Pancreatic PEComa, a not so uncommon neoplasm? Systematic review and therapeutic update. / PEComa pancreático ¿una neoplasia no tan infrecuente? Revisión sistemática y actualización clínico-terapéutica.

Pancreatic PEComas are extremely rare neoplasms with malignant potential, which mostly affect middle-aged women and are characterized by presenting melanocytic and myogenic markers in immunohistochemical analysis. There are no symptoms or pathognomonic imaging tests, so the diagnosis is established with the analysis of the surgical specimen or the FNA obtained with preoperative endoscopic ultrasound. The mean treatment consists on radical excision, adapting the intervention to the location of the tumor. To date, 34 cases have been described; however, more than 80% of them have been reported in the last decade, which suggests that it is a more frequent pathology than expected. A new case of pancreatic PEComa is reported and a systematic review of the literature is carried out according to the PRISMA guidelines with the aim of divulge this pathology, deepening its knowledge and updating its management.

Jejunal metastasis of renal cell carcinoma.

A 71-year-old female presented with melena and anemia. She had a past medical history of renal cell carcinoma diagnosed six years earlier and treated with left nephrectomy. Gastroscopy and colonoscopy showed no abnormalities. Renal cell carcinoma (RCC) is the third commonest urological malignancy, and approximately 25-50% of patients develop metastatic disease after surgery of the primary tumor. The most common sites of metastasis involve lung, lymph nodes, liver, bone and adrenal glands.

Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.

[Morbidity and mortality after a Hartmann operation due to peritonitis originating from a sigmoid diverticulum disease (Hinchey grade III-IV)]. / Morbilidad y mortalidad tras la intervención de Hartmann por peritonitis de origen diverticular (grados III-IV de Hinchey).

INTRODUCTION: Hartmann's operation has occasionally been criticised for its high morbidity-mortality and permanent stomas. To compare risk factors is difficult due to different severity scores for diverticulitis with no standardisation. We attempted to define the morbidity-mortality of Hartmann's operation for sigmoid diverticulitis with peritonitis Hinchey III-IV and to identify some factors associated with morbidity-mortality and non-restoration of intestinal continuity. PATIENTS AND METHOD: Retrospective analysis of 72 patients: age, gender, ASA score, length of time between symptoms and surgery, Hinchey's score, Mannheim index, preoperative creatinine and co-morbidities. RESULTS: Hinchey's score III, 75%. Male, 35. Median age, 66.5 years. Morbidity-mortality: 48.6% and 23.6%, respectively. ASA > 2 (p = 0.03) and age > 65 years (p = 0.03) in bivariate analysis; and ASA > 2 (p = 0.002) and a history of ischaemic cardiac disease (p = 0.04) in multivariate analysis were associated with postoperative complications. In bivariate analysis mortality was associated with ASA > 2 (p = 0.02), age > 65 years (p = 0.02), chronic obstructive pulmonary disease (p = 0.001), Mannhein index >or= 25 (p = 0.01) and pulmonary postoperative complications (p = 0.003). Multivariate analyses were statistical significant: chronic obstructive pulmonary disease (p = 0.001) and postoperative respiratory infection (p = 0.02). Fifty-five patients survived and 65.5% continued to restoration of intestinal continuity. Age > 65 years (p = 0.004) and ASA score > 2 at first operation (p = 0.004) were predictive for non-reversal of Hartmann's procedure. CONCLUSIONS: Hartmann's operation is highly associated with morbidity-mortality in severe peritonitis of sigmoid diverticular origin, Hinchey III-IV. The majority of patients have severe co-morbidities and high-grade risk factors which are related to the incidence of morbidity and mortality.