Juan Salazar Gonzalez

All Publications

• Robotic Left Hepatectomy with Hilar Dissection and Portal Lymphadenectomy Following Preoperative Gemcitabine, Cisplatin, and Pembrolizumab for Intrahepatic Cholangiocarcinoma. Annals of surgical oncology Gonzalez, J. F., Aliseda, D., Harrison, J. M., Visser, B. C. 2025

  Abstract

  The historic management of resectable intrahepatic cholangiocarcinoma (ICC) included open resection and portal lymphadenectomy.1 In the modern era of effective perioperative systemic and immunotherapies, more locally advanced tumors are being converted to resectable disease.2 As the surgical limits of safe oncologic resection continue to expand at experienced centers, minimally invasive approaches have also gained traction given the superior intraoperative optics, improved dexterity, and expedited recovery of patients.3 As such, we report a successful robotic resection of a locally advanced left-sided ICC pre-treated with induction chemoimmunotherapy.A 40-year-old male patient was found to have a left-sided liver mass during workup for right-sided abdominal pain. Dedicated triphasic computed tomography (CT) revealed a 10 cm mass with two possible ipsilobar daughter satellite lesions as well as tumor thrombus emanating from the left portal vein and bulky periportal lymphadenopathy. Biopsy confirmed ICC without targetable mutations. CA19-9 was elevated at 400 U/mL. After multidisciplinary tumor board review of this patient's locally advanced case, induction therapy with gemcitabine, cisplatin, and pembrolizumab was initiated. After five treatment cycles (roughly 4 months), the patient underwent restaging imaging, which demonstrated a robust radiographic response, including withdrawal of the tumor thrombus deeper into the left portal system as well as reduction in CA19-9 levels. Given the patient's young age, good performance status, and impressive treatment response, we reviewed the risks and benefits of proceeding with robotic left hepatectomy and portal lymphadenectomy. Note that several contingencies were discussed preoperatively, including open conversion and a more extensive resection should the tumor be understaged or progressed off therapy. To ensure sufficient liver remnant, we routinely spare the caudate in left hepatectomies for ICC unless there is compelling evidence of preoperative radiographic involvement. Finally, we planned to address the receding tumor thrombus with intraoperative ultrasound and using intraoperative frozen section. Should this return positive, we discussed with the patient a venous resection and reconstruction to achieve a negative margin.Operative time was 4 h with an estimated blood loss of 150 cc. Cumulative Pringle time was 30 min. The patient had an uneventful postoperative recovery and was discharged home on postoperative day 3. Final pathology revealed a single 5.7 cm ICC with complete pathologic response and negative margins. Notably, 4 of 11 lymph nodes were involved with tumor for a final TNM staging of T1bN1. After multidisciplinary re-review of this patient's pathology, the patient resumed their preoperative systemic regimen. At most recent 4-month follow-up, there is no evidence of radiographic or biochemical recurrence, and systemic therapy continues to be well tolerated. On the basis of tumor board recommendations, systemic therapy is planned for a total of 6 months in addition to one full year of immunotherapy.With a combination of preoperative chemoimmunotherapy and robotic left hepatectomy, we describe a successful oncologic outcome for a patient with locally advanced ICC.

  View details for DOI 10.1245/s10434-025-18515-y

  View details for PubMedID 41109879

• "How I Do It:" Robotic Transduodenal Ampullectomy for an Ampullary Adenoma. Journal of hepato-biliary-pancreatic sciences Salazar Gonzalez, J. F., Aliseda, D., Harrison, J. M., Visser, B. C. 2025

  View details for DOI 10.1002/jhbp.70002

  View details for PubMedID 40879215

• Exploring the Impact of Diabetes on Kidney Transplant: Patient Outcomes and Management Strategies. Cureus Eltayeb, H. H., Rawat, A., Salazar Gonzalez, J. F., Ahmad, F. N., Lee Young, J. T., Algitagi, F., Khattak, L. Z., Qazi, I. U., Arya, A., Asad, Z. F., Issimdar, I. A., Siddiqui, H. F. 2025; 17 (3): e80843

