Experiencia de la cirugía del cáncer de mama durante la pandemia de COVID-19 / Experience of breast cancer surgery during the COVID-19 pandemic

Introducción: La pandemia por COVID-19ha tenido un importante impacto en todos los ámbitos; uno de los más afectados ha sido la sanidad. La pandemia ha supuesto una reorganización de los recursos tanto humanos como materiales, dada la saturación del sistema sanitario. Como especialistas en el cáncer de mama hemos tenido que adaptarnos a esta situación, reorganizando y ajustando los cuidados a los medios profesionales e infraestructuras de los que disponíamos en cada momento. La incidencia variable a lo largo del año ha permitido desarrollar una actividad normalizada en algunas ocasiones. Nos proponemos describir nuestra experiencia en la cirugía del cáncer de mama durante este año de pandemia de COVID-19.Material y métodos: Estudio observacional retrospectivo de pacientes intervenidas de neoplasia de mama desde el 14 de marzo de 2020 hasta el 14 de marzo de 2021.Resultados: Se han intervenido 138 neoplasias de mama en 136 mujeres.La edad media fue de 62 años (36-88). Hubo 86 pacientes (63,2%) en régimen de cirugía mayor ambulatoria y 50 pacientes (36,8%) con ingreso. El tiempo medio desde el diagnóstico hasta la visita en consultas externas fue de 5,7 días y el tiempo medio desde el diagnóstico hasta el inicio del tratamiento de 45 días.Conclusiones: Durante este año de pandemia de COVID-19 hemos podido asegurar la asistencia y tratamiento de las mujeres con cáncer de mama con adecuados intervalos entre el diagnóstico y el tratamiento. A este proceso ha contribuido la implementación previa de la cirugía mayor ambulatoria en el cáncer de mama. (AU)

Introduction: The COVID-19 pandemic has had an important impact in all areas; health service has been one of the most affected. The pandemic has led to a reorganization of human and material resources and has caused a saturation of the health service. As specialists in breast cancer, we have adapted to this situation by reorganizing and adapting care to the professional environments and infrastructures that were available when necessary. The incidence has varied during 2020 and it has made possible to normalize the work on some occasions. We would like to describe our experience in breast cancer surgery during this COVID-19 pandemic year.Material and methods: Retrospective observational study of patients operated on breast cancer from 14th March 2020 to 14th March 2021.Result: A number of 138 breast cancer have been operated on 136 women. The average age is 62 years (36-8); there were 86 patients operated on major ambulatory surgery regimen (63.2%) and 50 patients (36.8%) were hospitalized. The average time from diagnosis to outpatient visit was 5.7 days and the average time from diagnosis to the beginning of the treatment of 45 days.Conclusions: During this COVID-19 pandemic year, we have been able to ensure the care and treatment of women with breast cancer with adequate time intervals between diagnosis and treatment. This process has also been favored by the prior establishment of major ambulatory surgery in our medical center.

Immediate Breast Reconstruction with Prosthesis and Titanized Mesh Using a Dual-Plane Approach: Complications and Risk Factors Analysis.

INTRODUCTION: The immediate breast reconstruction after mastectomy has gained prominence in recent years and is considered one of the main procedures in oncoplastic surgery. In the case of reconstruction with prostheses, the use of a mesh to extend the pectoralis major muscle is often required to partially cover the implant. The main objective of this study was to determine the percentage of complications in immediate breast reconstructions with a titanized mesh using a dual-plane approach and establish risk factors for prosthesis complications and extrusion. MATERIALS AND METHODS: A retrospective study that included women who received postmastectomy reconstructions from January 2012 to December 2019 in a secondary hospital in Spain. RESULTS: A total of 57 immediate reconstructions were performed in 47 women. There were complications in 16 mastectomies (28.1%), of which seven (12.3%) were Clavien-Dindo ≤ IIIa and nine (15.7%) were IIIb. A total of three patients presented prosthetic extrusion, and the prosthesis was removed in five. The degree of contracture according to the Baker scale was I-II in 50 mastectomies (87.7%) and III-IV in seven (12.3%). CONCLUSION: The immediate breast reconstruction with a titanized mesh using a dual-plane approach is a technique with an acceptable percentage of complications. The need for a Wise pattern and the necrosis of the nipple-areola complex in the postoperative period are risk factors for implant loss. Patients undergoing radiotherapy and/or chemotherapy and with a previous surgery are more likely to present capsular contracture. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.

