Impact of the COVID-19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer.

INTRODUCTION: We evaluate the impact of COVID-epidemic in colorectal cancer (CRC) diagnosis during Spain's state of emergency. METHODS: We compared newly diagnosed patients with patients diagnosed in the same period of 2019. RESULTS: A new diagnosis of CRC decreased 48% with a higher rate of patients diagnosed in the emergency setting (12.1% vs. 3.6%; p = .048) and a lower rate diagnosed in the screening program (5.2% vs. 33.3%; p = .000). CONCLUSIONS: Fewer patients have been diagnosed with CRC, with a higher rate of patients diagnosed in an emergency setting.

Stent placement prior to initiation of chemotherapy in patients with obstructive, nonoperative left sided tumors is associated with fewer stomas.

BACKGROUND AND OBJETIVES: Due to the potential risks associated with stent placement, European Society Gastrointestinal Endoscopy does not recommend prophylactic insertion of stents in patients without symptoms. The aim was to compare complication rates, need of surgery, colostomy formation, and survival between stent placement prior to start of chemotherapy (SEMS group) and upfront ChT (ChT group) in patients with endoscopically non-transverable metastatic left-sided colorectal cancer. METHODS: Gender, age, CEA, tumor location, sites of metastatic disease, peritoneal involvement, liver involvement, and angiogenesis inhibitors administration, were recorded. Complication rates, need of surgery, stoma creation, and survival were compared between both groups by univariate and multivariate test. Complications of SEMS placement in both groups were compared. RESULTS: We studied 75 men and 40 women, with a mean age of 66.3 years. Overall complication and perforation rates were similar but patients in the ChT group had a significant higher need of surgery and subsequent stoma creation. Perforation after SEMS placement rates were higher in patients receiving ChT than in patients without ChT. Survival was related to peritoneal carcinomatosis and administration of biological agents. CONCLUSIONS: SEMS placement prior to ChT administration dismissed the need of subsequent surgery and decreased the rates of permanent stoma formation.

Influencia del volumen quirúrgico en los resultados oncológicos después de estandarizar la cirugía en el Proyecto Español del Cáncer de Recto / Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project

INTRODUCCIÓN: Determinar la influencia del volumen quirúrgico en los resultados oncológicos del Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos. MÉTODOS: Se incluyeron 2.910 pacientes consecutivos tratados con una operación curativa entre marzo de 2006 y marzo de 2010 en 36 hospitales. Los hospitales se clasificaron según el número de pacientes operados por año en: pequeños (12-23), intermedios (24-35) y grandes (≥ 36). RESULTADOS: Con un seguimiento de al menos cinco años la incidencia acumulada de recidiva local fue 6,6 (IC 95% 5,6-7,6), la de metástasis 20,3 (IC 95% 18,8-21,9) y la de supervivencia global 73,0 (IC 95% 74,7-71,3). En el análisis de regresión multinivel, la supervivencia global fue mayor en los hospitales que operaban 36 o más pacientes [HR 0,727 (IC 95% 0,556-0,951); p = 0,02]. El riesgo de recidiva local y metástasis no se relacionó con el volumen quirúrgico. Además, hubo una variación significativa en las tasas de supervivencia global (mediana hazard ratio [MHR] 1,184 [IC 95% 1,071-1,333]), recidiva local (MHR 1,308 [IC 95% 1,010-1,668]) y metástasis (MHR 1,300 [IC 95% 1,181-1,476]) entre todos los hospitales. CONCLUSIONES: En los grupos multidisciplinares seleccionados e incluidos en el proyecto de la Asociación Española de Cirujanos, que incluye la enseñanza de la escisión total del mesorrecto y la realimentación de los resultados, la supervivencia global es mayor en los hospitales con mayor volumen quirúrgico, y la variabilidad interhospitalaria de la tasa de recidiva local no se explica por el volumen quirúrgico

INTRODUCCIÓN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons. METHODS: Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥ 36 procedures per year). RESULTS: After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI 95% 5.6-7.6), 20.3 (CI 95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI 95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI 95% 1.071-1,333]), local recurrence (MHR 1.308 [CI 95% 1.010-1.668]) and metastases (MHR 1.300 [CI 95% 1.181; 1.476]) between all hospitals. CONCLUSIONS: Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more PATIENTS: However, local recurrence was not influenced by caseload

Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project. / Influencia del volumen quirúrgico en los resultados oncológicos después de estandarizar la cirugía en el Proyecto Español del Cáncer de Recto.