  Abstract

  Diabetic kidney disease (DKD) is a serious consequence of diabetes mellitus (DM). If not managed effectively, DKD often develops into end-stage renal disease (ESRD). The most successful treatment for ESRD is kidney transplantation, offering improved quality of life and survival rates. For insulin-dependent diabetic patients with ESRD, simultaneous pancreas-kidney transplantation (SPKT) offers a treatment alternative that treats both kidney failure and the underlying diabetes. However, SPKT involves more complicated surgery, prolonged operative time, and a higher risk of complications. This review aims to highlight the impact of DM on kidney transplant recipients (KTRs) regarding post-transplant complications, graft survival, mortality rates, and the role of glucose-lowering medications and immunosuppressants. The incidence of urinary tract infections, cardiovascular complications, and diabetic foot disease was higher among KTRs. A decrease in graft survival rate at five years was observed among diabetics compared to non-diabetics, with similar graft survival rates among type 1 and type 2 DM. The mortality rate was notably higher among diabetic patients, with cardiovascular complications being the leading cause. The emergence of new-onset diabetes mellitus post-transplantation (NODAT) is a significant cause of concern. Certain risk factors, including a family history of DM, age >45 years, obesity, male gender, and immunosuppressive medications, have been linked to this phenomenon. Immunosuppression is a substantial challenge among diabetics as certain medications such as tacrolimus have shown to be considerably diabetogenic compared to cyclosporine and belatacept, and it is also postulated that corticosteroids can lead to hyperglycemia. Some studies proved that glucose-lowering medications, including insulin degludec, glucagon-like peptide-1 receptor agonists, thiazolidinediones, and sodium-glucose cotransporter 2 inhibitors, are safe and effective among KTRs. However, these studies are debatable and of low confidence. Hence, it is imperative to conduct large clinical trials and establish definitive guidelines to manage pre-existing diabetes and NODAT among KTRs with multidisciplinary care to help clinicians improve patient outcomes.

  View details for DOI 10.7759/cureus.80843

  View details for PubMedID 40255815

• A Narrative Review on the Role of Artificial Intelligence (AI) in Colorectal Cancer Management. Cureus Babu, B., Singh, J., Salazar González, J. F., Zalmai, S., Ahmed, A., Padekar, H. D., Eichemberger, M. R., Abdallah, A. I., Ahamed S, I., Nazir, Z. 2025; 17 (2): e79570

  Abstract

  The role of artificial intelligence (AI) tools and deep learning in medical practice in the management of colorectal cancer has gathered significant attention in recent years. Colorectal cancer, being the third most common type of malignancy, requires an innovative approach to augment early detection and advanced surgical techniques to reduce morbidity and mortality. With its emerging potential, AI improves colorectal cancer management by assisting with accuracy in screening, pathology evaluation, precision, and postoperative care. Evidence suggests that AI minimizes missed cases during colorectal cancer screening, plays a promising role in pathology and imaging diagnoses, and facilitates accurate staging. In surgical management, AI demonstrates comparable or superior outcomes to laparoscopic approaches, with reduced hospital stays and conversion rates. However, these outcomes are influenced by clinical expertise and other dependable factors, including expertise in implementing AI-based software and detecting possible errors. Despite these advancements, limited multicenter studies and randomized trials restrict the comprehensive evaluation of AI's true potential and integration into standard practice. We used Pubmed, Google Scholar, Cochrane Library, and Scopus databases for this review. The final number of articles selected, depending on inclusion and exclusion criteria, is 122. We included papers published in the English language, literature published in the last 10 years, and adult patient populations above 35 years with colorectal cancer. We thoroughly included randomized controlled trials, cohort studies, meta-analyses, systematic reviews, narrative reviews, and case-control studies. The use of AI paves the way for the adoption of more personalized medicine. This review highlights the advantages of AI at various disease stages for colorectal cancer patients and evaluates its potential for cost-effective implementation in clinical practice.

  View details for DOI 10.7759/cureus.79570

  View details for PubMedID 40144438

  View details for PubMedCentralID PMC11940584

• Artificial Intelligence and Early Detection of Breast, Lung, and Colon Cancer: A Narrative Review. Cureus Debellotte, O., Dookie, R. L., Rinkoo, F., Kar, A., Salazar González, J. F., Saraf, P., Aflahe Iqbal, M., Ghazaryan, L., Mukunde, A. C., Khalid, A., Olumuyiwa, T. 2025; 17 (2): e79199

  Abstract

  Artificial intelligence (AI) is revolutionizing early cancer detection by enhancing the sensitivity, efficiency, and precision of screening programs for breast, colorectal, and lung cancers. Deep learning algorithms, such as convolutional neural networks, are pivotal in improving diagnostic accuracy by identifying patterns in imaging data that may elude human radiologists. AI has shown remarkable advancements in breast cancer detection, including risk stratification and treatment planning, with models achieving high specificity and precision in identifying invasive ductal carcinoma. In colorectal cancer screening, AI-powered systems significantly enhance polyp detection rates during colonoscopies, optimizing the adenoma detection rate and improving diagnostic workflows. Similarly, low-dose CT scans integrated with AI algorithms are transforming lung cancer screening by increasing the sensitivity and specificity of early-stage cancer detection, while aiding in accurate lesion segmentation and classification. This review highlights the potential of AI to streamline cancer diagnosis and treatment by analyzing vast datasets and reducing diagnostic variability. Despite these advancements, challenges such as data standardization, model generalization, and integration into clinical workflows remain. Addressing these issues through collaborative research, enhanced dataset diversity, and improved explainability of AI models will be critical for widespread adoption. The findings underscore AI's potential to significantly impact patient outcomes and reduce cancer-related mortality, emphasizing the need for further validation and optimization in diverse healthcare settings.

