Simultaneous Surgical Approach with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Concurrent Peritoneal and Liver Metastases of Colon Cancer Origin.

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational study from a prospective maintained data base. Patients who underwent a simultaneous peritoneal cytoreduction and liver resection plus HIPEC were studied. Postoperative outcomes and overall and disease free survival were analyzed. Univariate and multivariate analyses were performed. Results: From January 2010 to October 2022, 22 patients operated with peritoneal and liver metastasis (LR+) were compared with 87 patients operated with peritoneal metastasis alone (LR-). LR+ group presented higher serious morbidity (36.4 vs. 14.9%; p: 0.034). Postoperative mortality did not reach statistical difference. Median overall and disease free survival was similar. Peritoneal carcinomatosis index was the only predictive factor of survival. Conclusions: Simultaneous peritoneal and liver resection is associated with increased postoperative morbidity and hospital stay, but with similar postoperative mortality and OS and disease free survival. These results reflect the evolution of these patients, considered inoperable until recently, and justify the trend to incorporate this surgical strategy within a multimodal therapeutic plan in highly selected patients.

Three-dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease.

AIM: The aim of this study is to demonstrate the added value of three-dimensional (3D) reconstruction models and artificial intelligence for preoperative planning in complex perianal Crohn's disease. MRI is the gold standard for diagnosis of complex perianal fistulas and abscess due to its high sensitivity, but it lacks high specificity values. This creates the need for better diagnostic models such as 3D image processing and reconstruction (3D-IPR) with artificial intelligence (AI) algorithms. METHOD: This is a prospective study evaluating the utility of 3D reconstruction models from MRI in four patients with perineal Crohn's disease (pCD). RESULTS: Four pCD patients had 3D reconstruction models made from pelvic MRI. This provided a more visual representation of perianal disease and made possible location of the internal fistula orifice, seton placement in fistula tracts and abscess drainage. CONCLUSION: Three-dimensional reconstruction in CD-associated complex perianal fistulas can facilitate disease interpretation, anatomy and surgical strategy, potentially improving preoperative planning as well as intraoperative assistance. This could probably result in better surgical outcomes to control perianal sepsis and reduce the number of surgical procedures required in these patients.

Apendicitis aguda secundaria a ingesta de cuerpo extraño / Acute appendicitis secondary to foreign body ingestion

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Aportaciones de la fluorescencia a la cirugía endocrina / Contributions of fluorescence to endocrine surgery

El uso de la fluorescencia en cirugía se ha ampliado y difundido en los últimos años, lo que ha constituido un auténtico fenómeno tecnológico ligado a la aparición de dispositivos adaptados a su utilización en los abordajes laparoscópicos y robóticos. La cirugía guiada por fluorescencia en el campo de la cirugía endocrina está igualmente en auge. Cada vez son más los artículos que describen su uso en la cirugía de las glándulas tiroides, paratiroides y suprarrenal, aunque con series aun modestas y con protocolos diversos no estandarizados. Existen actualmente diversas áreas de desarrollo de la aplicación de la fluorescencia en cirugía endocrina. Cabe destacar el uso de la fluorescencia con verde de indocianina en cirugía suprarrenal, la identificación y predicción de la perfusión paratiroidea con verde de indocianina, y la autofluorescencia de las glándulas paratiroides. El objetivo de este artículo es revisar las actuales aplicaciones de la fluorescencia en cirugía endocrina

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery