Sclerosing angiomatoid nodular transformation (SANT) of the spleen: review of the literature / Nodular angiomatoide esclerosante transformación (SANT) de la bazo: revisión de la literatura

We present a sclerosing angiomatoid nodular transformation (SANT) case report in a 60 year-old-woman. SANT is an extremely rare benign disease of the spleen that it is radiologically similar to malignant tumors, and clinically difficult to differentiate from other splenic diseases. Splenectomy is both diagnostic and therapeutic in symptomatic cases. The analysis of the resected spleen is necessary to achieve the final diagnosis of SANT.(AU)

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: review of the literature.

We present a sclerosing angiomatoid nodular transformation (SANT) case report in a 60 year-old-woman. SANT is an extremely rare benign disease of the spleen that it is radiologically similar to malignant tumors, and clinically difficult to differentiate from other splenic diseases. Splenectomy is both diagnostic and therapeutic in symptomatic cases. The analysis of the resected spleen is necessary to achieve the final diagnosis of SANT.

External Prospective Validation of the Modified CriSTAL Score for 30- and 90-day Mortality in Geriatric Urgent Surgical Patients.

OBJECTIVE: This study aimed to determine the predictive accuracy of the modified clinical prognostic tool Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) to predict 30-day and 90-day mortality in older patients undergoing urgent abdominal surgery. BACKGROUND: Anticipating the mid-term mortality of older patients undergoing urgent surgery is complex and flawed with uncertainty. METHODS: A prospective study of consecutive ≥ 65 years old presenting at the emergency department who subsequently underwent urgent abdominal surgery. The modified CriSTAL score was calculated in the sample using the FRAIL scale instead of the Clinical Frailty Scale. Discrimination (area under the receiver-operating characteristic (AUROC)) and model calibration were used to test the predictive accuracy of the modified CriSTAL score for death within 30-day mortality as the primary outcome. RESULTS: A total of 500 patients (median age 78 years) were enrolled. The observed 30-day and 90-day mortality rate were 11.6% and 13.6%. The modified CriSTAL tool AUROC curve to predict 30-day and 90-day mortality was 0.78 and 0.77. The model was well calibrated according to the Hosmer-Lemeshow test (p: 0.302) and the calibration plots to predict 30-day and 90-day mortality. CONCLUSIONS: The modified CriSTAL tool (with FRAIL scale as frailty instrument) had good discriminant power and was well calibrated to predict 30-day and 90-day mortality in elderly patients undergoing urgent abdominal surgery. The modified CriSTAL tool is an easy preoperative tool that could assist in the prognosis of postoperative outcomes and decision-making discussions with patients before for urgent abdominal surgery.

Estudio prospectivo de los factores asociados al delirium en el postoperatorio de la cirugía abdominal urgente / Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery

INTRODUCCIÓN: El delirium es una complicación frecuente en pacientes ancianos intervenidos de cirugía abdominal urgente. MÉTODOS: Estudio prospectivo que incluye pacientes consecutivos ≥ 65 años intervenidos de cirugía abdominal urgente entre 2017 y 2019. Se registró: edad, sexo, ASA, estado fisiológico, deterioro cognitivo, fragilidad (escala de Frail), dependencia funcional (escala de Barthel), calidad de vida (Euroqol-5D-EVA), estado nutricional (MNA-SF), diagnóstico preoperatorio, tipo de cirugía (clasificación BUPA), vía de abordaje y diagnóstico de delirium postoperatorio (Confusion Assessment Method). Se realizó un análisis univariante y multivariante para analizar la relación de estas variables con el delirium. RESULTADOS: El estudio incluye 446 pacientes con una mediana de edad de 78 años; el 63,6% eran ASA ≥ III y el 8% presentaban un deterioro cognitivo previo. El 13,2% eran frágiles y el 5,4% de los pacientes tenían un grado de dependencia grave o total. Un 13,6% desarrollaron delirium en el postoperatorio. En el análisis univariante todas las variables son estadísticamente significativas salvo el sexo, el tipo de cirugía (BUPA) y la duración. En el análisis multivariante los factores asociados fueron: la edad (p < 0,001; OR: 1,08 [IC 95%: 1,038-1,139]), el ASA (p = 0,026; OR: 3,15 [IC 95%: 1,149-8,668]), la alteración fisiológica (p < 0,001; OR: 5,8 [IC 95%: 2,176 15,457]), el diagnóstico (p = 0,006) y el deterioro cognitivo (p < 0,001; OR: 5,8 [IC 95%: 2,391-14,069]). CONCLUSIÓN: Los factores asociados al delirium son la edad, el ASA, la alteración fisiológica a su llegada a urgencias, el diagnóstico preoperatorio y el deterioro cognitivo previo

INTRODUCTION: Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS: Prospective study of consecutive patients aged ≥ 65 years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS: The study includes 446 patients with a median age of 78 years, 63.6% were ASA ≥ III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P < .001; OR: 1,08; 95% CI: 1,038-1,139), ASA (P = .026; OR: 3.15; 95% CI: 1.149-8.668), physiological state (P < .001; OR: 5.8; 95% CI: 2.176-15.457), diagnosis (P = .006) and cognitive impairment (P < .001; OR: 5.8; 95% CI: 2.391-14.069). CONCLUSION: The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment

Prospective validation of the Urgent Surgery Elderly Mortality risk score (USEM).

INTRODUCTION: We aimed to test the predictive ability and to compare the predictive ability of the USEM to SRS, SORT and ASA in a prospective sample. PATIENTS AND METHODS: A Prospective cohort of >65-year-old patients undergoing urgent abdominal surgery in a Hospital. Models calibration and discrimination were evaluated using the receiver operating characteristics curves and the Hosmer-Lemeshow test. RESULTS: A total of 500 patients with a median age of 78 years were included. The AUROC in the validation cohort was 0.824. The USEM overestimated mortality (Test Hosmer-Lemeshow p < 0.001), after recalibration the USEM provided an accurate prediction of postoperative mortality. CONCLUSIONS: After the recalibration, the USEM had good discriminant power to estimate the risk of mortality in elderly patients after urgent abdominal surgery.

Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery. / Estudio prospectivo de los factores asociados al delirium en el postoperatorio de la cirugía abdominal urgente.

INTRODUCTION: Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS: Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS: The study includes 446 patients with a median age of 78years, 63.6% were ASA ≥III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P<.001; OR: 1,08; 95%CI: 1,038-1,139), ASA (P=.026; OR: 3.15; 95%CI: 1.149-8.668), physiological state (P<.001; OR: 5.8; 95%CI: 2.176-15.457), diagnosis (P=.006) and cognitive impairment (P<.001; OR: 5.8; 95%CI: 2.391-14.069). CONCLUSION: The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.

Efecto de la colocación de prótesis biliares preoperatorias en las complicaciones infecciosas de la duodenopancreatectomía cefálica / The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy

Introducción: existe controversia sobre el efecto de las prótesis biliares preoperatorias (PBP) en las complicaciones de la duodenopancreatectomía (DPC). No hay recomendaciones para la profilaxis antibiótica en estos pacientes. Nuestro objetivo es estudiar la asociación de las PBP, bacteriología y el desarrollo de complicaciones después de la DP. Métodos: estudio observacional retrospectivo con 90 pacientes consecutivos sometidos a DPC entre 2015-2018. Se indicó PBP en pacientes con bilirrubina total > 12 mg/dl que no pudieron ser intervenidos en un tiempo razonable. La profilaxis antibiótica fue cefoxitina en pacientes sin PBP y tratamiento de cinco días con piperacilina-tazobactam con PBP. Se realizó sistemáticamente un cultivo de bilis. Resultados: la edad promedio fue de 69 años. Cincuenta y un pacientes tuvieron complicaciones (56%), con una mortalidad del 3%. La estancia media fue de once días. Se colocó PBP en 51 pacientes (56%). La profilaxis antibiótica fue adecuada en 62 pacientes (69%). Los gérmenes más aislados fueron E. faecium (30%), E. coli (20%) y E. faecalis (19%). Los pacientes con PBP tuvieron un porcentaje significativamente mayor de cultivos positivos (98% frente a 25%, p < 0,01), mayor número de gérmenes (2,9 frente a 0,5, p < 0,01) y sepsis perioperatoria (31% frente a 12%, p = 0,03), sin aumentar la estancia o la morbilidad global. Conclusiones: las PBP aumentan el riesgo de sepsis perioperatoria, el porcentaje de cultivos positivos y el número promedio de gérmenes aislados. El protocolo de profilaxis con cefoxitina y el tratamiento con pipercilina-tazobactan con PBP tratan adecuadamente al 69% de los pacientes. Con este protocolo, las PBP no implican un aumento de las complicaciones ni de la estancia

Introduction: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD. Methods: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed. Results: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity. Conclusions: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay

The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy.

INTRODUCTION: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD. METHODS: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed. RESULTS: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity. CONCLUSIONS: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay.

