Results of colon cancer surgery in patients over 75 years old.

BACKGROUND: Colon cancer is the second most frequent cause of death in both genders. Survival has increased since 1980, although this increase has been lower in patients ≥75 years old. We analyzed the results of surgical treatment for this pathology in this group of patients. METHODS: This retrospective, observational and descriptive study analyzed data relating to 315 patients undergoing colon cancer surgery between January 2010 and December 2011. Surgical results (surgical procedure, mean postoperative stay, isolated lymph nodes, postoperative morbidity and mortality) were compared between patients who were <75 and ≥75 years old. RESULTS: Statistical significance was observed in the percentages of hypertension (P = 0.001), cardiovascular disease (P = 0.006) and bronchopathy (P = 0.005) for the older group. No differences were found between the groups regarding surgical results, except higher postoperative morbidity and mortality in the ≥75 years old age group (P = 0.02 and P = 0.03, respectively). In the multivariate analysis, the factors associated with postoperative morbidity were age and preoperative albumin levels (P < 0.05). Cancer-specific survival (CSS) was lower in older patients (P < 0.05). The multivariate analysis of survival determined that age and tumour stage are independent predictive factors (P = 0.004 and P = 0.039, respectively), unlike American Society of Anesthesiologists score. CONCLUSIONS: Age does not influence the surgical results after colon cancer resection but is associated with increased postoperative morbidity and mortality. CSS is lower in patients who are ≥75 years old.

Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding.

BACKGROUND: The incidence of presacral venous bleeding during rectal resection is low, but this complication can be severe and even lethal. Occasionally, the traditional methods - such as pelvic gauze packing and the use of metallic thumbtacks - are not effective. When combined with their complications and difficulties, these failures have resulted in numerous creative procedures with which to control this complication. In 1994, the indirect electrocoagulation method, which is performed via a fragment of the rectus abdominis muscle of the abdomen, was introduced to control presacral venous bleeding. METHODS: From January 2002 to December 2015, five of 872 patients with rectal cancer and one patient with rectal metastasis of gastric cancer developed presacral venous bleeding, and this technique was used in every case. RESULTS: Haemostasis was permanent in all cases. There were no complications such as infection or rebleeding. CONCLUSION: In our experience, indirect electrocoagulation via a fragment of the rectus abdominis muscle of the abdomen is a rapid, easily executed and effective method for controlling presacral venous bleeding during rectal resection.

Enfermedad diverticular complicada: toma de posición sobre tratamiento ambulatorio, intervención de Hartmann, lavado-drenaje peritoneal y cirugía laparoscópica. Documento de consenso de la Asociación Española de Coloproctología y Sección de Coloproctología de la Asociación Española de Cirujanos / Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons

Desde la Asociación Española de Coloproctología (AECP) y la Sección de Coloproctología de la Asociación Española de Cirujanos (AEC), se propone un documento de consenso sobre la enfermedad diverticular complicada que pueda ser de utilidad en la toma de decisiones. En él se expone, principalmente, la actualidad en el tratamiento ambulatorio, la intervención de Hartmann, el lavado laparoscópico peritoneal, así como el papel del abordaje laparoscópico en la resección colónica (AU)

The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed (AU)

Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons. / Enfermedad diverticular complicada: toma de posición sobre tratamiento ambulatorio, intervención de Hartmann, lavado-drenaje peritoneal y cirugía laparoscópica. Documento de consenso de la Asociación Española de Coloproctología y Sección de Coloproctología de la Asociación Española de Cirujanos.

The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed.

Presacral venous bleeding during mobilization in rectal cancer.

AIM: To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. METHODS: A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined. RESULTS: This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication. CONCLUSION: A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

Morbilidad y mortalidad de la ileostomía derivativa temporal en la cirugía por cáncer de recto / Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery

INTRODUCCIÓN: La ileostomía derivativa temporal es utilizada frecuentemente para disminuir las consecuencias de una dehiscencia anastomótica distal tras la escisión total del mesorrecto en la cirugía del cáncer rectal. Esta técnica quirúrgica está asociada a una alta morbilidad y a una mortalidad no despreciable. El objetivo de este estudio es evaluar la morbilidad y la mortalidad asociadas a la ileostomía y su posterior cierre. MATERIAL Y MÉTODOS: Entre 2001 y 2012 fueron analizados retrospectivamente 96 pacientes con ileostomía derivativa temporal. Se analizó la morbimortalidad tras la creación de la ileostomía y posteriormente al cierre de la misma, incluyendo como variables la edad, sexo, comorbilidades, tiempo transcurrido hasta la reconstrucción del tránsito y tratamiento adyuvante. RESULTADOS: El estoma fue permanente en 5 pacientes y 5 fueron exitus. La morbimortalidad relacionada con el estoma mientras este estuvo presente fue del 21 y 1% respectivamente. Se realizó el cierre del estoma en 86 pacientes y el 57% había recibido previamente adyuvancia. No hubo mortalidad postoperatoria tras el cierre y la morbilidad fue del 24%. El tiempo medio entre la cirugía inicial y la reconstrucción intestinal fue de 152,2 días. Este intervalo fue significativamente superior en los pacientes que recibieron adyuvancia. No se encontró significación estadísticamente significativa entre las variables analizadas y las complicaciones. CONCLUSIONES: La ileostomía está asociada a una baja mortalidad y a una morbilidad alta antes y después de su cierre. La quimioterapia adyuvante retrasa significativamente la reconstrucción intestinal, aunque en este estudio no ha influido en el índice de complicaciones

INTRODUCTION: A temporary diverting ileostomy is frequently used to reduce the consequences of a distal anastomotic leakage after total mesorectal excision in rectal cancer surgery. This surgical technique is associated with high morbidity and a not negligible mortality. The aim of this study is to evaluate the morbidity and mortality rate associated with an ileostomy and its posterior closure. MATERIAL AND METHODS: Between 2001 and 2012, 96 patients with temporary diverting ileostomy were retrospectively analyzed. Morbidity and mortality were analyzed before and after the stoma closure. The studied variables included age, sex, comorbidities, time to bowel continuity restoration and adjuvant chemotherapy. RESULTS: In 5 patients the stoma was permanent and another 5 died. The morbidity and mortality rates associated with the stoma while it was present were 21 and 1% respectively. We performed a stoma closure in 86 patients, 57% of whom had previously received adjuvant therapy. There was no postoperative mortality after closure and the morbidity rate was 24%. The average time between initial surgery and restoration of intestinal continuity was 152.2 days. This interval was significantly higher in patients who had received adjuvant therapy. No statistically significant difference was found between the variables analyzed and complications. CONCLUSIONS: Diverting ileostomy is associated with low mortality and high morbidity rates before and after closure. Adjuvant chemotherapy significantly delays bowel continuity restoration, although in this study did not influence in the rate of complications

Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery.

INTRODUCTION: A temporary diverting ileostomy is frequently used to reduce the consequences of a distal anastomotic leakage after total mesorectal excision in rectal cancer surgery. This surgical technique is associated with high morbidity and a not negligible mortality. The aim of this study is to evaluate the morbidity and mortality rate associated with an ileostomy and its posterior closure. MATERIAL AND METHODS: Between 2001 and 2012, 96 patients with temporary diverting ileostomy were retrospectively analyzed. Morbidity and mortality were analyzed before and after the stoma closure. The studied variables included age, sex, comorbidities, time to bowel continuity restoration and adjuvant chemotherapy. RESULTS: In 5 patients the stoma was permanent and another 5 died. The morbidity and mortality rates associated with the stoma while it was present were 21 and 1% respectively. We performed a stoma closure in 86 patients, 57% of whom had previously received adjuvant therapy. There was no postoperative mortality after closure and the morbidity rate was 24%. The average time between initial surgery and restoration of intestinal continuity was 152.2 days. This interval was significantly higher in patients who had received adjuvant therapy. No statistically significant difference was found between the variables analyzed and complications. CONCLUSIONS: Diverting ileostomy is associated with low mortality and high morbidity rates before and after closure. Adjuvant chemotherapy significantly delays bowel continuity restoration, although in this study did not influence in the rate of complications.

Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes / Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients

Introducción: Analizamos nuestra experiencia y los resultados obtenidos con el uso del vacuum assisted closure (VAC®, KCI Clinic Spain SL) en el manejo del abdomen abierto. Material y métodos Revisamos de forma retrospectiva las laparostomías realizadas entre junio de 2006 y marzo de 2011 usando la terapia VAC® en el Hospital Xeral-Cíes de Vigo. Resultados Incluimos a 23 pacientes consecutivos (18 varones y 5 mujeres) en los que se usó el VAC® en un abdomen abierto por distintas indicaciones (traumatismo abdominal, peritonitis, pancreatitis, patología isquémica o síndrome compartimental abdominal). El VAC® precisó recambio una media de 3,1 veces por paciente (1-7), con una duración total media de la terapia de 14,8 días (2-43) hasta el cierre, lográndose el cierre primario en 18 de 21 pacientes (86%). La estancia media hospitalaria fue de 110,1 días (8-163) y 6 pacientes (26%) fallecieron durante el ingreso por problemas relacionados con su proceso de base. Siete casos (30%) presentaron complicaciones durante la terapia VAC®: 3 abscesos intraabdominales (13%), 4 fístulas o dehiscencias de suturas (17%) y 1 evisceración (4%).Conclusiones La terapia VAC® es de manejo sencillo con una aceptable tasa de complicaciones, particularmente la de fístulas intestinales, y una mortalidad reducida. De los diversos sistemas disponibles para el cierre diferido de un abdomen, el VAC® supone un progreso considerable en estos últimos años gracias a su material adaptable y sus numerosas ventajas. Posiblemente su uso aumentará en el futuro (AU)

Introduction: We analyse our experience and the results obtained with the use of vacuumassisted closure (VAC1, KCI Clinic Spain SL) in the management of open abdomen.Material and methods: We retrospectively reviewed the la parostomies performed between June 2006 and March 2011 using VAC1treatment in the Hospital Xeral-Cíes, Vigo. Results: We included 23 consecutive patients (18 males and 5 females) on whom the VAC1was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischemic disease or abdominal compartmental syndrome). The VAC1neededchanging a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%).The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC1 therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%).Conclusions: VAC1therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC1has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future (AU)

[Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients]. / Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes.

INTRODUCTION: We analyse our experience and the results obtained with the use of vacuum assisted closure (VAC(®), KCI Clinic Spain SL) in the management of open abdomen. MATERIAL AND METHODS: We retrospectively reviewed the laparostomies performed between June 2006 and March 2011 using VAC(®) treatment in the Hospital Xeral-Cíes, Vigo. RESULTS: We included 23 consecutive patients (18 males and 5 females) on whom the VAC(®) was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischaemic disease or abdominal compartmental syndrome). The VAC(®) needed changing a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of 14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%). The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC® therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%). CONCLUSIONS: VAC(®) therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC(®) has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future.