  View details for DOI 10.7759/cureus.79199

  View details for PubMedID 40125138

  View details for PubMedCentralID PMC11926462

• Role of Immunotherapy in Conjunction With the Surgical Treatment of Breast Cancer: Preoperative and Postoperative Applications. Cureus Sabu, N., Attia Hussein Mahmoud, H., Salazar González, J. F., Naruboina, N., Esteban Rojas Prieto, S., Govender, S., Ruthvik Phani Narayan, V., Priyank Batukbhai, B., Ahmadi, Y. 2024; 16 (10): e71441

  Abstract

  Breast cancer is one of the most common cancers in the world. Since the appearance of molecular medicine, the perspective of breast cancer treatment has changed, making it more successful in comparison with the treatment during previous years. Numerous ongoing trials are exploring the capacity of immunotherapy, mainly in immune checkpoint inhibitors (ICIs), in conjunction with conventional therapies or with antibody-drug conjugates (ADCs). The current narrative review discusses the advantages and limitations of immunotherapy in breast cancer treatment in conjunction with the surgical options available. Going through the modern capacity of surgery treatment and how the use of immunotherapy in conjunction with it has emerged as a transformative approach to breast cancer and listing the main complications and adverse effects caused by ICIs. We searched Google Scholar, PubMed, MEDLINE, and EMBASS. Fourteen different articles showed that the use of cytokines and cancer vaccines revealed new possibilities to treat breast cancer with antibodies against PD-1/PD-L1 (pembrolizumab), PI3K/Akt/mTOR (alpelisib and everolimus), CAR T-cell (chimeric antigen receptor), PARP (poly ADP-ribose polymerase), and CTLA4 (cytotoxic T-lymphocyte-associated protein 4), and with representative relevance of changing in tumor microenvironment. Immunotherapy made it possible to reduce recurrences, after radiotherapy and surgery. Estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) targets show also a high effectivity. In recent years, the release of new strategies has become promising, for changing the microenvironment and de-escalation of therapy based on tumor biology, novel biomarkers, and tumor spread.

  View details for DOI 10.7759/cureus.71441

  View details for PubMedID 39539894

  View details for PubMedCentralID PMC11559439

• Endovascular approach of hepatic artery pseudoaneurysm after Whipple procedure: Case report and literature review. International journal of surgery case reports Ayala, D., Gonzalez, J., Salazar, J. F., Rey Chaves, C. E., Conde, D., Sabogal Olarte, J. C. 2023; 105: 108103

  Abstract

  Pseudoaneurysms after pancreatoduodenectomy are an uncommon complication, but they are associated with life-threatening outcomes in up to 50 % due to the development of postoperative bleeding. They usually result as a consequence of local inflammatory processes, such as pancreatic fistula or intra-abdominal collections. The cornerstones of treatment are thus intraoperative management and early identification of the complication.We present a 62-year-old female patient in postoperative pancreatoduodenectomy due to a periampullary tumor, that presented upper gastrointestinal bleeding which required multiple transfusions. During hospitalization, the patient presented a refractory hypovolemic shock to conservative measures. It was documented intra-abdominal hemorrhage due to hepatic artery pseudoaneurysm that required endovascular management with common hepatic artery embolization, with successful bleeding control.Pseudoaneurysms are the result of tissue damage after surgery. The usual clinical presentation is upper gastrointestinal bleeding unresponsive to conservative treatment that results in hemodynamic instability due to hypovolemic shock. Prevention is currently based on preoperative and intraoperative measures such as nutritional repletion, vessel protection, adequate hemostasis, and prevention and treatment of pancreatic leak and abdominal infection. Once documented, treatment can be endovascular or surgical.The formation of pseudoaneurysms after pancreaticoduodenectomy is an uncommon and challenging complication. Early diagnosis, risk factor detection and a combined multidisciplinary approach lead to better outcomes, avoiding open surgical procedures that can increase morbidity and mortality rates.

  View details for DOI 10.1016/j.ijscr.2023.108103

  View details for PubMedID 37018946

  View details for PubMedCentralID PMC10112170