Pub Date : 2026-02-01DOI: 10.1016/j.ciresp.2025.800280
Carlos Cerdán-Santacruz , Matteo Frasson
{"title":"Manejo del cáncer de recto: el futuro ya es presente","authors":"Carlos Cerdán-Santacruz , Matteo Frasson","doi":"10.1016/j.ciresp.2025.800280","DOIUrl":"10.1016/j.ciresp.2025.800280","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800280"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.ciresp.2025.800279
Marcos Bruna , María Asunción Acosta , Silvia Carbonell , Luis Gómez , Marian Mayo , Salvador Morales-Conde , Aitana Garcia-Tejero , Silvia Aguas , David Ruíz de Angulo , Vicente Munitiz , Luisa Martínez de Haro , Vanessa Concepción , Fernando Mingol , Miriam Menéndez , Gabriel Salcedo , Esteban Martín , Ana Senent , Alexis Luna , Dulce Momblán , Pablo Priego , Mónica Miró
Hiatal hernia (HH) is a relatively prevalent condition in our setting, yet there is little clinical evidence or guidelines establishing precise recommendations for its diagnostic and therapeutic management.
In order to establish clinical recommendations for the diagnostic and therapeutic management of patients with complex hiatal hernia, defined as a primary type III or IV mixed hernia, a large one with >30% of the gastric contents in the thoracic cavity, or a recurrence. This document was prepared based on current scientific evidence and the experience of a group of 28 expert surgeons, using GRADE methodology in order to establish recommendations on 13 controversial aspects related to this pathology.
Although the quality of evidence and the degree of recommendation are high in some areas, high-quality prospective clinical studies are needed to clarify certain unresolved points of controversy.
{"title":"Hernias de hiato complejas. Recomendaciones de manejo diagnóstico y terapéutico","authors":"Marcos Bruna , María Asunción Acosta , Silvia Carbonell , Luis Gómez , Marian Mayo , Salvador Morales-Conde , Aitana Garcia-Tejero , Silvia Aguas , David Ruíz de Angulo , Vicente Munitiz , Luisa Martínez de Haro , Vanessa Concepción , Fernando Mingol , Miriam Menéndez , Gabriel Salcedo , Esteban Martín , Ana Senent , Alexis Luna , Dulce Momblán , Pablo Priego , Mónica Miró","doi":"10.1016/j.ciresp.2025.800279","DOIUrl":"10.1016/j.ciresp.2025.800279","url":null,"abstract":"<div><div>Hiatal hernia (HH) is a relatively prevalent condition in our setting, yet there is little clinical evidence or guidelines establishing precise recommendations for its diagnostic and therapeutic management.</div><div>In order to establish clinical recommendations for the diagnostic and therapeutic management of patients with complex hiatal hernia, defined as a primary type III or IV mixed hernia, a large one with<!--> <!-->>30% of the gastric contents in the thoracic cavity, or a recurrence. This document was prepared based on current scientific evidence and the experience of a group of 28 expert surgeons, using GRADE methodology in order to establish recommendations on 13 controversial aspects related to this pathology.</div><div>Although the quality of evidence and the degree of recommendation are high in some areas, high-quality prospective clinical studies are needed to clarify certain unresolved points of controversy.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800279"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.ciresp.2025.800254
Paula Jimenez-Fonseca , Marcos Bruna , Javier Gallego , Mónica Miró , Mireia Gil , Fernando Pereira , Gema Marín , Delia Cortés , Roberto Pazo , Mariagiulia Dal Cero , Elena Martín , Fernando Rivera
This manuscript presents a systematic review and expert consensus from oncology and surgery on the management of metastatic gastric cancer. A literature search was conducted in PubMed and Google Scholar, selecting 28 relevant studies (21 clinical trials and 7 systematic reviews), along with international guidelines. The objective was to assess the role of surgery and locoregional therapies in patients with peritoneal, hepatic, pulmonary, or nodal metastases, and to establish multidisciplinary recommendations. Cytoreductive surgery associated to HIPEC may offer benefits in selected patients with limited peritoneal carcinomatosis (Peritoneal Carcinomatosis Index ≤6), an absence of distant metastasis, an adequate response to systemic chemotherapy and an ECOG performance status of 0-1. Resection of non-peritoneal metastases may also be considered in specific contexts. Prospective clinical trials are required to confirm these findings and define optimal selection criteria.
