Quality indicators of transanal total mesorectal excision (TaTME) for rectal cancer

Introduction: Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods: A cohort prospective study with 50 (14 female and 36male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results: There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the external anal margin) between the two groups. The rates of: postoperativemorbidity (TaTME: 35%; LaTME: 30%; p=0.763);mortality (0%); anastomotic leak (TaTME: 10%; LaTME: 13%; p=0.722); wound infection (TaTME: 0%; LaTME: 3.3%; p=0.409); reoperation (TaTME: 5%; LaTME: 6.6%; p=0.808); and readmission (TaTME: 5%; LaTME: 0%; p=0.400), as well as the length of the hospital stay (TaTME: 13.5 days; LaTME: 11 days; p=0.538), were similar in both groups. There were no statistically significant differences in the rates of positive circumferential resection margin (TaTME: 5%; LaTME: 3.3%; p=0.989) and positive distal resection margin (TaTME: 0%; LaTME: 3.3%; p=0.400), the completeness of the TME (TaTME: 100%; LaTME: 100%), and the number of lymph nodes harvested (TaTME: 15; LaTME: 15.5; p=0.882) between two groups. Conclusion: Transanal total mesorectal excision is a safe and feasible surgical procedure for middle/lower-third rectal cancer. (AU)

Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer.

INTRODUCTION: neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach for locally advanced gastric cancer (GC). Interval timing to surgery after NACT in GC is controversial. The aim of this study was to evaluate the impact of NACT interval time on tumor response and overall survival. MATERIAL AND METHODS: a retrospective analysis from a prospective database was performed at a single referral tertiary hospital, from January 2010 to October 2018. Patients were assigned to three groups according to the surgical interval time after NACT: < 4 weeks, 4-6 weeks and > 6 weeks. Univariate and multivariable analyses were performed in order to clarify the impact of NACT on post-neoadjuvant pathological complete response rate (ypCR), downstaging (DS) and overall survival (OS). RESULTS: of the 60 patients analyzed, 18 patients (30 %) had an interval time to surgery < 4 weeks, 26 (43.3 %) between 4-6 weeks and 16 (26.7 %) > 6 weeks. Two patients (3 %) had achieved ypCR and 37 patients (62 %) had achieved DS. There were no differences in DS rates among the interval time groups (p: 0.66). According to the multivariate analysis, only poorly differentiated carcinoma was significantly related to lower DS rates (p: 0.04). Cox regression analysis showed that the NACT interval time had no impact on OS. According to the multivariate analysis, > 25 lymph node harvested (HR: 0.35) and female sex (HR: 5.67) were OS independent predictors. CONCLUSIONS: the NACT interval time prior gastrectomy for locally advanced GC is not associated with ypCR or DS and has no impact on overall survival.

Laparoscopic duodenojejunostomy as a treatment for Wilkie's syndrome. Analysis of a four cases series.

We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS is an infrequent disease, whose diagnosis can be challenging for patients suffering recurrent digestive symptoms. Our patients refered a history of chronic postprandial abdominal pain associated with vomiting, intestinal transit disorders or an uncontrolled weight loss. Abdominopelvic angio-CT was part of the research in all the cases, objectifying a decrease in the angle between Superior Mesenteric Artery (SAM) and Aorta below 25°. In case of chronic or refractory cases, the surgical treatment may be an option. Laparoscopic duodenojejunostomy constitutes the treatment of choice due its low rate of complications and acceptable results.

Surgical management of familial adenomatous polyposis: pancreas-sparing duodenectomy or pancreaticoduodenectomy (Whipple procedure).

Duodenal cancer is the main cause of death for patients with FAP syndrome (familial adenomatous polyposis) treated with a colectomy. The disease follows the adenoma to carcinoma sequence and is diagnosed during follow-up in 7-36% of patients. Endoscopic treatment is used during the first treatment stage of the disease and surgery is an adequate therapeutic option when endoscopic control is insufficient.

Role of negative pressure wound therapy in the prevention of surgical site infection in colorectal surgery. / Papel de la terapia presión negativa en la prevención de infección del sitio quirúrgico en cirugía colorrectal.

BACKGROUND: Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS: We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS: No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS: NPWT is a useful SSI prevention treatment in colorectal surgery.