C-reactive protein postoperative values to predict clinically relevant postoperative pancreatic fistula after distal pancreatectomy.

INTRODUCTION: despite significant medical and technological advances, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is reported to be between 3-45 %. The main objective of this study was to analyze the early post-surgical risk factors for developing POPF after DP. MATERIAL AND METHODS: a retrospective observational study was performed on a prospective basis of patients undergoing DP in a tertiary hospital from January 2011 to December 2021. Sociodemographic, preoperative analytical, tumor-related and postoperative complications variables were analyzed. RESULTS: of the 52 patients analyzed, 71.8 % of the sample had postoperative drains amylase elevation. However, 25.7 % of the total had grade-B and/or grade-C POPF. Univariate logistic regression with the variables studied showed the following as risk factors for B-C or clinically relevant POPF: amylase values in drainage at the 5th postoperative day (POD) (p = 0.097; 1.01 [1-1.01]), preoperative BMI (p = 0.015; 1.27 [1.04-1.55]) and C-reactive protein (CRP) value at the 3rd POD (p = 0.034; 1.01 [1.01-1.02]). The ROC curve of CRP value at the 3rd POD showed an area under the curve of 0.764 (95 % CI: 0.6-0.93) and the best cut-off point was 190 mg/l (sensitivity 89 % and specificity 67 %). CONCLUSIONS: CRP value at the 3rd POD is a predictive factor for POPF after DP. Early detection of patients at risk of POPF based on these characteristics could have an impact on their postoperative management.

C-reactive protein postoperative values to predict clinically relevant postoperative pancreatic fistula after distal pancreatectomy

Introduction: despite significant medical and technological advances, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is reported to be between 3-45 %. The main objective of this study was to analyze the early post-surgical risk factors for developing POPF after DP. Material and methods: a retrospective observational study was performed on a prospective basis of patients undergoing DP in a tertiary hospital from January 2011 to December 2021. Sociodemographic, preoperative analytical, tumor-related and postoperative complications variables were analyzed. Results: of the 52 patients analyzed, 71.8 % of the sample had postoperative drains amylase elevation. However, 25.7 % of the total had grade-B and/or grade-C POPF. Univariate logistic regression with the variables studied showed the following as risk factors for B-C or clinically relevant POPF: amylase values in drainage at the 5th postoperative day (POD) (p = 0.097; 1.01 [1-1.01]), preoperative BMI (p = 0.015; 1.27 [1.04-1.55]) and C-reactive protein (CRP) value at the 3rd POD (p = 0.034; 1.01 [1.01-1.02]). The ROC curve of CRP value at the 3rd POD showed an area under the curve of 0.764 (95 % CI: 0.6-0.93) and the best cut-off point was 190 mg/l (sensitivity 89 % and specificity 67 %). Conclusions: CRP value at the 3rd POD is a predictive factor for POPF after DP. Early detection of patients at risk of POPF based on these characteristics could have an impact on their postoperative management (AU)

Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico / Impact of unplanned resection and re-excision of a soft tissue sarcoma on prognosis

INTRODUCCIÓN: Hasta un 40% de los sarcomas de partes blandas (SPB) son resecados de forma no planificada, dejando tumor residual en más del 50% de los casos. La implicación pronóstica de estas resecciones no está claramente definida, dado que existen escasos estudios comparativos que demuestren cómo afecta a la tasa de recurrencia local, de metástasis y de supervivencia. MÉTODOS: Revisión retrospectiva de pacientes intervenidos de un SPB de enero de 2000 a enero de 2016 clasificándolos respecto a intervención planificada o no planificada. Se compararon las tasas de recurrencia y metástasis en global y por estadios. RESULTADOS: Ceintitrés pacientes con SPB fueron tratados de forma planificada y 16 de forma no planificada, con 13 reintervenciones. El 40% del grupo planificado presentó un estadio avanzado respecto al 20% del grupo no planificado. El 77% de los pacientes con resección no planificada reintervenidos presentaron tumor residual en la pieza. La tasa de recidiva local en el grupo de no planificados fue considerablemente más alta (73,5% frente al 43,8%). La tasa de metástasis en no planificados fue del 45,5%, frente al 56,3% en planificados (p > 0,05). En el grupo de no planificados el patrón de recidiva fue más errático con peores resultados en estadios precoces. Concusiones: La resección no planificada de los SPB asocia mayores tasas de recurrencia local y peores resultados funcionales a pesar del manejo oncológico posterior. En las lesiones de partes blandas es fundamental reconocer los signos de alarma que sugieren malignidad para llevar a cabo un estudio diagnóstico específico y evitar resecciones inadecuadas

