Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis.

BACKGROUND: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a procedure that has had encouraging results for peritoneal metastases (PM) from diverse tumour origins, but it is not exempt from high morbidity. Recently, the important role of laparoscopy in oncologic surgeries and its benefits have been evaluated for CRS + HIPEC in selected patients, which has yielded promising results. The aim of our study is to analyse the use of laparoscopy for CRS + HIPEC in patients with limited peritoneal disease. METHODS: We have conducted a retrospective study from a prospective database in our tertiary referral hospital within the period of January 2009 to July 2019, which includes 825 patients who had PM from varying tumour origins. We have compared the patients treated with the laparoscopic approach (L-CRS-HIPEC) to a matched population who have undergone the open approach (O-CRS-HIPEC) and fulfil the same selection criteria. We have analysed the postoperative outcomes and survival results. RESULTS: We have confirmed the homogeneity between the sample of the O-CRS + HIPEC (n = 42) and the L-CRS + HIPEC (n = 18) regarding preoperative and intraoperative features. The L-CRS + HIPEC group had shorter hospital stays, (median of 4 [2-10] days versus 9 [2-19] days) and reduced wait time to return to chemotherapy (median of 4 [3-7] weeks and a median of 8 [4-36] weeks) than the O-CRS + HIPEC group. No differences were found regarding the need for perioperative blood transfusion, surgery time or postoperative morbi-mortality. No early locoregional relapse occurred in the L-CRS + HIPEC group and short term disease-free survival did not differ between groups. CONCLUSIONS: Laparoscopy for CRS + HIPEC is feasible and safe in highly selected patients, with no significant differences concerning postoperative morbi-mortality or early oncological results. We have found that patients who have undergone laparoscopic operations have shorter hospital stays and that they return to adjuvant chemotherapy sooner. Further investigation is required to confirm the benefits of minimally invasive procedures for the management of PM.

[Childhood cutaneous polyarteritis nodosa]. / Panarteritis nudosa cutánea infantil.

Cutaneous polyarteritis nodosa is a form of polyarteritis nodosa. It is a rare disease in children and is characterized by its benign and chronic course. There is no evidence of hypertension or organ dysfunction. The aim of this study was to present a case of cutaneous polyarteritis nodosa and to review the literature. We describe the case of a 3-year-old male child with multiple, red, painful, edematous nodules of the extremities and trunk. Dermatologic findings were accompanied by fever and arthritis. Laboratory findings showed an acute phase response associated with raised antistreptolysin titer. Diagnosis was based on biopsy of the affected skin lesion in which necrotizing arteritis of the lower dermis with neutrophilic and eosinophilic infiltrates was found. The patient responded well to corticosteroid therapy. The evaluation of children with cutaneous polyarteritis nodosa should include laboratory studies to detect streptococcal infection.

Panarteritis nudosa cutánea infantil / Childhood cutaneous polyarteritis nodosa

La panarteritis nudosa (PAN) cutánea es una forma de poliarteritis nudosa, rara en niños, caracterizada por su curso benigno y crónico. No hay evidencia de hipertensión ni disfunción orgánica. El objetivo de este artículo es presentar un caso más de PAN cutánea y realizar una revisión bibliográfica. Se describe el caso de un niño de 3 años de edad, con múltiples nódulos enrojecidos, dolorosos y edematosos en las extremidades y tronco. Los hallazgos cutáneos estuvieron acompañados de fiebre y artritis. Los hallazgos de laboratorio mostraron unos reactantes de fase aguda y título de antiestreptolisina elevados. El diagnóstico se realizó con biopsia de la lesión cutánea, en las que se encontró arteritis necrosante en la dermis profunda con infiltrado de neutrófilos y eosinófilos. El paciente respondió de forma adecuada al tratamiento con esteroides. En la evaluación de los niños con PAN cutánea deben incluirse estudios para detectar infección estreptocócica (AU)