Rendimiento del stent en el manejo de la obstrucción intestinal por cáncer de colon izquierdo. Estudio ambispectivo y unicéntrico / Stent performance in obstructive left colon cancer. Unicentric and cross-sectional study

Objetivo: Evaluar la eficacia, seguridad y resultados clínicos y oncológicos del stent colónico en la estrategia terapéutica inicial de la obstrucción intestinal por cáncer de colon izquierdo. Métodos: Estudio descriptivo y ambispectivo (2008-2018) de pacientes con diagnóstico clínico y radiológico de obstrucción neoplásica de colon izquierdo en los que se indicó colocación de stent, analizando los grupos de stent paliativo, stent como puente a cirugía y cirugía urgente por fallo o complicaciones del stent. Resultados: El estudio incluyó a 208 pacientes. La tasa de éxito técnico y clínico fue del 82,2 y del 74,5%, respectivamente, con perforación asociada en el 4,3% de la muestra. En el 32,2% el stent se comportó como puente a cirugía, mientras que el 28,4% de los pacientes precisaron intervención quirúrgica urgente. En el 39,4% el stent fue colocado con intención paliativa. La proporción de cirugía laparoscópica, resección oncológica, anastomosis primaria y ganglios obtenidos fue superior en los pacientes intervenidos mediante cirugía electiva frente a la urgente, con menor estancia postoperatoria y orbimortalidad postoperatoria grave. Los pacientes en estadio II-III con resección tumoral oncológica intervenidos de forma programada presentaron mayor supervivencia que aquellos intervenidos de urgencia (p = 0,001). Conclusiones: El tratamiento de la oclusión neoplásica de colon izquierdo mediante stent supone una estrategia eficaz para operar de forma electiva un número importante de pacientes y evita la colostomía en pacientes paliativos, aunque las complicaciones o el fracaso de la técnica conllevan cirugía urgente en casi un tercio de los pacientes

Objective: To evaluate the efficacy, safety and clinical and oncological results of colonic stents in the initial therapeutic strategy of obstructive left colon cancer. Methods: Descriptive and ambispective study (2008-2018) of patients with clinical and radiological diagnosis of neoplastic obstruction of the left colon in whom a colonic stent was indicated, analyzing the following groups: palliative stent, stent as bridge to surgery and urgent surgery in case of stent failure or complications. Results: The study included 208 patients. The technical and clinical success rates were 82.2% and 74.5%, respectively, with associated perforation in 4.3% of the sample. In 32.2%, the stent was placed as bridge to surgery, while 28.4% required urgent surgical intervention. The stent was placed with palliative intent in 39.4%. The proportion of laparoscopic surgery, oncological resection, primary anastomosis and lymph nodes resected were higher in patients undergoing elective surgery than in urgent surgery, with shorter postoperative stay and less severe postoperative morbidity and mortality. Stage II-III patients with oncological tumor resection who underwent elective surgery had increased survival compared to those who underwent urgent surgery (P = 0.001). Conclusions: Initial treatment of neoplastic obstruction of the left colon with a stent is an effective strategy in elective surgery and avoids permanent colostomy in palliative patients, although complications or stent failure lead to urgent surgery in almost one-third of patients

Stent performance in obstructive left colon cancer. Unicentric and cross-sectional study. / Rendimiento del stent en el manejo de la obstrucción intestinal por cáncer de colon izquierdo. Estudio ambispectivo y unicéntrico.

