotherapy (ChRT) or induction chemotherapy (Ch). However the influence of ChRT and Ch on postoperative outcomes has not yet been clarified, with very few studies examining this issue. We retrospectively analyzed the efficacy in terms of pathological response and early postoperative complications of two protocols of preoperative ChRT and Ch for locally advanced gastric cancer. Methods: Between 2000 and 2008, 72 patients with operable locally advanced gastric cancer (cT3-4/N+) were treated with preoperative treatment: 1-patients receiving induction Ch or 2-neoadjuvant Ch followed by concurrent ChRT. Postoperative histopathological regression and surgical complications were investigated including variables related to patients, surgical variables, preoperative treatment, and tumor. Results: There were no differences in the incidence of complications between the ChRT and Ch groups (30.9% vs. 33.3%). The most frequent complications were nonspecific surgical complications (pneumonia [12.5%] and infection from intravenous catheters [9.7%]). Risk factors for complications were high-body mass index (BMI > 25 kg/m(2)) and extension of surgery to the pancreas and spleen. A major pathological response was observed in 33.3% of patients, being more frequent in the ChRT group (47.6% vs. 13.3%; chi(2), P = 0.0024).
Revista:
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN 0360-3016
Vol. 81
N° 2
Año 2011
Págs.439 - 444
Purpose: The main goals of preoperative chemoradiotherapy (CHRT) in rectal cancer are to achieve pathological response and to ensure tumor control with functional surgery when possible. Assessment of the concordance between clinical and pathological responses is necessary to make decisions regarding alternative conservative procedures. The present study evaluates the patterns of response after a preoperative CHRT regimen, and the value of endoscopic ultrasound (EUS) in assessing response. Methods and Materials: A total of 51 EUS-staged T3 to T4 and/or N0 to N+ rectal cancer patients received preoperative CHRT (intensity-modulated radiation therapy and capecitabine/oxaliplatin (XELOX) followed by radical resection. Clinical response was assesed by EUS. Rates of pathological tumor regression grade (TRG) and lymph node (LN) involvement were determined in the surgical specimen. Clinical and pathological responses were compared, and the accuracy of EUS in assessing response was calculated. Results: Twenty-four patients (45%) achieved a major pathological response (complete or >95% pathological response (TRG 3+/4)). Sensitivity, specificity, negative predictive value, and positive predictive value of EUS in predicting pathological T response after preoperative CHRT were 77.8%, 37.5%, 60%, and 58%, respectively. The EUS sensitivity, specificity, negative predictive value, and positive predictive value for nodal staging were 44%, 88%, 88%, and 44%, respectively. Furthermore, EUS after CHRT accurately predicted the absence of LN involvement in 7 of 7 patients (100%) with major pathological response of the primary tumor. Conclusion: Preoperative IMRT with concomitant XELOX induces favorable rates of major pathological response. EUS has a limited ability to predict primary tumor response after preoperative CHRT, but it is useful for accurately determining LN status. EUS may have a potential value in identifying patients with a very low risk of LN involvement in association with a good pathological response as potential candidates for conservative local surgical protocols. (C) 2011 Elsevier Inc.
Revista:
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN 0360-3016
Vol. 80
N° 3
Año 2011
Págs.698-704
PURPOSE:
To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution.
METHODS AND MATERIALS:
From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment.
RESULTS:
Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%.
CONCLUSIONS:
The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN 1699-048X
Vol. 13
N° 12
Año 2011
Págs.899-903
OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges rep
Revista:
JOURNAL OF NUTRITIONAL BIOCHEMISTRY
ISSN 0955-2863
Vol. 22
N° 7
Año 2011
Págs.634 - 641
Revista:
DISEASES OF THE COLON AND RECTUM
ISSN 0012-3706
Vol. 53
N° 4
Año 2010
Págs.629-630
Revista:
MODERN PATHOLOGY
ISSN 0893-3952
Vol. 23
N° Supl.1
Año 2010
Págs.168A
