Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.

[Preliminary multicentric study on the nutritional status in hospitalization at home (HaD) with the same informational application of nutritional assessment]. / Estudio multicéntrico preliminar sobre el estado nutricional en hospitalización a domicilio (HaD) con una misma aplicación informática de valoración nutricional.

INTRODUCTION: the prevalence of hospital malnutrition is high and involves an increase in health care costs. Home hospitalization (HH) allows better clinically stable patient control after an acute illness by a highly specialized health care team. OBJECTIVE: to know the nutritional condition of home hospitalization patients using a computer application that allows the implementation of early nutritional measures at home and improves post-hospital control of these patients. MATERIAL AND METHODS: prospective multicenter study of the nutritional condition of patients in four different home hospitalization centers during a period of two consecutive months in 2016. Variables were collected: home hospitalization, age, gender, reason for admission, associated morbidity, origin, diagnosis, social assessment, previous nutritional support, height, weight, weight loss, time of weight loss, total proteins, albumin, lymphocytes, cholesterol, body mass index (BMI), nutritional condition, type and degree of malnutrition. Nutritional condition was assessed using the application HEN-Persan and results were statistically analyzed using the SPSS 21.0 software. RESULTS: no significant differences were found between the four centers. In home hospitalization patients, 36% presented a normal nutritional screening and 87% presented some degree of malnutrition, while combined malnutrition prevailed (63%). Depending on the nutritional degree, 36% of patients had mild malnutrition, 27% presented moderate malnutrition and 35% had severe malnutrition. CONCLUSIONS: a computer application allows for an immediate, secure and reliable nutritional assessment in home hospitalization that helps introduce early nutritional measures and improve post-hospital control of patients.

INTRODUCCIÓN: la malnutrición hospitalaria tiene una elevada prevalencia y comporta un incremento del coste sanitario. La hospitalización a domicilio (HaD) permite el control en el domicilio de un episodio hospitalario agudo estable clínicamente por un equipo sanitario especializado.Objetivo: conocer el estado nutricional de los pacientes que ingresen en HaD con una misma aplicación informática (app) para poder instaurar medidas nutricionales precoces en el domicilio y mejorar la evolución posthospitalaria de los pacientes. MATERIAL Y METODOLOGÍA: estudio multicéntrico prospectivo y descriptivo del estado nutricional en cuatro unidades de HaD, durante un periodo de dos meses consecutivos durante el año 2016. Se recogieron las variables: unidad de HaD, edad, sexo, motivo de ingreso, patología asociada, procedencia, diagnóstico, valoración social, soporte nutricional previo, talla, peso, pérdida de peso, tiempo de la pérdida de peso, proteínas totales, albúmina, linfocitos, colesterol, índice de masa corporal (IMC), estado nutricional según el IMC, riesgo nutricional, tipo y grado de desnutrición. Se realizó la valoración nutricional con la app HEN-Persan y se analizaron los resultados estadísticamente con el programa informático SPSS 21.0. RESULTADOS: no existen diferencias significativas entre las cuatro unidades. Globalmente, el 36% de pacientes ingresados en HaD presentaban un estado nutricional normal. El 87% presentaba algún tipo de malnutrición, predominando la desnutrición de tipo mixta (63%). Según el grado,fue leve (36%), moderada (27%) y grave (35%). CONCLUSIONES: la utilización de una app permite tener una valoración nutricional inmediata, de manera fácil, segura y fiable en HaD, para poder introducir medidas nutricionales precoces y mejorar la evolución posthospitalaria de los pacientes.

Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy.

INTRODUCTION: Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). MATERIAL AND METHODS: From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. RESULTS: The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. CONCLUSION: SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique.