Enrique Luque-de-León

Mammary analog secretory carcinoma of the parotid gland: A case report and literature review.

Highlights • Mammary analog secretory carcinoma (MASC) is a newly described carcinoma of the salivary glands.• MASC is characterized by morphologic and immunohistochemical features that strongly resemble a secretory carcinoma (SC) of the breast.• MASC and SC of the breast share the presence of translocation t(12;15) (p13;q25), that results in the formation of an oncogenic fusion gene ETV6-NTK3.• The majority of MASC present among men and arise from the parotid gland.• MASC is a low-grade carcinoma with potential for high-grade transformation.

Conversion of One-Anastomosis Gastric Bypass (OAGB) Is Rarely Needed if Standard Operative Techniques Are Performed

1. Mini-gastric bypass (MGB)/One-anastomosis gastric bypass (OAGB) is currently performed by an increasing number of surgeons around the world [2, 3]. Published experiences have escalated in recent years and are positioning MGB/OAGB as a safe and effective alternative in bariatric/metabolic surgery [2–4]. Although a controversy has arisen in regard to the name of the procedure [5], this should not divert attention and demerit overall outcomes achieved and reported. 2. The main argument in opposition to MGB/OAGB has been the possibility of bile reflux (BR) and its repercussions. This was critically stated by Johnson et al. [6] in a review from complicationsmanaged at different hospitals, whose purpose was to assess (and discredit) the claim that revisional surgery was rarely required in this patient population [7]. This article, however, was full of assumptions, and as previously expressed [8], drawing valid conclusions without a denominator (total number of patients) is impossible. Moreover, no descriptions about operative findings were given, particularly in those cases with Bintractable^ BR; some may have been similar to the present case [1], which, due to its gastric pouch characteristics, in fact resemble the old (and abandoned) Mason’s loop—see below [9]. 3. BR after MGB/OAGB has been reported to be rare, presenting sporadically after specific triggers, usually at night and subsiding after medical treatment [2, 3, 10–15]. In addition, BR in these instances has usually been identified clinically and through ancillary studies only in the stomach [10, 12, 16]. Even those highly critical of MGB described Bintractable^ BR gastritis (and not esophagitis) as the indication to reoperate on their patients [6]. The fact that BR does not reach the esophagus has important implications [17]. 4. Fear of cancer due to BR has also been an issue mainly based on older studies from the time of peptic ulcer surgery. Several of these have been contradictory and did not take into account various confounding variables such as Helicobacter pylori [18]. In any case, even the highly criticized Mason’s loop with its proven BR has not been associated with esophageal cancer, and so far, only one case of gastric pouch cancer has been reported 26 years after [19]. Three other cases of cancer after Mason’s loop have been found; however, these were unrelated to BR as * Enrique Luque-de-León eluque@prodigy.net.mx

Evaluation of Weight Loss Indicators and Laparoscopic One-Anastomosis Gastric Bypass Outcomes

Mini-gastric bypass/One-anastomosis gastric bypass (MGB-OAGB) is an effective bariatric technique for treating overweight and obesity, controlling and improving excess-weight-related comorbidities. Our study evaluated OAGB characteristics and resulting weight evolution, plus surgical success criteria based on various excess weight loss indicators. A prospective observational study of 100 patients undergoing OAGB performed by the same surgical team (two-year follow-up). Surgical characteristics were: surgery duration, associated complications, bowel loop length, hospital stay, and weight loss at 6 postoperative points. 100 patients were treated (71 women, 29 men); mean initial age was 42.61 years and mean BMI, 42.61 ± 6.66 kg/m2. Mean surgery duration was 97.84 ± 12.54 minutes; biliopancreatic loop length was 274.95 ± 23.69 cm. Average hospital stay was 24 hours in 98% of patients; no surgical complications arose. Weight decreased significantly during follow-up (P < 0.001). Greatest weight loss was observed at 12 months postsurgery (68.56 ± 13.10 kg). Relative weight loss showed significant positive correlation, with greatest weight loss at 12 months and %excess BMI loss > 50% achieved from the 3-month follow-up in 92.46% of patients. OAGB seems to be effective in treating obesity, with short hospital stays. Relative weight loss correlates optimally with absolute outcomes, but both measures should be used to evaluate surgical results.