¿Pueden los biomarcadores inflamatorios ayudar al diagnóstico y predecir el pronóstico de la colecistitis aguda gangrenosa? Un estudio prospectivo / No disponible

INTRODUCCIÓN: el diagnóstico de la colecistitis aguda gangrenosa constituye un reto diagnóstico para el médico y en pocas ocasiones se realiza de manera preoperatoria. MATERIAL Y MÉTODOS: presentamos un estudio longitudinal prospectivo de 180 pacientes a los que se les realiza colecistectomía secundaria a colecistitis aguda. Se realiza curva ROC para determinar el punto de corte preoperatorio de diferentes biomarcadores (ratio neutrófilo-linfocito [RNL], proteína C reactiva [PCR], ratio plaqueta-linfocito [RPL], lactato y procalcitonina) y asociación con hallazgos perioperatorios y postoperatorios. RESULTADOS: el área bajo la curva para RNL, PCR, RPL, lactato y procalcitonina fue de 0,75, 0,8, 0,65 y 0,6, respectivamente. CONCLUSIÓN: RNL > 5 y PCR > 100 permanecen como factores independientes de gangrena (odds ratio [OR] ajustada de 2 y 2,1, respectivamente)

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Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study.

The diagnosis of gangrenous acute cholecystitis represents a diagnostic challenge for the physician and is rarely identified preoperatively. We report a longitudinal prospective study in 180 patients who underwent cholecystectomy for acute cholecystitis. A ROC curve was obtained to determine the preoperative cut-off for various biomarkers (neutrophil to lymphocyte ratio [NLR], C-reactive protein [CRP], platelet to lymphocyte ratio [PLR], lactate and procalcitonin) and their association with both preoperative and postoperative findings. The area under the curve (AUC) for NLR, CRP, PLR, lactate and procalcitonin was 0.75, 0.8, 0.65 and 0.6, respectively. NLR > 5 and CRP > 100 are still independent factors for gangrene (adjusted odds ratio [OR], 2 and 2.1, respectively).

Repercusión en el manejo quirúrgico de la ecografía de reevaluación para caracterización de lesiones detectadas en resonancia magnética / Effect on surgical management of second-look ultrasound to characterise lesions detected by magnetic resonance imaging

INTRODUCCIÓN: La ecografía de reevaluación, o de «second-look» (ESL), es útil para caracterizar lesiones de nueva aparición identificadas durante el estudio mediante resonancia magnética (RM). También puede ayudar a optimizar el tratamiento quirúrgico, ya que permite realizar biopsias y obtener un resultado anatomopatológico de las lesiones. El objetivo de este estudio es determinar la utilidad de la ESL para la identificación y la caracterización de lesiones detectadas incidentalmente por RM, así como la repercusión posterior en el manejo quirúrgico. MATERIAL Y MÉTODO: Se realizó un estudio observacional retrospectivo en el que se incluyen mujeres diagnosticadas de cáncer de mama a las que se les realiza ESL tras RM, entre 2013 y 2015. Se recogieron datos epidemiológicos, del tumor primario, características de las lesiones identificadas por RM y posteriormente por ESL, procedimientos quirúrgicos y resultados anatomopatológicos. RESULTADOS: Se identificaron 168 lesiones nuevas mediante RM en 110 pacientes. De ellas, 123 (73,2%) fueron objetivadas posteriormente en la ESL. De acuerdo con el sistema BI-RADS, 88 (71,6%) lesiones se caracterizaron como BI-RADS3 y 24 (19,5%) como BI-RADS4. El resultado de la biopsia tras ESL fue de malignidad en 17 lesiones, lo cual conlleva un cambio de actitud quirúrgica en 15 pacientes. CONCLUSIONES: La ESL puede ser útil para optimizar el tratamiento quirúrgico de las pacientes con cáncer de mama en las que se detecta una nueva lesión mediante RM, permitiendo caracterizar, localizar dicha lesión y realizar biopsias para obtener un resultado anatomopatológico que nos ayude a decidir si es necesaria su exéresis

INTRODUCTION: Second-look ultrasound (SLU) is useful to characterise new lesions identified by magnetic resonance imaging (MRI). SLU may also help to optimise surgical treatment since it allows the performance of biopsies and histopathological analysis of the lesions. The aim of this study was to determine the utility of SLU to identify and characterise lesions initially detected by MRI, as well as its subsequent influence on surgical management. MATERIAL AND METHOD: We performed an observational retrospective study that included women diagnosed with breast cancer who underwent SLU after MRI between 2013 and 2015. We collected data on epidemiological factors, the primary tumour, the characteristics of the lesions identified by MRI and subsequently by SLU, surgical procedures, and histopathological results. RESULTS: A total of 168 new lesions were identified by MRI in 110 patients. Of these, 123 (73.2%) were subsequently identified in SLU. Using the BI-RADS system, 88 (71.6%) lesions were classified as BI-RADS3 and 24 (19.5%) as BI-RADS4. The result of biopsy after SLU was malignancy in 17 lesions, leading to a change of surgical management in 15 patients. CONCLUSIONS: SLU can be useful to optimise the surgical treatment of patients with breast cancer and detection of a new lesion by MRI. SLU allows these lesions to be characterised and localised and biopsies to be taken. This in turn allows histopathological analysis, which helps to determine the need for extirpation of the lesion

