Browsing by Author "Bellolio, Felipe"
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- ItemBenefit of adjuvant 5-fluorouracil based chemotherapy for colon cancer: a retrospective cohort study(SOC MEDICA SANTIAGO, 2016) Mondaca, Sebastian; Villalon, Constanza; Luis Leal, Jose; Zuniga, Alvaro; Bellolio, Felipe; Padilla, Oslando; Palma, Silvia; Garrido, Marcelo; Nervi, BrunoBackground: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and Methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15-0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23-0.94). Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival.
- ItemClinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile(2024) Silva, Felipe; Bustamante, Miguel; Latorre, Gonzalo; Flandez, Jorge; Montero, Isabella; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Iglesias, Andres; Bellolio, Felipe; Molina, Maria Elena; Migueles, Rodrigo; Urrejola, Gonzalo; Larach, Tomas; Besser, Nicolas; Sharp, Allan; Aguero, Carlos; Riquelme, Arnoldo; Vargas, Jose Ignacio; Candia, Roberto; Monrroy, Hugo; De Simone, Federico; Espino, AlbertoBackground: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. Aim: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. Methods: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. Results: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n = 38), gastrointestinal stromal tumors (GIST) (21.8%, n = 19), lymphoma (17.2%, n = 15) and adenocarcinoma (AC) (11.5%, n = 10). GIST was more frequent in duodenum (50%; n = 12) and NET in the ileum (65.8%; n = 25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC ( p = 0.035), as well as gastrointestinal bleeding in GIST ( p = 0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5 -year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1 - 99.2), 82.2% (95%CI: 57.6 - 93.3), 40.0% (95%CI: 16.5 - 82.8) and 25.9% (95%CI: 4.5 - 55.7%), respectively. NET (HR 6.1; 95%CI: 2.1 - 17.2) and GIST (HR 24.4; 95%CI: 3.0 - 19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. Conclusions: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes. (c) 2024 Elsevier Espana, S.L.U. All rights reserved.
- ItemDiagnóstico y manejo de colitis ulcerosa grave. Una mirada actualizada(2017) Hernandez Rocha, Cristian; Ibanez, Patricio; Elena Molina, Maria; Klaassen, Julieta; Valenzuela, Andrea; Candia, Roberto; Bellolio, Felipe; Zuniga, Alvaro; Miguieles, Rodrigo; Francisco Miquel, Juan; Chianale, Jose; Alvarez Lobos, ManuelUlcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.
- ItemEarlier surgery is associated to re duce d postoperative morbidity in ileocaecal Crohn's disease: Results from SURGICROHN-LATAM study(2023) Avellaneda, Nicolas; Coy, Claudio Saddy Rodrigues; Fillmann, Henrique Sarubbi; Saad-Hossne, Rogerio; Munoz, Juan Pablo; Garcia-Duperly, Rafael; Bellolio, Felipe; Rotholtz, Nicolas; Rossi, Gustavo; Marquez, Juan Ricardo; Cillo, Mariano; Lacerda-Filho, Antonio; Carrie, Augusto; Maruyama, Beatriz Yuki; Fillmann, Lucio Sarubbi; Ferro, Ezequiel; Londono-Schimmer, Eduardo; Iglesias, Andres; Harriott, Camila Bras; Campana, Juan Pablo; Estrada, Daniel Londono; Balachandran, Rogini; Kontze, Paulo GustavoBackground: Early surgical resection is an emerging concept for patients with ileocaecal Crohn's disease (CD). The aim of this study was to compare postoperative outcomes after ileocaecal resections between patients with luminal and complicated CD.Methods: A retrospective analysis of patients operated for ileocaecal CD during an 8-year period in ten tertiary referral academic centres from Latin America was performed. Patients were allocated into 2 groups: those operated for early (luminal) disease (Early Crohn's Disease-ECD-) and for complications of CD (Complicated Crohn's disease-CCD-). A comparative analysis was performed regarding short-term outcomes of surgery, considering overall postoperative complications as main outcome. Results: 337 patients were included in the analysis, 60 (17.80%) in the ECD group. Smoking and ex-posure to perioperative biologic drugs were more prevalent in CCD group. CCD patients had increased requirement of urgent surgery (26.71 vs. 15%, p = 0.056), longer operative time (164.25 vs. 90.53 min, p < 0.01), lower rates of primary anastomosis (90.23 vs. 100%, p = 0.012), increased rate of overall postopera-tive complications (33.21 vs. 16.67%, p = 0.013), more reoperations (13.36 vs. 3.33%, p = 0.026), and higher rates of major anastomotic fistulas and hospital stay. On multivariable analysis, smoking ( p = 0.001,95%CI: 2.59-32.11), operative time ( p = 0.022,95%CI:1-1.02), associated procedures ( p = 0.036,95%CI:1.09-15.72) and intraoperative complications ( p = 0.021,95%CI:1.45-92.31) were independently related to presenting postoperative complications.