Author Correction: Evaluation of Weight Loss Indicators and Laparoscopic One-Anastomosis Gastric Bypass Outcomes

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Miguel-Angel Carbajo, MD, PhD

Dr. Miguel-A Carbajo is a pioneer in the fields of Laparoscopic and Obesity Surgery in Europe, Latin America, and the Middle East. He was born during the postcivil war period in a historical village in the province of Palencia in north-central Spain called Dueñas and grew up in a farmer family. Dr. Carbajo studied Medicine at the University of Valladolid (UV). Due to his early interest in history and literature, he wrote several historical books concerning the rates of illiteracy in deprived areas. Later, he was able to conduct literacy campaigns for adults throughout Spain. He graduated with honors and joined the Unit of Surgical Pathology where he was initially responsible for the education of interns. In 1977, after obtaining a postgraduate degree in General and Gastrointestinal Surgery, he was placed in charge of the Surgical Unit at the University Clinic of Rio Hortega Hospital in Valladolid, where he was involved in all surgical subspecialties including thoracic, vascular, trauma, and gastrointestinal. It was there where he developed a great interest in teaching. During his years at the University Clinic, he taught at both the undergraduate and postgraduate levels. As Chairman of the Infections and Nutrition Committee, and Planning Manager for the Emergency Unit, he developed a keen interest in the management of sepsis and severe intraabdominal infections. He was a member of the first programs to implement enteral and parenteral nutrition in these patients. This led to the publication of innovative scientific papers on pancreatitis and peritonitis, as well as artificial nutrition and the use of glutamine as an intestinal restorer in patients with bowel resections and/or severe sepsis. Furthermore, as a means to overcome the scarce technology during that time in Spain, in 1979, he developed the first laparoscopic surgical techniques through optical lenses and a light source, performing hundreds of diagnostic and therapeutic procedures. In 1989, he was appointed Head of the General and Gastrointestinal Surgery Unit at Medina del Campo Hospital (Valladolid), during a time when laparoscopic surgery with a camera was being introduced in France. After observing Dr. F. Dubois’s procedures in Paris, he immediately started the systematic implementation of cholecystectomy and other emerging laparoscopic techniques, which soon allowed his hospital to become a reference center in laparoscopic surgery both at the national and international levels. Over the following years, he organized more than 30 advanced laparoscopic surgery workshops, and several symposia on endoscopic suturing. * Aniceto Baltasar baltasarani@gmail.com

Anti-Reflux One-Anastomosis Gastric Bypass (OAGB)—(Spanish BAGUA): Step-By-Step Technique, Rationale and Bowel Lengths

The One-Anastomosis Gastric Bypass (OAGB) is a technical modification of the Mini-Gastric Bypass (MGB) which was developed in the year 2002. Although both procedures have the common principles of performing only one anastomosis and avoiding an alimentary (Roux) limb, OAGB includes some different technical and conceptual proposals which among others, essentially include: (1) Complete measurement of the entire small bowel (SB) to determine extent of bypassed biliopancreatic limb and common channel; lengths of these segments are not fixed but assigned according to body mass index, SB length and other metabolic variables, which lead OAGB into having a more malabsorptive profile, (2) Explicit dissection of the angle of His and a very long and narrow gastric pouch constructed over a 36-Fr calibration tube, (3) Creation of an “anti-reflux mechanism” by an 8–10 cm latero-lateral continuous suture between the (selected) SB and gastric pouch, which is reinforced by fixation of the apex of the SB to the excluded stomach, (4) Width of the latero-lateral gastro-ileal anastomosis (~2.5 cm) is wider than in Roux-Y Gastric Bypass, but not as wide as in MGB. Implementation of all these measures has turned OAGB into a more robust operation which minimizes the possibility of reflux or marginal ulcer and leads to better medium- and long-term results in terms of weight loss and metabolic benefits.

Results of the One-Anastomosis Gastric Bypass (OAGB): Safety, Nutritional Considerations and Effects on Weight, Co-Morbidities, Diabetes and Quality of Life

Morbid obesity is a chronic, progressive, relentless and multifactorial disease leading to catastrophic repercussions for the patient. Although surgery is currently the only effective alternative in its treatment, the “ideal” bariatric operation is yet to be found. After performing many of the available open and laparoscopic options in bariatric surgery, and aware of several issues with the Roux-en-Y gastric bypass which we were performing at the time, we decided to evaluate the Mini-gastric bypass (MGB) which had recently been reported. The laparoscopic One-Anastomosis Gastric Bypass (OAGB) was thus created in the year 2002, as a modification of the MGB with differentiated conceptual principles and technical features. Since then, we have periodically reported our outcomes both in scientific meetings and publications. This chapter updates our experience with a prospectively collected database of now 3000 patients during a 15 year period.

