RESUMEN
Context: Models for predicting individual risks of surgical complications are advantageous for operative decision making and the nature of postoperative management procedures. Objective: Validate the "ACS NSQIP® Risk Calculator" in the prediction of postoperative complications during colorectal cancer surgery, operated during the years 2015 to 2019. Methods: this is a prognostic validation study of the "ACS NSQIP®" applied retrospectively to patients operated on for colorectal cancer in the surgical department of Farhat Hached hospital, during the 2015 and 2019 5-year term. Three levels of adjustment. Discrimination and calibration were carried out mainly by ROC curves (AUC ⩾ 0.8). Results: In this study, 129 patients were included with a sex ratio of 1.22 and a median age of 62 years. The most common operative procedure was low segmental colectomy with colorectal anastomosis. Thirty-seven patients (28.7%) had at least one postoperative complication. The prediction and cuts-off points values of mortality (AUC = 0.858; CI95% [0.570-0.960]; Cuts-off points = 1.8%), cardiac complications (AUC = 0.824; CI95% [0.658-0.990]; Cuts-off points = 1.8%), thromboembolic complications (AUC = 0.802; CI95% [0.617-0.987]; Cuts-off point = 3.1%), and renal insufficiency (AUC = 0.802; CI95% [ 0.623-0.981]; Cuts-off point = 1.2%) were adjusted according to level 1 of the calculator. Conclusion: This work contextualized the prediction of postoperative complications in colorectal surgery in the university general surgery department of Farhat Hached in Sousse (Tunisia), making it possible to improve the quality and safety of surgical care. The application of the Tunisian mini calculator is recommended as well as the generalization of validation following the development of a generic calculator for all operating procedures.
RESUMEN
Introduction: Sarcomatoid carcinoma of the stomach is a very rare type of malignant gastric tumor characterized by distinct cell morphology.Only six cases have been reported in the literature. We report a case which illustrates the great rapidity of evolution and the aggressiveness of this histological type. Case presentation: A 80-year-old patient was explored for loss of 20 kg and epigastralgia. The explorations showed a non-metastatic antral sarcomatoid carcinoma with celiac necrotic lymphe node. The oncologic comitee decision was surgery straight away without perioperative chemotherapy.4 weeks after his first CT scan the patient was admitted for preparation for surgery. Clinical and morphological examination showed a clear increase in tumor size with associated tumor infection.The patient had distal gastrectomy. The tumor was perforated and locally advanced.The final pathological exams confirmed the histological type. Surgery was R0, but 4 months after surgery, local recurrence compressing gastro intestinal anastomosis was occurred. Clinical discussion: Operative difficulties and rapid recurrence after surgery would have been avoided by faster surgery after diagnosis. However, the surgery time was only 1 month, which illustrates the rapid evolution of sarcomatoid tumors. Conclusion: Sarcomatoid carcinoma is a rare tumor. These tumors can be aggressive with a large tumoral voulume and high rate of locoregional lymph node involvement. Our case illustrate the aggressiveness of this tumor. The benefit of peri-operative treatment is unknown.
