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This article aims to analyze and to simplify the optimal dose and time of intravenous indocyanine green (ICG) administration to achieve the identification of the cystic duct and the common bile duct (CBD).A consecutive series of 146 patients was prospectively analyzed and divided into three groups according to the time of ICG administration: at induction of anesthesia group (20-30 min); hours before group (between 2 and 6 h); and the day before group (≥6 h); and two groups according to the dose of ICG: 1 cc (2.5 mg) or weight-based dose (0.05 mg/kg).The CBD was better visualized in the at induction of anesthesia group (85.4%), in the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia group (86.7%) and in the hours before group (97.1%) (p = 0.027).Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered 2-6 h before the procedure is the optimal. However, ICG administered 30 min prior to the surgery is enough for adequate visualization of biliary structures.

The "liver-first" approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes neoadjuvant chemotherapy, resection of the ASLM followed by CRC resection.Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7 mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves.Seventy-five of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (Clavien-Dindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS was 8.5 and 5-year OS was 53%.In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival.

Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented.The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality.64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]). In liver surgery the mean operative time was 204.4 minutes (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days). In pancreatic surgery, the mean operative time was 243.8 minutes (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days).Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.

Resumen Fundamento y objetivo la deteccion preoperatoria de afeccion ganglionar en el cancer gastrico es fundamental para el planteamiento del tratamiento neoadyuvante, pero resulta dificil. La tomografia computarizada (TC), un instrumento diagnostico de primera linea, aporta unos resultados controvertidos. El objetivo del estudio ha sido establecer el rendimiento de la TC helicoidal en la prediccion de afeccion ganglionar para el cancer gastrico. Pacientes y metodo se ha realizado un analisis preoperatorio y retrospectivo de 62 casos consecutivos de pacientes intervenidos de reseccion gastrica por adenocarcinoma. Se analizaron la sensibilidad, la especificidad, la precision y la eficiencia. Se registraron la distribucion del numero de ganglios aislados, el diametro del ganglio de mayor tamano aislado y la precision por estadio TNM para la afeccion ganglionar. Resultados la sensibilidad de la TC fue de 0,43, la especificidad de 0,96, la precision de 0,55 y la eficiencia de 0,67. Se observaron diferencias significativas en el diametro medio entre los grupos con y sin afeccion ganglionar: 16,29 mm (intervalo de confianza del 95%, 7,1–15,6) y 10,25 mm (intervalo de confianza del 95%, 4,8–25,5), respectivamente. Se aprecio una perdida de precision para los grupos N1 y N2. Conclusiones la TC helicoidal muestra un escaso rendimiento para la valoracion preoperatoria de la afeccion ganglionar. Pese a ello, sigue siendo la tecnica inicial de eleccion.

En el articulo ‘‘Rendimiento de la tomografia computarizada helicoidal en la prediccion de afeccion ganglionar preoperatoria en el cancer gastrico’’ F. Espin Alvarez, A. Bianchi Cardona, L. Pulido Martinez, J. Feliu Canaleta, A. Moreno Luna y MJ. Fantova Cosculluela, publicado en Med Clin (Barc) 2009;132:214–16 hay un error en los intervalos de confianza de la tabla 2. A continuacion publicamos la tabla 2 correcta