Reply to “Reviews of One Anastomosis Gastric Bypass” by K. Mahawar

Contrary to his Reply to Letters [1], Dr. Mahawar’s opening assertion [2] that he is a member of the Mini-Gastric Bypass– One-Anastomosis Gastric Bypass Club (which has >300 members) is not correct. Dr. Mahawar in two similar papers [3, 4], published in Obesity Surgery 2 months apart, concludes that MGB may carry a risk of reflux and carcinoma. Drs. Musella and Milone [5] and we [1] answered these assertions in our Reply. The Conclusion of Mahawar’s first paper [3] states BThis procedure may carry a risk of gastric and/or esophageal reflux^ and warns of Ba higher risk of cancers in the gastric tube and oesophagus in the long term – surgeons should counsel their patients appropriately .̂ The Conclusion of his second paper [4] states BSurgeons must be aware of these controversial aspects...., including the controversy surrounding risk for gastric and oesophageal cancers, to be able to counsel their patients appropriately .̂ This is after he had questioned us whether CA occurs after MGB and agreed with us that this is not a feature, especially when compared to other bariatric operations [1, 5]. It was following this, in 2015 and 2016, that he reported, based on his small experience, the fact that reflux is infrequent and carcinoma almost unknown after MGB. Our Letter to the Editor discusses his issues [2], as we explain the two operations [1]—MGB and its variant OAGB. Many of us have performed >2000 of these procedures and are at the professorial level, so that his assertion that we are Bunscientific^ [2] is offensive.

Sentinel Lymph Node Biopsy in the Setting of Conjunctival Melanoma: Report of Two Cases and Literature Review

Objective: To report two cases of conjunctival melanoma (CM) that underwent sentinel lymph mapping (SLNM) and sentinel lymph node biopsy (SLNB) with good results. Introduction: Conjunctival melanoma (CM) is a very rare malignancy, with an incidence of less than one per million cases per year. Metastatic dissemination may occur via lymphatic or hematogenous routes. The regional lymph nodes most commonly involved in the head and neck region are found in the deep cervical node chain and in the parotid gland. The management of the lymph nodes in patients with CM is debatable with some authors recommending SLNM with SLNB. The indications for performing SLNM and SLNB are CM with a thickness of 1 mm or greater. Case report: Two patients diagnosed with CM underwent SLNM and SLNB with complete surgical resection of the conjunctival lesions and superficial parotidectomy as part of the SLNB. Final pathology reported confirmed a complete resection of the lesions and a negative SLNB. The procedure was performed without any postoperative complications. Both patients on follow-up are free of disease without evidence of local or regional recurrence. Conclusion: Evidence of the accuracy SLNM and SLNB in CM in the literature is sparse. We report on two cases where the identification of the SLN was accurate with no postoperative complications. We believe based the available evidence that SLNM and SNLB is feasible, accurate, with a low complication rate in patient with CM. Introduction Conjunctival melanoma (CM) is a rare malignancy with an incidence of 0.15 to 0.49 cases per million persons per year [1,2]. It is a very aggressive non-cutaneous neoplasm that represents only 5% of ocular melanomas with a 10-year mortality rate of 30% [3,4]. It is identified more frequently in the elderly population (53% of the cases), and in Caucasians (94% of the cases) [5]. The main clinical manifestations are a pigmented lesion, lump, or swelling in the conjunctiva in 83% of the cases. In approximately 61% of the cases the lesion is usually located at the limbal conjunctiva and in 46% of the cases in the temporal quadrant of the eye [5]. Metastases can be detected with positron emission tomography / computed tomography (PET/CT). However, micro-metastasis through the lymphatic system can only be detected with sentinel lymph node mapping (SLNM) and sentinel lymph node biopsy (SLNB) [6]. The aim of this study is to present two cases of CM were SLNM and SLNB was performed as part of their management with adequate identification of the SLN with no added morbidity. Case 1 A 72-year old male, with a history of chronic irritation of the left eye for more than two months, was evaluated by an ophthalmologist who diagnosed a CM and send him to our clinic. We identified two pigmented lesions, one of approximately 1 cm in size and another of approximately 2 cm in size. Both lesions had irregular borders, one was in the temporal region, and the other on the nasal region of the eye (Figure 1). He was initially treated with Mitomycin C for 16 days without any objective response. After a multidisciplinary review of the case, it Correspondence to: Rodrigo Arrangoiz, Sociedad Quirúrgica S.C. at the American British Cowdray Medical Center. Department of Surgical Oncology and Head and Neck Tumors. Av. Carlos Graef Fernandez # 154 – 515 Colonia Tlaxala, Delegación Cuajimalpa Mexico City, Mexico 05300, Tel: 52551664 7200; E-mail: rodrigo.arrangoiz@yahoo.com

Pulmonary extraskeletal myxoid chondrosarcoma: A case report and literature review

Highlights • Extraskeletal myxoid chondrosarcoma (EMC) is a rare tumor characterized by the multinodular growth of primitive chondroid cells in an abundant myxoid matrix.• EMC is categorized as a tumor of uncertain differentiation by the 2002 WHO classification.• EMC has shown to have the recurrent balanced chromosomal translocation t(9;22) (q22;q12.2), which leads to the oncogenic fusion gene EWSR1-NR4A3.• EMC usually presents in male patients beyond their fifth decade as a slow growing, palpable mass in the extremities.• Pulmonary extraskeletal myxoid chondrosarcomas are extremely rare with only isolated case reports found in the literature.