{"title":"Manejo quirúrgico del adenocarcinoma gástrico estadio IV: revisión sistemática y recomendaciones del Grupo de Tratamiento de los Tumores Digestivos y la Asociación Española de Cirujanos","authors":"Paula Jimenez-Fonseca , Marcos Bruna , Javier Gallego , Mónica Miró , Mireia Gil , Fernando Pereira , Gema Marín , Delia Cortés , Roberto Pazo , Mariagiulia Dal Cero , Elena Martín , Fernando Rivera","doi":"10.1016/j.ciresp.2025.800254","DOIUrl":"10.1016/j.ciresp.2025.800254","url":null,"abstract":"<div><div>This manuscript presents a systematic review and expert consensus from oncology and surgery on the management of metastatic gastric cancer. A literature search was conducted in PubMed and Google Scholar, selecting 28 relevant studies (21 clinical trials and 7 systematic reviews), along with international guidelines. The objective was to assess the role of surgery and locoregional therapies in patients with peritoneal, hepatic, pulmonary, or nodal metastases, and to establish multidisciplinary recommendations. Cytoreductive surgery associated to HIPEC may offer benefits in selected patients with limited peritoneal carcinomatosis (Peritoneal Carcinomatosis Index ≤6), an absence of distant metastasis, an adequate response to systemic chemotherapy and an ECOG performance status of 0-1. Resection of non-peritoneal metastases may also be considered in specific contexts. Prospective clinical trials are required to confirm these findings and define optimal selection criteria.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800254"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.ciresp.2025.800276
Ismael Gómez Giménez , Juan Jesús Rubio Garcia , Silvia Carbonell Morote , José Manuel Ramia Ángel
Gastric cancer (GC) has high mortality due to late diagnosis from nonspecific symptoms. Advances in diagnostics and artificial intelligence (AI) promise earlier detection through greater sensitivity and specificity. This study reviews literature, including meta-analyses and systematic reviews, on AI in gastric adenocarcinoma (GA). In December 2024, following PRISMA, we searched PubMed, Web of Science, and Cochrane. Seventeen of 228 articles met inclusion criteria, comparing AI with other diagnostic or therapeutic approaches. Findings indicate AI may enhance imaging, histological assessment, endoscopy techniques, and surgical procedures. Progressive hospital implementation could significantly transform GA diagnosis, treatment, and prognosis.
胃癌（GC）由于非特异性症状诊断较晚，死亡率高。诊断技术和人工智能（AI）的进步有望通过提高灵敏度和特异性，更早地发现疾病。本研究回顾了有关AI在胃腺癌（GA）中的应用的文献，包括meta分析和系统综述。2024年12月，在PRISMA之后，我们搜索了PubMed、Web of Science和Cochrane。228篇文章中有17篇符合纳入标准，将人工智能与其他诊断或治疗方法进行了比较。研究结果表明，人工智能可以增强成像、组织学评估、内窥镜技术和外科手术。渐进式医院实施可显著改变GA的诊断、治疗和预后。
{"title":"IA en el diagnóstico y manejo del adenocarcinoma gástrico: revisión sistemática","authors":"Ismael Gómez Giménez , Juan Jesús Rubio Garcia , Silvia Carbonell Morote , José Manuel Ramia Ángel","doi":"10.1016/j.ciresp.2025.800276","DOIUrl":"10.1016/j.ciresp.2025.800276","url":null,"abstract":"<div><div>Gastric cancer (GC) has high mortality due to late diagnosis from nonspecific symptoms. Advances in diagnostics and artificial intelligence (AI) promise earlier detection through greater sensitivity and specificity. This study reviews literature, including meta-analyses and systematic reviews, on AI in gastric adenocarcinoma (GA). In December 2024, following PRISMA, we searched PubMed, Web of Science, and Cochrane. Seventeen of 228 articles met inclusion criteria, comparing AI with other diagnostic or therapeutic approaches. Findings indicate AI may enhance imaging, histological assessment, endoscopy techniques, and surgical procedures. Progressive hospital implementation could significantly transform GA diagnosis, treatment, and prognosis.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 3","pages":"Article 800276"},"PeriodicalIF":1.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.ciresp.2025.800277
Antonio Ríos , Beatriz Mahíllo , Beatriz Domínguez-Gil
The transmission of diseases through organ transplantation is an inherent risk to the transfer of biological material between individuals. This risk must be minimized, while also avoiding the unnecessary loss of organs suitable for transplantation obtained from donors with a history of a condition that may affect organ function or may be transmitted to the recipient—such donors are referred to as non-standard risk donors. The final decision to transplant organs from these donors must be made following a thorough risk/benefit assessment.
