Yuri Goldes’s research while affiliated with Tel Aviv University and other places


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Publications (17)


640. EPIPHRENIC DIVERTICULECTOMY WITH HELLER MYOTOMY AND DOR FUNDOPLICATION
  • Article

September 2024

Diseases of the Esophagus

Ya'ara Gutman

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Josef Braun

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Harel Jacobi

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[...]

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Yehonatan Nevo

The attached video demonstrates epiphrenic diverticulectomy with Heller myotomy and Dor fundoplication, in a symptomatic 62 years old female patient with regurgitation and achalasia. The video offers a unique insight into the complexities of treating this uncommon condition. In this case, a laparoscopic transhiatal approach was used. The video shows the key steps of the surgery, including challenges posed by the diverticulum's unusual location (left side of the esophagus), necessitating the careful opening of the left crura for optimal visualization and safe resection. We believe this teaching case not only sheds light on the intricacies of managing epiphrenic diverticulum but also underscores the importance of tailored approaches in addressing atypical presentations. https://www.dropbox.com/scl/fi/jutvx1akf32nlgf8o57bp/epiphrenic-diverticuluectomy.mp4?rlkey=nmscb8y1k84g9cnfmzohtgjvp&dl=0


Neutrophil to Lymphocyte Ratio in Patients Who Received Neoadjuvant Treatment before Gastrectomy

May 2023

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6 Reads

The Israel Medical Association journal

Background: The neutrophil to lymphocyte ratio (NLR) has demonstrated prognostic value in various malignant conditions, including gastric adenocarcinoma. However, chemotherapy may affect NLR. Objectives: To evaluate the prognostic value of NLR as an accessory decision-making tool in terms of operating patients after neoadjuvant chemotherapy in patients with resectable gastric cancer. Methods: We collected oncologic, perioperative, and survival data of patients with gastric adenocarcinoma who underwent curative intent gastrectomy and D2 lymphadenectomy between 2009 and 2016. The NLR was calculated from preoperative laboratory tests and classified as high (> 4) and low (≤ 4). The t-test, chi-square, Kaplan-Meier analysis, and Cox multivariate regression models were used to assess associations of clinical, histologic, and hematological variables with survival. Results: For 124 patients the median follow-up was 23 months (range 1-88). High NLR was associated with greater rate of local complication (r=0.268, P < 0.01). The rate of major complications (Clavien-Dindo ≥ 3) was higher in the high NLR group (28% vs. 9%, P = 0.022). Among the 53 patients who received neoadjuvant chemotherapy, those with low NLR had significantly improved disease-free survival (DFS) (49.7 vs. 27.7 months, P = 0.025). Low NLR was not significantly associated with overall survival (mean survival, 51.2 vs. 42.3 months, P = 0.19). Multivariate regression identified NLR group (P = 0.013), male gender (P = 0.04), and body mass index (P = 0.026) as independently associated with DFS. Conclusions: Among gastric cancer patients planned for curative intent surgery who underwent neoadjuvant chemotherapy, NLR may have prognostic value, particularly regarding DFS and postoperative complications.


Giant Diaphragmatic Hernia in Elastoderma
  • Article
  • Full-text available

February 2022

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31 Reads

The Israel Medical Association journal

Download

Basic demographic and clinical data
Clinical, laboratory, and imaging presentation of patients
Intra-operative data
Hospitalization and short follow-up outcomes
Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience

May 2021

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41 Reads

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11 Citations

The Israel Medical Association journal

Background: The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. Objectives: To evaluate the presentation and management of patients with acute appendicitis. Methods: A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. Results: Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. Conclusions: The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.


Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer

April 2020

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98 Reads

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63 Citations

Annals of Surgical Oncology

Background Neoadjuvant FOLFIRINOX is a standard-of-care treatment for BRPC patients. Patients with gBRCAm who have demonstrated improved response to platinum-based chemotherapy may have impaired homologous repair deficiency. This study aimed to describe the pathologic complete response rate and long-term survival for patients with germline BRCA1 or BRCA2 mutation (gBRCAm) and borderline resectable pancreatic cancer (BRPC) treated with neoadjuvant FOLFIRINOX.MethodsA dual-center retrospective analysis was performed. Patients who had BRPC treated with neoadjuvant FOLFIRINOX followed by curative resection were identified from clinical databases. Pathologic complete response was defined as no viable tumor cells present in the specimen. Common founder Jewish germline BRCA1 or BRCA2 mutation was determined for available patients.ResultsThe 61 BRPC patients in this study underwent resection after neoadjuvant FOLFIRINOX. Analysis of BRCA mutation was performed for 39 patients, and 9 patients were found to be BRCA2 germline mutation carriers. The pathologic complete response rate was 44.4% for the gBRCAm patients and 10% for the BRCA non-carriers (p = 0.009). The median disease-free survival was not reached for the gBRCAm patients and was 7 months for the BRCA non-carriers (p = 0.03). The median overall survival was not reached for the gBRCAm patients and was 32 months for the BRCA non-carriers (p = 0.2). After a mean follow-up period of 33.7 months, all eight patients with pathologic complete response were disease-free.Conclusions The study showed that gBRCAm patients with BRPC have an increased chance for pathologic complete response and prolonged survival after neoadjuvant FOLFIRINOX. The results support the benefit of exposing gBRCAm patients to platinum-based chemotherapy early in the course of the disease. Neoadjuvant FOLFIRINOX should be considered for BRCA carriers who have resectable pancreatic cancer.


The impact of pancreatic cancer resection in the era of effective systemic treatment.

February 2020

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31 Reads

Journal of Clinical Oncology

722 Background: Surgical resection is the only curative modality in pancreatic cancer, yet the vast majority of patients undergoing surgery succumb of their disease. No randomized studies have been performed to assess the survival impact of the procedure. We hypothesized that in the era of effective systemic treatments, the survival advantage of surgical resection would be lessened. Methods: A meta-analysis of published phase III clinical trials in pancreatic cancer in both the post resection adjuvant setting and the locally advanced metastatic setting, based upon indirect aggregate data. Data was stratified based upon the systemic agents used. Patients from trials arms for which there were not complementary data sets with/without surgical resection were excluded. Primary endpoint was 3 year overall survival (OS). Results: Trials were published between 1997 and 2018. A total of 2722 patients were included in the data analysis, of whom 1645 underwent tumor resection and 814 were metastatic. Median follow-up was 40 months. Analyses were performed of five systemic options with / without tumor resection. Across the trials averaged 3 yr OS was 0%, 0.8%, 0%, and 3.8% for 5FU, gemcitabine, gemcitabine + capecitabine, & FOLFIRINOX respectively; and 18.1%, 30.0%, 37.9%, 42.5%, and 62.5% for the same systemic treatments delivered following surgical resection. Hence the additive impact of surgical resection on absolute 3 yr OS was only 18.1% in the absence of systemic treatment, but 30.0%, 37.1%, 42.5% and 58.8% in the presence of 5FU, gemcitabine, gemcitabine + capecitabine, FOLFIRINOX respectively. Conclusions: Within the limitations of this analysis, it appears that our hypothesis was incorrect, and that the opposite is true. The introduction of effective systemic therapies has greatly increased the impact of pancreatic surgery on long-term survival in pancreatic cancer. Consequently, every effort should be made to bring patients to curative resection.


FIGURE 1. Rectal prolapse extraction.
TABLE 1 . Demographics and surgical data
FIGURE 2. Lateral division of the prolapse by a linear stapler at the 3 o'clock position.
Perineal Stapled Rectal Prolapse Resection in Elderly Patients: Long-term Follow-up

September 2018

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497 Reads

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11 Citations

Diseases of the Colon & Rectum

Background: Full-thickness rectal prolapse has a significant negative impact on quality of life. The therapeutic options, specifically in elderly patients, are imperfect. Perineal stapled rectal prolapse resection is a novel operation for treating external rectal prolapse. Long-term follow-up following this procedure is lacking. In our study, we report a long-term follow-up of 30 patients, analyzing the long-term recurrence rate, morbidity, and functional outcome. Objective: This study aimed to examine the long-term results of perineal stapled rectal resection in a population unfit for prolonged general anesthesia. Design: This was a cohort study with a prospective follow-up. Settings: This study was conducted at a single tertiary referral center. Patients: Patients undergoing perineal stapled rectal resection from January 2010 to June 2013 were included. Interventions: Perineal stapled rectal prolapse resection was performed. Main outcome measures: The primary outcome measured was prolapse recurrence. Results: A total of 30 patients underwent the surgical intervention. The median follow-up period was 61 months (range, 37-65). No intraoperative or postoperative complications occurred. Six patients (20%) had recurrent rectal prolapse, and continence was not achieved in any of the patients. Two patients who had recurrence underwent a redo perineal stapled rectal resection. Limitations: This study was limited by the small cohort of selected patients. Conclusions: Frail patients that can only endure a short procedure under regional anesthesia should be considered for perineal stapled rectal prolapse resection. The lack of mortality and morbidity, specifically in this population, along with the low long-term recurrence rates, make this a favorable surgical alternative. See Video Abstract at http://links.lww.com/DCR/A745.