- ItemGallbladder polyps(2006) Escalona, Alex; Leon, Francisca; Bellolio, Felipe; Pimentel, Fernando; Guajardo, Matias; Gennero, Ruben; Cruz, Juan Pablo; Viviani, Paola; Ibanez, LuisBackground: Gallbladder polyps are becoming a common finding. The management of these polyps is complicated considering that they can bear malignant lesions. Aim: To analyze the ultrasonographic and histopatbologic findings of patients operated due to gallbladder polyps. Patients and methods: The records of patients with ultrasonograpbic diagnosis of gallbladder polyp and that underwent cholecystectomy in a thirteen years period were reviewed, collecting their demographic, ultrasonograpbic and histopathological data. Results: One hundred and twenty three patients were operated. Tbe mean age was 44 +/- 13 years, and 69% were women. The mean size of polyps in ultrasonography was 7.3 +/- 5 mm. Histopathology confirmed the presence of polyps in 79% of patients, with a mean size and number of lesions of 5.1 +/- 3.8 mm and 2.1 +/- 2, respectively. Nine percent of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p = 0.003). Four cases of adenoma (3.2%) were diagnosed; one of them had in situ carcinoma. All were single and larger than 10 mm. We found a significant correlation between ultrasonograpbic and histopathological polyp size determination (r = 0.47; p = 0.002). Polyp size was also a predictor of the presence of adenoma (p = 0.043; confidence intervals., 1.006-1.424). Conclusions: There is a good correlation between the size of the gallbladder polyp in ultrasonography and the size in the histopathology report. Gallbladder adenoma is uncommon and it correlates with the size of the polyp. In this series, size was the only predictor of the presence of adenoma.
- ItemIleal pouch-anal anastomosis in ulcerative colitis: outcomes, functional results, and quality of life in patients with more than 10-year follow-up(SPRINGER, 2020) Carcamo, L.; Miranda, P.; Zuniga, A.; Alexander, E.; Molina, M. E.; Urrejola, G.; Larach, T.; Miguieles, R.; Bellolio, FelipePurpose Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). IPAA was incorporated into our institution in 1984, and thereafter, more than 200 procedures have been performed. The functional results and morbidity of this surgery have been reported previously. However, long-term functional outcomes and quality of life have not been evaluated. Methods As a cohort study, we identified all consecutive patients who underwent IPAA for UC between 1984 and 2017 and selected those with more than 10-year follow-up. Demographic data, morbidity, and pouch survival information were obtained. Long-term functional results and quality of life were evaluated through an e-mail survey using the oresland score and the Cleveland Global Quality of Life scales, respectively. Results Of 201 patients, 116 met the inclusion criteria. Median follow-up was 20 (10-34) years. Early post-operative complications (30 days) were observed in 19 (16.4%) patients and 66 (56.9%) presented adverse events. The IPAA preservation rate at 10 and 20 years was 96.5% and 93.1%, respectively. Long-term functional scores presented a median of 6 (1-15) points. IPAA function was satisfactory in 11 (20.0%) patients, acceptable in 18 (32.7%), and deficient in 26 (47.3%). The median score for global quality of life was 0.8 (0.23-1.0) points. Conclusion IPAA as treatment for UC meets the expectations of cure of the disease, maintaining adequate long-term intestinal functionality associated with a good quality of life in most patients.
- ItemImplementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay(2021) Jarry, Cristian; Carcamo, Leonardo; Jose Gonzalez, Juan; Bellolio, Felipe; Miguieles, Rodrigo; Urrejola, Gonzalo; Zuniga, Alvaro; Crovari, Fernando; Elena Molina, Maria; Tomas Larach, JoseReconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA;p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes;p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days;p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.
