Drains after thyroid surgery. / Drenajes en el posoperatorio de cirugía tiroidea.

BACKGROUND: Thyroidectomy is one of the most common procedures and the most feared complication is the hematoma that obstructs the airway, which leads to the use of drains, although the evidence of the benefits of its use is limited. OBJECTIVE: To analyze the frequency of the use of drains, the type of surgery and hospital stay in patients undergoing thyroid surgery. METHOD: We included patients with diverse thyroid diseases with and without drains. The information was gathered retrospectively, including the patient characteristics, the type of surgery and the histopathology result. RESULTS: Out of the 44 patients, only 9% used drainage and the most frequent diagnosis was papillary thyroid cancer. The most frequent procedure was right hemithyroidectomy; all patients with drainage had larger lesions, but no statistical difference was found between the groups (p = 0.174). Drains have been used for multiple reasons, although evidence shows it is unnecessary. In this study we observed that the patients with longer hospital stay were the cases of lesions that needed complex procedures, which can contribute to the use of drains. CONCLUSIONS: The use of drains is controversial; it depends on the surgical education of the surgeon. In this study drains were used for procedures with bigger lesions, although there was no difference with patients with similar lesions without drains. The best way of avoiding the use of drains is to be careful and pay attention to details during surgery.

INTRODUCCIÓN: La tiroidectomía es uno de los procedimientos más comunes y su complicación más temida es el hematoma que obstruye la vía aérea, lo cual lleva al uso de drenajes, aunque la evidencia del beneficio de estos es limitada. OBJETIVO: Analizar la frecuencia del uso de drenajes, el tipo de cirugía y la estancia hospitalaria en pacientes sometidos a cirugía de tiroides. MÉTODO: Se incluyeron pacientes con diversas afecciones, manejados con y sin drenaje. La información fue recolectada de forma retrospectiva, incluidas las características del paciente, el procedimiento y el reporte histopatológico. RESULTADOS: De los 44 pacientes, solo se usó drenaje en el 9% y el diagnóstico más frecuente fue cáncer papilar. El procedimiento más frecuente fue la hemitiroidectomía derecha; todos los pacientes con drenaje tenían lesiones de mayor tamaño, pero no se encontró una diferencia estadística entre los grupos (p = 0.174). Se han usado drenajes por diversas razones, a pesar de que la evidencia sugiere que es innecesario. En este estudio, los pacientes con mayor tiempo de estancia hospitalaria correspondieron a los casos de lesiones que ameritaron procedimientos complejos, lo cual puede contribuir al tiempo de estancia y al uso de drenaje. CONCLUSIONES: El uso del drenaje es controversial, depende del cirujano y de su formación. En este estudio se indicó para procedimientos con lesiones de mayor tamaño, sin observar diferencias con los pacientes sin drenaje con lesiones similares. La mejor forma de evitar el uso de drenajes es realizar una adecuada y detallada hemostasia en el transoperatorio.

Factores de riesgo asociados a recidiva de carcinoma papilar de tiroides / Risk factors associated with recurrence of papillary thyroid carcinoma

RESUMEN Introducción: Aunque el carcinoma papilar de tiroides (CPT) tiene una buena sobrevida, en el 30% de los casos recidivará a largo plazo. Se han descrito factores pronósticos como el tamaño, histopatología, procedimiento quirúrgico y administración de yodo radiactivo. Objetivo: Este trabajo pretende determinar factores de riesgo de recidiva a largo plazo. Material y método: Se realizó un estudio retrospectivo y observacional, se incluyeron a los pacientes sometidos a cirugía por CPT con seguimiento a 10 años, y se analizaron variables clínicas y bioquímicas relacionadas con la recidiva a largo plazo. Resultados: Se identificaron 91 pacientes con seguimiento de 10 años. No se encontró relación para recidiva con historia familiar oncológica, enfermedad tiroidea pre-via, pero sí con tabaquismo (p 0,040). Se encontraron a 27 (29%) con recidiva, en relación a lesiones >3 cm (p 0,05), y CPT multicéntrico (p 0,003). Conclusión: El tiempo de evolución prolongado favorece el crecimiento de las lesiones, y la diseminación de la enfermedad, así como la recidiva. El CPT es una enfermedad con capacidad metastásica a largo plazo, que requiere un seguimiento cercano y detección oportuna de pacientes susceptibles de recidiva. El tiempo entre el diagnóstico y la cirugía es un factor fundamental para el crecimiento de las lesiones y la propagación de la enfermedad, por lo que se debe reducir el tiempo de espera, evitando así las lesiones de mayor tamaño, diseminación de células tumorales y la recidiva con peor pronóstico para los pacientes.