Figure 2: Pre-surgical Haemorrhoids
Figure 3: Following Doppler guided hemorrhoidal laser procedure
Clinical data of patients with second-and third-degree hemorrhoids
Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids

June 2018

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107 Reads

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21 Citations

Laser Therapy

Background: Hemorrhoids are a common anorectal condition with a major medical and socioeconomic impact. Owing to the high incidence of symptomatic hemorrhoids in the adult population together with the risk of complications of traditional surgery, researchers are seeking less invasive methods of hemorrhoidal treatment.The aim of this study was to present our experience with the mini-invasive Doppler guided hemorrhoidal laser procedure (HeLP) in symptomatic 2nd and 3rd degree hemorrhoids with absent or minimal mucosal prolapse. Methods: The cohort included 62 patients with symptomatic hemorrhoids who underwent the HeLP at a tertiary medical center in 2014-2016. Data were collected on clinical and perioperative characteristics and outcome. Findings were compared between patients with second- and third-degree hemorrhoids. Results: The cohort included 41 male and 21 female patients of mean age 41.5 years. Fifty-one had bleeding and 11 had hemorrhoidal syndrome. Mean operative time was 16.6 ± 3.7 minutes. A total of 8-12 arterial branches were treated. Patients were discharged home within a mean of 91.95 ± 20.48 minutes and allowed to resume normal activities. Compared to patients with second-degree hemorrhoids, patients with third-degree hemorrhoids had a significantly higher rate of recto-anal repair (18.2% vs 0, p < 0.05), intraoperative bleeding (11.3% vs 5%, p < 0.05), and thrombus formation in the hemorrhoids (11.3 % vs 0, p < 0.01). At the six-month follow-up, no complications were reported, and there was significant improvement in symptoms.Using the visual analog scale, no pain was reported by 82.3% of patients at one week after surgery and 95.2% of patients at one month after surgery. Conclusion: Patients with hemorrhoids treated with Doppler-guided laser had an excellent outcome in terms of resolution of symptoms and postoperative pain. Only Minor short-term complications were noted. Doppler-guided laser seems to be an effective and painless technique for the treatment of symptomatic second- to third grade hemorrhoids with minimal mucosal prolapse.


Risk Factors for Complications of Total/Subtotal Gastrectomy for Gastric Cancer: Prospectively Collected, Based on the Clavien-Dindo Classification System

May 2018

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30 Reads

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11 Citations

The Israel Medical Association journal

Background: Recent studies have analyzed risk factors associated with complications after gastric cancer surgery using the Clavien-Dindo classification (CD). However, they have been based on Asian population cohorts (Chinese, Japanese, Korean). Objectives: To prospectively analyze all post-gastrectomy complications according to severity using CD classification and identify postoperative risk factors and complications. Methods: We analyzed all gastrectomies for gastric cancer performed 2009-2014. Recorded parameters included demographic data, existing co-morbidities, neo-adjuvant treatment, intra-operative findings, postoperative course, and histologic findings. Postoperative complications were graded using CD classification. Results: The study comprised 112 patients who underwent gastrectomy. Mean age was 64.8 ± 12.8 years; 53 patients (47%) underwent gastrectomy, 37 (34%) total gastrectomy, and 22 (19%) total extended gastrectomy. All patients had D2 lymphadenectomy. The average number of retrieved lymph nodes was 35 ± 17. Severe complication rate (≥ IIIa) was 14% and mortality rate was 1.8%. In a univariate analysis, age > 65 years; ASA 3 or higher; chronic renal failure; multi-organ resection; and tumor, node, and metastases (TNM) stage ≥ IIIc were found to be significantly associated with CD complication grade > III (P = 0.01, P = 0.05, P = 0.04, P = 0.04, and P = 0.01, respectively). Multivariate regression analysis revealed advanced stage (≥ IIIc) and age > 65 years to be significant independent risk factors (P < 0.05). Conclusions: Age > 65 and advanced stage (≥ IIIc) were the primary risk factors for complications of grade > III according to the CD classification following gastrectomy for gastric cancer.



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Citations (11)


... En cuanto al uso de tomografía axial computarizada, nuestro estudio no tuvo variaciones durante los dos periodos estudiados; esto contrasta con los resultados obtenidos por English et al. 11 , en su estudio multicéntrico llevado a cabo en Inglaterra, donde el uso de tomografía para diagnóstico de apendicitis aguda fue mayor, en la cohorte pre-pandemia de 43,2 % y en la cohorte de pandemia de 54,9 %, con aumento durante el periodo de pandemia. Similar al estudio de Aharoni et al. 12 , realizado en Israel, y el estudio de Achaval et al. 13 , en la ciudad de Buenos Aires, los dos grupos de comparación no mostraron variación alguna en los hallazgos intraoperatorios. ...