UNLABELLED: INTRODUCCIóN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons. METHODS: Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥36 procedures per year). RESULTS: After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI95% 5.6-7.6), 20.3 (CI95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI95% 1.071-1,333]), local recurrence (MHR 1.308 [CI95% 1.010-1.668]) and metastases (MHR 1.300 [CI95% 1.181; 1.476]) between all hospitals. CONCLUSIONS: Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients. However, local recurrence was not influenced by caseload.

Variabilidad interhospitalaria de la dehiscencia anastomótica en el Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos: La influencia del volumen quirúrgico / Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume

INTRODUCCIÓN: El objetivo de este estudio observacional multicéntrico fue determinar la tasa de dehiscencia anastomótica en los hospitales que participan en el Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos y evaluar si había diferencias atribuibles al volumen quirúrgico entre los hospitales que participan en él. MÉTODOS: La variación interhospitalaria se cuantificó mediante un estudio multinivel realizado con una base de datos prospectiva de los pacientes operados por un adenocarcinoma de recto con una resección anterior en 84 hospitales, entre marzo de 2006 y diciembre de 2013. En los análisis se incluyeron: las variables demográficas, la clasificación de la American Society of Anaesthesiologists, la utilización de un estoma de derivación, la localización y el estadio del tumor, la administración de tratamiento neoadyuvante y el volumen quirúrgico anual del hospital. RESULTADOS: Se analizó a 7.231 pacientes operados consecutivamente. La tasa de dehiscencia anastomótica fue del 10,0%. Los porcentajes de dehiscencia de los hospitales, estratificados por el volumen quirúrgico annual, variaron entre el 9,9 y el 11,3%. En el análisis de regresión multinivel el sexo masculino, los tumores localizados por debajo de 12 cm medidos desde el margen anal y los estadios T avanzados favorecieron la aparición de la dehiscencia, mientras que la presencia de un estoma de derivación la previno. El volumen quirúrgico anual del hospital no se asoció con la dehiscencia (OR: 0,852; [0,487-1,518]; p = 0,577). Además, se observó una variación significativa de la tasa de dehiscencia entre los hospitales (MOR: 1,475; [1,321-1,681]; p < 0,001). CONCLUSIÓN: La dehiscencia anastomótica varía de forma estadísticamente significativa entre los hospitales incluidos en el proyecto, y esta diferencia no se puede atribuir al volumen quirúrgico anual

OBJECTIVE: This multicentre observational study aimed to determine the anastomotic leak rate in the hospitals included in the Rectal Cancer Project of the Spanish Society of Surgeons and examine whether hospital volume may contribute to any variation between hospitals. METHODS: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all adenocarcinomas of the rectum operated by an anterior resection at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, use of defunctioning stoma, tumour location and stage, administration of neoadjuvant treatment, and annual volume of elective surgical procedures. RESULTS: A total of 7231 consecutive patients were included. The rate of anastomotic leak was 10.0%. Stratified by annual surgical volume hospitals varied from 9.9 to 11.3%. In multilevel regression analysis, the risk of anastomotic leak increased in male patients, in patients with tumours located below 12 cm from the anal verge, and advanced tumour stages. However, a defunctioning stoma seemed to prevent this complication. Hospital surgical volume was not associated with anastomotic leak (OR: 0.852, [0.487-1.518]; P=.577). Furthermore, there was a statistically significant variation in anastomotic leak between all departments (MOR: 1.475; [1.321-1.681]; P<0.001). CONCLUSION: Anastomotic leak varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volumen

[Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume]. / Variabilidad interhospitalaria de la dehiscencia anastomótica en el Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos: La influencia del volumen quirúrgico.

OBJECTIVE: This multicentre observational study aimed to determine the anastomotic leak rate in the hospitals included in the Rectal Cancer Project of the Spanish Society of Surgeons and examine whether hospital volume may contribute to any variation between hospitals. METHODS: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all adenocarcinomas of the rectum operated by an anterior resection at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, use of defunctioning stoma, tumour location and stage, administration of neoadjuvant treatment, and annual volume of elective surgical procedures. RESULTS: A total of 7231 consecutive patients were included. The rate of anastomotic leak was 10.0%. Stratified by annual surgical volume hospitals varied from 9.9 to 11.3%. In multilevel regression analysis, the risk of anastomotic leak increased in male patients, in patients with tumours located below 12 cm from the anal verge, and advanced tumour stages. However, a defunctioning stoma seemed to prevent this complication. Hospital surgical volume was not associated with anastomotic leak (OR: 0.852, [0.487-1.518]; P=.577). Furthermore, there was a statistically significant variation in anastomotic leak between all departments (MOR: 1.475; [1.321-1.681]; P<0.001). CONCLUSION: Anastomotic leak varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.