Influencia de la creación de una Unidad de Mama en los parámetros quirúrgicos y criterios de calidad del tratamiento quirúrgico del cáncer de mama / Influence of the creation of a Breast Unit on the surgical parameters and quality criteria of the surgical treatment of breast cancer

Objetivos: La European Society of Mastology (EUSOMA) propone criterios de calidad en el diagnóstico y tratamiento del cáncer de mama y recomienda la evaluación de las Unidades de Mama aplicando dichos criterios. En nuestro centro, coincidiendo con la acreditación de la Unidad de Mama por la Sociedad Española de Senología y Patología Mamaria (SESPM) en el año 2000, se asignaron 2 cirujanos a dedicación preferente a la misma. El objetivo es evaluar la repercusión en parámetros quirúrgicos y los criterios de calidad relacionados con el tratamiento quirúrgico tras la adscripción de los cirujanos a la patología mamaria. Material y métodos: Estudio retrospectivo de pacientes tratadas de cáncer de mama entre 1990 y 2010, distribuidas en dos periodos, A; 1990-1999 y B; 2000-2010. Se evalúan datos demográficos, diagnósticos, el tratamiento aplicado, las complicaciones postoperatorias, el seguimiento, la recidiva y 10 criterios de calidad propuestos por EUSOMA. Resultados: La serie se compone de 1.881 mujeres intervenidas por cáncer de mama, 671 en el periodo A y 1.210 en el B. Se han encontrado diferencias significativas entre ambos periodos en la estancia (9,8 días vs. 2,7 días) y complicaciones postoperatorias (17,4% vs. 10%). Existe mejoría significativa en el periodo B en 6 de los 10 criterios evaluados. Conclusiones: La dedicación preferente de los cirujanos a la patología de la mama dentro de una Unidad de Mama ha conseguido reducir las complicaciones y la estancia hospitalaria postoperatoria, se ha obtenido mejoría en los criterios de calidad que evalúan el diagnóstico completo, la indicación y el tratamiento de los ganglios axilares y el seguimiento postoperatorio

Objectives: The European Society of Mastology (EUSOMA) has proposed quality criteria in the diagnosis and treatment of breast cancer and recommends the evaluation of breast units applying these criteria. In our centre, coinciding with the accreditation of the breast unit by the Spanish Society of Senology and Breast Pathology in 2000, two surgeons were assigned to work full-time in breast cancer. The objective of this study was to evaluate the effects of the surgeons' secondment to breast disease on the surgical parameters and the quality criteria related to surgical treatment. Material and methods: We performed a retrospective study that included patients treated for breast cancer between 1990 and 2010, divided into two periods, A; 1990-1999 and B; 2000-2010. We evaluated demographic data, diagnoses, treatment, postoperative complications, follow-up, recurrence, and the 10 quality criteria related to surgical treatment proposed by EUSOMA. Results: The series consisted of 1,881 women who underwent surgery for breast cancer: 671 in period A and 1210 in B. There were significant differences between the two periods in postoperative stay (9.8 vs. 2.7 days) and postoperative complications (17.4% vs. 10%). Significant improvement was found in period B in 6 of the 10 criteria evaluated. Conclusions: Assigning two surgeons to work full-time in a breast unit reduced complications and postoperative hospital stay, and improved the quality criteria that assess complete diagnosis, indication and treatment of axillary lymph nodes and postoperative follow-up

The Urgent Surgery Elderly Mortality risk score: a simple mortality score

Introduction: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). Patients and methods: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). Conclusions: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery

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Supervivencia y morbimortalidad del adenocarcinoma de páncreas tratado con duodenopancreatectomía cefálica con extirpación total del mesopáncreas / Survival, morbidity and mortality of pancreatic adenocarcinoma after pancreaticoduodenectomy with a total mesopancreas excision

Introducción: el adenocarcinoma de páncreas es la neoplasia maligna más frecuente del área periampular; con una supervivencia a cinco años, se sitúa en torno al 20%. Objetivo: el objetivo de nuestro estudio es mostrar los resultados de supervivencia y seguridad de los pacientes intervenidos mediante duodenopancreatectomía cefálica con extirpación total del mesopáncreas (ETMP). Material y métodos: estudio observacional prospectivo que incluye 114 pacientes con adenocarcinoma de páncreas, intervenidos mediante duodenopancreatectomía con ETMP entre 2008 y 2017. Se analizaron las variables demográficas, el estadio tumoral, el número de ganglios extirpados, la ratio ganglionar, la clasificación R y los factores pronósticos del intervalo libre de enfermedad y la supervivencia mediante un análisis multivariante. Resultados: presentaron complicaciones 54 (47,3%) pacientes; 22 (19,3%) se clasificaron como graves. La mortalidad fue del 4,3%. El seguimiento medio fue de 26,2 meses. Durante este periodo, 73 (64%) pacientes presentaron una recaída con un intervalo medio de 40,9 meses. El patrón de recaída fue principalmente hepático (26,3%), seguido de la recaída local (20%). La supervivencia media fue del 40,38% y la actuarial, del 26,6% a cinco años. Los factores relacionados con la recaída fueron la estadificación T3 o superior (RR 8,1 [1,1; 61]) y las resecciones R1 (RR 13,4 [2,7; 66,5]) y con la supervivencia, las resecciones R1 (RR 10,7 [2,5; 46,2]). Conclusión: la ETMP garantiza una linfadenectomía y una ratio ganglionar adecuadas según los estándares publicados. La supervivencia de los pacientes intervenidos por adenocarcinoma de páncreas en nuestro centro es del 68,4% a un año y del 26,6% a cinco años. El principal factor de recaída y de mortalidad son las resecciones R1

