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- Mortality From Esophagectomy for Esophageal Cancer Across Low, Middle, and High-Income Countries: an International Cohort Study.Publication . Pinho, Ana Catarina; Silva, R; Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative: Writing Committee; Steering Committee; National Leads; Site Leads; Collaborators; ElsevierBackground: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
- Prognostic Value of the Advanced Lung Cancer Inflammation Index in Intrahepatic Cholangiocarcinoma.Publication . Catalano, Giovanni; Alaimo, Laura; Chatzipanagiotou, Odysseas P; Ruzzenente, Andrea; Aucejo, Federico; Pinto Marques, Hugo; Lam, Vincent; Hugh, Tom; Bhimani, Nazim; Maithel, Shishir K; Kitago, Minoru; Endo, Itaru; Martel, Guillaume; Pulitano, Carlo; Shen, Feng; Popescu, Irinel; Koerkamp, Bas Groot; Bauer, Todd W; Cauchy, François; Poultsides, George A; Weiss, Matthew; Gleisner, Ana; Pawlik, Timothy MIntroduction: The advanced lung cancer inflammation index (ALI), which combines inflammation and nutrition data, was recently proposed as a prognostic biomarker. We assessed the impact of ALI on overall survival (OS) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent surgery for ICC were identified from an international cohort. ALI was calculated as body-mass index (BMI)∗albumin/neutrophil-to-lymphocyte ratio; patients were categorized into "low-" and "high-ALI" using log-rank statistics. The impact of ALI on OS was compared against other inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII = platelets∗NLR]) using Harrell's Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences, propensity score matching was employed. Results: Among 1045 patients, more than one-half of individuals underwent major hepatectomy (n = 582, 55.7 %), median tumor size was 5.5 cm (IQR, 3.8-7.8), and median ALI was 38.9 (IQR 26.5-57.2). On multivariate analysis, low ALI was an independent risk factor for worse OS (HR 1.21, 95 % CI 1.01-1.46; p = 0.04). Patients with low ALI had worse 5-year OS (36.9 % vs. 49.9 %; p < 0.001), which remained significant after PSM (36.9 % vs. 41.3 %; p = 0.039). ALI had a comparable discriminatory ability compared with NLR, PLR, and SII (C-index: 0.646 vs. 0.644 vs. 0.640 vs. 0.641, respectively), yet had a lower AIC (5475.31 vs. 5546.80 vs. 5550.45 vs. 5548.62, respectively) suggesting slightly better model fit and accuracy. Conclusions: ALI was an independent predictor of OS among patients undergoing surgery for ICC. Nutritional and inflammatory markers should be incorporated into predictive models to improve prognostic stratification.
- Advantage of Log Odds of Metastatic Lymph Nodes After Curative-Intent Resection of Gallbladder Cancer.Publication . Catalano, Giovanni; Alaimo, Laura; Chatzipanagiotou, Odysseas P; Ruzzenente, Andrea; Aucejo, Federico; Pinto Marques, Hugo; Bhimani, Nazim; Hugh, Tom; Maithel, Shishir K; Kitago, Minoru; Endo, Itaru; Pawlik, Timothy MBackground: Lymph node metastasis (LNM) is among the most important predictors of poor prognosis after surgery for gallbladder cancer (GBC). Traditionally, staging has been based on the raw count of LNM, with a high risk of understaging patients who undergo inadequate lymph node dissection (LND). The log odds of metastatic lymph nodes (LODDS) may represent an alternative staging approach to stratify patients more accurately after resection of GBC. Patients and methods: In this cross-sectional study, patients who underwent curative-intent surgery with LND for GBC were identified from an international database. Two predictive models were built and compared, each integrating a different lymph nodes status indicator [i.e., American Joint Committee on Cancer (AJCC) and LODDS]. Results: Among 199 patients, the median number of lymph nodes examined was 5 [interquartile range (IQR): 3.0, 8.0]; most patients had T1 (n = 26, 13.1%) or T2 (n = 97, 48.7%) disease, and a subset had LNM (n = 87, 44.0%). Multivariable Cox analysis demonstrated LODDS was an independent predictor of overall survival [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.5-2.3; p < 0.001]. The LODDS model demonstrated better performance compared with a traditional model that utilized the AJCC N category [concordance (C) index: 0.814 versus 0.763; p < 0.001]. Patients classified as high- versus low-risk based on LODDS had much worse overall survival (OS) (4.9% versus 83.7%, respectively; p < 0.001). The LODDS model performance remained high even among patients with inadequate LND (< 6 LN) (C index: 0.87). An online calculator was developed ( https://catalano-giovanni.shinyapps.io/LoddsGBC/ ). Conclusions: A novel prognostic model based on LODDS may overcome the inherent limitations of the current AJCC staging system, reducing understaging among patients with fewer than six total lymph nodes evaluated.