Variabilidad interhospitalaria de la mortalidad postoperatoria en el proyecto del cáncer de recto de la Asociación Española de Cirujanos. La influencia del volumen quirúrgico / Hospital variability in postoperative mortality after rectal cancer surgery in the Spanish association of surgeons project: The impact of hospital volume

INTRODUCCIÓN: El objetivo de este estudio observacional multicéntrico ha sido examinar la variación de la mortalidad postoperatoria de la cirugía electiva entre los hospitales que participan en el Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos, y evaluar si el volumen quirúrgico anual del hospital y las características de los pacientes contribuyen a la variación entre los hospitales. MÉTODOS: La variación interhospitalaria se cuantificó mediante un estudio multinivel realizado con una base de datos prospectiva de los pacientes operados por un adenocarcinoma de recto con una resección anterior y una amputación abdominoperineal en 84 hospitales, entre marzo de 2006 y diciembre de 2013. En los análisis se incluyeron: las variables demográficas, la clasificación ASA, la localización y el estadio del tumor, la administración de tratamiento neoadyuvante y el volumen quirúrgico anual del hospital. RESULTADOS: Se analizó a 9.809 pacientes operados consecutivamente. La tasa de mortalidad operatoria fue 1,8%. Los porcentajes de mortalidad de los hospitales estratificados por el volumen quirúrgico anual variaron entre 1,4 y 2,0%. En el análisis de regresión multinivel, el sexo masculino (OR 1,623 [1,143; 2,348]; p < 0,008), la edad avanzada (OR 5,811 [3,479; 10,087)]; p < 0,001) y la puntuación del ASA (OR 10,046 [3,390; 43,185]; p < 0,001) se asociaron con la mortalidad a los 30 días de la operación. Sin embargo, el volumen quirúrgico anual del hospital no se asoció con la mortalidad (OR 1,309 [0,483; 4,238]; p = 0,619). Además, se observó una variación significativa de la mortalidad entre los hospitales (MOR 1,588 [1,293; 2,015]; p < 0,001). CONCLUSIÓN:La mortalidad operatoria varía de forma estadísticamente significativa entre los hospitales incluidos en el proyecto, y esta diferencia no se puede atribuir al volumen quirúrgico anual

OBJECTIVE: This multicentre observational study examines variation between hospitals in postoperative mortality after elective surgery in the Rectal Cancer Project of the Spanish Society of Surgeons and explores whether hospital volume and patient characteristics contribute to any variation between hospitals. METHODS: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all rectal adenocarcinomas operated by an anterior resection or an abdominoperineal excision at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, tumour location and stage, administration of neoadjuvant treatment, and annual volume of surgical procedures. RESULTS: A total of 9809 consecutive patients were included. The rate of 30-day postoperative mortality was 1.8% Stratified by annual surgical volume hospitals varied from 1.4 to 2.0 in 30-day mortality. In the multilevel regression analysis, male gender (OR 1.623 [1.143; 2.348]; P < .008), increased age (OR: 5.811 [3.479; 10.087]; P < .001), and ASA score (OR 10.046 [3.390; 43.185]; P < .001) were associated with 30-day mortality. However, annual surgical volume was not associated with mortality (OR 1.309 [0.483; 4.238]; P = .619). Besides, there was a statistically significant variation in mortality between all departments (MOR 1.588 [1.293; 2.015]; P < .001). CONCLUSION: Postoperative mortality varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume

Hospital variability in postoperative mortality after rectal cancer surgery in the Spanish Association of Surgeons project: The impact of hospital volume.

