Resultados de la esofaguectomía mínimamente invasiva por cáncer de esófago a medio y largo plazo

Introducción: La esofagectomía es actualmente el tratamiento curativo del cáncer de esófago. El objetivo de este trabajo es conocer los resultados de la esofaguectomía mínimamente invasiva a corto y medio plazo en pacientes intervenidos de carcinoma epidermoide y adenocarcinoma de esófago en nuestro hospital. Material y Métodos: Se recogieron 19 pacientes desde enero de 2020 hasta junio de 2021 y se realizó el seguimiento a todos ellos durante 20 meses. Se recogieron diferentes variables relacionadas con el paciente, el tumor, la cirugía y referentes al postoperatorio. Los datos fueron almacenados y procesados usando el software estadístico R-Comander asumiendo un error α de 0,05. Resultados: La mediana de estancia hospitalaria total fue de 29 días. Seis pacientes, precisaron de reingreso en Reanimación: dos por shock séptico secundario a la fuga de anastomosis grado III, uno por hemorragia digestiva alta y los tres por insuficiencia respiratoria. A los 90 días reingresaron un 5,3% del total de pacientes. No se produjeron fallecimientos en los tres meses siguientes a la cirugía. Todos los pacientes presentaron una supervivencia mayor de seis meses. La supervivencia global a seis, 12 y 18 meses se sitúa en 100, 84 y 63%. La supervivencia libre de enfermedad a los tres meses fue del 84%, a los 6 meses del 63% y al año el 58%. Discusión: Los resultados obtenidos en nuestro estudio coinciden con lo que hay reflejado en la literatura. Por tanto, la esofagectomía mínimamente invasiva es una técnica efectiva en el tratamiento del cáncer de esófago.

Introduction: Oesophagectomy is currently the curative treatment for oesophageal cancer. The aim of this study is to know the results of minimally invasive oesophagectomy in the short and medium term in patients operated on for squamous cell carcinoma and adenocarcinoma of the oesophagus in our hospital. Material and Methods: 19 patients were collected from January 2020 to June 2021 and all of them were followed up for 20 months. Different variables related to the patient, tumour, surgery and postoperative period were collected. Data were stored and processed using R-Comander statistical software assuming an α-error of 0.05. Results: The median total hospital stay was 29 days. Six patients required readmission to resuscitation: two for septic shock secondary to grade III anastomotic leak, one for upper gastrointestinal haemorrhage and three for respiratory failure. At 90 days, 5.3% of the total number of patients were re-admitted. There were no deaths in the three months following surgery. All patients had a survival of more than six months. Overall survival at six, 12 and 18 months was 100, 84 and 63%. Disease-free survival at three months was 84%, at six months 63% and at one year 58%. Discussion: The results obtained in our study coincide with those reported in the literature. Minimally invasive oesophagectomy is therefore an effective technique in the treatment of oesophageal cancer.

Lesión pancreática que esconde una transformación quística acinar

Objetivo: La transformación quística acinar del páncreas es una patología poco frecuente y que afecta en su mayoría a mujeres de mediana edad. Material y Métodos: Presentamos el caso de dicha patología en un varón joven que debutó con dolor en hipocondrio izquierdo y en la pruebas de imagen se evidenció una lesión quística en cola pancreática de 50x45mm, con calcificaciones lineales. Se realizó pancreatectomía distal. Resultados: El diagnóstico anatomopatológico informó de transformación quística acinar. Discusión: Dada la dificultad de un diagnóstico preoperatorio, es frecuente someter al paciente a una intervención quirúrgica con una elevada morbilidad, a pesar de tratarse de una lesión benigna, ya que se siguen las indicaciones quirúrgicas para otras patologías quísticas pancreáticas. La presencia de mutaciones y el hecho de que algunos de ellos también presentan cambios epiteliales mucinosos, justificaría el debatir la posibilidad de mantener a estos pacientes bajo vigilancia a largo plazo.

Objective: Acinar cystic transformation of the pancreas is a rare pathology that affects mostly middle-aged women. Material and Methods: We present a case of this pathology in a young man who presented with pain in the left hypochondrium and imaging tests revealed a cystic lesion in the pancreatic tail measuring 50x45mm, with linear calcifications. Distal pancreatectomy was performed. Results: The anatomopatho-logical diagnosis was acinar cystic transformation. Discussion: given the difficulty of a preoperative diagnosis, the patient is often subjected to surgery with high morbidity, despite being a benign lesion, as surgical indications for other pancreatic cystic pathologies are followed. The presence of mutations and the fact that some of them also present mucinous epithelial changes would justify discussing the possibility of keeping these patients under long-term surveillance.

