Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients.

AIM: The purpose of the present study was to evaluate the accuracy of computed tomography colonography (CTC) in the preoperative localization and TN staging of colon cancer. CTC can be an effective technique for preoperative evaluation of colon cancer and could facilitate the selection of high-risk patients who may benefit from neoadjuvant chemotherapy. METHOD: This was a prospective observational study conducted at a single tertiary-care centre. It involved 217 patients (225 tumours) who had colon cancer and underwent preoperative CTC and elective colectomy. The radiologist determined the TNM stage using postprocessing software with multiplanar images and virtual colonoscopy. The following criteria were analysed for every colon tumour: location, size and signs of direct colon wall invasion. The histopathological findings of the surgical colectomy specimens served as the reference standard for local staging. RESULTS: CTC detected all tumours and achieved an exact location in 208 cases (92.4%). CTC findings changed the surgical plan in 31 patients (14.3%) following colonoscopy. The accuracy in differentiating T3/T4 vs T1/T2 tumours was 87.1%, with a sensitivity and specificity of 88.5% and 84.1%, respectively (kappa = 0.71). For high-risk tumours (T3 ≥ 5 mm and T4), CTC showed an accuracy, sensitivity and specificity of 82.7%, 86% and 80%, respectively (kappa = 0.65). The accuracy of N-stage evaluation was 69.3%, the sensitivity 74% and the specificity 67.1% (kappa = 0.37). CONCLUSION: CTC provides accurate information for the assessment of tumour localization and T staging, allowing better surgical planning and also allows the selection of locally advanced tumours that may benefit from new treatments such as neoadjuvant chemotherapy.

Pediatric living donor liver transplantation: results of laparoscopic vs. open graft removal. / Trasplante hepático pediátrico de donante vivo, resultados en función de extracción del injerto por laparotomía vs. laparoscopia.

INTRODUCTION: Laparoscopic graft removal for pediatric living donor liver transplantation (PLDLT) reduces morbidity and surgical aggressiveness for the donor. It is important to assess whether the approach used for removal purposes compromises implantation. The objective of this study was to analyze PLDLT progression in children according to whether the graft had been removed laparoscopically or through open surgery. MATERIAL AND METHODS: A retrospective, analytical cohort study of PLDLTs carried out in our institution from 2009 to 2020 was carried out. RESULTS: Transplantation was performed in 14 patients, with a median age of 34.5 (R: 6-187) months. In 6 donors (42%), graft removal was conducted laparoscopically. In 1 donor (7%), removal was initiated laparoscopically, but conversion was required. This patient was included within the open surgery group, which consisted of 8 (58%) donors. No differences were found in terms of operating times, ICU stay, hospital stay, complications during admission, or complications post-admission in the recipient. The surgical approach did not compromise the length of the vessels to be anastomosed in any graft, and it added no extra difficulty to implantation. No differences were found in terms of removal times or hospital stay for the donor. Only 1 donor from the laparoscopy group required re-intervention due to bleeding following port insertion. CONCLUSION: PLDLT patients had similar results regardless of the removal approach used, which did not compromise the structures of the graft to be anastomosed, or add any extra difficulty to implantation.

INTRODUCCION: La extracción laparoscópica del injerto para el trasplante hepático pediátrico de donante vivo (THPDV) es una herramienta que reduce la morbilidad y agresividad quirúrgica en el donante. Es importante estudiar si la vía de extracción compromete el implante. El objetivo del estudio es analizar la evolución del THPDV en el niño en función de si el injerto fue extraído por vía abierta o laparoscopia. MATERIAL Y METODOS: Estudio de cohortes retrospectivo y analítico de los THPDV realizados entre 2009 y 2020 en nuestro centro. RESULTADOS: Se trasplantaron 14 pacientes, con edad mediana de 34,5 (R: 6-187) meses. En 6 donantes (42%) se realizó la extracción del injerto vía laparoscópica. En un donante se inició la extracción por laparoscopia, pero fue necesaria la conversión (7%), esté se clasificó en el grupo de laparotomía, compuesta por 8 (58%) donantes. No se encontraron diferencias en el tiempo quirúrgico, en los días en la unidad de cuidados intensivos, en la estancia hospitalaria, en las complicaciones durante el ingreso ni en las complicaciones postingreso en el receptor. El abordaje quirúrgico no comprometió en ningún injerto la longitud de los vasos a anastomosar, sin suponer una dificultad en el implante. No se evidenciaron diferencias en el tiempo de extracción ni en los días de hospitalización del donante. Solo un donante del grupo de laparoscopia precisó reintervención por sangrado de la incisión de un trocar. CONCLUSION: Los pacientes con THPDV presentan resultados similares, independientemente de la vía de extracción del injerto. La vía de abordaje no comprometió las estructuras del injerto a anastomosar, ni dificultó el momento del implante.