OBJECTIVE: This multicentre observational study examines variation between hospitals in postoperative mortality after elective surgery in the Rectal Cancer Project of the Spanish Society of Surgeons and explores whether hospital volume and patient characteristics contribute to any variation between hospitals. METHODS: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all rectal adenocarcinomas operated by an anterior resection or an abdominoperineal excision at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, tumour location and stage, administration of neoadjuvant treatment, and annual volume of surgical procedures. RESULTS: A total of 9809 consecutive patients were included. The rate of 30-day postoperative mortality was 1.8% Stratified by annual surgical volume hospitals varied from 1.4 to 2.0 in 30-day mortality. In the multilevel regression analysis, male gender (OR 1.623 [1.143; 2.348]; P<.008), increased age (OR: 5.811 [3.479; 10.087]; P<.001), and ASA score (OR 10.046 [3.390; 43.185]; P<.001) were associated with 30-day mortality. However, annual surgical volume was not associated with mortality (OR 1.309 [0.483; 4.238]; P=.619). Besides, there was a statistically significant variation in mortality between all departments (MOR 1.588 [1.293; 2.015]; P<.001). CONCLUSION: Postoperative mortality varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.

Multicenter study of outcome in relation to the type of resection in rectal cancer.

BACKGROUND: A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer. OBJECTIVE: The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection. DESIGN: This was an observational study. SETTINGS: The study took place throughout the network of hospitals that compose the National Health Service in Spain. PATIENTS: This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed. MAIN OUTCOME MEASURES: Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed. RESULTS: After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571-1.563; p = 0.825). LIMITATIONS: The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project. CONCLUSIONS: Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.

Comparative study of one-stage colectomy of the descending colon in emergency and elective surgery without mechanical preparation.

PURPOSE: The aim of this study was to compare one-stage colectomy of the descending colon without mechanical preparation in emergency and elective surgery. METHODS: From January 2004 to September 2009, 327 consecutive patients underwent surgery in a coloproctology unit for several conditions of the descending colon, 122 on an emergency basis and 205 as elective surgery. In the emergency surgery group, patients with septic shock, multiorgan failure, immunodeficiency or corticoid treatment, ASA IV stage, generalized fecal peritonitis (Hinchey IV stage), nonviable cecum or unresectable tumors were excluded (n = 54). In the elective surgery group, patients who underwent intraoperative colonoscopy, total abdominal colectomy, or an ostomy were excluded (n = 59). In the remaining 214 patients, a colectomy of the descending colon with primary colorectal anastomosis was performed without mechanical bowel preparation, 68 in emergency surgery and 146 in elective surgery. The end points of the study were mortality, anastomotic dehiscence, and surgical site infection. RESULTS: No differences were found in mortality (0 in the emergency group vs 3 (2%) in the elective group; P = .571), symptomatic anastomotic dehiscence (1 in the emergency group (1.4%) vs 4 in the elective group (2.7%); P = 1.000), or surgical site infection (7 (10.2%) in the emergency group vs 8 (5.4%) in the elective group; P = .250). CONCLUSIONS: In emergencies involving the descending colon one-stage surgery may be performed without colonic preparation as safely as elective surgery in selected patients considered suitable for segmental resection of the descending colon and primary anastomosis.

[Incidence of psychiatric disorders in patients with fecal incontinence]. / Incidencia de problemas psiquiátricos en pacientes con incontinencia fecal.

OBJECTIVE: To evaluate the presence of psychiatric alterations in patients with fecal incontinence. PATIENTS AND METHOD: Eighty consecutive patients (67 women) with fecal incontinence were evaluated. All the patients completed the the specific GHQ-28 questionnaire to evaluate psychiatric symptoms. The questionnaire had previously been validated in the Spanish language. A score equal to or higher than 6 points was considered to indicate pathology. Incontinence was evaluated by the Cleveland Clinic Florida-Fecal Incontinence severity score (range 0 - 20). Psychiatric antecedents prior to fecal incontinence were recorded. RESULTS: Thirty-two patients (40%) had pathological scores on the GHQ-28 questionnaire (mean 13.59, range: 7-26). The mean Cleveland score was 11.52 (range: 2-20). Patients with pathological GHQ-28 scores had higher fecal incontinence scores (14.28 vs 9.68; p < 0.0001). A significant lineal correlation was found between GHQ-28 scores and the severity of fecal incontinence (p < 0.0001). Psychiatric antecedents were found in 17 patients (21.3%). In these patients no correlation was found between GHQ-28 score and the severity of incontinence. In the subgroup of patients without psychiatric antecedents this correlation was maintained (p < 0.003). Of these, 20 (31.7%) had pathologic scores on the GHQ-28, and the mean incontinence severity score was significantly higher than that of those with a normal GHQ-28 score (13.15 vs. 9.25; p < 0.004). CONCLUSIONS: The prevalence of psychiatric alterations is high in patients with fecal incontinence and is correlated with its severity. Patients with psychiatric antecedents can bias evaluation of the association between psychiatric alterations and the severity of fecal incontinence.

