Diagnostic challenges: low-grade adenosarcoma on deep endometriosis.

BACKGROUND: Müllerian adenosarcoma is a rare malignancy. These tumors occur mainly in the uterus, but also in extrauterine locations, usually related to endometriosis. Because of their rarity, there is limited data on optimal management strategies. CASE PRESENTATION: We present a 44-year-old woman with a history of endometriosis who consults for chronic pelvic pain. In the imaging tests, a heterogeneous mass is observed that impresses endometriosis, encompassing the uterus and left appendage. Surgery is performed by finding an extrauterine adenosarcoma that affected the uterus, ovary and bladder wall. CONCLUSION: This is a rare case but should be considered in a patient with atypical clinical characteristics or preoperative pathology, so we show the diagnostic and therapeutic strategies carried out for the resolution of the case.

Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: a cross-sectional study.

BACKGROUND: The aim of the present study was to analyse the fatigue experienced by surgeons during and after performing robotic and laparoscopic surgery and to analyse muscle function, self-perceived fatigue and postural balance. METHODS: Cross-sectional study considering two surgical protocols (laparoscopic and robotic) with two different roles (chief and assistant surgeon). Fatigue was recorded in two ways: pre- and post-surgery using questionnaires [Profile of Mood States (POMS), Quick Questionnaire Piper Fatigue Scale and Visual Analogue Scale (VAS)-related fatigue] and parametrising functional tests [handgrip and single-leg balance test (SLBT)] and during the intervention by measuring the muscle activation of eight different muscles via surface electromyography and kinematic measurement (using inertial sensors). Each surgery profile intervention (robotic/laparoscopy-chief/assistant surgeon) was measured three times, totalling 12 measured surgery interventions. The minimal duration of surgery was 180 min. RESULTS: Pre- and post-surgery, all questionnaires showed that the magnitude of change was higher for the chief surgeon compared with the assistant surgeon, with differences of between 10 % POMS and 16.25 % VAS (robotic protocol) and between 3.1 % POMS and 12.5 % VAS (laparoscopic protocol). In the inter-profile comparison, the chief surgeon (robotic protocol) showed a lower balance capacity during the SLBT after surgery. During the intervention, the kinematic variables showed significant differences between the chief and assistant surgeon in the robotic protocol, but not in the laparoscopic protocol. Regarding muscle activation, there was not enough muscle activity to generate fatigue. CONCLUSION: Prolonged surgery increased fatigue in the surgeon; however, the magnitude of fatigue differed between surgical profiles. The surgeon who experienced the greatest fatigue was the chief surgeon in the robotic protocol.

Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study.

BACKGROUND: Although two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen. METHODS: This retrospective study was conducted in our center between 2011-2015 in 30 patients who underwent surgery for peritoneal carcinomatosis secondary to colorectal cancer, in whom cytoreduction and HIPEC were performed by the Coliseum (15) or closed techniques (15). The main end points were morbidity, mortality, hemodynamic changes, and abdominal temperature. The comparative analysis of quantitative variables at different times was done with the parametric repeated measure ANOVA for those variables that fulfilled the suppositions of normality and independence and the Friedman non-parametric test for the variables that did not fulfill either of these suppositions. RESULTS: There were no deaths in either group. The incidence of postoperative complications in the Coliseum group was 53% (8 patients), grade II-III. The incidence of complications in the closed group was 13% (2 patients), grade II-III. The intra-operative conditions regarding the systolic and diastolic pressures were more stable using the closed abdomen technique (but not significantly so). We found statistically significant differences in abdominal temperature in favor of the closed technique (p = 0.009). CONCLUSIONS: Both HIPEC procedures are similar. In our series, the closed technique resulted in a more stable intra-abdominal temperature.

Negative pressure therapy as palliative treatment for a colonic fistula.

Colonic fistulas in an open wound are always a challenge for colorectal surgeons, and this report provides a technique for the appropriate management of these cases. We communicate the use of a negative pressure dressing therapy as part of the palliative care for a patient following the development of an enterocutaneous fistula. The use of this therapy allowed us to keep the patient clean and comfortable during the last few days of his life.

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer.

Introduction: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. Methods: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. Results: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37−4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37−5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). Conclusions: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

Prevalence of Anxiety and Depression Symptoms and Their Relationship with Nutritional Status and Mortality in Patients with Colorectal Cancer.

BACKGROUND: Anxiety and depression are common in patients with cancer. The aim of this study is to determine the prevalence of anxiety and depression symptoms in colorectal cancer (CRC) patients awaiting elective surgery and whether there is an association with their preoperative nutritional status and postoperative mortality. METHODS: A prospective study was conducted on 215 patients with CRC proposed for surgery. Data about nutritional status were collected using the Global Leadership Initiative on Malnutrition (GLIM) criteria, while anxiety and depression symptoms data were collected using Hospital Anxiety and Depression Scale (HADS). RESULTS: HADS detected possible anxiety in 41.9% of patients, probable anxiety in 25.6%, possible depression in 21.9%, and probable depression in 7.9%. GLIM criteria found 116 (53.9%) patients with malnutrition. The HADS score for depression subscale was significantly higher in malnourished patients than in well-nourished (5.61 ± 3.65 vs. 3.95 ± 2.68; p = 0.001). After controlling for potential confounders, malnourished patients were 10.19 times more likely to present probable depression (95% CI 1.13-92.24; p = 0.039). Mortality was 1.9%, 4,2%, and 5.6% during admission and after 6 and 12 months, respectively. Compared to patients without depressive symptomatology, in patients with probable depression, mortality risk was 14.67 times greater (95% CI 1.54-140.21; p = 0.02) during admission and 6.62 times greater (95% CI 1.34-32.61; p = 0.02) after 6 months. CONCLUSIONS: The presence of anxiety and depression symptoms in CRC patients awaiting elective surgery is high. There is an association between depression symptoms, preoperative nutritional status, and postoperative mortality.

Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases.

Robotic-assisted laparoscopic surgery attempts to facilitate rectal surgery in the narrow space of the pelvis. The aim of this study is to compare the outcomes of robotic versus laparoscopic surgery for rectal cancer. Monocentric retrospective study including 300 patients who underwent robotic (n = 178) or laparoscopic (n = 122) resection between Jan 2009 and Dec 2017 for high, mid and low rectal cancer. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, except for sex and ASA status. There were no statistical differences between groups in the conversion rate to open surgery. Surgical morbidity and oncological quality did not differ in either group, except for the anastomosis leakage rate and the affected distal resection margin. There were no differences in overall survival rate between the laparoscopic and robotic group. Robotic surgery could provide some advantages over conventional laparoscopic surgery, such as three-dimensional views, articulated instruments, lower fatigue, lower conversion rate to open surgery, shorter hospital stays and lower urinary and sexual dysfunctions. On the other hand, robotic surgery usually implies longer operation times and higher costs. As shown in the ROLARR trial, no statistical differences in conversion rate were found between the groups in our study. When performed by experienced surgeons, robotic surgery for rectal cancer could be a safe and feasible option with no significant differences in terms of oncological outcomes in comparison to laparoscopic surgery.

Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients.

(1) There is evidence of the embryological, anatomical, histological, genetic and immunological differences between right colon cancer (RCC) and left colon cancer (LCC). This research has the general objective of studying the differences in outcome between RCC and LCC. (2) A longitudinal analytical study with prospective follow-up of the case-control type was conducted from 1 January 2010 to 31 December 2017 including 398 patients with 1:1 matching, depending on the location of the tumor. Inclusion criteria: programmed colectomies, 15 cm above the anal margin, adults and R0 surgery. (3) Precisely 6.8% of the exitus occurred in the first 6 months of the intervention. At 6 months, patients with LCC presented a mean survival of 7 months higher than RCC (p = 0.028). In the first stages, it can be observed that most of the exitus are for patients with RCC (stage I p = 0.021, stage II p = 0.014). In the last stages, the distribution of the deaths does not show differences between locations (stage III p = 0.683, stage IV p = 0.898). (4) The results show that RCC and LCC are significantly different in terms of evolution, progression, complications and survival. Patients with RCC have a worse prognosis, even in the early stages of the disease, due to more advanced N stages, larger tumor size, more frequently poorly differentiated tumors and a greater positivity of lymphovascular invasion than LCC.

Fistulización a recto de un teratoma quístico maduro, una rara complicación / Rectal fistulization of a mature cystic teratoma, a rare complication

RESUMEN Los teratomas quísticos maduros son los tumores ováricos más frecuentes. La fistulización de estos a órganos vecinos (colon, intestino delgado y vejiga) es una complicación que cuando se presenta nos obliga a descartar un proceso infiltrativo. Tanto la malignización como la formación de fistulas son complicaciones excepcionales. Está descrito en la bibliografía la malignización como mecanismo de formación de dichas fistulas. Este hecho nos suele obligar a llevar a cabo intervenciones agresivas, como exenteraciones pélvicas anteriores y posteriores. Sin embargo, una revisión de los casos publicados (18) muestra que sólo el 22 % de las fistulas son resultado de una malignización de dicho teratoma. Presentamos una paciente con un teratoma quístico maduro que fistulizó a recto y su manejo en nuestro servicio. Precis: La fistulización a órganos vecinos de un teratoma es una complicación excepcional que requiere un diagnóstico preciso puesto que no siempre es secundaria a neoplasia.

ABSTRACT Mature cystic teratomas are the most common ovarian tumors. The fistulization of these teratomas to adjacent organs (colon, small intestine and bladder) is a complication that when it occurs forces us to rule out an infiltrative process. Together with malignancy, the fistula is a rare complication. Literature describes malignancy as a mechanism for the formation of these fistulas. This event usually forces us to carry out aggressive interventions, such as anterior and posterior pelvic exenterations. However, the case records of 18 patients report that only 22 % of fistulas are produced by malignant teratoma. The following case study presents a mature cystic teratoma that fistulated the rectum and its management in our service.

Linfangioma quístico esplénico / Splenic cystic lymphangioma

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Diagnóstico diferencial de masa quística abdominal: el quiste de uraco malignizado / Differential diagnosis of a cystic abdominal mass: Malignant transformation of the urachal cyst

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Uso endoscópico de electrocauterio en el tratamiento de estenosis anastomótica ileorrectal / Endoscopic treatment with diathermy of ileorectal anastomotic stricture

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Resección laparoscópica de angiomixoma pélvico agresivo / Laparoscopic resection of an aggressive pelvic angiomyxoma

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Papel de la colangioyeyunostomía periférica intrahepática al segmento III (Soupault-Couinaud) para la ictericia maligna en la era de los stents endoscópicos y percutáneos / Role of segment iii peripheral intrahepatic cholangio-jejunostomy (Soupault-Couinaud) for malignant jaundice in the era of endoscopic and percutaneous stents

Objetivo. Presentar los resultados de nuestra experiencia con la técnica de Soupault-Couinaud (colangioyeyunostomía intrahepática periférica al segmento III) como terapeútica paliativa en pacientes seleccionados con lesiones malignas no resecables de la confluencia hepática. Se revisan asimismo las distintas opciones de tratamiento para este tipo de pacientes. Pacientes y método. Estudiamos de forma retrospectiva las historias clínicas de 7 pacientes intervenidos mediante este procedimiento en la Unidad de Cirugía HBP de nuestro Servicio de Cirugía Digestiva entre los años 1993 y 2000. Se han recogido los datos clínicos y analíticos preoperatorios, así como la información de la patología causante del bloqueo hiliar, y se comparan con la evolución clínica y los datos analíticos postoperatorios y de seguimiento, para poder así demostrar la utilidad o no de la técnica. Resultados. De los 7 pacientes, tres eran varones y 4 mujeres, con una edad media de 66 años. La ictericia estuvo presente en el 100 por ciento de los casos, y el 85,7 por ciento de los pacientes refirieron en el momento del ingreso prurito, síndrome tóxico y dolor abdominal superior. Las patologías causantes del bloqueo hiliar fueron cáncer de vesícula biliar (4 casos), colangiocarcinoma (dos casos) y metástasis ganglionares de ampuloma (un caso). En todos los casos la decisión de realizar una colangioyeyunostomía intrahepática periférica al segmento III fue tomada en el mismo acto operatorio. Los valores medios de bilirrubina total preoperatorios fueron de 13,4 mg/dl (rango de 3,7 a 23,5 mg/dl). El 85,7 por ciento de los pacientes experimentaron mejoría postoperatoria importante del síndrome ictérico, con descenso de la colemia previa al alta hasta una media de 5,3 mg/dl (rango de 0,82 a 16,51 mg/dl). La mortalidad fue nula, y la morbilidad del 57,1 por ciento, con una supervivencia media de 6 meses. Conclusión. A pesar del limitado número de pacientes de esta serie, pensamos que la colangioyeyunostomía intrahepática periférica al segmento III (técnica de Soupault-Couinaud) aún representa una buena opción terapéutica paliativa para pacientes seleccionados con lesiones malignas no resecables de la confluencia hepática. En unidades HBP especializadas presenta una aceptable morbilidad y una minima (nula en nuestra experiencia) mortalidad, proporcionando a estos enfermos una paliación clínica y analítica prolongada, con la consiguiente repercusión en una mejor calidad de vida. (AU)