OBJECTIVE: To evaluate the efficacy, safety and clinical and oncological results of colonic stents in the initial therapeutic strategy of obstructive left colon cancer. METHODS: Descriptive and ambispective study (2008-2018) of patients with clinical and radiological diagnosis of neoplastic obstruction of the left colon in whom a colonic stent was indicated, analyzing the following groups: palliative stent, stent as bridge to surgery and urgent surgery in case of stent failure or complications. RESULTS: The study included 208 patients. The technical and clinical success rates were 82.2% and 74.5%, respectively, with associated perforation in 4.3% of the sample. In 32.2%, the stent was placed as bridge to surgery, while 28.4% required urgent surgical intervention. The stent was placed with palliative intent in 39.4%. The proportion of laparoscopic surgery, oncological resection, primary anastomosis and lymph nodes resected were higher in patients undergoing elective surgery than in urgent surgery, with shorter postoperative stay and less severe postoperative morbidity and mortality. Stage II-III patients with oncological tumor resection who underwent elective surgery had increased survival compared to those who underwent urgent surgery (P=0.001). CONCLUSIONS: Initial treatment of neoplastic obstruction of the left colon with a stent is an effective strategy in elective surgery and avoids permanent colostomy in palliative patients, although complications or stent failure lead to urgent surgery in almost one-third of patients.

Traumatismo abdominal en un hospital de tercer nivel. Análisis de resultados, consideraciones terapéuticas y evaluación con índices pronóstico / Abdominal injuries treated in a referral hospital: analysis of outcomes, treatment approaches, and prognostic scales

Objetivo. Conocer la epidemiología y distribución de los traumatismos abdominales en nuestro medio. Evaluar el comportamiento y fiabilidad de la aplicación de índices pronósticos de gravedad analizando su correlación con las decisiones terapéuticas y los resultados obtenidos Método. Estudio retrospectivo en el que se han incluido todos los pacientes con diagnóstico de traumatismo abdominal grave ingresados en un hospital español de referencia, entre 2009 y 2015. Se registraron variables epidemiológicas, clínicas y de resultados, así como la puntuación de distintos índices pronósticos. Resultados. Muestra 153 pacientes, con mediana de edad de 38 años y predominio masculino (73,9%). Correspondieron a traumatismos de tipo cerrado (94,1%) y su etiología principal los accidentes de tráfico (60,1%). El bazo fue el órgano más frecuentemente afectado (44,4%), seguido por el hígado (36,6%). La mediana de la estancia hospitalaria fue de 11 días y la mortalidad global de 13%. Aunque el 62,7% se manejó con éxito de forma conservadora, se observó una mayor puntuación de Injury Severity Score (ISS) y Trauma and Injury Severity Score (TRISS) en aquellos pacientes que precisaron tratamiento quirúrgico (p = 0,0001), en los que fallecieron (p = 0,0001) y en aquellos con mayor estancia hospitalaria (RTS -Reevised Trauma Score- p = 0,001 y TRISS p = 0,016). Conclusiones. La etiología de los traumatismos abdominales y los balances lesionales en nuestro medio fueron similares a los observados a nivel nacional. La puntuación en las escalas estudiadas tuvo una asociación directa con la necesidad de tratamiento quirúrgico, los días de estancia hospitalaria, la morbilidad y la mortalidad

Objectives. To describe the abdominal injuries treated in our hospital. We assessed the behavior and reliability of prognostic scales, analyzing the correlations between them and therapeutic decisions and outcomes. Methods. Retrospective study including all patients with major abdominal injuries admitted to our hospital between 2009 and 2015. We gathered epidemiologic and clinical data, outcomes, and scores on several prognostic scales. Results. The median age of the 153 patients we identified from case records was 38 years; 73.9% were males. Most cases involved blunt trauma (94.1%) sustained in traffic accidents (60.1%). The spleen and the liver were the organs most often affected (in 44.4% and 36.6%, respectively). The median length of stay in the hospital was 11 days, and overall mortality was 13%. Although conservative management was successful in 62.7% of the cases, we found that patients who had a higher ISS (Injury Severity Score) or TRISS (Trauma and Injury Severity Score) assessments more often required surgery or died (P=.0001, both comparisons). Those who had longer hospital stays had a higher Revised Trauma Score or TRISS (P=.001 and P=.016, respectively). Conclusions. The causes of abdominal injuries and the types treated in our hospital were similar to those described for the rest of Spain. Punctuation on prognostic severity scales correlated directly with the need for surgery, length of hospital stay, complications, and mortality