Introduction: pancreatic adenocarcinoma is the most common malignancy in the periampullary region, with a five-year survival rate around 20%. Objective: the goal of our study was to determine the survival and safety data of a number of patients that underwent a cephalic duodenopancreatectomy (CDP) with total mesopancreas excision (TMPE). Material and methods: a prospective observational study was performed of 114 patients with pancreatic adenocarcinoma who underwent duodenopancreatectomy and TMPE over the period 2008-2017. Demographic variables, tumor stage, number of lymph nodes excised, lymph node ratio, R classification, the prognostic factor disease-free interval and survival were all assessed in a multivariate analysis. Results: complications were reported for 54 (47.3%) patients, of which 22 (19.3%) were categorized as serious. The mortality rate was 4.3% and the mean follow-up was 26.2 months. During this period, 73 (64%) patients relapsed after a mean interval of 40.9 months. The relapse pattern was mainly hepatic (26.3%), followed by local relapse (20%). Mean survival was 40.38 and actuarial survival was 26.6% at five years. Relapse-related factors included stage T3 or higher (RR 8.1 [1.1-61]) and an R1 resection (RR 13.4 [2.7-66.5]) and survival-related factors included an R1 resection (RR 10.7 [2.5-46.2]). Conclusion: TMPE ensures an adequate lymphadenectomy and lymph node ratio according to reported standards. The survival of patients that have undergone surgery for pancreatic adenocarcinoma in our institution is 68.4% at one year and 26.6% at five years. An R1 resection is the primary factor for both relapse and survival

The Urgent Surgery Elderly Mortality risk score: a simple mortality score.

INTRODUCTION: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). PATIENTS AND METHODS: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. RESULTS: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). CONCLUSIONS: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.

Survival, morbidity and mortality of pancreatic adenocarcinoma after pancreaticoduodenectomy with a total mesopancreas excision.

INTRODUCTION: pancreatic adenocarcinoma is the most common malignancy in the periampullary region, with a five-year survival rate around 20%. OBJECTIVE: the goal of our study was to determine the survival and safety data of a number of patients that underwent a cephalic duodenopancreatectomy (CDP) with total mesopancreas excision (TMPE). MATERIAL AND METHODS: a prospective observational study was performed of 114 patients with pancreatic adenocarcinoma who underwent duodenopancreatectomy and TMPE over the period 2008-2017. Demographic variables, tumor stage, number of lymph nodes excised, lymph node ratio, R classification, the prognostic factor disease-free interval and survival were all assessed in a multivariate analysis. RESULTS: complications were reported for 54 (47.3%) patients, of which 22 (19.3%) were categorized as serious. The mortality rate was 4.3% and the mean follow-up was 26.2 months. During this period, 73 (64%) patients relapsed after a mean interval of 40.9 months. The relapse pattern was mainly hepatic (26.3%), followed by local relapse (20%). Mean survival was 40.38 and actuarial survival was 26.6% at five years. Relapse-related factors included stage T3 or higher (RR 8.1 [1.1-61]) and an R1 resection (RR 13.4 [2.7-66.5]) and survival-related factors included an R1 resection (RR 10.7 [2.5-46.2]). CONCLUSION: TMPE ensures an adequate lymphadenectomy and lymph node ratio according to reported standards. The survival of patients that have undergone surgery for pancreatic adenocarcinoma in our institution is 68.4% at one year and 26.6% at five years. An R1 resection is the primary factor for both relapse and survival.

Neoplasia papilar mucinosa intraductal de conducto principal en un paciente con páncreas divisum / Intraductal papillary mucinous neoplasm of the main duct in a patient with pancreas divisum

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Intraductal papillary mucinous neoplasm of the main duct in a patient with pancreas divisum.

