ABSTRACT
Introducción: Proponemos valorar la utilidad del recuento celular en el cáncer de colon en nuestro medio. Material y Métodos. Realizamos un estudio observacional, analítico, longitudinal y retrospectivo, basado en un esquema de cohortes. Se reclutan a 47 pacientes intervenidos de cáncer de colon en 2015. Se establecieron dos grupos según estadio anato-mopatológico final (grupo 1: estadios 0 y I y grupo 2: estadios II, III y IV) y se recogen sus datos analíticos en distintos momentos. Con los recuentos celulares se calcularon las curvas ROC para varias ratios, para establecer el punto de corte a partir del cual la probabilidad de pertenecer al grupo 1 es más alta. Se forman dos grupos, A y B, según sus valores de ratio y tomando el punto de corte para dividirlos y se comparan factores anatomopatológicos de mal pronóstico, datos quirúrgicos y clínicos. Se describe también el valor de la NLR en pacientes con mala evolución de la enfermedad. Resultados: No encontramos diferencias estadísticamente significativas en la evolución de ambos grupos, A y B, tampoco en cuanto a su relación con factores de mal pronóstico anatomopatológicos o clínicos. Se realiza también un seguimiento de los valores del NLR en pacientes que presentaron recidiva o metástasis, exponiendo resultados descriptivos. Conclusiones. Se trata de una medida sencilla de determinar, por lo que a pesar de no haber encontrado diferencias significativas, valoramos su utilidad cómo elemento informativo y consideramos su interés en demostrar la significancia estadística aumentando tamaño muestral y periodo de seguimiento en trabajos posteriores
Introduction. We propose to evaluate the utility of cell counts in colon cancer in our environment. Material and Methods. We conducted an observational, analytical, longitudinal and retrospective study, based on a cohort scheme. 47 patients were recruited who underwent colon cancer in 2015. Two groups were established according to the final anato-mopathological stage (group 1: stages 0 and I and group 2: stages II, III and IV) and their analytical data were collected at different times. With the cell counts the ROC curves were calculated for several ratios, to establish the cut-off point from which the probability of belonging to group 1 is higher. Two groups are formed, A and B, according to their ratio values and taking the cut-off point to divide them and comparing anatomopathological factors of poor prognosis, surgical and clinical data. The value of the NLR is also described in patients with poor evolution of the disease. Results. We did not find statistically significant differences in the evolution of both groups, A and B, neither in relation to their relationship with poor pathological or clinical prognostic factors. The NLR values were also monitored in patients with recurrence or metastasis, with descriptive results. Conclusions. This is a simple measure to determine, so despite not having found significant differences, we value its usefulness as an informative element and we consider its interest in demonstrating statistical significance by increasing sample size and follow-up period in subsequent studies
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Colonic Neoplasms/epidemiology , Cell Count/methods , Odds Ratio , Cohort Studies , Spain/epidemiologyABSTRACT
BACKGROUND: paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established. MATERIAL AND METHODS: a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007. RESULTS: we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%. CONCLUSION: equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.
Subject(s)
Hernia, Hiatal/surgery , Laparoscopy , Adult , Aged , Aged, 80 and over , Digestive System Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Introducción: la hernia hiatal paraesofágica representa el 5-10% de las hernias hiatales. Su importancia radica en las gravescomplicaciones que pueden presentar, como el vólvulo gástrico, yse recomienda el tratamiento quirúrgico una vez establecido eldiagnóstico.Material y métodos: estudio retrospectivo de los pacientesintervenidos en nuestro centro de hernia hiatal paraesofágica entre1985 y 2007.Resultados: estudiamos 90 casos, 68 mujeres y 22 varones,con edad media de 67,6 años (37-96). Cuarenta y cinco pacientespresentaban pirosis, 34 dolor epigástrico postprandial y 15 disfagia;ocho pacientes fueron diagnosticados como vólvulo gástrico.Se realizaron 81 intervenciones programadas y 9 urgentes. En 47casos el abordaje fue abierto y en 43 laparoscópico, de los cuales5 se convirtieron a cirugía abierta. Se realizó funduplicatura D´Oren 35 casos, Nissen en 35, Toupet en 14, cierre simple de pilaresen 2, Narbona en 1 y Lortat-Jakob en 1; en 10 pacientes se colocaronmallas. La tasa de complicaciones en cirugía abierta fue10,6% y en laparoscópica 9,5% (p > 0,05). La estancia media fue9,1 días en cirugía abierta y 3,4 en laparoscópica (p < 0,05). Enel seguimiento, analizamos 84 pacientes, con una mediana de 12años (1-19): 15 continuaban sintomáticos, objetivándose recidivaen 8 (5 fueron reintervenidos). El 95,5% de los pacientes estabansatisfechos con los resultados.Conclusión: se obtuvieron resultados equivalentes tras cirugíalaparoscópica y abierta, con estancia hospitalaria significativamentemenor en los primeros. Por ello creemos que se debe considerarla cirugía laparoscópica como abordaje de elección paratratar la hernia hiatal paraesofágica(AU)
Background: paraesophageal hiatal hernia represents 5-10%of hiatal hernias. Its importance is based on the severe complicationsit may have, including gastric volvulus, and surgical treatmentis recommended when a diagnosis is established.Material and methods: a retrospective study of all patientswho underwent surgery for paresophageal hernia between 1985and 2007.Results: we studied 90 cases, 68 females and 22 males with amedian age of 67.6 years (37-96). Forty-five patients reported pyrosis,34 epigastric postprandial pain, and 15 dysphagia; eightpatients were diagnosed with gastric volvulus. Eighty-one patientsunderwent elective surgery and 9 emergency surgery. Forty-sevencases underwent an open procedure and 43 a laparoscopicone; 5 (11.6%) of them required conversion. The techniques performedwere D´Or fundoplication in 35 cases, Nissen in 35,Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complicationrate for open procedure was 10.6 and 9.5% for the laparoscopicone (p > 0.05). Median hospital stay was 9.1 days for theopen procedure and 3.4 for the laparoscopic one (p < 0.05). Asfollow-up, we analyzed 84 patients. After a median follow-up of12 years (1-19), 15 patients were still symptomatic (17.8%), withrecurrence in 8 cases (5 required reoperation). The satisfactionrate was 95.5%Conclusion: equivalent results were observed after laparoscopicand open surgery and a significant shorter hospital stay inthe laparoscopic one. Therefore, we think that laparoscopicsurgery should be considered as the election procedure for paraesophagealhiatal hernia(AU)