Determining the optimal interval between neoadjuvant radiochemotherapy and surgery in rectal cancer: a retrospective cohort study.

INTRODUCTION: In locally advanced rectal cancer, the optimal interval between completion of neoadjuvant radiochemotherapy (RT-ChT) and surgical resection remains unclear due to contradictory data on the benefits of extending this interval. Therefore, the aim of this retrospective study was to determine the impact of this interval on outcomes in patients treated for rectal cancer at our center. METHODS: We retrospectively reviewed 382 consecutive patients treated for stage II/III rectal cancer between October 1, 2012, and December 31, 2017. We evaluated four different cut-off points (56, 63, 70, and 77 days) to determine which had the greatest impact on treatment outcomes. RESULTS: The median time between completion of RT-ChT and surgery was 67.2 days (range, 28-294). Intervals > 8 weeks (56 days) were associated with worse therapeutic outcomes. Specifically, an interval ≥ 77 days was associated with a significant decrease in overall survival (OS; 84% vs. 70%; p = 0.004), which is why we selected this interval for the comparative analysis. Several outcome variables were significantly better in the short interval (< 77 days) group, including margin involvement (5.2% vs. 13.9%; p = 0.01), sphincter preservation (78% vs. 59.3%; p = 0.003), and distant dissemination (22.6% vs. 32.5%; p = 0.04). No significant between-group differences were found in complete/nearly complete response rates (19.2% vs. 24.4%; p = 0.3). Time to surgery was statistically significant on both the univariate and multivariate analyses. CONCLUSIONS: Our findings suggest that surgery should not be delayed more than 8 weeks (56 days) after neoadjuvant treatment. An interval > 8 weeks should only be considered in patients who demonstrate a good response to neoadjuvant RT-ChT.

Short-Course Radiotherapy in Locally Advanced Rectal Cancer.

INTRODUCTION: To date, we do not know the best therapeutic scheme in locally advanced rectal cancer when patients are older or have comorbidities. METHODS: In 2009, we established a prospective treatment protocol that included short-course preoperative radiotherapy (RT) with standard surgery +/- chemotherapy in frail patients, mostly older than 80 years or with comorbidities. RESULTS: We included 87 patients; the mean follow-up was 43.5 months (0.66-106.3). Disease-specific survival and disease-free survival at 36 months were 86.3% and 82.8%; at 60 months, they were 78.2% and 78%, respectively, with a local recurrence rate of 2.5%. The rate of late radiotoxicity was 9% in the form of sacral insufficiency fracture and small bowel obstruction with one death. The interval before surgery varied according to the involvement of the mesorectal fascia, but it was less than 2 weeks in 45% of cases. The rate of R0 was 95%. Surgical complications included abdominal wound dehiscence (3.5%), anastomotic leak (2.4%), and reoperations (11.5%). Downstaging was observed in 51% of the cases, regardless of the interval before surgery. DISCUSSION: Therapeutic outcomes in our group of elderly patients and/or patients with comorbidities with neoadjuvant short-course RT are such as those of the general population treated with neoadjuvant RT-chemotherapy, all with acceptable toxicity. Therefore, this treatment scheme, with short-course preoperative RT, would be the most appropriate in this group of patients.

[Bile duct cysts in adults: surgical procedure]. / Quistes de los conductos biliares del adulto: estrategia quirúrgica.

