Pathologic stage of ypT0N+ rectal cancers following neo-adjuvant treatment: clinical interpretation of an orphan status.

Approximately 20% of locally advanced rectal cancers treated with neoadjuvant therapy achieve a pathologic complete response, but approximately 10% of them present residual nodal metastases (ypT0N+). We aimed this research to compare the survival rates of ypT0/ypTisN+ and stage 3a rectal cancer patients. A large multicenter study recently investigated ypT0/ypTis rectal cancers treated between 2005 and 2015 in Italy and Spain. ypT0/ypTisN+ were selected and compared with stage 3a rectal cancers treated at the same institutions with upfront surgery (ySICO group). Additionally, the SEER database was searched for patients with stage 3a rectal cancers treated with surgery in the same years. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were analyzed using Kaplan-Meier curves and random survival forest analysis (RSF). The ySICO study population consisted of 19 ypT0/2ypTisN+ (mean follow-up 41.8 months) and 72 Stage 3a patients (mean follow-up 56.9 months). These subgroups were comparable, but stage 3a patients were treated more frequently with adjuvant therapy (90.5% vs 61.9%, p 0.0001). No significant differences were reported between the ySICO subgroups for the OS, DFS, and DSS curves. When the 1213 SEER patients were added to Stage 3a, the RFS model failed to differentiate OS between groups that presented identical survival. Root analysis showed that adjuvant therapy was the only variable differentiating OS and DSS in the ySICO population. These findings suggest that ypT0/ypTisN+ and stage 3a rectal cancers could be ranked together based on their similar outcomes and pathologic assessment, and they stress the importance of adjuvant therapy in patients presenting with residual nodal metastases.

Ischaemic conditioning of the stomach previous to esophageal surgery.

A gastric conduit is most frequently used for reconstruction in oesophageal surgery, and ischemia of the conduit is the most fragile aspect of the esophagogastric anastomosis with as consequence the anastomotic leakage. In order to avoid it, the concept of ischaemic conditioning of the stomach previous to surgery has been designed. The basis of ischemic conditioning is that interrupting vascularization of the stomach before making the anastomosis eases the gastric fundus adaptation to ischemic conditions. It consists of the interruption of the principal feeding arteries of the stomach (except the right gastroepiploic artery) weeks before esophagectomy. Previously published literature contemplates two different techniques: angiographic embolization or laparoscopic ligation or division of vessels. In this study, the anatomic and physio-pathologic background of ischemic preconditioning is described and the published current evidence is reviewed.

Predictors of hernia recurrence after Rives-Stoppa repair in the treatment of incisional hernias: a retrospective cohort.

BACKGROUND: Rives-Stoppa retromuscular repair (RSR) has been traditionally used to provide adequate coverage for large abdominal wall defects and appears to be more advantageous compared to other surgical techniques concerning complications and recurrence rates. The aim of this study was to identify the independent predictors associated to hernia recurrence after RSR in the treatment of incisional hernias. METHODS: This is a retrospective observational study of 213 patients who underwent RSR between June 2007 and January 2014 at a tertiary centre. Main inclusion criteria were adults with midline hernia classified as M1, M2, M3, M4, or M5, according to EHS classification. All the cases presented a transverse hernia defect measurement greater than 5 cm (grades W2 and W3). Recurrence rate was determined by clinical examination plus confirmation by abdominal CT scan. RESULTS: At a median of 57.6 months (range 46-75 months) of postoperative follow-up, we reported 15 cases of recurrence (7.1%). Recurrences occurred after a mean period of 19.4 months (range 2-49 months). On multivariate analysis, steroid or immunosuppressive drugs use (OR 2.02; CI 1.16-3.95, p = 0.004), the development of postoperative hematoma (OR 2.9; CI 1.55-4.10, p = 0.001), and needing surgery for the hematoma (OR 2.1; CI 1.21-3.29, p = 0.004) were predictors of recurrence after RSR. There was no significant difference in recurrence rate among obesity, smoking, urgent repair, type of mesh fixation, operative time, type of prosthesis, or concomitant procedures. CONCLUSIONS: In our current study, using immunosuppressive drugs, the development of postoperative hematoma and needing surgery for the hematoma were associated with increased risk of hernia recurrence after RSR.

Recidiva local del cáncer de mama tras reconstrucción con injerto autólogo / Local recurrence of breast cancer after autologous graft reconstruction

Las recurrencias ipsilaterales de cáncer de mama tras realización de cirugía radical y reconstrucción posterior, son poco frecuentes. El propósito de este estudio es examinar su incidencia y los factores asociados en las pacientes sometidas a mastectomía y reconstrucción con colgajo autólogo por carcinoma invasivo, tras revisar nuestra serie de pacientes mastectomizadas por cáncer de mama con reconstrucción con colgajo autólogo en los últimos 10 años (AU9

Ipsilateral recurrence of breast cancer after radical surgery and subsequent reconstruction is rare. The aim of this study was to analyse its incidence and associated factors in patients undergoing mastectomy and autologous graft reconstruction for invasive carcinoma, after analysing our series of patients undergoing these procedures in the last 10 years (AU)

Breast dermatofibrosarcoma. Case report / Dermatofibrosarcoma protuberans de mama: a propósito de un caso

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Preoperative preparation of «loss of domain¼ hernia. Progressive pneumoperitoneum and botulinum toxin type A. / Preparación preoperatoria de la hernia con pérdida de domicilio. Neumoperitoneo progresivo y toxina botulínica tipo A.

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias.

Preparación preoperatoria de la hernia con pérdida de domicilio. Neumoperitoneo progresivo y toxina botulínica tipo A / Preoperative preparation of «loss of domain» hernia. Progressive pneumoperitoneum and botulinum toxin type A

El neumoperitoneo progresivo preoperatorio y la toxina botulínica tipo A son herramientas útiles en la preparación de los pacientes con hernias gigantes que han perdido el domicilio. Ambos procedimientos son armas complementarias del procedimiento quirúrgico, especialmente con el uso de técnicas protésicas sin tensión, que permiten el manejo integral de estos pacientes. Este artículo tiene por objeto actualizar conceptos relacionados con ambos procedimientos, incidiendo en las ventajas que aportan en el manejo preoperatorio de las hernias gigantes que han perdido el domicilio (AU)

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias (AU)