INTRODUCTION: Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. METHODS: Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. RESULTS: Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision.40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages.77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs.43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. CONCLUSION: The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections

Impact of unplanned resection and re-excision of a soft tissue sarcoma on prognosis. / Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico.

INTRODUCTION: Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. METHODS: Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. RESULTS: Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs. 43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. CONCLUSION: The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections.

Management of Esophageal Perforation: 28-Year Experience in a Major Referral Center.

Esophageal perforation constitutes a surgical emergency. Despite its gravity, no single strategy has been described as sufficient to deal with most situations to date. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 28-year period, to characterize optimal treatment options in this severe disease. A retrospective clinical review of all patients treated for esophageal perforation at Ramón y Cajal Hospital between January 1987 and December 2015 was performed (n = 57). Iatrogenic injury was the most frequent cause of esophageal perforation (n = 32). Abdominal esophagus was the main location (23 patients; 40.4%). Eight patients (14%) were managed with antibiotics and parenteral nutrition. In seven patients (12.3%), an endoscopic stent was implanted. Surgical therapy was performed in 38 patients (66.7%). Morbidity and 90-day mortality rates were 61.4 and 28 per cent, respectively. Five patients were reoperated (8.8%). Median hospital stay was 23.5 days. The mortality rate was higher among patients with spontaneous and tumoral perforation (54.5 and 100%; P = 0.009), delayed diagnosis (>24 hours; P = 0.0001), and abdominal/thoracic location (37.5%; P = 0.05). No statistical differences were found between surgical and conservative/endoscopic management (31% vs 20%; P = 0.205) although hospital staying was longer in surgical group (36.30 days vs 15.63 days; P = 0.029). Esophageal perforation was associated with high morbidity and mortality rates. Global outcomes depend on etiology, site of perforation, and delay in diagnosis. An individualized approach for each patient should be chosen to prevent septic complications of this potentially fatal disease.

Manual de Urgencias Quirúrgicas

Incluye: valoración preoperatoria del paciente, anestésicos locales, sepsis, diagnóstico por imagen de la patología torácica urgente, diagnóstico por imagen del abdomen agudo, manejo radiológico del traumatismo craneoencefálico, facial y espinal, manejo radiológico del traumatismo abdominal, manejo radiológico del traumatismo osteomuscular, radiología intervIncluye: valoración preoperatoria del paciente, anestésicos locales, sepsis, diagnóstico por imagen de la patología torácica urgente, diagnóstico por imagen del abdomen agudo, manejo radiológico del traumatismo craneoencefálico, facial y espinal, manejo radiológico del traumatismo abdominal, manejo radiológico del traumatismo osteomuscular, radiología intervencionista en urgencias quirúrgicas, antibioterapia profiláctica en cirugía de urgencias, abdomen agudo, apendicitis aguda, obstrucción intestinal, pancreatitis aguda, patología urgente de la vía biliar, hemorragia digestiva alta, hemorragia digestiva baja, complicaciones de la enfermedad inflamatoria intestinal, diverticulitis aguda, el paciente politraumatizado. Valoración inicial, traumatismo abdominal, patología vascular abdominal de urgencias, patología anorrectal urgente, infecciones de partes blandas, mordeduras y picaduras, urgencias en cirugía torácica, urgencias urológicas, urgencias en ginecología, traumatismos cardíacos, traumatismo craneoencefálico, urgencias raquimedulares, patología maxolofacial en urgencias, traumatología facial, isquemia aguda de las extremidades, aneurismas arteriales, disección aórtica, traumatismos vasculares, patología venosa aguda, pie diabético, manejo general de heridas, heridas de la mano, tratamiento de las quemaduras, urgencias oftalmológicas, urgencias otológica, nasosinusales y faringolaríngeas, vértigo, epistaxis y otras urgencias en ORL.

Multidisciplinary management in rectal cancer.

The treatment of rectal cancer has evolved over the last few decades from surgery alone to treatments with trimodal therapy for high-risk patients. The involvement of a multidisciplinary team of radiologists, pathologists, surgeons, radiotherapists and medical oncologists is now fundamental for decision-making and outcomes. The evolution of different diagnostic and therapeutic techniques has optimised the therapeutic rate. Future studies will determine the optimal regimen for inducing complete responses in locally advanced disease and whether the intensification of local treatments could enable the use of more conservative treatments, as for other tumour locations. The study of biomarkers will be essential in this respect.

Formación quirúrgica en España: resultados de una encuesta nacional / Surgical training in Spain: Results of a national survey

Introducción: El objetivo del estudio intenta realizar una aproximación al estado de la formación quirúrgica en España y analizar su adecuación a los objetivos del programa. Material y métodos: Se presentan y se analizan los resultados de dos encuestas realizadas por la Asociación Española de Cirujanos a los residentes y a los tutores de Cirugía General basadas en las conclusiones del XXVII Congreso Nacional de Cirugía. Las cuestiones formuladas hacían referencia a aspectos generales del servicio y particulares en relación con el acceso, la actividad docente, la actividad quirúrgica, la actividad investigadora y las perspectivas personales. Las respuestas fueron definidas, adaptadas y categorizadas como variables cuantitativas y cualitativas. Se utilizó un programa estadístico G Stat 2.0 para el procesamiento y la presentación descriptiva de los resultados. Resultados: El número de residentes y tutores a quienes se enviaron las encuestas fue de 626 y 142. Fueron respondidas el 19% de las encuestas de residentes y el 29% de las encuestas de tutores. Según el año de residencia, predominaron las de residentes de primer año (32%) frente a los de años ulteriores, siendo el índice de respuesta de los R5 del 7,2%. El 91% conocía bien el programa de la especialidad y el 76% estaba satisfecho con la formación recibida. Conclusiones: Los resultados obtenidos en cuanto a actividad quirúrgica concuerdan con los previstos en el programa tanto en el número de procedimientos como en su progresión a lo largo de la residencia, aunque no es posible asegurar su uniformidad. Las funciones y la acreditación de los tutores que constituyen uno de los pilares fundamentales del proceso formativo están pendientes de regulación específica (AU)

Introduction: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. Material and methods: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. Results: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. Conclusions: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations (AU)

[Surgical training in Spain: results of a national survey]. / Formación quirúrgica en España: resultados de una encuesta nacional.

INTRODUCTION: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. MATERIAL AND METHODS: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. RESULTS: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. CONCLUSIONS: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.

Postoperative complications of colon surgery.

Colon surgery comprises a high number of patients treated in a gastrointestinal surgery department. Like any major surgery, it may present diverse surgical and medical postoperative complications. In this article we review the most frequent surgical complications of colon surgery: abdominal sepsis, postoperative ileus, bleeding, fistula, evisceration, ureteral lesion, colostomy problems and damage to upper mesenteric vessels. Every colorectal surgeon must know all the possible complications of colon surgery to achieve an early diagnosis and correct management.

Dilatación transparietohepática de estenosis biliar benigna: experiencia de 5 años / Transparieto-hepatic dilation of benign biliary stenosis: 5 years experience

Objetivo: Valorar los resultados de la dilatación percutánea transparietohepática de las estenosis biliares benignas durante un período de 5 años. Diseño: Estudio retrospectivo para evaluar la técnica, las complicaciones y los resultados clínicos, analíticos y radiológicos. Pacientes: Se recogieron datos de 13 pacientes diagnosticados de estenosis biliar benigna que se trataron mediante dilatación percutánea en nuestro centro entre los años 2002–2006. Se excluyó a los pacientes diagnosticados de enfermedad maligna y a aquellos pacientes a los que se les colocó una prótesis. Siete de los pacientes han sido receptores de trasplante hepático. Un paciente había recibido dilatación endoscópica en 2 ocasiones con persistencia de la estenosis. Resultados: Se comprobó mejoría clínica y radiológica en el 60% de los casos y analítica en el 69% de los casos (el 61% de normalización). El 30% de los casos presentó reestenosis, de los que el 50% fueron subsidiarios de rescate mediante redilatación. Las complicaciones que se presentaron (30,7%) se resolvieron de forma conservadora. No se observaron diferencias significativas entre el grupo de trasplante y el grupo sin trasplante. Conclusiones: La dilatación de las estenosis benignas de la vía biliar por vía transparietohepática es una técnica bastante segura, tiene una alta tasa de resolución a medio plazo y permite evitar la cirugía en más de un 75% de los pacientes. Los resultados deben confirmarse en muestras mayors (AU)

Objective: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years. Design: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results. Patients: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting. Results: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups. Conclusions: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples (AU)

[Transparieto-hepatic dilation of benign biliary stenosis: 5 years experience]. / Dilatación transparietohepática de estenosis biliar benigna: experiencia de 5 años.

OBJECTIVE: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years. DESIGN: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results. PATIENTS: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting. RESULTS: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups. CONCLUSIONS: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples.

Complicaciones posoperatorias de la cirugía colónica / Postoperative complications of colon surgery

La cirugía del colon supone un importante trabajo en cualquier servicio de cirugía digestiva. Como cualquier cirugía mayor puede presentar complicaciones posoperatorias, tanto quirúrgicas como médicas, muchas de ellas pueden ser graves o incluso fatales. En este trabajo revisamos las complicaciones quirúrgicas posoperatorias más frecuentes: sepsis de origen abdominal, íleo posquirúrgico, hemorragia, fístula, evisceración, lesión ureteral, problemas con la colostomía y lesión de grandes vasos mesentéricos superiores. Todo cirujano digestivo debe conocer las posibles complicaciones de la cirugía colónica para conseguir un diagnóstico precoz y un manejo adecuado de las mismas.

Colon surgery comprises a high number of patients treated in a gastrointestinal surgery department. Like any major surgery, it may present diverse surgical and medical postoperative complications. In this article we review the most frequent surgical complications of colon surgery: abdominal sepsis, postoperative ileus, bleeding, fistula, evisceration, ureteral lesion, colostomy problems and damage to upper mesenteric vessels. Every colorectal surgeon must know all the possible complications of colon surgery to achieve an early diagnosis and correct management.

[General surgery and the digestive system: new program, same challenges]. / Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos.

On 8 may 2007, the Official Bulletin (BOE) published the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as "a major discipline paradigm" should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program.

Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos / General surgery and the digestive system: new program, same challenges

El 8 de mayo de 2007 se publicó en el BOE el nuevo Programa Formativo de la Especialidad. La Sección de Formación Posgraduada de la AEC, consciente de la trascendencia de esta situación, ha realizado un análisis preliminar reflexivo de él y propone una serie de objetivos. El nuevo plan articula un programa formativo que establece 3 objetivos generales en relación con los conocimientos, habilidades y actitudes que el residente debe asimilar y desarrollar, define puntualmente el producto final, sin modificaciones sustanciales con el anterior programa y potencia 2 aspectos fundamentales: la formación en cirugía mínimamente invasiva y la formación investigadora, aunque sorprende la incorporación de nuevas rotaciones, anteriormente inéditas, y la continuidad del modelo actual de evaluación. La coherencia en la definición de la cirugía general como “paradigma de disciplina troncal” debería suponer modificaciones estructurales importantes. Aspectos como regulación del tiempo de trabajo y formativo, directrices europeas, desmotivación profesional y modificación del espectro vocacional de los nuevos residentes dificultarán a priori la optimización del resultado. En 2017 y tras 5 promociones de cirujanos así formados será momento de juzgar los resultados de este programa (AU)

On 8 may 2007, the Official Bulletin (BOE) publi-shed the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as “a major discipline paradigm” should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program (AU)