¿Constituye la cirugía mayor ambulatoria una opción de tratamiento adecuado en la enfermedad de Crohn perianal? / No disponible

Introducción: El tratamiento quirúrgico de las fístulas perianales en pacientes con enfermedad de Crohn (EC) ha sufrido algunos cambios con la llegada de las terapias biológicas. Material y método: Se han evaluado 25 pacientes con EC perianal entre diciembre de 2005 y septiembre de 2007. Todos los pacientes se trataron en régimen ambulatorio siguiendo un protocolo diagnóstico-terapéutico consensuado con la Unidad de Inflamatoria de nuestro hospital. El tratamiento consistió en el drenaje de abscesos con colocación de sedales y/o histerotomía junto con el tratamiento con anti-TNF. El objetivo de este trabajo ha sido valorar los resultados de los primeros pacientes tratados en régimen de cirugía mayor ambulatoria (CMA).Resultados: El número medio de fístulas fue de 2,31 ± 1,22(1-5), siendo en el 84% fístulas complejas y la más frecuente la transesfinteriana alta. La colocación de sedales fue el procedimiento más aplicado en un 60%, con una permanencia media de21,1 ± 7,9 semanas. Se administraron biológicos en un 84% (21pacientes). Ningún paciente preciso ingreso hospitalario derivado de complicaciones quirúrgicas o anestésicas. Conclusiones: La CMA puede ser un abordaje seguro en el manejo de la enfermedad perianal en la EC (AU)

Background: The surgical management of perianal fistulas in patients with Crohn’s disease (CD) has experienced some changes since the appearance of biological therapies. Material and method: Twenty-five patients with perianal CD were analyzed from December 2005 to September 2007. All these patients were treated as ambulatory surgery following a diagnostic-therapeutic protocol developed by the Inflammatory Bowel Disease Unit of our hospital. The treatment was based on the drainage of the abscesses with Seton placement and/or fistulotomy associating anti-TNF. The aim of this study is to evaluate the results of the first patients who underwent this treatment in ambulatory surgery. Results: The mean number of fistulas was 2.31 ± 1.22 (1-5),84% of which were complex. The most frequent type was a hightrans-sphincteric fistula. Insertion of set on was the most common procedure (60%) with a mean time placement of 21.1 ± 7.9weeks. Biological therapies were used in 84% (21 patients). No patients required further hospitalization due to surgical or anesthetic complications. Conclusions: Ambulatory surgery can become a safe approach for the management of perianal disease in CD (AU)

Tumores del estroma gastrointestinal (GIST): factores pronósticos de supervivencia tras citorreducción R0 / No disponible

Objetivo: analizar los posibles factores pronósticos de supervivenciaen tumores estromales gastrointestinales c-kit positivo(GIST), tras citorreducción óptima R0.Pacientes y método: estudio de 35 pacientes intervenidosen nuestra Unidad desde enero 2002 a febrero 2007, con tumoresdel estroma gastrointestinal CD117/c-kit positivo en los quese alcanzó citorreducción quirúrgica sin residuo tumoral macroscópico.Una base de datos prospectiva nos proporcionó las distintasvariables analizadas, de carácter demográfico, anatómico, clínico,histopatológico e inmunohistoquímico, entre otras. Elanálisis de la supervivencia actuarial se realizó según el método deKaplan-Meier y el análisis multivariante mediante el método de regresiónmúltiple de Cox.Resultados: la supervivencia global a 5 años fue del 77%,con una supervivencia media de 52 meses. El riesgo de malignidadsegún la clasificación de Fletcher y el tamaño tumoral mayorde 10 cm, influyeron significativamente de forma negativa sobrela supervivencia de los pacientes, tras el análisis univariante realizado(p < 0,05). La actividad proliferativa Ki-67 mayor del 50%fue la única covariable con significación estadística en el análisismultivariante. El 20% de los tumores recurrieron. Sólo 3 pacientesmetastáticos recibieron tratamiento adyuvante con mesilato deimatinib, todos ellos con Ki-67 > 50% y vivos en la actualidad.Conclusiones: el índice proliferativo Ki-67 podría representarun excelente marcador pronóstico de supervivencia en aquellospacientes con tumores del estroma gastrointestinal c-kit positivo.Su confirmación y el punto de corte adecuado deberían serobjeto de futuros estudios prospectivos, así como su posible utilidadpara seleccionar pacientes candidatos al tratamiento con mesilatode imatinib

Objective: to analyze the different factors predictive of survivalassociated with optimal R0-cytoreduction in c-kit-positivegastrointestinal stromal tumors.Methods: thirty-five patients were operated on in our OncologicalSurgery Department from January 2002 to February2007 because of CD117/c-kit-positive gastrointestinal stromal tumors,and an optimal surgical cytoreduction was obtained withoutmacroscopical residual disease. Demographic, anatomical, clinical,pathological, and immunohistochemical variables were analyzedfrom a specific database. Survival and multivariate analyseswere developed using Kaplan-Meier and multiple Cox regressionmodels, respectively.Results: five-year overall survival was 77% with a mean survivalof 52 months. Risk of malignant behaviour according toFletcher’s classification and tumor size higher than 10 cm had asignificantly negative influence on overall survival in the univariateanalysis (p < 0.05). Proliferative Ki-67 activity higher than 50%was the only statistically significant variable in the multivariateanalysis. Twenty percent of tumors recurred. Only 3 patients withmetastatic disease received adjuvant treatment with imatinib mesylate,all of them with Ki-67 > 50% and currently alive.Conclusions: the poliferative Ki-67 index could represent anexcellent predictive factor for survival in patients with c-kit-positivestromal gastrointestinal tumors. Confirmation and an adequatecut-off level should be the main objectives for futureprospective studies, mostly focused on the appropriate selectionof optimal candidates to imatinib-mesylate-based treatment

[Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction]. / Tumores del estroma gastrointestinal (GIST): factores pronósticos de supervivencia tras citorreducción R0.

OBJECTIVE: To analyze the different factors predictive of survival associated with optimal R0-cytoreduction in c-kit-positive gastrointestinal stromal tumors. METHODS: Thirty-five patients were operated on in our Oncological Surgery Department from January 2002 to February 2007 because of CD117/c-kit-positive gastrointestinal stromal tumors, and an optimal surgical cytoreduction was obtained without macroscopical residual disease. Demographic, anatomical, clinical, pathological, and immunohistochemical variables were analyzed from a specific database. Survival and multivariate analyses were developed using Kaplan-Meier and multiple Cox regression models, respectively. RESULTS: Five-year overall survival was 77% with a mean survival of 52 months. Risk of malignant behaviour according to Fletcher s classification and tumor size higher than 10 cm had a significantly negative influence on overall survival in the univariate analysis (p < 0.05). Proliferative Ki-67 activity higher than 50% was the only statistically significant variable in the multivariate analysis. Twenty percent of tumors recurred. Only 3 patients with metastatic disease received adjuvant treatment with imatinib mesylate, all of them with Ki-67 > 50% and currently alive. CONCLUSIONS: The poliferative Ki-67 index could represent an excellent predictive factor for survival in patients with c-kit-positive stromal gastrointestinal tumors. Confirmation and an adequate cut-off level should be the main objectives for future prospective studies, mostly focused on the appropriate selection of optimal candidates to imatinib-mesylate-based treatment.