Early discharge in Mild Acute Pancreatitis. Is it possible? Observational prospective study in a tertiary-level hospital.

BACKGROUND AND AIMS: In acute pancreatitis (AP), first 24 h are crucial as this is the period in which the greatest amount of patients presents an organ failure. This suggests patients with Mild AP (MAP) could be early identified and discharged. This is an observational prospective trial with the aim to demonstrate the safety of early discharge in Mild Acute Pancreatitis (MAP). METHODS: Observational prospective study in a third level single centre. Consecutive patients with AP from March 2012 to March 2014 were collected. INCLUSION CRITERIA: MAP, tolerance to oral intake, control of pain, C Reactive Protein <150 mg/dL and blood ureic nitrogen < 5 mg/dL in two samples. EXCLUSION CRITERIA: pregnant, lack of family support, active comorbidities, temperature and serum bilirubin elevation. Patients with MAP, who met the inclusion criteria, were discharged within the first 48 h. Readmissions within first week and first 30 days were recorded. Adverse effects related to readmissions were also collected. RESULTS: Three hundred and seventeen episodes were collected of whom 250 patients were diagnosed with MAP. From these, 105 were early discharged. Early discharged patients presented a 30-day readmission rate of 15.2% (16 patients out of 105) corresponding to the readmission rates in Acute Pancreatitis published to date. Any patient presented adverse effects related to readmissions. CONCLUSION: Early discharge in accurately selected patients with MAP is feasible, safe and efficient and leads to a decrease in median stay with the ensuing savings per process and with no increase in readmissions or inmorbi-mortality.

Neoadjuvant therapy and transanal endoscopic surgery in T2-T3 superficial, N0, M0 rectal tumors. Local recurrence, complete clinical and pathological response. / Neoadyuvancia y cirugía endoscópica transanal en neoplasias de recto T2-T3 superficial, N0, M0. Recidiva local, respuesta clínica y patológica completa.

INTRODUCTION: The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. METHODS: This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016). The treatment consisted of preoperative chemotherapy (5-fluorouracil or capecitabine) combined with radiotherapy (50, 4Gy) and transanal endoscopic surgery after 8weeks. Preoperative, surgical, pathological and long-term oncologic results were analyzed. RESULTS: Twenty-four patients were included in the study. Two of them required rescue radical surgery for unfavorable pathological results. A local recurrence (4.5%) was observed and 2patients presented systemic recurrence (9%), with a median follow-up of 45 months. A complete clinical tumor response was achieved in 12 patients (50%), and complete pathological tumor response in 9 patients (37.5%). Postoperative complications were observed in 5 patients (20.8%), and they were mild except one. There was no postoperative mortality. CONCLUSIONS: In this stage of rectal cancer, our results seem to support this strategy, mainly when a complete pathological response is achieved. The complete clinical tumor response does not coincide with the pathological tumor response. Randomized prospective studies should be performed to standardize this treatment.

Neoadyuvancia y cirugía endoscópica transanal en neoplasias de recto T2-T3 superficial, N0, M0. Recidiva local, respuesta clínica y patológica completa / Neoadjuvant therapy and transanal endoscopic surgery in T2-T3 superficial, N0, M0 rectal tumors. Local recurrence, complete clinical and pathological response

INTRODUCCIÓN: La asociación de quimiorradioterapia preoperatoria y cirugía endoscópica transanal en el cáncer rectal T2-T3 superficial presenta resultados prometedores en pacientes seleccionados. El objetivo principal es evaluar la recurrencia locorregional y sistémica a largo plazo y los objetivos secundarios son aportar resultados de morbilidad postoperatoria y la correlación entre la respuesta patológica completa y clínica completa. MÉTODOS: Estudio observacional retrospectivo de una serie consecutiva de pacientes diagnosticados de cáncer de recto T2-T3 superficial, N0, M0 que se trataron con quimiorradioterapia neoadyuvante y escisión transanal del tumor (2008-2016). Se recogieron los datos de forma prospectiva. El tratamiento consistió en quimioterapia preoperatoria (5-fluorouracilo o capecitabina) combinada con radioterapia (50,4Gy) y cirugía endoscópica transanal tras 8semanas. Se analizaron las variables preoperatorias, quirúrgicas, patológicas y los resultados oncológicos a largo plazo. RESULTADOS: De los 24 pacientes incluidos, 2requirieron rescate a cirugía radical por resultados patológicos desfavorables. Con un seguimiento mediano de 45 meses, se observó recurrencia local en un paciente (4,5%) y 2pacientes presentaron recurrencias sistémicas (9%). La respuesta clínica tumoral completa se logró en 12 pacientes (50%) y la respuesta patológica tumoral completa en 9 pacientes (37,5%). Las complicaciones postoperatorias se apreciaron en 5 pacientes (20,8%), todas leves excepto una. No hubo mortalidad postoperatoria. CONCLUSIONES: En este estadio del cáncer rectal, nuestros resultados parecen apoyar esta estrategia, principalmente cuando se logra una respuesta patológica tumoral completa. La respuesta clínica tumoral completa no coincide con la respuesta patológica tumoral. Se deben llevar a cabo estudios prospectivos aleatorizados para estandarizar este tratamiento

INTRODUCTION: The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. METHODS: This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016). The treatment consisted of preoperative chemotherapy (5-fluorouracil or capecitabine) combined with radiotherapy (50, 4Gy) and transanal endoscopic surgery after 8weeks. Preoperative, surgical, pathological and long-term oncologic results were analyzed. RESULTS: Twenty-four patients were included in the study. Two of them required rescue radical surgery for unfavorable pathological results. A local recurrence (4.5%) was observed and 2patients presented systemic recurrence (9%), with a median follow-up of 45 months. A complete clinical tumor response was achieved in 12 patients (50%), and complete pathological tumor response in 9 patients (37.5%). Postoperative complications were observed in 5 patients (20.8%), and they were mild except one. There was no postoperative mortality. CONCLUSIONS: In this stage of rectal cancer, our results seem to support this strategy, mainly when a complete pathological response is achieved. The complete clinical tumor response does not coincide with the pathological tumor response. Randomized prospective studies should be performed to standardize this treatment