ABSTRACT Introduction: The papillary thyroid cancer has good survival rate, however, 30% of the patients will have a recurrence. Prognostic factors have been described such as size, histopathology, surgical procedure and administration of radioactive iodine. Aim: To determine preventable risk factors for long-term recurrence. Material and method: This is a retrospective and observational study, patients undergoing surgery for CPT and 10 year follow up were included to analyze clinical and biochemical variables related to long-term recurrence. Results: Ninety-one patients with a 10-year follow-up were identified. No relationship was found for recurrence with oncological family history, previous thyroid disease, but smoking was a risk factor (p 0.040). We found 27 (29%) with relapse, in relation to lesions > 3 cm (p 0.05), and multicentric PTC (p 0.003). Conclusion: The long evolution time favors the growth of lesions, the spread of the disease, as well as the recurrence. The CPT is a disease with long-term metastatic capacity; it requires close monitoring and opportune detection of patients susceptible to recurrence. The time between diagnosis and surgery is a fundamental factor for the growth of the lesions and the spread of the disease, so the waiting time must be reduced, thus avoiding larger lesions, malignant cell dissemination and recurrence with worse prognosis for patients.

[Prevalencia y factores de riesgo para lesiones premalignas en pacientes menores de 55 años sometidos a colonoscopia en un hospital de tercer nivel]. / Prevalence and risk factors for premalignant lesions in patients younger than 55 years old founded on colonoscopy on a tertiary center.

ANTECEDENTES: El cáncer colorrectal es causa importante de mortalidad y la colonoscopia es efectiva para reducir su incidencia y mejorar la supervivencia con la resección de las lesiones precursoras. OBJETIVO: Determinar la prevalencia, las características y la histología de las lesiones en pacientes < 55 años en un hospital de tercer nivel. MÉTODO: Se realizó un estudio retrospectivo y observacional de enero de 2010 a diciembre de 2014 en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, con el reporte de 555 colonoscopias y los datos clínicos de las historias hospitalarias de los pacientes incluidos en el estudio. RESULTADOS: Los hallazgos fueron lesiones premalignas en el 40% de los pacientes, con pólipos en 98 casos y con un tamaño de 5.2 mm; de ellos, el 54% se localizaron en el colon, el 24% en el sigmoides, el 27% en el recto y el 1% en el ano. En los reportes se observó una prevalencia del 63% de pólipos neoplásicos (riesgo relativo [RR]: 2.3; intervalo de confianza del 95% [IC 95%]: 1.5-3.7) en pacientes con antecedente de tabaquismo, y del 42% (RR: 1.8; IC 95%: 1.2-2.6) con antecedente de consumo de alcohol. CONCLUSIONES: La prevalencia de lesiones premalignas es similar para los menores de 55 años. Esto indica la importancia del diagnóstico oportuno y de evitar la progresión. Sería conveniente extender el seguimiento a hospitales de segundo nivel en pacientes con factores de riesgo para ampliar lo reportado y contribuir a mejorar los resultados en la sanidad pública. BACKGROUND: Colorectal cancer is an important cause of mortality, colonoscopy is effective to reduce its incidence and improve survival with the resection of premalignant lesions. OBJECTIVE: To determine the prevalence, characteristics and histology of lesions in patients younger than 55 years of age in a tertiary hospital. METHOD: This is a retrospective observational study, we colected data at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, with the report of 555 colonoscopies, and clinical data from the hospital archives of medic histories of selected patients. RESULTS: Premalignant lesions were found on 40% of the patients. The findings were polyps in 98 cases with a size of 5.2 mm; 54% were located in the colon, 24% in the sigmoid, 27% in the rectum and 1% in the anus. A prevalence of 63% of neoplastic polyps was observed (RR: 2.3; 95% CI: 1.5-3.7) in smokers; and 42% (RR: 1.8; 95% CI: 1.2-2.6) in patients with alcohol consumption. CONCLUSIONS: The prevalence for premalignant lesions is similar for patients under 55 years of age. This highlights the importance of early diagnosis and avoiding progression. It would be convenient to extend the follow-up to second-level hospitals in patients with risk factors to contribute to improvement of public health system outcomes.

