Publications by authors named "Jose Ramia"

Textbook outcome (TO) is a composite measure that reflects the most desirable surgical results as a single indicator. The aim of this study was to assess the achievement of TO at a hepatopancreatobiliary (HPB) surgery unit in a Spanish tertiary hospital. We performed a retrospective observational study of all consecutive patients who underwent HPB surgery over a 4-year period.

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  • The use of percutaneous cholecystostomy (PC) for treating acute cholecystitis (AC) has increased due to an aging population and supportive guidelines, prompting a need for clearer management protocols.
  • An international consensus was developed through a two-round Delphi survey with 27 questions, and participants aimed for a minimum 70% agreement on the management of PCs.
  • Out of these, six key recommendations were established, including the timing of PC implementation and the need for cholangiography before PC removal, highlighting the necessity for comprehensive guidelines on PC management in AC patients.
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  • Breast cancer is prevalent among women, with 20-30% of patients developing metastases, primarily affecting the liver. Patients with liver metastases have a wide range of survival rates, influenced by various factors.
  • This study aimed to assess the long-term survival and disease-free outcomes for patients who had surgery for liver metastases stemming from breast cancer.
  • Results indicated that surgery can enhance long-term survival, with specific patient characteristics (like health status, hormone receptor positivity, and prior treatments) linked to improved outcomes.
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Background: Pancreatic head cancer patients who undergo pancreatoduodenectomy (PD) often experience disease recurrence, frequently associated with a positive margin status (R1). Total mesopancreas excision (TMpE) has emerged as a potential approach to increase surgical radicality and minimize locoregional recurrence. However, its effectiveness and safety remain under evaluation.

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  • The study aimed to establish a common language regarding extreme liver surgery to facilitate better comparison of surgical outcomes across different centers.
  • A Delphi methodology was used, gathering opinions from 38 expert surgeons, who largely agreed on key definitions related to total vascular occlusion and surgical approaches, achieving consensus on various topics.
  • Ultimately, 75% agreed on a definition for extreme liver surgery, highlighting the importance of a unified approach in managing patients with complex liver diseases.
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Introduction: Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The "textbook outcome"(TO) indicates the quality of care commonly used in oncological procedures, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained.

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  • * Conducted between June 2019 and August 2020, the retrospective analysis involved 40 hospitals, with insights derived from over 2,200 liver surgeries, including 1350 for colorectal metastases, of which 150 utilized the liver-first strategy.
  • * Findings revealed no significant differences in surgical outcomes between hospitals performing fewer than 50 versus those performing 50 or more liver surgeries per year, prompting further research into optimal candidate selection for this treatment approach.
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  • The PUECOF study seeks expert consensus on the best organizational practices for Pancreas Units, involving 30 surgical leaders across 14 countries in a Delphi survey.
  • *Surgeons emphasize the importance of multidisciplinary meetings, leadership development, and measurable outcomes, while viewing clinical professionals and patients as key stakeholders.
  • *Although the technical aspects of pancreatic surgery will remain unchanged, Pancreas Units could enhance surgeons' workflows, professional growth, and collaborative opportunities, ultimately improving patient outcomes.
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Background: The effect of radiologic splenic vessels involvement (RSVI) on the survival of patients with pancreatic adenocarcinoma (PAC) located in the body and tail of the pancreas is controversial, and its influence on postoperative morbidity after distal pancreatectomy (DP) is unknown. This study aimed to determine the influence of RSVI on postoperative complications, overall survival (OS), and disease-free survival (DFS) in patients undergoing DP for PAC.

Methods: A multicenter retrospective study of DP was conducted at 7 hepatopancreatobiliary units between January 2008 and December 2018.

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Background: Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a 1-country prospective study of distal pancreatectomies (DPs) and determined BM.

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Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis.

Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis.

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  • * Data from 808 patients were analyzed, revealing that 46.9% achieved TO, with significantly lower overall complications (11.9% vs. 86%) compared to those who did not achieve TO, leading to increased major complications and mortality rates.
  • * Factors enhancing the likelihood of achieving TO include treatment at specialized centers, initial surgery transfer, and conservative or surgical management, highlighting the importance of effective perioperative care in managing BDI.
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Enhanced recovery after surgery (ERAS) programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022. Liver surgery is usually performed in oncological patients (liver metastasis, hepatocellular carcinoma, cholangiocarcinoma, ), but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined. Theoretical advantages of ERAS programs are: ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes; a better and faster postoperative recovery should let oncologic teams begin chemotherapeutic regimens on time; prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.

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Introduction: Solid pseudopapillary tumors (SPT) of the pancreas are rare exocrine neoplasms of the pancreas. Correct preoperative diagnosis is not always feasible. The treatment of choice is surgical excision.

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Background: Intraductal papillary neoplasm of the bile ducts (IPNB) is a rare disease in Western countries. The aim of this study was to compare tumor characteristics, management strategies, and outcomes between Western and Eastern patients who underwent surgical resection for IPNB.

Methods: A multi-institutional retrospective series of patients with IPNB undergoing surgery between January 2010 and December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), and at Nagoya University Hospital, Japan.

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  • The study focuses on the recurrence of isolated pancreatic metastases from Renal Cell Carcinoma (RCC) and evaluates the outcomes of repeat pancreatic resections after initial surgery.
  • It involved a retrospective analysis of 131 resections in 116 patients from January 2010 to May 2020, comparing those who had single versus iterative pancreatic surgeries.
  • Results indicated that while disease-free survival (DFS) rates were slightly better in the iterative group, overall survival (OS) rates were similar for both groups, suggesting that repeat surgery is a viable option for managing RCC-related pancreatic metastases.
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Background: Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed.

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