- Improving Recurrence Prediction in Intrahepatic Cholangiocarcinoma: The Synergistic Impact of the FIB-4 Index and Tumor Burden Score on Post-hepatectomy Outcomes.Publication . Akabane, Miho; Kawashima, Jun; Woldesenbet, Selamawit; Macedo, Amanda B; Cauchy, François; Shen, Feng; Maithel, Shishir K; Groot Koerkamp, Bas; Alexandrescu, Sorin; Kitago, Minoru; Weiss, Matthew; Martel, Guillaume; Pulitano, Carlo; Aldrighetti, Luca; Poultsides, George A; Imaoka, Yuki; Guglielmi, Alfredo; Bauer, Todd W; Endo, Itaru; Gleisner, Ana; Pinto Marques, Hugo; Pawlik, Timothy MBackground: The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS). Methods: ICC patients undergoing hepatectomy (2000-2020) were identified using a multi-institutional database. Patients were categorized as low (low TBS/low FIB-4 index), intermediate (low TBS/high FIB-4 index or high TBS/low FIB-4 index), and high (high TBS/high FIB-4 index). Results: Among 1168 patients in different TBS and FIB-4 index cohorts, 3-year recurrence varied considerably. For instance, among the patients with low TBS, individuals with a high FIB-4 index had a greater risk of recurrence than patients with a low FIB-4 index (59.9 vs. 47.7%; P = 0.01). Among patients with a high TBS, individuals with a high versus a low FIB-4 index had a higher incidence of recurrence (76.8 vs. 69.0%; P = 0.04). A similar pattern was observed among patients with both a low FIB-4 index (low [47.7%] vs. high [69.0%] TBS) and a high FIB-4 index (low [59.9%] vs. high [76.8%] TBS; both P < 0.001). Patients with a high [27.5%] versus a low [48.8%] TBS; P < 0.001) and patients with a high [34.2%] versus a low [43.5%] FIB-4 index; P = 0.01) had a worse OS. The multivariable analysis demonstrated an increasing risk of recurrence in the intermediate-index (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.20-2.16; P = 0.001) and high-index (HR, 2.13; 95% CI 1.45-3.13; P < 0.001) groups versus the low-index group. Conclusions: Both tumor-related and non-tumorous characteristics should be used to predict risk of recurrence and survival more accurately among patients with ICC following hepatic resection.
- Robotic Surgery in Conversion After Adjustable Gastric BandingPublication . Ferreira, M; Miranda, C; Rodrigues, S; Nabais, C; Borges, N; Albuquerque, N; Guerra, A; Pereira, J; Manaças, L
- Breast Adipose Tissue's Xenobiotics and Fatty Acid Profile-A Preliminary Study in Portuguese Women with Breast Cancer.Publication . Sousa, Sara; Paíga, Paula; Araújo, Bárbara; Coelho, Francisca; Castela, Inês; Vasques, Miguel; Sampaio, Clara; Duarte, Marta; Correia, Ana; Teixeira, Diana; Pestana, Diogo; Faria, Ana; Delerue-Matos, Cristina; Ramalhosa, Maria João; Calhau, Conceição; Fernandes Domingues, ValentinaCountless environmental pollutants and xenobiotics, are widespread and linked to hazardous effects, including breast cancer. Due to their lipophilic properties, these accumulate in fat tissue, such as breast adipose tissue. However, little is still known about their combined effects and distribution within the breast microenvironment. Alterations in fatty acid metabolism can be a biomarker for cancer progression and a potential bioindicator of pollutant exposure. In this study, the fatty acid profile and levels of organochlorine and organophosphate pesticides (OCPs and OPPs), polychlorinated biphenyls (PCBs), brominated flame retardants (BFRs), organophosphate esters (OPEs), polycyclic aromatic hydrocarbons (PAHs) and synthetic musks (SMs) were measured in 48 breast adipose tissue samples from breast cancer and healthy patients (controls). Twelve xenobiotics were detected at high frequency rates, and the distribution profile of these pollutants differed between cohorts. In total, 163 correlations were identified between specific fatty acids and breast cancer patients' data, with distinct correlation patterns between cohorts. Fatty acids show the potential to be biomarkers of the presence of lipophilic xenobiotics in the breast microenvironment; however, more studies are needed. This preliminary study is the first to analyze OPPs, OPEs, and PAHs in breast adipose tissue and report associations between xenobiotics and specific fatty acids.