Cáncer de mama en pacientes transgénero. Revisión de la literatura / Breast cancer in transgender patients. A review

El término «transgénero» hace referencia a las personas que experimentan su identidad de género de manera diferente del género asignado en el nacimiento. La glándula mamaria representa un claro signo de feminidad e identidad corporal, por lo que su tratamiento adquiere especial relevancia tanto en varones como en mujeres transgénero. Los tratamientos de reasignación de género (hormonales o quirúrgicos) afectarán directamente al tejido glandular mamario, lo que puede afectar al riesgo de presentar un cáncer de mama y modificar así los procesos diagnósticos y terapéuticos. Se realiza en este estudio una revisión y resumen de la literatura científica más relevante sobre este campo, abordando los aspectos clínicos referentes al diagnóstico y el tratamiento de la enfermedad mamaria en pacientes transgénero

The term "transgender" refers to people who experience their gender identity differently from the gender assigned at birth. The mammary gland represents a clear sign of femininity and body identity, so its treatment acquires special relevance in transgender men and women. Gender reassignment treatments (hormonal or surgical) will directly affect the mammary glandular tissue, which may affect the risk of presenting breast cancer and thus modify the diagnostic and therapeutic processes. A review and summary of the most relevant scientific literature on this field is carried out in this study, addressing the clinical aspects related to the diagnosis and treatment of mammary pathology in transgender patients

Tumor de células granulares de la mama: presentación de un caso y revisión de la literatura médica española / Granular cell tumour of the breast: Case report and a review of the Spanish literature

El tumor de células granulares de la mama es una neoplasia infrecuente y generalmente benigna derivada de las células de Schwann. Presentamos el caso de una mujer con tumor de células granulares de la mama, así como una revisión de los casos descritos en la literatura médica española durante los últimos 20 años. Debido a que clínica y radiológicamente pueden presentarse de forma muy diversa, y simular un carcinoma de mama, el tumor de células granulares debe incluirse en el diagnóstico diferencial de los tumores de la mama por las implicaciones terapéuticas que conlleva (AU)

Granular cell tumours of the breast are an uncommon and generally benign neoplasm, which arise from Schwann cells. We present the case of a woman with a granular cell tumour of the breast and provide a review of cases published in the Spanish medical literature during the last 20 years. Clinically and radiologically these tumours often show diverse presentation and can simulate other lesions like breast carcinoma. Consequently, to provide appropriate treatment, granular cell tumours of the breast must be included in the differential diagnosis of breast neoplasms (AU)

Gastric necrosis secondary to strangulated giant paraesophic hiatal hernia.

Asymptomatic giant hiatal hernia comprises a relatively common disease, mostly presented in women with 50 years onwards. The therapeutic approach remains controversial in recent years. Under the latest SAGES`revision, all the symptomatic hernias must be repaired, but the symptomatic hiatal hernia definition isn`t even now established. We present the case os a A 67 - year old woman with an asymptomatic hiatal hernia, that is admitted to our hospital owing to toracic and abdominal pain. This pain was related with food intake for 6 months. The patient presents a clear worsening in the last 24 hours, with no other asociated symptomatology. Suspecting an incarcerated hiatal hernia with stomach perforation, the patient is taken to theatre for a laparotomy during the early hours. An atypic gastrectomy of the greater curvature with a gastropexy is performed with fixation to the anterior abdominal wall. The surgery is completed with a feeding jejunostomy. The Manegement of giant paraesophagic hernias, still remains as one of the challenge of the esophageal surgeons.

Necrosis gástrica secundaria a hernia hiatal gigante paraesofágica estrangulada / Gastric necrosis secondary to strangulated giant paraesophic hiatal hernia

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Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis.

BACKGROUND: The choice of surgical technique to extract stones from the common bile duct (CBD) depends on local experience, anatomical characteristics and also on the size, location and number of stones. Most authors consider choledochotomy an alternative to failed transcystic exploration, although some use it exclusively. Although the CBD is traditionally closed with T-tube drainage after choledochotomy, its use is associated with 11.3-27.5 % morbidity. This study examined the efficacy of laparoscopic CBD exploration (LCBDE) with primary closure for the treatment of CBD stones using intraoperative cholangiography (IOC). METHODS: Retrospective study of 160 patients who underwent LCBDE with primary closure after choledochotomy between January 2001 and December 2012. RESULTS: The diagnosis of choledocholithiasis was definitively made in all cases by IOC. The overall complication rate was 15 % and the biliary complication rate was 7.5 %. Bile leakage was reported in 11 patients (6.8 %). In over half the cases (63.6 %), no further action was required and the leak closed spontaneously. Six patients were reoperated (3.75 %), two for bile peritonitis and four for haemoperitoneum. The success rate for stone clearance was 96.2 %. The mortality rate and CBD stricture rate were 0 %. CONCLUSION: Primary closure after choledochotomy to clear stones from the CBD is a safe technique that confers excellent results and allows one-stage treatment.