Incidencia de problemas psiquiátricos en pacientes con incontinencia fecal / Incidence of psychiatric disorders in patients with fecal incontinence

Objetivo. Valorar la presencia de alteraciones psiquiátricas en las personas con incontinencia fecal. Pacientes y método. Ochenta pacientes (67 mujeres) diagnosticados de incontinencia fecal. Todos cumplimentaron el cuestionario específico GHQ-28, validado en lengua española para evaluación de alteraciones psiquiátricas; es patológica una puntuación igual o superior a 6. La gravedad de la incontinencia se evaluó con la escala de la Cleveland Clinic-Florida (rango, 0-20). Se recogieron los antecedentes psiquiátricos anteriores a su incontinencia fecal. Resultados. Treinta y dos pacientes (40%) presentaban puntuaciones patológicas en el cuestionario GHQ-28 (media, 13,59; rango, 7-26). La media de gravedad de la incontinencia ha sido de 11,52 puntos (rango, 2-20). Los pacientes con puntuaciones patológicas en el cuestionario GHQ-28 tenían puntuaciones mayores en la escala de gravedad de incontinencia (14,28 frente a 9,68; p < 0,0001). Se ha encontrado una correlación lineal significativa (p < 0,0001) entre las puntuaciones del GHQ-28 y la gravedad de la incontinencia fecal. Presentaban antecedentes psiquiátricos 17 pacientes (21,3%) en los que se pierde la correlación entre la puntuación del GHQ-28 y la gravedad de la incontinencia. En el subgrupo sin antecedentes se mantiene esta correlación (p < 0,003). De ellos, 20 (31,7%) presentaban puntuaciones patológicas del GHQ-28, con una media de gravedad de la incontinencia significativamente superior a aquellos con puntuación normal (13,15 frente a 9,25; p < 0,004). Conclusiones. La presencia de alteraciones psiquiátricas es alta en los pacientes con incontinencia, y tiene correlación con la gravedad de la incontinencia. Los antecedentes psiquiátricos pueden sesgar la valoración de los pacientes con incontinencia fecal (AU)

Objective. To evaluate the presence of psychiatric alterations in patients with fecal incontinence. Patients and method. Eighty consecutive patients (67 women) with fecal incontinence were evaluated. All the patients completed the the specific GHQ-28 questionnaire to evaluate psychiatric symptoms. The questionnaire had previously been validated in the Spanish language. A score equal to or higher than 6 points was considered to indicate pathology. Incontinence was evaluated by the Cleveland Clinic Florida-Fecal Incontinence severity score (range 0 - 20). Psychiatric antecedents prior to fecal incontinence were recorded. Results. Thirty-two patients (40%) had pathological scores on the GHQ-28 questionnaire (mean 13.59, range: 7-26). The mean Cleveland score was 11.52 (range: 2-20). Patients with pathological GHQ-28 scores had higher fecal incontinence scores (14.28 vs 9.68; p < 0.0001). A significant lineal correlation was found between GHQ-28 scores and the severity of fecal incontinence (p < 0.0001). Psychiatric antecedents were found in 17 patients (21.3%). In these patients no correlation was found between GHQ-28 score and the severity of incontinence. In the subgroup of patients without psychiatric antecedents this correlation was maintained (p < 0.003). Of these, 20 (31.7%) had pathologic scores on the GHQ-28, and the mean incontinence severity score was significantly higher than that of those with a normal GHQ-28 score (13.15 vs. 9.25; p < 0.004). Conclusions. The prevalence of psychiatric alterations is high in patients with fecal incontinence and is correlated with its severity. Patients with psychiatric antecedents can bias evaluation of the association between psychiatric alterations and the severity of fecal incontinence (AU)

[Introduction of laparoscopy in the treatment of rectal cancer in a coloproctology unit]. / Introducción de la laparoscopia en el tratamiento del cáncer de recto en una unidad de coloproctología.