- ItemInsuficiencia intestinal secundaria a síndrome de intestino corto : resultados de un programa multidisciplinario de rehabilitación intestinal(2016) Elena Molina, Maria; Bellolio, Felipe; Klaassen, Julieta; Gomez, Javier; Villalon, Constanza; Francisco Guerra, Juan; Zuniga, AlvaroBackground: In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. Aim: To report the results of our program in patients suffering intestinal failure. Patients and Methods: A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed. Initial work up included prior intestinal surgery, blood tests, endoscopic and imaging studies. Also demographic data, medical and surgical management as well as clinical follow-up, were registered. Results: Data from 14 consecutive patients aged 26 to 84 years (13 women) was reviewed. Mean length of remnant small bowel was 100 cm and they were on parenteral nutrition for a median of eight months. Seven of 14 patients had short bowel secondary to mesenteric vascular events (embolism/thrombosis). Medical management and autologous reconstruction of the bowel included jejuno-colic anastomosis in six, enterorraphies in three, entero-rectal anastomosis in two, lengthening procedures in two, ileo-colic anastomosis in one and reversal Roux-Y gastric bypass in one. Thirteen of 14 patients were weaned off parenteral nutrition. Conclusions: Our Multidisciplinary Intestinal Rehabilitation Program, allowed weaning most of the studied patients off parenteral nutrition.
- ItemLaparoscopic colon surgery: time to leave the urinary catheter in the operating room?(2024) Riquoir, Christophe; Vela, Javier; Lascano, Raquel; Urrejola, Gonzalo; Bellolio, Felipe; Molina, Maria Elena; Miguieles, Rodrigo; Larach, Jose TomasIntroduction'Fast track' guidelines have incorporated multimodal measures to optimize perioperative outcomes in surgery, with laparoscopy being a pivotal component for its advantages in early recovery. In this setting, current recommendations regarding the use of a urinary catheter suggest its removal within the first 24-hours postoperatively. However, few studies have assessed the feasibility of leaving the operating room without it. The purpose of this study is to compare the perioperative outcomes of patients undergoing elective laparoscopic colonic resections leaving the operating room with and without a urinary catheter.MethodsA retrospective study was conducted utilizing prospectively collected data from patients undergoing elective colon resections over a 17-month period. The patients were classified into two groups based on the presence or absence of a urinary catheter upon leaving the operating room, and subsequently, their perioperative outcomes were compared.ResultsA total of 107 patients met the inclusion criteria (n = 28 with a urinary catheter and n = 79 without). Cancer was the most prevalent diagnosis (83.2%), and right hemicolectomy the most frequently performed surgery (32.7%). Two events of urinary catheter reinsertions were reported, both in the no-catheter group (0% vs 2.53%, p = 0.969), and there were no cases of urinary tract infections. The overall and severe complications rates exhibited no significant differences (25% vs. 26.6%, p = 1, and 7.14% vs. 5.06%, p = 1) and the length of stay was similar (p = 0.220).ConclusionRemoving the urinary catheter before leaving the operating room appears to be safe and associated with very low rates of urinary retention in selected patients undergoing laparoscopic colonic or upper rectal resections.
- ItemLaparoscopic extended right colectomy with complete mesocolic excision for transverse colon cancer is feasible in the setting of vascular anatomical variations - A video vignette(2024) Alvarado, Juan; Montero, Isabella; Besser, Nicolas; Vela, Javier; Bellolio, Felipe; Tomas Larach, Jose
- ItemLearning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study(2024) Vela, Javier; Riquoir, Christophe; Jarry, Cristian; Silva, Felipe; Besser, Nicolas; Urrejola, Gonzalo; Molina, Maria Elena; Miguieles, Rodrigo; Bellolio, Felipe; Larach, Jose TomasBackgroundRetrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC.MethodsConsecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM).ResultsTwo hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient = - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases).ConclusionThe learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.
- ItemRisk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicenter Latin American experience(2023) Avellaneda, Nicolas; Coy, Claudio Saddy Rodrigues; Fillmann, Henrique Sarubbi; Saad-hossne, Rogerio; Mun, Juan Pablo; Garcia-duperly, Rafael; Bellolio, Felipe; Rotholtz, Nicolas; Rossi, Gustavo; Marquez, Juan Ricardo; Cillo, Mariano; Lacerda-filho, Antonio; Carrie, Augusto; Maruyama, Beatriz Yuki; Fillmann, Lucio Sarubbi; Craveiro, Marcela Maria Silvino; Ferro, Ezequiel; Londono-schimmer, Eduardo; Iglesias, Andres; Harriott, Camila Bras; Campana, Juan Pablo; Estrada, Daniel London; Balachandran, Rogini; Kotze, Paulo GustavoIntroduction: Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures.