Stent placement prior to initiation of chemotherapy in patients with obstructive, nonoperative left sided tumors is associated with fewer stomas.

BACKGROUND AND OBJETIVES: Due to the potential risks associated with stent placement, European Society Gastrointestinal Endoscopy does not recommend prophylactic insertion of stents in patients without symptoms. The aim was to compare complication rates, need of surgery, colostomy formation, and survival between stent placement prior to start of chemotherapy (SEMS group) and upfront ChT (ChT group) in patients with endoscopically non-transverable metastatic left-sided colorectal cancer. METHODS: Gender, age, CEA, tumor location, sites of metastatic disease, peritoneal involvement, liver involvement, and angiogenesis inhibitors administration, were recorded. Complication rates, need of surgery, stoma creation, and survival were compared between both groups by univariate and multivariate test. Complications of SEMS placement in both groups were compared. RESULTS: We studied 75 men and 40 women, with a mean age of 66.3 years. Overall complication and perforation rates were similar but patients in the ChT group had a significant higher need of surgery and subsequent stoma creation. Perforation after SEMS placement rates were higher in patients receiving ChT than in patients without ChT. Survival was related to peritoneal carcinomatosis and administration of biological agents. CONCLUSIONS: SEMS placement prior to ChT administration dismissed the need of subsequent surgery and decreased the rates of permanent stoma formation.

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection.

BACKGROUND: The aim of this study was to evaluate the rate of complications from the primary tumour (CPT) requiring surgical or endoscopic intervention during chemotherapy treatment in patients with incurable synchronous stage IV colorectal cancer, the possibility of predicting such complications and their influence on survival. METHODS: One hundred and twenty-five patients were initially treated with chemotherapy. Patients were grouped on the basis of appearance or not of CPT. We assessed the relation between age, gender, carcinoembryonic antigen (CEA) level, primary tumour location, alkaline phosphatase level, unilobar or bilobar liver involvement, presence of peritoneal carcinomatosis, the number of sites of metastatic disease, the addition of target therapies to chemotherapy, the ability to traverse the tumour with an endoscope and the appearance of complications due to the primary tumour and overall survival. RESULTS: Mean age was 64.9 years, and 89 patients were men. Over a mean of 234 days, 25 patients (20 %) developed a CPT. Eighteen patients required surgery, and seven were treated exclusively by an endoscopic procedure. Mean survival was 15.8 months. We found a statistically relevant correlation between the inability to traverse the tumour with an endoscope and the occurrence of a CPT. There was no statistical differences in survival between both groups, but patients receiving target therapies had better survival. CONCLUSION: Twenty percent of patients will suffer a CPT during chemotherapy treatment. The inability to pass the tumour with an endoscope can predict the CPT. Survival was only related to the addition of target therapies to chemotherapy.

[Surgical site infection in general surgery: 5-year analysis and assessment of the National Nosocomial Infection Surveillance (NNIS) index]. / Infección de sitio quirúrgico en un servicio de cirugía general. Análisis de cinco años y valoración del índice National Nosocomial Infection Surveillance (NNIS).

INTRODUCTION: The aim of this study was to describe the rate of surgical site infections (SSI), classified according to the NNIS index and its components, as well as to evaluate this scale and assess the importance of several factors that influence the development of an SSI. PATIENTS AND METHOD: All episodes of SSI were prospectively registered over a 5-year period. All patients (infected or not) were given an NNIS index and an NNIS category. Postoperative hospital stay and bacteria cultured from the surgical site were also analyzed. Chi2 test, Student's t-test and multiple logistic regression were used. RESULTS: There were 6,218 patients and 513 SSI (8.25%). The infection rate was 2.27% for clean surgery, 9.17% for clean-contaminated surgery, 11.40% for contaminated surgery, and 19.14% for dirty surgery; 4% for ASA I, 8.23% for ASA II, 13.54% for ASA III, 19.55% for ASA IV, and 33.33% for ASA V; 6.97% for length of procedure = 75th percentile, and 23.01% for > 75th percentile; 3.95% for NNIS 0, 8.17% for NNIS 1, 22.08% for NNIS 2, and 37.23% for NNIS 3. Among the components of the NNIS index, the length of the surgical procedure had the greatest influence on the rate of SSI (OR = 3.43 versus OR = 2.60 for the grade of contamination and OR = 2.20 for ASA index). The infection rates according to the type of intervention were: 30.9% in hepatobiliopancreatic surgery, 24.3% in small bowel surgery, 16.1% in colorectal surgery, 15.4% in gastroduodenal surgery; 8.5% in other soft tissue interventions, 7.7% in exploratory laparotomies, 6.4% in appendicectomies for appendicitis, 5.0% in cholecystectomy, 5.0% in other interventions of the digestive tract, 3.3% in breast surgery, 1.5% in herniorrhaphies, and 0.7% in endocrine surgery. CONCLUSIONS: The NNIS index is a valid instrument for classifying surgical patients according to the risk of developing an SSI. Of the three components, the length of the intervention has the greatest influence on increasing the risk of infection. The NNIS categories also distinguish different levels of risk of infection.

Infección de sitio quirúrgico en un servicio de cirugía general. Análisis de cinco años y valoración del índice National Nosocomial Infection Surveillance (NNIS) / Surgical site infection in general surgery: 5-year analysis and assessment of the National Nosocomial Infection Surveillance (NNIS) index

Introducción. Se describe la tasa de infección de sitio quirúrgico (ISQ) valorando la validez del sistema del índice National Nosocomial Infection Surveillance (NNIS) de estratificación del riesgo y la influencia de los diferentes factores en la aparición de una ISQ. Pacientes y método. Registro prospectivo durante 5 años de incidencia de ISQ según el índice y categoría del NNIS, estancias postoperatorias y gérmenes aislados. Se realizaron pruebas de la X2, de la t de Student y regresión logística múltiple. Resultados. El número de pacientes es de 6.218, y el de ISQ, de 513 (8,25%). La tasa de infecciones en cirugía limpia es del 2,27%, la de limpia-contaminada, del 9,17%, la de contaminada, del 11,40%, y la de sucia, del 19,14%. En pacientes con ASA I: 4,0%, ASA II: 8,23%, ASA III: 13,54%, ASA IV: 19,55% y ASA V: 33,33%; con un tiempo intervención percentil 75 del 23,01%. Con índice NNIS 0: 3,95%, NNIS 1: 8,17%, NNIS 2: 22,08% y NNIS 3: 37,23%. La duración de la intervención es el factor del índice NNIS que más influye en la tasa de infecciones (odds ratio [OR] = 3,43, frente a 2,60 del grado de contaminación y 2,20 del nivel ASA). La tasa de infecciones en la categoría de la cirugía hepatobiliopancreática es del 30,9%; la de intervenciones sobre el intestino delgado, del 24,3%; la de la cirugía colorrectal, del 16,1%; la de la cirugía gastroduodenal, del 15,4%; la de otras intervenciones en partes blandas, del 8,5%; la de laparotomías exploradoras, del 7,7%; la de apendicectomías por apendicitis, del 6,4%; la de colecistectomías, del 5,0%; la de otras intervenciones en el aparato digestivo, del 5,0%; la de la cirugía mamaria, del 3,3%; la de herniorrafias, del 1,5%, y la de intervenciones endocrinológicas, del 0,7%. Conclusiones. El índice NNIS es válido en nuestros pacientes para estratificar el riesgo de presentar una ISQ. El factor tiempo es el que tiene mayor peso en el riesgo de infección, y el nivel ASA, el menor. La categoría NNIS también discrimina diferentes grados de riesgo (AU)

Introduction. The aim of this study was to describe the rate of surgical site infections (SSI), classified according to the NNIS index and its components, as well as to evaluate this scale and assess the importance of several factors that influence the development of an SSI. Patients and method. All episodes of SSI were prospectivelly registered over a 5-year period. All patients (infected or not) were given an NNIS index and an NNIS category. Postoperative hospital stay and bacteria cultured from the surgical site were also analyzed. X2 test, Student's t-test and multiple logistic regression were used. Results. There were 6,218 patients and 513 SSI (8.25%). The infection rate was 2.27% for clean surgery, 9.17% for clean-contaminated surgery, 11.40% for contaminated surgery, and 19.14% for dirty surgery; 4% for ASA I, 8.23% for ASA II, 13.54% for ASA III, 19.55% for ASA IV, and 33.33% for ASA V; 6.97% for length of procedure =75th percentile, and 23.01% for >75th percentile; 3.95% for NNIS 0, 8.17% for NNIS 1, 22.08% for NNIS 2, and 37.23% for NNIS 3. Among the components of the NNIS index, the length of the surgical procedure had the greatest influence on the rate of SSI (OR = 3.43 versus OR = 2.60 for the grade of contamination and OR = 2.20 for ASA index). The infection rates according to the type of intervention were: 30.9% in hepatobiliopancreatic surgery, 24.3% in small bowel surgery, 16.1% in colorectal surgery, 15.4% in gastroduodenal surgery; 8.5% in other soft tissue interventions, 7.7% in exploratory laparotomies, 6.4% in appendicectomies for appendicitis, 5.0% in cholecystectomy, 5.0% in other interventions of the digestive tract, 3.3% in breast surgery, 1.5% in herniorrhaphies, and 0.7% in endocrine surgery. Conclusions. The NNIS index is a valid instrument for classifying surgical patients according to the risk of developing an SSI. Of the three components, the length of the intervention has the greatest influence on increasing the risk of infection. The NNIS categories also distinguish different levels of risk of infection (AU)