INTRODUCTION: The application of the laparoscopic approach to the treatment of rectal cancer is controversial. The aim of the present study was to evaluate whether the introduction of this technique in a coloproctology unit modified the quality of rectal cancer surgery. MATERIAL AND METHOD: We performed a prospective, nonrandomized study of all patients with rectal cancer who underwent surgery with curative intent in 2003 and 2004. Patients with stage T4 tumors were excluded. Of the 59 patients included, 33 underwent laparoscopic surgery and 26 underwent open surgery. A series of intraoperative and postoperative variables and characteristics of the surgical specimen were compared between the two groups. RESULTS: No differences were found between the two groups in the type of intervention performed or in the rate of sphincter preservation. Overall morbidity was 39% in the laparoscopic group and 34% in the open surgery group (NS). Anastomotic dehiscence was 9.5% and 5.8% respectively (NS). The length of hospital stay was similar in both groups. The distal margin was adequate in all patients. The circumferential resection margin was positive (< 1 mm) in 10.7% of patients in the laparoscopic group who underwent total mesorectal excision and in 13.6% of those in the open surgery group (NS). The mean number of isolated nodes was 12.5 in the laparoscopic group and 15.5 in the open surgery group (NS). CONCLUSION: The introduction of the laparoscopic approach in the treatment of rectal cancer in our unit has not lowered surgical quality, as measured by clinical and histopathological variables.

Introducción de la laparoscopia en el tratamiento del cáncer de recto en una unidad de coloproctología / Introduction of laparoscopy in the treatment of rectal cancer in acoloproctology unit

Objetivo. La aplicación de la vía laparoscópica al tratamiento del cáncer de recto es un tema controvertido. El objetivo de este trabajo ha sido valorar si la introducción de esta técnica en una unidad de coloproctología ha supuesto alguna merma en la calidad de la cirugía del cáncer de recto. Material y método. Estudio prospectivo no aleatorizado que ha incluido a todos los pacientes con neoplasia de recto intervenidos con intención curativa en los años 2003 y 2004, excluyendo los tumores estadiados preoperatoriamente como T4. De los 59 pacientes incluidos, se intervino por vía laparoscópica a 33 y por vía abierta a 26. En estos 2 grupos de pacientes se ha estudiado comparativamente una serie de variables intraoperatorias, postoperatorias y de la pieza quirúrgica. Resultados. No hubo diferencias entre los 2 grupos en el tipo de intervención practicada ni en la tasa de preservación esfinteriana. La morbilidad global fue del 39% en el grupo de cirugía laparoscópica y del 34% en el grupo de cirugía abierta, sin diferencias significativas. La dehiscencia anastomótica fue del 9,5 y el 5,8%, respectivamente, sin diferencias significativas. Las estancias hospitalarias fueron similares. El margen distal fue adecuado en todos los casos. El margen de resección circunferencial fue positivo (< 1 mm) en el 10,7% de los pacientes del grupo laparoscópico sometidos a exéresis total del mesorrecto y en el 13,6% de los del grupo abierto, sin diferencias significativas. La media de ganglios aislados fue de 12,5 en el grupo de cirugía laparoscópica y de 15,5 en el grupo de cirugía abierta, sin diferencias significativas. Conclusiones. La introducción en nuestra unidad de la vía laparoscópica para el tratamiento del cáncer de recto no ha supuesto un detrimento en la calidad de la cirugía, medida ésta por parámetros clínicos y anatomopatológicos (AU)

Introduction. The application of the laparoscopic approach to the treatment of rectal cancer is controversial. The aim of the present study was to evaluate whether the introduction of this technique in a coloproctology unit modified the quality of rectal cancer surgery. Material and method. We performed a prospective, nonrandomized study of all patients with rectal cancer who underwent surgery with curative intent in 2003 and 2004. Patients with stage T4 tumors were excluded. Of the 59 patients included, 33 underwent laparoscopic surgery and 26 underwent open surgery. A series of intraoperative and postoperative variables and characteristics of the surgical specimen were compared between the two groups. Results. No differences were found between the two groups in the type of intervention performed or in the rate of sphincter preservation. Overall morbidity was 39% in the laparoscopic group and 34% in the open surgery group (NS). Anastomotic dehiscence was 9.5% and 5.8% respectively (NS). The length of hospital stay was similar in both groups. The distal margin was adequate in all patients. The circumferential resection margin was positive (< 1 mm) in 10.7% of patients in the laparoscopic group who underwent total mesorectal excision and in 13.6% of those in the open surgery group (NS). The mean number of isolated nodes was 12.5 in the laparoscopic group and 15.5 in the open surgery group (NS). Conclusion. The introduction of the laparoscopic approach in the treatment of rectal cancer in our unit has not lowered surgical quality, as measured by clinical and histopathological variables (AU)