Pancreas divisum is a congenital anomaly present in 5-10% of the population and is usually asymptomatic. Pancreatic intraductal papillary mucinous neoplasms (IPMN) are mucinous cystic tumors that have malignant potential and are classified according to their location as IPMN of the main duct, branch duct or mixed type. Larger lesions and those originating in the main duct have an increased risk of malignancy. The real incidence is unknown as most lesions are asymptomatic.

Delayed gastric emptying following pancreatoduodenectomy: a Roux-en-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study

Introduction: delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy (PD) and it occurs in 50% of cases. Objectives: the endpoint was to determine if there were any differences in the incidence of DGE between Roux-en-Y gastrojejunostomy (ReY) and Billroth II gastrojejunostomy (BII) in PD with pancreaticogastrostomy (PG). Methods: this was a case-control prospective randomized study of all PD cases between 2013 and 2016. Sixty-four patients were included, 32 in each group. An intention-to-treat statistical analysis was performed. Results: no significant differences were found with regard to morbidity and mortality or hospital stay. DGE was present in 25% of the patients in the BII group in comparison to 15.6% in the ReY group, which was not statistically significant (p = 0.35). There was a higher percentage of patients with primary DGE in the BII group, 12.5% versus 6.2%, but this was not statistically significant (p = 0.53). No difference in DGE severity was observed. Male gender (OR 8.38 [1.1; 129]), abdominal complications (OR 15 [1.7; 396.9]), pre-operative malnutrition (OR 99.7 [3.3, 11,126]) and hemorrhage (OR 9.4 [1.37, 107.94]) were the main risk factors for DGE according to the multivariate analysis. Conclusions: there were no significant differences in the incidence or severity of DGE between BII or ReY after PD with PG

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Delayed gastric emptying following pancreatoduodenectomy: a Roux-en-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study.

INTRODUCTION: delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy (PD) and it occurs in 50% of cases. OBJECTIVES: the endpoint was to determine if there were any differences in the incidence of DGE between Roux-en-Y gastrojejunostomy (ReY) and Billroth II gastrojejunostomy (BII) in PD with pancreaticogastrostomy (PG). METHODS: this was a case-control prospective randomized study of all PD cases between 2013 and 2016. Sixty-four patients were included, 32 in each group. An intention-to-treat statistical analysis was performed. RESULTS: no significant differences were found with regard to morbidity and mortality or hospital stay. DGE was present in 25% of the patients in the BII group in comparison to 15.6% in the ReY group, which was not statistically significant (p = 0.35). There was a higher percentage of patients with primary DGE in the BII group, 12.5% versus 6.2%, but this was not statistically significant (p = 0.53). No difference in DGE severity was observed. Male gender (OR 8.38 [1.1; 129]), abdominal complications (OR 15 [1.7; 396.9]), pre-operative malnutrition (OR 99.7 [3.3, 11,126]) and hemorrhage (OR 9.4 [1.37, 107.94]) were the main risk factors for DGE according to the multivariate analysis. CONCLUSIONS: there were no significant differences in the incidence or severity of DGE between BII or ReY after PD with PG.

Nuestra experiencia en el tratamiento del PEComa hepático / Our experience in the surgical treatment of liver PEComa

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Quality standards in 480 pancreatic resections: a prospective observational study.

Pancreatic resection is a standard procedure for the treatment of periampullary tumors. Morbidity and mortality are high, and quality standards are scarce in our setting. International classifications of complications (Clavien-Dindo) and those specific for pancreatectomies (ISGPS) allow adequate case comparisons. The goals of our work are to describe the morbidity and mortality of 480 pancreatectomies using the international classifications ISGPS and Clavien-Dindo to help establish a quality standard in our setting and to compare the results of CPD with reconstruction by pancreaticogastrostomy (1,55) versus 177 pancreaticojejunostomy). We report 480 resections including 337 duodenopancreatectomies, 116 distal pancreatectomies, 11 total pancreatectomies, 10 central pancreatectomies, and 6 enucleations. Results for duodenopancreatectomy include: 62 % morbidity (Clavien > or = III 25.9 %), 12.3 % reinterventions, and 3.3 % overall mortality. For reconstruction by pancreaticojejunostomy: 71.2 % morbidity (Clavien > or = III 34.4 %), 17.5 % reinterventions, and 3.3 % mortality. For reconstruction by pancreaticogastrostomy: 51 % morbidity (Clavien > or = III 15.4%), 6.4 % reinterventions, and 3.2 % mortality. Differences are significant except for mortality. We conclude that our series meets quality criteria as compared to other groups. Reconstruction with pancreaticogastrostomy significantly reduces complication number and severity, as well as pancreatic fistula and reintervention rates.