Core outcome set for surgical trials in gastric cancer (GASTROS study): international patient and healthcare professional consensus.

BACKGROUND: Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim of this study was to develop a core outcome set (COS)-a standardized group of outcomes important to key international stakeholders-that should be reported by future trials in this field. METHODS: Stage 1 of the study involved identifying potentially important outcomes from previous trials and a series of patient interviews. Stage 2 involved patients and healthcare professionals prioritizing outcomes using a multilanguage international Delphi survey that informed an international consensus meeting at which the COS was finalized. RESULTS: Some 498 outcomes were identified from previously reported trials and patient interviews, and rationalized into 56 items presented in the Delphi survey. A total of 952 patients, surgeons, and nurses enrolled in round 1 of the survey, and 662 (70 per cent) completed round 2. Following the consensus meeting, eight outcomes were included in the COS: disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and 'serious' adverse events. CONCLUSION: A COS for surgical trials in gastric cancer has been developed with international patients and healthcare professionals. This is a minimum set of outcomes that is recommended to be used in all future trials in this field to improve trial design and synthesis of evidence.

Cirugía ambulatoria endocrina de cuello / No disponible

INTRODUCCIÓN: la baja morbimortalidad de la cirugía de tiroides y paratiroides ha favorecido su inclusión en el campo de la cirugía mayor ambulatoria. Tras una amplia experiencia en cirugía endocrina de cuello de "corta estancia" realizamos un estudio prospectivo para valorar la posibilidad de su realización de forma ambulatoria. MATERIAL Y MÉTODOS: en un año hemos intervenido 17 lobectomías tiroideas y 12 paratiroidectomías de forma ambulatoria. Se excluyeron el hipertiroidismo, patología neoplásica, cirugía extensa y reoperaciones con el fin de disminuirlas posibles complicaciones. Las intervenciones se realizaron con anestesia general. RESULTADOS: no tuvimos ningún caso de hemorragia, hipocalcemia postoperatoria ni infección de herida y la mortalidad global fue 0.Nuestra principal complicación fueron las naúseas y vómitos que obligaron a ingresar a 5 pacientes (17.24 %) durante 24 horas. Tres más permanecieron ingresados por deseo propio. DISCUSION-CONCLUSIÓN: la cirugía ambulatoria de tiroides y paratiroides es factible y segura cuando se lleva a cabo una selección estricta del paciente y existe una experiencia en el equipo quirúrgico. Sin embargo, la frecuencia de náuseas y vómitos y la gravedad de las potenciales complicaciones, sobre todo del hematoma compresivo, no permiten afirmar que la Cirugía Mayor Ambulatoria endocrina de cuello sea el tratamiento de elección frente a la cirugía "de un día" (AU)

INTRODUCTION: The low morbidity and mortality of thyroid and parathyroid surgery allows us to operate in an outpatient setting. Our wide experience in short-stay surgery allowed (..) (AU)