Results after Definitive Surgical Treatment in Patients with Enteroatmospheric Fistula.

As enteroatmospheric fistulas (EAF) lack healthy overlying tissue, spontaneous healing is very unlikely. Our aim was to identify risk factors for recurrence and mortality after definitive surgical treatment for EAF. Sixty-two consecutive patients with a diagnosis of EAF were submitted to definitive surgical repair (fistula resection and primary anastomosis) during a 6-year period. Several patient, disease, and operative variables were assessed as risk factors associated to our endpoints: recurrence and mortality. All patients were followed-up until hospital discharge or death. Univariate and multivariate analysis were performed. There were 24 females and 38 males with a median age of 53 years (interquartile ranges 43-63). EAF recurred in 23 patients. Univariate analysis identified several risk factors for recurrence which included performing more than one anastomosis (20 vs 52%, P = 0.013), failure of achieving total abdominal closure (16 vs 47%, P = 0.025), intraoperative hemorrhage >400 cc (28 vs 65%, P = 0.007), presence of multiple fistulas (25 vs 61%, P = 0.008), and preoperative C-reactive protein >0.5 mg/dL (54 vs 82%, P = 0.029). The latter two remained significant after multivariate analysis. Final EAF closure was attained in 47 patients (76%) and 8 more (13%) had a low-output (<50 mL/day) enterocutaneous fistula. Timing of surgery was not related to fistula recurrence. Eight patients died (13%), and fistula recurrence was the only risk factor found related to mortality both through univariate (26 vs 5%, P = 0.043) and after multivariate analysis. EAF management represents a rather challenging problem. Timing for surgical treatment is controversial and is based mostly on patient status and surgeon's criteria. Recurrence is associated to EAF characteristics and an inflammatory state; it was also the only factor associated to mortality.

Biliary cysts in adults. 26 years experience at a single center.

BACKGROUND: Biliary cysts are duct dilatation that can occur on all biliary ducts, 20-25% is diagnosed in adults. The classic triad for the clinical presentation consists on abdominal pain, jaundice and abdominal mass. The standard treatment is surgical resection and bilioenteric anastomosis. The objective of this study is to analyze the prevalence and characteristics of biliary cysts in our center. METHODS: This is an observational retrospective study, we included patients older than 16 years old with biliary cyst from march 1989 to February 2015. The demographic and clinical information was collected from the charts and electronic records available at our Hospital. RESULTS: Biliary cysts were reported on 52 patients, only 25 clinical charts were available. The main symptom was abdominal pain in 21 (84%). The diagnosis was performed with abdominal ultrasound in 16 (64%). The most frequent type was IA in 9 (36%). All patients were treated with surgery as a definitive management. DISCUSSION: Vague clinical presentation results on a delay of the diagnosis and treatment. Surgical resection is recommended for patients since they have an increased risk for malignant transformation. Postoperative complications in our patients were stenosis of bilioenteric anastomosis in 3 (12%) patients. CONCLUSIONS: Biliary cysts require an accurate diagnosis and surgical treatment in order to decrease the risk of malignant transformation and progression of the disease. Precise surgical treatment is needed to achieve complete resection and a long term postoperative follow up is mandatory.