Cross-cultural validation and Spanish translation of the Boston Interview to evaluate severely obese patients seeking metabolic/bariatric surgery.

INTRODUCTION: obesity is a global health problem. Metabolic/Bariatric surgery (MBS) has proven to be one of the most effective methods for treating the most severe forms. However, a thorough evaluation and preparation of people seeking MBS is necessary. In Spain, there are no standardized interviews to carry out the psychosocial assessment of people seeking MBS. The Boston Interview for MBS (BIBS) is a recognized and flexible tool to evaluate the psychosocial factors. OBJECTIVE: to present the process of translation into Spanish and cross-cultural adaptation of the BIBS. MATERIALS AND METHODS: the reverse translation procedure was followed. To validate the translation, a multidisciplinary group of experts was formed. They were asked to rate the clarity of wording and cultural adaptation of the translation items. In addition, the translated interview was used to evaluate 173 patients seeking MBS who rated their satisfaction with the interview experience. RESULTS: the evaluation of the translation by a group of experts was favorable (global mode and median were 3-excellent, IQR of 1). The overall percentage agreement of the adequacy of "cultural adaptation" of the text was 85.8 % (95 % CI, 0.784, 0.932) and of the "clarity of wording" was 84.7 % (95 % CI, 0.7644; 0.9286). Furthermore, it was well accepted by the majority of the patients interviewed (p(50) 10 out of 10). CONCLUSIONS: the Spanish translation of the BIBS is available for the assessment of Spanish-speaking people seeking MBS. It was rated as having good fidelity to the original English version, and was deemed highly satisfactory by patients.

[Is body mass index a prognostic factor of survival in colonic cancer? A multivariate analysis]. / ¿Es el índice de masa corporal un factor pronóstico de supervivencia en el cáncer de colon? Análisis multivariable.

INTRODUCTION: The long-term survival of patients operated on for colonic cancer depends on many factors. Obesity decreases the life expectancy of the general population who suffer from it, but it is not clear whether obesity, measured by the Body Mass Index (BMI), is a prognostic factor of survival for patients operated on for colonic cancer. MATERIAL AND METHODS: The patients included in this study had TNM stage I, II y III, and were subjected to elective surgery for cancer of the colon in the Girona University Hospital between 1990 and 2001. The BMI was classified according to the WHO classification. A total of 38 different variables were studied using a bivariate analysis with BMI. A Cox model was subsequently constructed with the most clinically relevant parameters, and with those most strongly associated with survival in the bivariate analysis. RESULTS: BMI was not associated with survival in the bivariate analysis. Neither did the multivariate analysis show that BMI was an independent prognostic factor of long-term survival in cancer of the colon without metastasis, but it did show that the TNM stage, ASA score, surgical technique, age at surgery, and the immune cell response were prognostic factors. CONCLUSIONS: The body mass index is not a prognostic factor of the long-term survival of patients with colonic cancer.

[The impact of obesity on the histopathological characteristics of colorectal tumours. An observational study]. / Impacto de la obesidad en las características anatomopatológicas de los tumores colorrectales. Estudio observacional.

BACKGROUND: To asses the influence of body mass index on the tumour characteristics of patients subjected to colorectal cancer surgery. MATERIALS AND METHODS: Retrospective observational study. Patients subjected to curative elective colorectal cancer surgery at Hospital Josep Trueta de Girona (Spain), from 1990 to 2001. Univariate and bivariate analyses were performed to evaluate differences in tumour characteristics with regard to body mass index. RESULTS: A total of 369 patients with colorectal cancer were included into the study, 213 (57.7%) with colon cancer, and 156 (42.3%) with rectal cancer. For colon cancer patients, when the BMI was higher than 25 kg/m(2), the tumour grade was worst (P=0.011), and when BMI was above 30 kg/m(2) there were more lymph node metastasis. For rectal tumours, the higher the BMI, the more lymph node metastasis (P=0.041), and higher tumour stage (P=0.023). CONCLUSIONS: Patients with a higher BMI have more lymph node metastasis when submitted to elective colorectal cancer surgery. In the case of colon cancer they also have worst tumour grades, and in the case of rectal cancer, a more advanced tumour stage.

¿Es el índice de masa corporal un factor pronóstico de supervivencia en el cáncer de colon? Análisis multivariable / Is Body Mass Index a prognostic factor of survival in colonic cancer? A multivariate analysis

Introducción La supervivencia a largo plazo de los pacientes intervenidos por cáncer de colon depende de múltiples factores. La obesidad disminuye la expectativa de vida de la población general que la padece, pero no está claro si la obesidad, medida con el índice de masa corporal (IMC), es un factor pronóstico de supervivencia para los pacientes intervenidos por cáncer de colon. Material y métodos Hemos incluido en este estudio a pacientes en estadios TNM I, II y III, sometidos a cirugía electiva por cáncer de colon en el Hospital Universitari de Girona entre 1990 y 2001. El IMC se ha categorizado siguiendo la clasificación de la OMS. Hemos estudiado 38 parámetros distintos realizando un estudio bivariable con el IMC. El modelo de Cox ha sido construido posteriormente con los parámetros más clínicamente relevantes y con los más fuertemente asociados con la supervivencia en el estudio bivariable. Resultados El IMC no se asoció con la supervivencia en el análisis bivariable. El análisis multivariable tampoco mostró que el IMC sea un factor pronóstico independiente de supervivencia a largo plazo en el cáncer de colon sin metástasis, pero sí lo fueron el estadio TNM, la puntuación ASA, la técnica quirúrgica, la edad a la cirugía y la respuesta inmunitaria celular. Conclusiones El IMC no es un factor pronóstico de supervivencia a largo plazo en pacientes con cáncer de colon (AU)

Introduction: The long-term survival of patients operated on for colonic cancer depends on many factors. Obesity decreases the life expectancy of the general population who suffer from it, but it is not clear whether obesity, measured by the Body Mass Index (BMI), is a prognostic factor of survival for patients operated on for colonic cancer. Material and methods: The patients included in this study had TNM stage I, II y III, and were subjected to elective surgery for cancer of the colon in the Girona University Hospital between 1990 and 2001. The BMI was classified according to the WHO classification. A total of 38 different variables were studied using a bivariate analysis with BMI. A Cox model was subsequently constructed with the most clinically relevant parameters, and with those most strongly associated with survival in the bivariate analysis. Results: BMI was not associated with survival in the bivariate analysis. Neither did the multivariate analysis show that BMI was an independent prognostic factor of long-term survival in cancer of the colon without metastasis, but it did show that the TNM stage, ASA score, surgical technique, age at surgery, and the immune cell response were prognostic factors (AU)

Impacto de la obesidad en las características anatomopatológicas de los tumores colorrectales. Estudio observacional / The impact of obesity on the histopathological characteristics of colorectal tumours. An observational study

Introducción La obesidad es uno de los factores implicados en la génesis del cáncer colorrectal (CCR); sin embargo, no está claro cuál es el impacto que puede tener en las características anatomopatológicas de estos tumores una vez que se han desarrollado. Introducción El objetivo de este estudio es determinar en nuestros pacientes cómo influye el índice de masa corporal (IMC) en las características histológicas de estos tumores. Material y métodos Estudio retrospectivo observacional. Se incluyó en el estudio a los pacientes intervenidos electivamente por CCR con intención curativa en el Hospital Universitario de Girona, España, durante los años 1990 a 2001. Se ha realizado un análisis descriptivo y bivariable para evaluar posibles diferencias en función del IMC por lo que respecta a los datos tumorales. Resultados Se incluyó en el estudio a 369 pacientes con CCR: 213 pacientes (57,7%) con cáncer de colon y 156 pacientes (42,3%) con cáncer de recto. En el caso de los tumores de colon, los pacientes con IMC mayor de 25kg/m2 tuvieron tumores peor diferenciados (p=0,011), y los de IMC de más de 30kg/m2 tuvieron mayor afectación ganglionar que el resto. Para los tumores de recto, cuanto mayor fue el IMC mayor la afectación ganglionar (p=0,041) y el estadio tumoral TNM (p=0,023).Conclusiones Los pacientes con mayor IMC tienen mayor afectación ganglionar. En el caso del cáncer de colon son, además, tumores más indiferenciados, y en el caso del cáncer de recto son tumores en estadios más avanzados (AU)

Background To asses the influence of body mass index on the tumour characteristics of patients subjected to colorectal cancer surgery. Materials and methods Retrospective observational study. Patients subjected to curative elective colorectal cancer surgery at Hospital Josep Trueta de Girona (Spain), from 1990 to 2001.Materials and methods Univariate and bivariate analyses were performed to evaluate differences in tumour characteristics with regard to body mass index. Results A total of 369 patients with colorectal cancer were included into the study, 213 (57.7%) with colon cancer, and 156 (42.3%) with rectal cancer. For colon cancer patients, when the BMI was higher than 25kg/m2, the tumour grade was worst (P=0.011), and when BMI was above 30kg/m2 there were more lymph node metastasis. For rectal tumours, the higher the BMI, the more lymph node metastasis (P=0.041), and higher tumour stage (P=0.023).Conclusions Patients with a higher BMI have more lymph node metastasis when submitted to elective colorectal cancer surgery. In the case of colon cancer they also have worst tumour grades, and in the case of rectal cancer, a more advanced tumour stage (AU)