Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.

Neoplastic degeneration of chronic sacrococcygeal pilonidal sinus: report of seven cases and literature review.

INTRODUCTION: Neoplastic degeneration is an uncommon but extremely serious complication of pilonidal sinus (PS) disease. We pretend to determine the factors that influence in the prognosis of the neoplastic disease assessing clinical features and histological findings. MATERIALS AND METHODS: We retrospectively studied the patients diagnosed of malignization of PS in our institution from 2000 to 2019. RESULTS: Seven male patients with a mean age at diagnosis of 64.8 years old were collected. Average time between the initial symptoms of PS disease and the tumor diagnosis was 33.7 years. The patients presenting an ulcerative pattern in the primary tumor showed in all the cases perineural invasion, local deep structures infiltration, and neoplastic dissemination to the regional lymph nodes. All these patients died in an average time of 7 months. On the other hand, patients with exophytic patterns in the primary tumor did not present local invasion or regional nodes affectation. All the cases survive with an average follow-up of 70.5 months. CONCLUSIONS: Ulcerated lesions clearly show a worse prognosis than tumors with exophytic morphology. Factors as perineural infiltration, local deep structures infiltration, or regional lymph node involvement dramatically decrease survival rates.

OBJETIVO: La cancerificación es una complicación infrecuente pero grave de la enfermedad por sinus pilonidal. Intentaremos determinar los factores que influyen en el pronóstico de la enfermedad neoplásica basándonos en hallazgos clínicos e histopatológicos. MATERIAL Y MÉTODOS: retrospectivamente se revisan pacientes diagnosticados de malignización de sinus pilonidal en nuestra institución del 2000 a 2019. RESULTADOS: fueron recopilados los casos de siete varones con una media de edad al diagnóstico de 64.8 años. El promedio entre el inicio de los síntomas de sinus pilonidal y el diagnóstico del tumor fue de 33.7 años. Los pacientes con un patrón ulcerativo en el tumor primario presentaron todos invasión perineural, infiltración de estructuras profundas y diseminación a linfáticos regionales. Todos estos pacientes fallecieron en una media de 7 meses. Por el contrario, los pacientes que mostraban un patrón exofítico, no presentaron invasión local o afectación de los linfáticos regionales. Todos estos casos sobrevivieron, con una media de seguimiento de 70.5 meses. CONCLUSIONES: tumores primarios ulcerativos claramente presentan un peor pronóstico que los casos de morfología exofítica. Factores como la infiltración perineural, la invasión local de estructuras profundas o la afectación de los ganglios linfáticos regionales van ligados a una disminución dramática en la supervivencia.

Early or delayed laparoscopic cholecystectomy in acute cholecystitis? Conclusions of a controlled trial.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill defined. This study evaluated the effect of timing of LC in patients with acute cholecystitis. METHODOLOGY: Group 1, those patients who had LC for AC within 72 hours was compared with group 2, those who had LC for AC after 72 hours. Univariate logistic regression analysis and multivariate regression analysis were used to determine if any factors had a significant association with the complications, postoperative hospital stay, and conversion index. A value of p < 0.05 was considered statistically significant. RESULTS: Comparing the two groups, the conversion rate to an open procedure was significantly less (7.8% versus 18.4%, P_0.02) in the early treated patients. Furthermore, postoperative hospitalization (6.5 versus 9.5 days, P 0.01), and complications (8.8% versus 17.7%, P _0.02) were significantly reduced in patients undergoing early laparoscopic cholecystectomy. CONCLUSION: There is no advantage to delaying cholecystectomy for acute cholecystitis on the basis of outcomes in complications, rate of conversion to open surgery, and mean hospital stay. Thus, early cholecystectomy should be be the preferred surgical approach for patients with acute lithiasic cholecystitis.

Necrotizing soft tissue infections.

PURPOSE OF REVIEW: The purpose of this review is to consider recent advances in the definition, pathogenesis, diagnostic criteria, and treatment of necrotizing soft tissue infections. RECENT FINDINGS: The efficacy of early surgical debridement combined with antimicrobial therapy, close monitoring and physiologic support is strongly demonstrated. Novel therapeutic strategies including vacuum-assisted wound-closure therapy and intravenous immunoglobulin have been described. SUMMARY: Necrotizing soft-tissue infection is a rare infection of the subcutaneous tissue and fascia that is often associated with sepsis and can progress rapidly with a possible fatal outcome. Although the cause is not yet understood fully, patients often have a prior history of a small, trivial trauma, wound, or scratch. Establishing the diagnosis can be the main challenge in treating patients, and knowledge of all available tools is key for early and accurate diagnosis.