Tratamiento quirúrgico de las hemorroides / The surgical treatment of hemorrhoids

El tratamiento quirúrgico de las hemorroides está indicado en aquellas de grados III-IV, sintomáticas, que no han respondido al tratamiento conservador, ante una enfermedad asociada (fisura, fístula, colgajos cutáneos grandes) y en la trombosis hemorroidal. La hemorroidectomía sigue siendo el patrón oro. Los estudios aleatorizados no muestran ventajas de la técnica cerrada con relación a la abierta para reducir el dolor. La hemorroidopexia grapada produce menos dolor postoperatorio con relación a la hemorroidectomía, pero es menos eficaz para resolver los síntomas asociados a las hemorroides. Ningún procedimiento ha demostrado ventajas en reducir el dolor postoperatorio, salvo el uso de fármacos o técnicas anestésicas. En las hemorroides internas prolapsadas y trombosadas se puede realizar una hemorroidectomía de urgencia con los mismos resultados que con la cirugía electiva (AU)

Surgery is the most effective treatment in patients with symptomatic grade III-IV hemorrhoids who have not responded to outpatient treatment, when there is associated abnormalities (anal fissure, anal fistula, skin tags) and in thrombosed hemorrhoids. Hemorrhoidectomy is currently the "gold standard" treatment. Randomized controlled trials comparing open with closed hemorrhoidectomy show no significant differences in pain scores. Stapled hemorrhoidectomy produces less postoperative pain than hemorrhoidectomy but is less effective in terms of symptom control. No treatment is superior to others in reducing postoperative pain except the use of drugs and anesthetic techniques. In patients with prolapsed internal hemorrhoids and thrombosed hemorrhoids, treatment may initially consist of an urgent hemorrhoidectomy with the same results as those obtained with elective surgery (AU)

[The surgical treatment of hemorrhoids]. / Tratamiento quirúrgico de las hemorroides.

Surgery is the most effective treatment in patients with symptomatic grade III-IV hemorrhoids who have not responded to outpatient treatment, when there is associated abnormalities (anal fissure, anal fistula, skin tags) and in thrombosed hemorrhoids. Hemorrhoidectomy is currently the "gold standard" treatment. Randomized controlled trials comparing open with closed hemorrhoidectomy show no significant differences in pain scores. Stapled hemorrhoidectomy produces less postoperative pain than hemorrhoidectomy but is less effective in terms of symptom control. No treatment is superior to others in reducing postoperative pain except the use of drugs and anesthetic techniques. In patients with prolapsed internal hemorrhoids and thrombosed hemorrhoids, treatment may initially consist of an urgent hemorrhoidectomy with the same results as those obtained with elective surgery.

Estudio prospectivo de las complicaciones de la cirugía de la hernia en función de la edad de los pacientes / Prospective study of complications of hernia repair according to patient age

Objetivo. Valorar si el tratamiento quirúrgico electivo de la hernia inguinal en pacientes mayores de 75 años tiene unos resultados similares al observado en personas más jóvenes en términos de mortalidad y morbilidad. Material y método. Estudio prospectivo en 299 pacientes intervenidos de forma electiva durante 2002 por hernia inguinal unilateral no complicada; 54 pacientes (grupo 1) eran mayores de 75 años y 245 pacientes (grupo 2), menores de esta edad. Las variables registradas fueron: tipo de hernia, porcentaje de hernias primarias y recidivadas, tipo de anestesia, técnica de reparación, índice de sustitución en cirugía mayor ambulatoria y complicaciones postoperatorias. Resultados. Aunque el riesgo anestésico fue significativamente mayor en el grupo 1 (el 88,8 por ciento de pacientes ASA III frente al 6,9 por ciento; p < 0,0005), no hubo diferencias significativas entre ambos grupos en la morbimortalidad registrada (mortalidad: 0; complicaciones postoperatorias: 3,7 frente al 1,6 por ciento). Conclusión. Los resultados de la hernioplastia sin tensión son satisfactorios con independencia de la edad de los pacientes (AU)

Tratamiento de la hernia inguinocrural. Resultados comparativos entre una unidad de pared abdominal y un servicio de cirugía general / Treatment of inguinocrural hernia. Comparative results between an abdominal wall unit and a general surgery department

Introducción. La hernia inguinocrural es una de las afecciones más frecuentes en un servicio de cirugía general. Los mejores resultados obtenidos por cirujanos con especial interés en esta enfermedad han abierto el debate sobre si es necesaria o no una dedicación especial a esta cirugía. El objetivo de este trabajo ha sido comparar los resultados obtenidos por dos grupos de cirujanos en un servicio de cirugía general. Pacientes y método. Entre enero del año 2000 a diciembre del 2001 fueron intervenidos 755 pacientes diagnosticados de hernia inguinocrural unilateral no complicada. De ellos, 508 pacientes fueron intervenidos por dos cirujanos del servicio con dedicación especial a esta cirugía (grupo I) y el resto, 247 pacientes, fueron tratados por los restantes cirujanos del servicio (grupo II). Ambos grupos de pacientes fueron homogéneos en cuanto a edad, sexo, tipo de hernia y riesgo anestésico. Resultados. En el grupo I se utilizó profilaxis antibiótica en el 22 por ciento de los pacientes, mientras que en el grupo II se empleó en todos (p < 0,05). El 72 por ciento de los pacientes del grupo I fueron intervenidos con anestesia local y sedación, mientras que en el grupo II sólo se utilizaron en el 2 por ciento de las operaciones (p < 0,01). El 75 por ciento de los pacientes del grupo I fue intervenido en régimen ambulatorio, en el grupo II ningún paciente fue intervenido de forma ambulatoria (p < 0,01). La morbilidad del grupo I, del 1,7 por ciento, fue significativamente menor que la del grupo II, del 11,7 por ciento (p < 0,01).Conclusión. Es conveniente establecer, en los servicios de cirugía, unidades o grupos de cirujanos interesados en una enfermedad tan frecuente con el fin de mejorar los resultados (AU)

Profilaxis antibiótica en la hernioplastia inguinal / Antibiotic prophylaxis in inguinal hernioplasty

Introducción. Evaluar la necesidad de profilaxis antibiótica en el tratamiento de la hernia inguinal con material protésico. Material y método. Estudio prospectivo y aleatorizado en 250 pacientes intervenidos de forma electiva por hernia inguinal unilateral no complicada. En todos ellos se realizó una hernioplastia sin tensión utilizando malla de polipropileno. En 125 pacientes se realizó profilaxis antibiótica con 2 g de amoxicilinaácido clavulánico, administrada entre 15 y 30 min antes de comenzar la cirugía. Los restantes 125 pacientes no recibieron ninguna profilaxis. Los 2 grupos fueron homogéneos respecto a la edad, el sexo, el riesgo anestésico ASA, el tipo de anestesia bajo la que se realizó la cirugía, el tipo de hernia, el tiempo quirúrgico y el índice de sustitución en cirugía mayor ambulatoria. Resultados. Sólo se registró un caso de infección de herida quirúrgica que ocurrió en el grupo de pacientes con profilaxis antibiótica. La infección se curó tras drenaje y tratamiento antibiótico, y no fue preciso retirar la malla. No se observaron otras complicaciones infecciosas. Conclusiones. La tasa de infección de herida quirúrgica en la cirugía de la hernia inguinal no complicada es muy baja, y el uso de profilaxis antibiótica no parece mejorarla (AU)

Rotura pancreática aislada diagnosticada por TC en un traumatismo cerrado / Isolated blunt pancreatic rupture diagnosed by computerized axial tomography

La tomografía computarizada (TC) es el método de elección en el diagnóstico por la imagen de los pacientes hemodinámicamente estables con traumatismo abdominal cerrado. A diferencia de otras lesiones, la rotura pancreática puede ser difícil de diagnosticar mediante TC. Hasta en el 40 por ciento de los pacientes con lesión pancreática comprobada quirúrgicamente, la TC realizada puede ser normal. Presentamos un caso de rotura pancreática con sección del conducto principal que fue diagnosticada por TC. Se describe el papel de diferentes pruebas de laboratorio y de las técnicas de diagnóstico por la imagen en el planteamiento terapéutico del paciente con una lesión pancreática secundaria a un traumatismo abdominal cerrado (AU)