- Técnicas Cirúrgicas Bariátricas e Ganho MetabólicoPublication . Nabais, C; Borges, Nuno; Manaças, Leonor; Vaz Rodrigues, Sara; Rego de Figueiredo, Inês; Dhanani, Anjum; Paula, Filipa; Oliveira Torres, João; Silva-Nunes, José; Albuquerque, António; Guerra, AnabelaA cirurgia bariátrica é a intervenção mais eficaz no tratamento da obesidade, permitindo uma perda ponderal sustentada, elevadas taxas de remissão da diabetes mellitus tipo 2, redução do risco cardiovascular e mortalidade. Este artigo de revisão aborda as principais técnicas cirúrgicas e enquadra os respetivos ganhos metabólicos, que se iniciam muito precocemente após cirurgia, e se mantêm a longo prazo. Os mecanismos fisiopatológicos associados, e que extrapolam os componentes restritivo e malabsortivo classicamente descritos, são sumariamente explanados neste artigo, e que incluem, a exclusão do intestino proximal, a chegada precoce dos nutrientes ao intestino distal, a modulação neuroendócrina e de hormonas reguladoras do apetite, as modificações no metabolismo dos ácidos biliares e no microbioma intestinal. Conclui-se, sublinhando que a escolha da técnica deve ser individualizada, ponderando a eficácia metabólica que pode proporcionar, face ao risco de complicações cirúrgicas e nutricionais, e sempre no âmbito de um programa multidisciplinar.
- Global 30-Day Morbidity and Mortality of Primary Bariatric Surgery Combined with Another Procedure: The BLEND Study.Publication . Martinino, Alessandro; Nanayakkara, Kushan D L; Madhok, Brij; Wong, Geoffrey Yuet Mun; Abouelazayem, Mohamed; Pereira, Juan Pablo Scarano; Wazir, Ishaan; Balasubaramaniam, Vignesh; Said, Amira; Marques, Cláudia; Abdelbaeth, Amr; Al-Shami, Khayry; Albashari, Muna; Alkaseek, Akram; Almayouf, Mohammad Abdullah; Aloulou, Mohammad; Alqahtan, Awadh Robaan; Askari, Alan; Attia, Meena Faiez Assad; Awad, Ahmed K; Aykota, Muhammed Rasid; Bacalbasa, Nicolae; Barrera-Rodriguez, Francisco J; Benavoli, Domenico; Billa, Srikar; Borrelli, Vincenzo; Çalıkoğlu, İsmail; Campanelli, Michela; Carbajo, Miguel A; Chowdhury, Sharfuddin; Cristin, Luca; Dapri, Giovanni; Dong, Zhiyong; Elfawal, Mohamad Hayssam; Elgazar, Amr; Elhadi, Muhammed; Gentileschi, Paolo; Graham, Yitka; Haj, Bassel; Johnson, Joseph Andrew; Kalmoush, Abd-Elfattah Morsi; Kamal, Ayman; Kamocka, Anna; Khamees, Almu'atasim; Lisi, Giorgio; Hernandez, Edgard Efren Lozada; Marinari, Giuseppe M; Martines, Gennaro; Meric, Serhat; Mier, Fernando; Ali, Ahmed Mohamed; Mohammed, Diyaaldeen; Mohamed, Karim Mostafa; Mulita, Francesk; Musella, Mario; O'Malley, William Edward; Olmi, Stefano; Omarov, Taryel; Osama, Omnya; Perera, HMinali R; Piscitelli, Giovanni; Poghosyan, Tigran; Ramírez, David; Rezvani, Masoud; Ribeiro, Rui; Sabbota, Aaron; Sakran, Nasser; Sawaftah, Khaled Ahmad; Schiavone, Kaci; Şen, Ozan; Sotiropoulou, Maria; Tartaglia, Nicola; Tokocin, Merve; Trotta, Manuela; Türkçapar, Ahmet Gökhan; Uccelli, Matteo; Vargas, Cesar; Verras, Georgios -Ioannis; Wang, Cunchuan; Wei, Zhuoqi; Yang, Wah; Zerrweck, Carlos; Owen, Eloise; Gkoutos, Georgios V; Cardoso, Victor Roth; Singhal, Rishi; Mahawar, KamalBackground: No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures. Objectives: The objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair. Setting: This is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures. Methods: The audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score matching analysis compared the BLEND study patients with those from the GENEVA cohort to obtain objective evaluation between combined procedures and primary BMS alone. Results: A total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most commonly primary BMS (N = 653, 63%), and hiatal hernia repair was the most commonly concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedures had the highest morbidities among all combinations (17.1%). Out of overall 134 complications, 129 (96.2%) were Clavien-Dindo I-III, and 4 were CD V. Patients who underwent a primary bariatric surgery combined with another procedure had a pronounced increase in a 30-day complication rate compared with patients who underwent only BMS (12.7% vs. 7.1%). Conclusion: Combining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS is a viable option to consider in selected patients following multi-disciplinary discussion.
