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1.
Rev Fac Cien Med Univ Nac Cordoba ; 78(4): 335-339, 2021 12 28.
Artículo en Inglés | MEDLINE | ID: mdl-34962745

RESUMEN

INTRODUCTION: Microvascular free-flap reconstruction is one of the treatment options after large resection of head and neck neoplasms. The objectives of this study are to identify short-term outcomes and risk factors for flap complication in patients who underwent neoplasms resection of head and neck with microvascular free-flap reconstruction. METHODS: Retrospective study of patients who underwent surgery for head and neck neoplasm with microvascular free-flap reconstruction between January 2014-2020. Complications were studied at 30-days follow-up and divided into medical and flap complications. Factors independently associated with flap complication were analyzed. RESULTS: We included 31 patients (15 men). The mean age was 60 years. Reconstruction was performed with radial-forearm flap in 74% (n=23) and with free-fibula flap in 26% (n=8). Mean surgical time was 420 minutes. Median hospital length of stay was 7 days. Medical complications were of 23%. Minor complications were of 35% and major of 32%. There was no mortality in 30-days follow-up. Flap complications were of 35%. Reintervention was of 29%, surgical site infection of 9%, dehiscence of 29% and flap loss of 9.7%.  Surgical site infection was independently associated with prolonged surgical time (Odds ratio [OR]=1.03, IC95%=0.98-1.04, p=0.02) and body mass index equal to or greater than 30 (OR=1.38, IC95%=0.84-2.26, p=0.04) while flap loss was associated with prolonged surgical time (OR=1.02, IC95%=0.99-1.04, p=0.01). CONCLUSION: Microsurgical free-flap reconstruction should be considered in our population in patients with large head and neck neoplasms. Preoperative assessment of the risk of postoperative complications is essential before selecting patients for this surgery.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Colgajos Tisulares Libres/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos
2.
Cir Cir ; 88(3): 314-320, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32539009

RESUMEN

BACKGROUND: Laparoscopic colectomy (LC) presents similar short-term results and oncological outcomes to conventional colectomy (CC) in colon cancer. OBJECTIVES: Compare short-term and oncological outcomes at 3-year follow up between LC and CC. MATERIALS AND METHODS: Patients who underwent LC and CC for colon cancer between January 2010 and December 2017 were retrospectively analyzed. Short-term results and oncological outcomes were studied. RESULTS: Two hundred sixty-nine patients were included in the study. CC was performed in 37.5% and LC in 62.5%. LC presented shorter operative time (157 vs. 175 min, p = 0.01), shorter length of stay (8.4 vs. 10.5 days, p = 0.02), lees readmission (6% vs. 15%, p = 0.02), and lower morbidity (40% vs. 56%, p = 0.01). No differences were found for overall survival (OAS) (LC = 87.1% vs. CC = 82.8%, p = 0.28) and disease-free survival (DFS) (LC = 78.2% vs. CC = 75.3%, p = 0.47). Recurrence was observed in 37 patients (LC = 16.1% vs. CC = 18.3%, p = 0.53). No differences were found for local recurrence (LC = 6.5% vs. CC = 8.6%, p = 0.49) and distant recurrence (LC = 12.1% vs. CC = 16.1%, p = 0.3). Stage analysis showed no difference for recurrence, OAS, and DFS. CONCLUSIONS: LC is a safe procedure with short-term outcomes, OAS, DFS, and recurrence similar to CC. LC should be the initial indication in non-metastatic colon cancer in our population.


ANTECEDENTES: La colectomía laparoscópica (CL) presenta resultados a corto plazo y oncológicos similares a los de la colectomía convencional (CC) en cáncer de colon. OBJETIVO: Comparar los resultados a corto plazo y oncológicos a 3 años de seguimiento entre la CL y la CC. MATERIAL Y MÉTODOS: Pacientes intervenidos de CL y CC por cáncer de colon entre enero de 2010 y diciembre de 2017. Se estudiaron los resultados a corto plazo y oncológicos. RESULTADOS: Se incluyeron 269 pacientes (62.5% CL y 37.5% CC). La CL presentó menor tiempo quirúrgico (157 vs. 175 min; p = 0.01), menor estadía hospitalaria (8.4 vs. 10.5 días; p = 0.02), menor reinternación (6% vs. 15%; p = 0.02) y menor morbilidad (40 vs. 56%; p = 0.01). No se observan diferencias para sobrevida global (87.1% CL y 82.8% CC; p = 0.28) y sobrevida libre de enfermedad (78.2% CL y 75.3% CC; p = 0.47). Hubo recidiva en 37 pacientes (16.1% CL y 18.3% CC; p = 0.53). No se encontraron diferencias en recidiva local (6.5% CL y 8.6% CC; p = 0.49), a distancia (12.1% CL y 16.1% CC; p = 0.3), al dividir la recidiva, la sobrevida global y la sobrevida libre de enfermedad por estadios. CONCLUSIONES: La CL es un procedimiento seguro, con una sobrevida global, una sobrevida libre de enfermedad y una tasa de recidiva similares a las de la CC. La CL debería ser la indicación inicial en el cáncer de colon no metastásico en nuestra población.


Asunto(s)
Adenocarcinoma/cirugía , Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/estadística & datos numéricos , Neoplasias del Colon/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Escisión del Ganglio Linfático/estadística & datos numéricos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tempo Operativo , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
3.
Rev Fac Cien Med Univ Nac Cordoba ; 75(4): 229-233, 2018 11 14.
Artículo en Inglés | MEDLINE | ID: mdl-30734700

RESUMEN

BACKGROUND: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients with an incidence that varies between 5-30%. OBJECTIVE: Identify the risk factors for SSI in colonic surgery in our population. The secondary aims are to determine the incidence and type of SSI, as well as the incidence of an anastomotic leakage (AL). METHODS: Case-control study of patients undergoing colectomy between 2010-2014 at the Hospital Privado Univeristario de Córdoba and Hospital Raúl Ferreyra. Conventional and laparoscopic interventions, with a 30-day postoperative follow up, between 20-85 years and an ASA I-III were included. Patients undergoing emergency surgery and recto-anal resections were excluded. SSI was defined as an infection that occurred within 30 days after surgery. RESULTS: We included 238 patients. SSI was diagnosed in 27.7% (n=66) of the patients of which 12.2% were superficial, 4.6% deep incisional and 10.9% organ/space. Multivariate analysis showed that SSI was independently associated with male sex (odds ratio [OR] 3.15; IC95%:1.43-6.92; p=0.004), having undergone previous chemotherapy (OR 6.72; IC95%:1.48-30.93; p=0.01), need for conversion (OR 3.32; IC95%:1.13-9.77; p=0.02), reintervention within the 30 postoperative days (OR 12.34; IC95%:2.65-57.37, p=0.001) and AL (OR 12.83; IC95%:2.97- 55.5; p=0.001). AL had an incidence of 9.6%, of which 91% presented SSI and all were organ/space. CONCLUSION: We found that male sex, having undergone previous chemotherapy, conversion, reintervention within 30 postoperative days and AL are risk factors for SSI in our population. These results should be considered in implementing preventive measures for SSI.


Asunto(s)
Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Colectomía/efectos adversos , Colon/cirugía , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Neoplasias del Colon/cirugía , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/complicaciones , Femenino , Humanos , Incidencia , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tempo Operativo , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto Joven
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