To this end, the approach in Spain has been based on the provision of targeted support to transplant teams through the development and adoption of reference documents, a second-opinion system, and the generation of evidence through the prospective follow-up of recipients of organs trasplanted from this type of donors.
{"title":"Definiendo límites de seguridad en la donación de órganos: el donante de riesgo no estándar","authors":"Antonio Ríos , Beatriz Mahíllo , Beatriz Domínguez-Gil","doi":"10.1016/j.ciresp.2025.800277","DOIUrl":"10.1016/j.ciresp.2025.800277","url":null,"abstract":"<div><div>The transmission of diseases through organ transplantation is an inherent risk to the transfer of biological material between individuals. This risk must be minimized, while also avoiding the unnecessary loss of organs suitable for transplantation obtained from donors with a history of a condition that may affect organ function or may be transmitted to the recipient—such donors are referred to as non-standard risk donors. The final decision to transplant organs from these donors must be made following a thorough risk/benefit assessment.</div><div>To this end, the approach in Spain has been based on the provision of targeted support to transplant teams through the development and adoption of reference documents, a second-opinion system, and the generation of evidence through the prospective follow-up of recipients of organs trasplanted from this type of donors.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 3","pages":"Article 800277"},"PeriodicalIF":1.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146057541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.ciresp.2025.800283
Pablo Lozano Lominchar , Paula Muñoz , Cristina Ballester , Cristobal Muñoz Casares , Daniel Díaz , Vicente Olivares-Ripoll , Patricia Marrero , Lorena Cambeiro , Irene López , Hugo Vasques , Jose Manuel Asencio , on behalf of the Spanish Society of Surgeons, the Portuguese Sarcoma Group (Society of Surgeons)
Background
Retroperitoneal sarcoma (RPS) is a rare malignancy requiring complex surgical management. While Enhanced Recovery After Surgery (ERAS®) protocols have improved outcomes in various surgical specialties, their implementation in RPS remains inconsistent.
Objective
This study aimed to evaluate current perioperative care practices for RPS surgery across Spain and Portugal, identifying gaps in protocol standardization and assessing the feasibility of consensus-based approaches.
Methods
A structured online survey was distributed to members of the Spanish and Portuguese Societies of Surgeons. The questionnaire encompassed five domains: demographics, preoperative, intraoperative, and postoperative practices, and attitudes toward perioperative consensus.
Results
Among 266 survey accesses, 37 complete responses were analyzed. Only 27% of respondents reported having a dedicated ERAS® protocol for RPS, though 89.2% employed ERAS® pathways for other surgeries. Prehabilitation elements —such as smoking cessation (21.6%), nutritional support (73%), and supervised physical therapy (37.8%)— were inconsistently applied. Intraoperatively, goal-directed fluid therapy was used by 51.4%, while 97.3% adhered to restrictive transfusion thresholds. Postoperative variability was notable in diet resumption, mobilization, and nasogastric tube use. All respondents supported the creation of an RPS-specific perioperative care consensus.
Conclusions
There is marked heterogeneity in perioperative care for RPS across Iberian centers. Standardized, evidence-based guidelines are urgently needed to improve consistency and optimize patient outcomes.
腹膜后肉瘤（RPS）是一种罕见的恶性肿瘤，需要复杂的手术治疗。虽然ERAS （Enhanced Recovery After Surgery）方案改善了各种外科专科的预后，但其在RPS中的实施仍然不一致。目的本研究旨在评估目前西班牙和葡萄牙RPS手术的围手术期护理实践，确定方案标准化方面的差距，并评估基于共识的方法的可行性。方法对西班牙和葡萄牙外科医师协会会员进行结构化的在线调查。调查问卷包括五个方面：人口统计学，术前，术中，术后实践，以及对围手术期共识的态度。结果在266条调查通道中，分析了37条完整回复。只有27%的受访者报告有专门的ERAS®RPS方案，尽管89.2%的受访者采用ERAS®途径进行其他手术。戒烟（21.6%）、营养支持（73%）和有监督的物理治疗（37.8%）等康复要素的应用不一致。术中，51.4%的患者使用目标导向的液体治疗，而97.3%的患者坚持限制性输血阈值。术后在饮食恢复、活动和鼻胃管使用方面的差异是显著的。所有的应答者都支持建立一个特定于rps的围手术期护理共识。结论伊比利亚各中心RPS围手术期护理存在明显的异质性。迫切需要标准化的、以证据为基础的指南，以提高一致性并优化患者的预后。
{"title":"Cuidados perioperatorios en la cirugía del sarcoma retroperitoneal primario: una encuesta hispano-lusa sobre prácticas actuales","authors":"Pablo Lozano Lominchar , Paula Muñoz , Cristina Ballester , Cristobal Muñoz Casares , Daniel Díaz , Vicente Olivares-Ripoll , Patricia Marrero , Lorena Cambeiro , Irene López , Hugo Vasques , Jose Manuel Asencio , on behalf of the Spanish Society of Surgeons, the Portuguese Sarcoma Group (Society of Surgeons)","doi":"10.1016/j.ciresp.2025.800283","DOIUrl":"10.1016/j.ciresp.2025.800283","url":null,"abstract":"<div><h3>Background</h3><div>Retroperitoneal sarcoma (RPS) is a rare malignancy requiring complex surgical management. While Enhanced Recovery After Surgery (ERAS®) protocols have improved outcomes in various surgical specialties, their implementation in RPS remains inconsistent.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate current perioperative care practices for RPS surgery across Spain and Portugal, identifying gaps in protocol standardization and assessing the feasibility of consensus-based approaches.</div></div><div><h3>Methods</h3><div>A structured online survey was distributed to members of the Spanish and Portuguese Societies of Surgeons. The questionnaire encompassed five domains: demographics, preoperative, intraoperative, and postoperative practices, and attitudes toward perioperative consensus.</div></div><div><h3>Results</h3><div>Among 266 survey accesses, 37 complete responses were analyzed. Only 27% of respondents reported having a dedicated ERAS® protocol for RPS, though 89.2% employed ERAS® pathways for other surgeries. Prehabilitation elements —such as smoking cessation (21.6%), nutritional support (73%), and supervised physical therapy (37.8%)— were inconsistently applied. Intraoperatively, goal-directed fluid therapy was used by 51.4%, while 97.3% adhered to restrictive transfusion thresholds. Postoperative variability was notable in diet resumption, mobilization, and nasogastric tube use. All respondents supported the creation of an RPS-specific perioperative care consensus.</div></div><div><h3>Conclusions</h3><div>There is marked heterogeneity in perioperative care for RPS across Iberian centers. Standardized, evidence-based guidelines are urgently needed to improve consistency and optimize patient outcomes.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800283"},"PeriodicalIF":1.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.ciresp.2025.800256
Marina Garcés Albir , Francisco García García , Isabel Mora Oliver , Elena Muñoz Forner , Luis Sabater Orti , Dimitri Dorcaratto , GRUPO 3D-PANC Integrantes Grupo 3D-PANC
Neoadjuvant chemotherapy followed by surgery represents the treatment of choice for patients with borderline and locally advanced pancreatic adenocarcinoma (PAC). Despite being the diagnostic technique of choice for PAC staging, computed tomography (CT) has very low accuracy in identifying patients who may benefit from surgical resection after neoadjuvant therapy. Consequently, the study of new image processing technologies is gaining significant importance. However, no prospective validation studies of these new technologies currently exist. The 3D-PANC study is a multicenter prospective study that will include patients with borderline or locally advanced PAC undergoing neoadjuvant chemotherapy and surgical exploration with curative intent. The objective is to compare the accuracy of the 3D-MSP (Model for Surgery Planning) model versus conventional CT for preoperative diagnosis of vascular involvement after neoadjuvant treatment (NAT) in patients with borderline or locally advanced PAC. This will be achieved by analyzing the accuracy variables of both techniques against the gold standard (surgical outcomes and histopathological analysis).