- Consensus-Based Guidelines for Best Practices in the Selection and Use of Examination Gloves in Healthcare Settings.Publication . Freitas, Jorge; Lomba, Alexandre; Sousa, Samuel; Gonçalves, Viviana; Brois, Paulo; Nunes, Esmeralda; Veloso, Isabel; Peres, David; Alves, PauloBackground/objectives: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) present significant challenges in modern healthcare, leading to increased morbidity, mortality, and healthcare costs. Examination gloves play a critical role in infection prevention by serving as a barrier to reduce the risk of cross-contamination between healthcare workers and patients. This manuscript aims to provide consensus-based guidelines for the optimal selection, use, and disposal of examination gloves in healthcare settings, addressing both infection prevention and environmental sustainability. Methods: The guidelines were developed using a multi-stage Delphi process involving healthcare experts from various disciplines. Recommendations were structured to ensure compliance with international regulations and sustainability frameworks aligned with the One Health approach and Sustainable Development Goals (SDGs). Results: Key recommendations emphasize selecting gloves based on clinical needs and compliance with EN 455 standards. Sterile gloves are recommended for surgical and invasive procedures, while non-sterile gloves are suitable for routine care involving contact with blood and other body fluids or contaminated surfaces. Proper practices include performing hand hygiene before and after glove use, avoiding glove reuse, and training healthcare providers on donning and removal techniques to minimize cross-contamination. Disposal protocols should follow local clinical waste management regulations, promoting sustainability through recyclable or biodegradable materials whenever feasible. Conclusions: These consensus-based guidelines aim to enhance infection control, improve the safety of patients and healthcare workers, and minimize environmental impact. By adhering to these evidence-based practices, grounded in European regulations, healthcare settings can establish safe and sustainable glove management systems that serve as a model for global practices.
- Impact of Parathyroidectomy on Kidney Function in Adults With Primary Hyperparathyroidism.Publication . Bandovas, João Pedro; Candeias, Henrique; Mourão, Mariana; Dhanani, Anjum; Monteiro, Nuno; Crespo, Ana; Tavares, Paula; Pinto Marques, Hugo; Springer NatureIntroduction Primary hyperparathyroidism (PHPT) is characterized by persistent hypercalcemia and is associated with renal complications, including nephrolithiasis and progressive decline in the estimated glomerular filtration rate (eGFR). Although parathyroidectomy (PTX) is the definitive treatment, its impact on renal function remains uncertain, particularly in patients with pre-existing renal impairment. This study aims to evaluate 12-month changes in renal function after PTX in patients with PHPT, according to baseline kidney function. Methods This retrospective study included 48 patients with PHPT who underwent PTX between 2017 and 2020. Patients were stratified by baseline eGFR into two groups: ≥60 mL/min/1.73 m² (Group 1) and <60 mL/min/1.73 m² (Group 2). Clinical and laboratory parameters, including serum creatinine and eGFR, were analyzed at baseline and at 12 months postoperatively. Results Patients were predominantly women (ratio 3.8:1), and the surgical cure rate was 95.8%. Group 2 presented higher baseline calcium and PTH levels. At 12 months, both groups showed significant reductions in calcium and PTH. Group 1 experienced a statistically significant decline in eGFR, whereas Group 2 showed a slight, non-significant improvement, suggesting stabilization of renal function. Conclusion PTX does not appear to improve renal function in most patients with PHPT but may prevent further deterioration in those with pre-existing renal impairment. These findings support current guideline recommendations favoring surgical intervention in PHPT patients with compromised baseline kidney function.