Rotura atraumática idiopática de bazo

Objetivo: Se presenta un caso de rotura esplénica atraumática. Caso Clínico: Mujer joven que estando ingresada y con reposo relativo por colección intraabdominal cercana a la colostomía presenta rotura de bazo. Se realiza esplenectomía urgente evidenciando gran hemoperitoneo y rotura esplénica. Discusión y conclusiones: El diagnóstico de rotura esplénica atraumática debe tenerse en cuenta en los pacientes con dolor abdominal de aparición súbita ya que un retraso en el diagnóstico puede conducir a un aumento de la tasa de mortalidad.

Objective: A case of idiopathic atraumatic splenic rupture is presented. Clinical case: A young woman was admitted to hospital with relative rest due to an intra-abdominal collection near the colostomy and presented with a ruptured spleen. An urgent splenectomy was performed, revealing large haemoperitoneum and splenic rupture. Discussion and conclusions: the diagnosis of atraumatic splenic rupture should be taken into account in patients with sudden onset abdominal pain, as a delay in diagnosis may lead to an increased mortality rate.

La apendicitis aguda no aumenta el riesgo de cáncer de colon derecho en mayores 45 años

Objetivo: El objetivo principal consistió en determinar si en nuestra población existía una diferencia en la tasa de diagnóstico de cáncer de colon derecho para los pacientes mayores de 45 años en los 36 meses siguientes, tras apendicitis aguda en comparación con un grupo control. Pacientes y Métodos: Estudio de cohortes retrospectivo con un grupo expuesto de 300 pacientes con diagnóstico histológico de apendicitis aguda y un grupo control de 300 pacientes intervenidos de patología benigna entre enero de 2014 y agosto 2017. Se han realizado referencias cruzadas entre las historias clínicas electrónicas y la base de datos del Registro de Cáncer de Granada. Resultados: Se presentaron 2/300 pacientes (0,7%) mientras que en el grupo control, se presentaron 4/300 (1,3%). Antes estos hallazgos, no existe un mayor riesgo de desarrollar un carcinoma colon en los pacientes con apendicitis (p > 0,05). Discusión: La apendicitis aguda puede tratarse de la primera manifestación de carcinoma de colon derecho, sin embargo, en nuestra revisión no encontramos dicha asociación en nuestra población.

Aim: The main objective was to determine whether in our population there was a difference in the rate of right colon cancer diagnosis for patients over 45 years of age in the 36 months following acute appendicitis compared to a control group. Patients and Methods: Retrospective cohort study with an exposed group of 300 patients with histological diagnosis of acute appendicitis and a control group of 300 patients operated on for benign pathology between January 2014 and August 2017. Electronic medical records and the Granada Cancer Registry database were cross-referenced. Results: 2/300 patients (0.7%) presented while 4/300 (1.3%) presented in the control group. Given these findings, there is no increased risk of developing colon carcinoma in patients with appendicitis (p > 0.05). Discussion: Acute appendicitis may be the first manifestation of right colon carcinoma, however, in our review we found no such association in our population.

Systemic amyloidosis as a cause of chronic diarrhea after gastric surgery. Literature review.

Amyloidosis with gastrointestinal involvement is a rare cause of chronic diarrhoea, and should be considered especially in adult patients with intestinal malabsorption and extra GI manifestations. We present the case of a male patient who, after an oncological gastrectomy, presented with chronic diarrhea that did not respond to treatment and, after study, the cause of the diarrhea was finally found. Primary systemic light chain amyloidosis (AL) initially presents as chronic diarrhea and weight loss after gastrectomy. Immunohistochemistry was completely negative for amyloid A, which virtually rules out AA amyloidosis. With regard to the immunoglobulin chains, an amyloid signal was observed for both light chains, with a predominance of lambda light chain but not entirely conclusive. This situation is not uncommon since amyloid, whatever its chemical nature, can annex serum proteins, including immunoglobulin chains. In the case of chronic diarrhea, the possibility of amyloidosis should be kept in mind, especially in the case of weight loss.

Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question.

PURPOSE: Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. METHODS: This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1 g and erythromycin 500 mg the day before surgery. RESULTS: The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05). CONCLUSION: Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.

Neurotoxicity prevention with a multimodal program (ATENTO) prior to cancer treatment versus throughout cancer treatment in women newly diagnosed for breast cancer: Protocol for a randomized clinical trial.

A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.