Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial.

BACKGROUND: Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. METHODS: A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. RESULTS: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. CONCLUSION: These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.

Management of gastrocutaneous fistulas following gastrostomy: surgery as a therapeutic option.

Gastrocutaneous fistulas (GCF) following removal of gastrostomy tubes are an uncommon complication with many therapeutic options. It is a drawback that concerns both patient and surgeon, hindering the decision to perform an invasive treatment. Despite emerging minimally invasive procedures, we must not forget that surgery continues to be the standard treatment when they all fail.

The role of percutaneous endoscopic gastrostomy in the treatment of acute gastric volvulus.

Gastric volvulus is an uncommon pathology that can occur acutely, in a chronic setting, or even as a casual finding. The primary kind occurs in 30% of patients. Secondary causes include hiatal hernia types II-III up to 70% of cases. The main treatment of acute gastric volvulus is gastric decompression, by means of a nasogastric tube (NGT) or endoscopy. However, it is not a procedure exempt from complications. Traditionally, definitive treatment involves surgery, consisting in hernia reduction with gastropexy/anti-reflux technique and/or hiatoplasty. We present the case of a 83-year-old woman with permanent atrial fibrillation, among other cardiovascular conditions.

Simple liver cyst presenting with clinical signs and symptoms of right-sided heart failure.

Simple hepatic cysts are one of the most common benign lesions in the liver. Despite being frequently asymptomatic, if they reach large sizes in certain anatomical locations, they can appear under atypical symptomatology and cause significant morbidity. We present the case of a giant simple liver cyst as an exceptional cause of right-sided heart failure. Laparoscopic deroofing of the cyst achieved an outstanding improvement of the patient´s cardiac condition. A high diagnostic suspicion, a multidisciplinary approach and adequate treatment are essential for a favourable outcome.

Adenocarcinoma of the anal canal with an exceptional immunohistochemistry in a patient with serrated polyposis syndrome: a diagnostic challenge.

Anal adenocarcinomas account for approximately 10% of all anorectal tumours. We present the case of an adenocarcinoma of the proximal anal canal with exceptional immunohistochemistry as an incidental finding after haemorrhoidectomy, in a patient with endoscopically controlled serrated polyposis syndrome. Histopathological analysis of the specimen was a challenge in terms of differential diagnosis, which often determines the choice of therapeutic approach.

Evaluation of Myocardial Function Following SADI-S.

PURPOSE: The aim of this study was to compare myocardial mechanics using global longitudinal strain (GLS) before and after single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). MATERIALS AND METHODS: A total of 21 obese patients undergoing SADI-S were prospectively included. Transthoracic echocardiography was performed before and after the procedure, and left ventricle (LV) and right ventricle (RV) strain was assessed by two-dimensional speckle-tracking imaging (2DST). RESULTS: Mean time between pre-procedural and post-procedural echocardiograms was 9.2 ± 3.3 months. Postoperatively, %total weight loss (%TWL) was 33.0 ± 1.7 and % excess weight loss (%EWL) was 75.5 ± 3.6. Body mass index (BMI) significantly decreased after surgery (45.6 ± 1.2 vs 29.6 ± 1.0; p < 0.001). Postoperatively, LV GLS experienced a significant improvement (-19.8% ± 0.5 vs -22.2% ± 0.4; p < 0.001). Regarding other relevant functional parameters, RV free-wall strain was equally recovered (-19.1% ± 0.7 vs -21.0% ± 0.8; p 0.047). CONCLUSIONS: This study demonstrates important and favourable changes in cardiac deformation parameters after performing SADI-S. Malabsorptive bariatric techniques such as SADI-S induce significant weight loss, leading to an improvement in subclinical myocardial function in patients with obesity.

Cervical thyroid remnant consistent with papillary carcinoma as an incidental finding in a patient with benign total thyroidectomy ten years prior.

BACKGROUND: Differential diagnosis of a cervical lesion corresponding with papillary thyroid carcinoma (PTC) after benign total thyroidectomy can be a real challenge. METHODS: A cervical thyroid remnant compatible with papillary carcinoma was incidentally found ten years after total thyroidectomy for a non-functional multinodular goitre. Histological analysis of fine needle puncture aspiration (FNPA) was highly suggestive for PTC. Surgical excision of the cervical lesion was performed. Specimen study demonstrated a classic variant of PTC contacting a peripheral margin, applying ablative treatment with radioactive iodine postoperatively. RESULTS: The patient did not present signs of recurrence during follow-up. Small thyroid remnants after benign thyroidectomy are often left behind, although their risk of malignancy is exceptional. CONCLUSIONS: It is important to individualize therapeutic approach when facing this rare entity. We decided to treat the patient by removing the lesion followed by ablation therapy with successful results. PTC: Papillary thyroid carcinoma FNPA: Fine needle puncture aspiration.

Prevalencia, diagnóstico y tratamiento de las lesiones pulmonares traumáticas / Prevalence, diagnosis, and treatment of traumatic pulmonary injuries

La lesión pulmonar es relativamente infrecuente en el paciente politraumatizado y, posiblemente, subdiagnosticada inicialmente debido a su habitual asociación con otras lesiones aparentemente más graves, en particular tras el traumatismo cerrado. Por ello, es de vital importancia su diagnóstico precoz ya que puede conllevar consecuencias fatales si no se diagnostica a tiempo. Dada su localización anatómica, es habitual que se acompañe de lesiones concomitantes de otros órganos y estructuras vasculares intratorácicas, lo cual, unido a la necesidad ocasional de maniobras quirúrgicas críticas, resulta en altas tasas de morbimortalidad. El objetivo del trabajo fue estudiar las características de estas lesiones, incluyendo su incidencia, su mecanismo, y las técnicas diagnósticas y opciones terapéuticas disponibles, tanto quirúrgicas como no quirúrgicas. Además, se analizaron la evolución y el pronóstico de estos pacientes, con base en una revisión bibliográfica de 1965 hasta 2018

In the trauma patient, lung injury is relatively uncommon, possibly underdiagnosed due to its frequent association with other apparently more serious injuries, especially in cases of blunt trauma. Therefore, early diagnosis is of vital importance, as lung injuries can lead to fatal consequences. Due to their anatomical location, it is common for them to be associated with other organ and intrathoracic vascular structures, which together with the occasional need for critical surgical maneuvers, result in high rates of morbidity and mortality. The aim of the study is to describe the characteristics of pulmonary injuries including their incidence, mechanisms of injury, diagnostic techniques and available therapeutic options, both surgical and conservative. An analysis of the prognostic factors of these patients based on a review of the literature from 1965 to 2018 is included

Adenocarcinoma of the anal canal with an exceptional immunohistochemistry in a patient with serrated polyposis syndrome: a diagnostic challenge / Adenocarcinoma de canal anal con inmunohistoquímica excepcional en paciente con síndrome de poliposis serrada: un reto diagnóstico

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Manejo de la fístula gastrocutánea tras gastrostomía. La cirugía como opción terapéutica / No disponible

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Papel de la gastrostomía endoscópica percutánea en el tratamiento del vólvulo gástrico agudo / No disponible

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Presentación inusual de un quiste hepático simple gigante como causa de insuficiencia cardiaca derecha / Simple liver cyst presenting with clinical signs and symptoms of right-sided heart failure

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