{"title":"Protocolo del estudio 3D-PANC: ¿es la tecnología de imagen en tres dimensiones superior a la tomografía computarizada para evaluar la respuesta al tratamiento neoadyuvante en los pacientes con adenocarcinoma de páncreas borderline o localmente avanzado?","authors":"Marina Garcés Albir , Francisco García García , Isabel Mora Oliver , Elena Muñoz Forner , Luis Sabater Orti , Dimitri Dorcaratto , GRUPO 3D-PANC Integrantes Grupo 3D-PANC","doi":"10.1016/j.ciresp.2025.800256","DOIUrl":"10.1016/j.ciresp.2025.800256","url":null,"abstract":"<div><div>Neoadjuvant chemotherapy followed by surgery represents the treatment of choice for patients with borderline and locally advanced pancreatic adenocarcinoma (PAC). Despite being the diagnostic technique of choice for PAC staging, computed tomography (CT) has very low accuracy in identifying patients who may benefit from surgical resection after neoadjuvant therapy. Consequently, the study of new image processing technologies is gaining significant importance. However, no prospective validation studies of these new technologies currently exist. The 3D-PANC study is a multicenter prospective study that will include patients with borderline or locally advanced PAC undergoing neoadjuvant chemotherapy and surgical exploration with curative intent. The objective is to compare the accuracy of the 3D-MSP (Model for Surgery Planning) model versus conventional CT for preoperative diagnosis of vascular involvement after neoadjuvant treatment (NAT) in patients with borderline or locally advanced PAC. This will be achieved by analyzing the accuracy variables of both techniques against the gold standard (surgical outcomes and histopathological analysis).</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800256"},"PeriodicalIF":1.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.ciresp.2025.800249
Juli Busquets , Núria Peláez , Luis Secanella , Maria Sorribas , Elena Iborra
The resection of locally advanced adenocarcinoma of the pancreatic head with occlusion of the superior mesenteric vein and involvement of the splenomesentericportal confluent (EMP) sometimes requires prolonged venous clamping with risk of intestinal ischemia. The use of intraoperative venous shunts has been published by reference groups to allow successful resection. In our center we performed a total pancreatoduodenectomy for locally advanced pancreatic head adenocarcinoma with superior mesenteric vein occlusion (SMV) and splenomesentericportal confluent. The use of a transient ileo-caval shunt via a venous graft allowed resection of the tumor without repercussion on the bowel. The surgery ended with closure of the shunt, anastomosis of the graft to the portal vein and digestive reconstruction. The patient presented good tolerance to surgery and was discharged on the 7 th postoperative day. The pathology report described pancreatic adenocarcinoma ypT1N0(R0) regression grade GRT2/IIa, with 0/30 affected adenopathies.
{"title":"Shunt íleo-cava intraoperatorio transitorio en la resección de adenocarcinoma de cabeza de páncreas localmente avanzado: ¿rompiendo un techo?","authors":"Juli Busquets , Núria Peláez , Luis Secanella , Maria Sorribas , Elena Iborra","doi":"10.1016/j.ciresp.2025.800249","DOIUrl":"10.1016/j.ciresp.2025.800249","url":null,"abstract":"<div><div>The resection of locally advanced adenocarcinoma of the pancreatic head with occlusion of the superior mesenteric vein and involvement of the splenomesentericportal confluent (EMP) sometimes requires prolonged venous clamping with risk of intestinal ischemia. The use of intraoperative venous <em>shunt</em>s has been published by reference groups to allow successful resection. In our center we performed a total pancreatoduodenectomy for locally advanced pancreatic head adenocarcinoma with superior mesenteric vein occlusion (SMV) and splenomesentericportal confluent. The use of a transient ileo-caval <em>shunt</em> via a venous graft allowed resection of the tumor without repercussion on the bowel. The surgery ended with closure of the <em>shunt</em>, anastomosis of the graft to the portal vein and digestive reconstruction. The patient presented good tolerance to surgery and was discharged on the 7<!--> <!-->th postoperative day. The pathology report described pancreatic adenocarcinoma ypT1N0(R0) regression grade GRT2/IIa, with 0/30 affected adenopathies.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800249"},"PeriodicalIF":1.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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