OBJECTIVE: The reported prevalence rate of bile duct cysts is very low. However, the clinical presentation of bile duct cysts is common to other hepatobiliary diseases. In this article, we report on a series of patients who have been surgically treated over the last 15 years. MATERIAL AND METHOD: All the patients who had undergone bile duct cyst-related surgery at this hospital had their clinical history reviewed retrospectively from 1990 to 2002. Data were obtained prospectively from 2002 to 2005. The following variables were taken into account in our analysis: diagnosis data, surgical procedure, morbidity, post-surgery mortality rates, and follow-up. RESULTS: Over the last 15 years, 18 patients have undergone surgery at our hospital (6 male, 12 female). The most common clinical presentation was that of abdominal pain and the usual symptoms associated with acute cholangitis. As for surgical procedure, a complete cyst resection with biliary derivation was performed in all 15 cases. The histopathological diagnosis was choledochal cyst in 12 cases, Caroli's disease in 5 cases and a malignant choledochal cyst (adenocarcinoma) in 1 case. The most frequent post-surgical complication was bile leak (3 cases, 16.6%). There was no post-surgical mortality (0%). There were no relapses in the subsequent follow-up CONCLUSIONS: Our preferred surgical procedure is that of complete cyst resection with biliary derivation. Our overall results are similar to those of medical teams who practise a radical resective procedure, and better than those who practise partial resections.

Quistes de los conductos biliares del adulto: estrategia quirúrgica / Bile duct cysts in adults: surgical procedure

Introducción. Los quistes de los conductos biliares son una enfermedad muy poco prevalente. Sin embargo, su presentación clínica es común a la de otros procesos biliopancreáticos. Presentamos nuestra serie de pacientes intervenidos en los últimos 15 años. Material y método. Se han revisado retrospectivamente las historias clínicas de los pacientes intervenidos por esta enfermedad, en nuestro hospital, entre 1990 y 2002. A partir de 2002, se toman los datos de forma prospectiva hasta 2005. Se han analizado variables de métodos de diagnóstico, técnica quirúrgica, morbilidad y mortalidad postoperatoria y seguimiento posterior. Resultados. En los últimos 15 años se ha intervenido a 18 pacientes (6 varones, 12 mujeres). La presentación clínica más común ha sido el dolor abdominal, seguido del cuadro clínico de colangitis aguda. La técnica quirúrgica ha sido resección total del quiste + derivación biliodigestiva en el 100% de los casos. El diagnóstico anatomopatológico ha sido de quiste coledocal en 12 casos, enfermedad de Caroli en 5 casos, quiste coledocal malignizado (adenocarcinoma) en 1 caso. La complicación postoperatoria más frecuente ha sido la fístula biliar (3 casos, 16,6%). La mortalidad postoperatoria ha sido del 0%. En el seguimiento tardío, no se ha evidenciado recidiva del quiste en ningún caso (0%). Conclusiones. El tratamiento quirúrgico de elección es la resección total del quiste con derivación biliodigestiva. Nuestros resultados son equiparables a los de los equipos que practican una técnica de resección radical y, a su vez, son mejores que los de las series que practican resecciones parciales (AU)

Objective. The reported prevalence rate of bile duct cysts is very low. However, the clinical presentation of bile duct cysts is common to other hepatobiliary diseases. In this article, we report on a series of patients who have been surgically treated over the last 15 years. Material and method. All the patients who had undergone bile duct cyst-related surgery at this hospital had their clinical history reviewed retrospectively from 1990 to 2002. Data were obtained prospectively from 2002 to 2005. The following variables were taken into account in our analysis: diagnosis data, surgical procedure, morbidity, post-surgery mortality rates, and follow-up. Results. Over the last 15 years, 18 patients have undergone surgery at our hospital (6 male, 12 female). The most common clinical presentation was that of abdominal pain and the usual symptoms associated with acute cholangitis. As for surgical procedure, a complete cyst resection with biliary derivation was performed in all 15 cases. The histopathological diagnosis was choledochal cyst in 12 cases, Caroli´s disease in 5 cases and a malignant choledochal cyst (adenocarcinoma) in 1 case. The most frequent post-surgical complication was bile leak (3 cases, 16.6%). There was no post-surgical mortality (0%). There were no relapses in the subsequent follow-up Conclusions. Our preferred surgical procedure is that of complete cyst resection with biliary derivation. Our overall results are similar to those of medical teams who practise a radical resective procedure, and better than those who practise partial resections (AU)