Reference:

Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia
Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience

The Israel Medical Association journal

... The specific delivery of siR-NAs in tissues of interest remains a scientific lock, mainly due to the lack of efficient and selective delivery systems [9,10]. From lipid and polymer nanoparticles [11][12][13][14] that encapsulate free siRNA to well-defined and stable molecular Ligand-siRNA conjugates [15,16], a wide variety of delivery systems are currently on the study bench to fully unlock the potential of siRNAs. ...

A phase I trial of a local delivery of siRNA against k-ras in combination with chemotherapy for locally advanced pancreatic adenocarcinoma.

Journal of Clinical Oncology

... [19]. The results of gBRCA testing could play an important role in the selection of a second-line chemotherapeutic regimen because platinum-based chemotherapy, such as FOLFIRINOX, is preferred because it shows favorable treatment outcomes in patients with gBRCA-positive PC [38][39][40][41]. This preference may influence physicians' decisions regarding the timing of gBRCA testing. ...

Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer
  • Citing Article
  • April 2020

Annals of Surgical Oncology

... In the United States, perineal procedures comprise 50-60% of all procedures performed for rectal prolapse [31]. While in Europe, there is an increasing trend of ventral rectopexy [32]. ...

Perineal Stapled Rectal Prolapse Resection in Elderly Patients: Long-term Follow-up

Diseases of the Colon & Rectum

... Many studies have reported on the effectiveness of the HeLP treatment in treating symptomatic hemorrhoids [22][23][24] . Poor resolution of the mucosal prolapse especially with higher degree hemorrhoids is one of the outcomes that may be seen postoperative. ...

Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids

Laser Therapy

... The reasons are certainly to be found in the screening programs, in the diagnostic modalities and also in both medical and surgical therapeutic management. Early and reliable assessment of the risk for developing postoperative complications serves as an important contributor to preoperative, intra-operative, and postoperative decision making (15). Indeed, surgery still shows a high percentage of complications and mortality. ...

Risk Factors for Complications of Total/Subtotal Gastrectomy for Gastric Cancer: Prospectively Collected, Based on the Clavien-Dindo Classification System
  • Citing Article
  • May 2018

The Israel Medical Association journal

... In vitro, preclinical data demonstrate reliable anti-neoplastic effects of mutant specific K-ras siRNA in pancreatic cancer cell lines [14]. Presented below are the promising early clinical results of a study using an innovative loco-regional delivery method of a siRNA targeting the mutated K-RAS oncogene [15]. ...

Novel Kras-directed therapy in combination with chemotherapy for locally advanced pancreatic adenocarcinoma.
  • Citing Article
  • January 2014

Journal of Clinical Oncology

... Mutations in tumor suppressor genes also have a powerful role in the progression of PCs. The CDKN2A/p16 gene complexes are mutated in over 90% of PCs [30]. TP53 and MADH4/DPC4/SMAD4 mutations are seen in 60% and 50% of PCs, respectively, and appear late in tumor progression. ...

RNAi therapy targeting KRAS in combination with chemotherapy for locally advanced pancreatic cancer patients

Oncotarget

... DTI has been proved useful in the characterization of tissue microstructure and pathophysiology, originally of the central nervous system, and later of the peripheral nerves and skeletal muscles [15][16][17][18][19][20]. In abdominal organs, DTI was applied to investigate various pathologies of native and transplanted kidneys, to detect and characterize cancerous prostatic lesions, to assess liver fibrosis, inflammation, and focal liver lesions, to investigate focal pancreatic lesions, to evaluate pelvic floor disorders, normal and abnormal uterine zones and uterine malignancies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Preliminary data have shown the feasibility of testis DTI and the effectiveness of the technique in the characterization of testicular masses and the assessment of impaired spermatogenesis [39][40][41][42][43]. ...

Diffusion Tensor Magnetic Resonance Imaging of the Pancreas
PLOS ONE

... The three usual types of reconstruction are Billroth Ⅰ (ga stroduodenostomy), Billroth Ⅱ (loop gastrojejunostomy) and Roux-en-Y gastrojejunostomy. Billroth I is by far the most popular type of reconstruction in studies from Eastern countries, especially RCTs [30,31,[33][34][35][36] , while Billroth Ⅱ and Roux-en-Y reconstruction are almost exclusively employed in the West [32,[39][40][41][42] . This probably reflects the different perception of distal gastrectomy between the East and the West. ...

Laparoscopic Subtotal Gastrectomy for Gastric Cancer

JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons