Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer. Long-term outcome analysis.

BACKGROUND AND PURPOSE: It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes. PATIENTS AND METHODS: From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500-5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3-12 weeks) after chemoradiation. RESULTS: Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4-205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15). CONCLUSION: Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients.

Intraoperative radiotherapy with electrons: fundamentals, results, and innovation.

RATIONALE AND OBJECTIVES: To analyse the programme activity and clinical innovation and/or technology developed over a period of 17 years with regard to the introduction and the use of intraoperative radiotherapy (IORT) as a therapeutic component in a medical-surgical multidisciplinary cancer hospital. MATERIAL AND METHODS: To standardise and record this procedure, the Radiation Oncology service has an institutional programme and protocols that must be completed by the different specialists involved. For 17 years, IORT procedures were recorded on a specific database that includes 23 variables with information recorded on institutional protocols. As part of the development and innovation activity, two technological tools were implemented (RADIANCE and MEDTING) in line with the standardisation of this modality in clinical practice. RESULTS: During the 17 years studied, 1,004 patients were treated through 1,036 IORT procedures. The state of the disease at the time of IORT was 77% primary and 23% recurrent. The origin and distribution of cancers were 62% gastrointestinal, 18% sarcomas, 5% pancreatic, 2% paediatric, 3% breast, 7% less common locations, and 2% others. The research and development projects have generated a patent on virtual planning (RADIANCE) and proof of concept to explore as a professional social network (MEDTING). During 2012, there were 69 IORT procedures. There was defined treatment volume (target or target region) in all of them, and 43 were conducted by the virtual planning RADIANCE system. Eighteen have been registered on the platform MEDTING as clinical cases. CONCLUSION: The IORT programme, developed in a university hospital with an academic tradition, and interdisciplinary surgical oncology, is a feasible care initiative, able to generate the necessary intense clinical activity for tending to the cancer patient. Moreover, it is a competitive source for research, development, and scientific innovation.

Spigelian hernia. Personal experience and review of the literature.

OBJECTIVE: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. PATIENTS: We carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. RESULTS: We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. CONCLUSIONS: Diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.

Hernias de Spiegel. Nuestra experiencia y revisión de la literatura / Spigelian hernia. Personal experience and review of the literature

Objetivo: la hernia de Spiegel es una variedad poco frecuente de defecto de la pared abdominal. Presentamos nuestra serie de pacientes intervenidos con éste diagnóstico, así como una revisión de la literatura. Pacientes: se realiza un estudio retrospectivo de los pacientes intervenidos por hernia de Spiegel en nuestro centro entre los años 2001 y 2008. Se analizan factores epidemiológicos, forma de diagnóstico, características de la técnica quirúrgica, morbilidad, estancia hospitalaria, recidivas y seguimiento. Resultados: han sido intervenidos 39 pacientes, 25 mujeres y 14 hombres, con una edad media de 70 años. La localización más frecuente es la izquierda. El 74% de los pacientes presenta 1 o más factores de riesgo. El diagnóstico fue clínico en el 72% de los casos. La técnica más empleada es la hernioplastia seguida de la hernioplastia laparoscópica y en el 20% de los casos la intervención tuvo que realizarse de forma urgente. La morbilidad postoperatoria es escasa. Conclusiones: el diagnóstico de la hernia de Spiegel es fundamentalmente clínico. En caso de duda diagnóstica el TAC es la prueba de elección. En un porcentaje importante de pacientes la primera manifestación es la incarceración. La técnica quirúrgica dependerá de las características del paciente, la hernia y la experiencia del cirujano(AU)

Objective: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. Patients: we carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. Results: we have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. Conclusions: diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience(AU)

[Gastric surgery as a nutritional risk factor]. / Cirugía gástrica como factor de riesgo nutricional.

BACKGROUND: The stomach has a role in the digestion and absorption of nutrients, so patients are in nutritional risk after gastric resection. The aim of this work was to study the nutritional status of postgastrectomy outpatients followed in our hospital. METHODS: We retrospectively studied 54 patients (27 M, 27 F) followed more than 12 months postgastrectomy. Mean age was 61 +/- 14 yr and median follow-up was 35 months. The nutritional assessment included anthropometry, biochemical data and measurement of bone mineral density by dual-energy X-ray absorptiometry. The statistical analysis was performed by non-parametric tests. RESULTS: Malignancy was the most frequent indication (85%), 63% of patients had total gastrectomy. Patients were supplemented with iron (43%), B12 (87%), calcium (18%) and vitamin D (17%). 13% of patients had a BMI < 18.5. The incidence of 25 OH vitamin D deficiency and secondary hyperparathyroidism was 45% and 76%, respectively. The incidence of osteoporosis at lumbar spine was 46%. Matched with same age-sex people patients had 85.6% of bone mineral density. CONCLUSIONS: The loss of weight and the metabolic bone disease were the most prevalent impairments after gastric resection. These impairments point to the importance of a nutritional surveillance of patients after gastric resection.

Cirugía gástrica como factor de riesgo nutricional / Gastric surgery as a nutritional risk factor

Objetivo: El estómago tiene un papel importante en la digestión y absorción de nutrientes, por lo que los pacientes con resección gástrica están en riesgo nutricional. El objetivo del estudio fue evaluar el estado nutricional de pacientes gastrectomizados seguidos en una consulta externa de Nutrición de un Hospital General Universitario. Material y métodos: Estudiamos de manera retrospectiva 54 pacientes (27 V, 27 M) con un tiempo mínimo de evolución desde la gastrectomía de 12 meses. La edad media fue 61 ± 14 años y la media de seguimiento 35 meses. La valoración nutricional incluyó antropometría, datos bioquímicos y valoración de la densidad mineral ósea mediante DEXA. El estudio estadístico se realizó con pruebas no paramétricas. Resultados: La indicación principal de la cirugía fue oncológica (85%). El 63% de los pacientes presentaban gastrectomía total. Los pacientes recibieron suplementos de hierro (43%), vitamina B12 (87%), calcio (18%) y vitamina D (17%). El 13% de los pacientes tenían bajo peso (IMC < 18,5). La incidencia de deficiencia de 25 OH vitamina D y de hiperparatiroidismo secundario fue de 45% y 76%, respectivamente. La incidencia de osteoporosis en columna fue del 46%. Comparadas con personas de su misma edad y sexo, los pacientes mantenían el 85,6% de la densidad mineral ósea. Conclusiones: La pérdida de peso y la enfermedad metabólica ósea fueron las complicaciones más prevalentes en nuestros pacientes gastrectomizados. Por ello, creemos que es importante realizar un seguimiento nutricional en los pacientes gastrectomizados

Background: The stomach has a role in the digestion and absorption of nutrients, so patients are in nutritional risk after gastric resection. The aim of this work was to study the nutritional status of postgastrectomy outpatients followed in our hospital. Methods: We retrospectively studied 54 patients (27 M, 27 F) followed more than 12 months postgastrectomy. Mean age was 61 ± 14 yr and median follow-up was 35 months. The nutritional assessment included anthropometry, biochemical data and measurement of bone mineral density by dual-energy X-ray absorptiometry. The statistical analysis was performed by non-parametric tests. Results: Malignancy was the most frequent indication (85%), 63% of patients had total gastrectomy. Patients were supplemented with iron (43%), B12 (87%), calcium (18%) and vitamin D (17%). 13% of patients had a BMI < 18.5. The incidence of 25 OH vitamin D deficiency and secondary hyperparathyroidism was 45% and 76%, respectively. The incidence of osteoporosis at lumbar spine was 46%. Matched with same age-sex people patients had 85.6% of bone mineral density. Conclusions: The loss of weight and the metabolic bone disease were the most prevalent impairments after gastric resection. These impairments point to the importance of a nutritional surveillance of patients after gastric resection

Invaginaciones intestinales en el adulto de causa tumoral / Adult intestinal invaginations of tumoral origin

Propósito: Destacar la importancia de la patología neoplásica como una de las causas más fundamentales de las invaginaciones intestinales en el adulto.• Material y Métodos: Estudio descriptivo restrospectivo de invaginaciones intestinales en nuestro Centro de 1996 a 2000.• Resultados: Se presentaron once casos de invaginaciones (7 mujeres: 4 hombres) con una edad media de 54 años. La clínica más frecuente resultó la obstrucción intestinal, y el diagnóstico preoperatorio fue llevado a cabo en 6 casos, lo más habitual por medio de enema opaco. El tratamiento fue la laparotomía, demostrándose 6 lipomas, 2 adenocarcinomas, un leiomiosarcoma, una metástasis de melanoma cutáneo y un hematoma mural. En 10 casos se realizó resección intestinal según criterios oncológicos.• Conclusiones: En las invaginaciones intestinales en el adulto, son de gran importancia una adecuada sospecha clínica y diagnóstica, porque la correcta terapéutica quirúrgica llevará a su resolución, en cuyo origen subyace muchas veces una patología neoplásica. (AU)

Fístulas y colitis ulcerosa: a propósito de un caso / Fistulas and ulcerative colitis: a case report

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[Acute abdomen as a complication of a duodenal duplication cyst]. / Abdomen agudo como complicación de un quiste de duplicación duodenal.

The authors report an exceptional case of acute abdomen caused by the necrosis and perforation of a duodenal duplication cyst in a 23 year-old-patient. The cyst was located at the anterior and lateral surface of the duodenum, between its first and second portion. The patient underwent a cephalic duodenopancreatectomy (Whipple's procedure) because of the intimate adherence of the necrotic and inflammatory mass to duodenum and head of the pancreas. The histological examination of surgical specimen confirmed the diagnosis, showing a cystic structure lined with an epithelium and a common muscle wall shared by the cyst and the duodenum. There was no communication between the cyst and duodenal lumen.

[Mucin-hypersecretory pancreatic tumors: a pathology with defined characteristics]. / Tumores pancreáticos hipersecretores de mucina: una patología con características definidas.

We report a case of a mucin-producing tumor of the pancreas, a rare neoplasm of which only a few cases have been described in Europe. The finding of progressive hyperamylasemia without abdominal pain suggests the presence of this type of tumor. At endoscopic retrograde cholangio-pancreatography (ERCP), mucinous excretion and ductal dilation were found. Its prognosis is better than adenocarcinoma.

[Ulcerative jejunitis: a complication of celiac disease]. / Yeyunitis ulcerativa: una complicación de la enfermedad celiaca.

We report the case of a 57-year-old woman with celiac disease of long standing, who developed episodes of intestinal obstruction during two months. They were misdiagnosed as intestinal obstructions caused by adhesions. The barium meal and follow-through examination disclosed several jejunal stenoses. Therefore, the patient underwent early surgery where an intestinal resection was carried out. The histological examination showed the presence of benign ulcers at the stenoses. After surgery, the patient began to gain weight and her nutritional state improved remarkably.