Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases.

Robotic-assisted laparoscopic surgery attempts to facilitate rectal surgery in the narrow space of the pelvis. The aim of this study is to compare the outcomes of robotic versus laparoscopic surgery for rectal cancer. Monocentric retrospective study including 300 patients who underwent robotic (n = 178) or laparoscopic (n = 122) resection between Jan 2009 and Dec 2017 for high, mid and low rectal cancer. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, except for sex and ASA status. There were no statistical differences between groups in the conversion rate to open surgery. Surgical morbidity and oncological quality did not differ in either group, except for the anastomosis leakage rate and the affected distal resection margin. There were no differences in overall survival rate between the laparoscopic and robotic group. Robotic surgery could provide some advantages over conventional laparoscopic surgery, such as three-dimensional views, articulated instruments, lower fatigue, lower conversion rate to open surgery, shorter hospital stays and lower urinary and sexual dysfunctions. On the other hand, robotic surgery usually implies longer operation times and higher costs. As shown in the ROLARR trial, no statistical differences in conversion rate were found between the groups in our study. When performed by experienced surgeons, robotic surgery for rectal cancer could be a safe and feasible option with no significant differences in terms of oncological outcomes in comparison to laparoscopic surgery.

Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients.

(1) There is evidence of the embryological, anatomical, histological, genetic and immunological differences between right colon cancer (RCC) and left colon cancer (LCC). This research has the general objective of studying the differences in outcome between RCC and LCC. (2) A longitudinal analytical study with prospective follow-up of the case-control type was conducted from 1 January 2010 to 31 December 2017 including 398 patients with 1:1 matching, depending on the location of the tumor. Inclusion criteria: programmed colectomies, 15 cm above the anal margin, adults and R0 surgery. (3) Precisely 6.8% of the exitus occurred in the first 6 months of the intervention. At 6 months, patients with LCC presented a mean survival of 7 months higher than RCC (p = 0.028). In the first stages, it can be observed that most of the exitus are for patients with RCC (stage I p = 0.021, stage II p = 0.014). In the last stages, the distribution of the deaths does not show differences between locations (stage III p = 0.683, stage IV p = 0.898). (4) The results show that RCC and LCC are significantly different in terms of evolution, progression, complications and survival. Patients with RCC have a worse prognosis, even in the early stages of the disease, due to more advanced N stages, larger tumor size, more frequently poorly differentiated tumors and a greater positivity of lymphovascular invasion than LCC.

Form of presentation, natural history and course of postoperative venous thromboembolism in patients operated on for pelvic and abdominal cancer. Analysis of the RIETE registry. / Forma de presentación, historia natural y evolución de la enfermedad tromboembólica venosa postoperatoria en pacientes operados por cáncer abdominal y pélvico. Análisis del registro RIETE.

INTRODUCTION: Venous thromboembolism (VTE) represents a serious complication after oncologic surgery. Recent studies have shown that the risk of VTE persists several weeks after surgery. This study assesses the form of presentation and time course of VTE after abdominal and pelvic cancer surgery. METHODS: Prospective, multicenter, observational study that analyzes data from an international registry (RIETE) that includes consecutive patients with symptomatic VTE. Our study assesses the form and time of presentation of postoperative VTE, as well as main outcomes, in patients operated for abdominopelvic cancer 8 weeks prior to VTE diagnosis. Variables related to the presentation of VTE after hospital discharge are identified. RESULTS: Out of the 766 analyzed patients with VTE, 395 (52%) presented pulmonary embolism (PE). Most VTE cases (84%) were detected after the first postoperative week, and 38% after one month. Among patients with VTE in the first postoperative week, 70% presented PE. VTE presented after hospital discharge in 54% of cases. Colorectal, urologic, and gynecologic tumors, the use of radiotherapy, and blood hemoglobin levels were independently associated with VTE diagnosis after hospital discharge. Complications (thrombosis recurrence, bleeding, and death) occurred in 34% of patients with VTE detected before hospital discharge, compared to 24% in VTE after hospital discharge (P<0.01). CONCLUSIONS: VTE occurs after hospital discharge in most patients, particularly in those operated for colorectal, urologic, and gynecologic cancer. Pulmonary embolism is more frequent in patients who develop early VTE, who also have worse prognosis.

Forma de presentación, historia natural y evolución de la enfermedad tromboembólica venosa postoperatoria en pacientes operados por cáncer abdominal y pélvico. Análisis del registro RIETE / Form of presentation, natural history and course of postoperative venous thromboembolism in patients operated on for pelvic and abdominal cancer. Analysis of the RIETE registry

Introducción: La enfermedad tromboembólica venosa (ETV) representa una grave complicación tras la cirugía oncológica. Recientes estudios revelan que el riesgo de ETV postoperatoria se extiende durante varias semanas. Este estudio analiza la forma y momento de presentación de la ETV tras cirugía oncológica abdominal. Métodos: Estudio observacional, prospectivo y multicéntrico, que analiza los datos de un registro internacional (RIETE) que incluye pacientes consecutivos con ETV sintomática. Se evalúa la forma y momento de presentación de la ETV, así como su pronóstico, en pacientes operados por cáncer abdominopélvico en las 8 semanas previas a la ETV. Se identifican las variables que se asocian con la presentación de la ETV tras el alta. Resultados: Entre los 766 pacientes analizados, 396 (52%) presentaron embolia pulmonar (EP). La mayoría (84%) de los casos de ETV se presentaron después de la primera semana de la intervención y un 38% pasado un mes. El 70% de los pacientes con ETV precoz presentaron EP. El 54% de los casos desarrollaron ETV tras el alta. Los tumores colorrectales y genitourinarios, el uso de radioterapia y los niveles de hemoglobina resultaron variables independientes de ETV tras el alta. El 34% de los pacientes con ETV antes del alta tuvieron complicaciones (recidiva, hemorragia y defunción), frente al 24% con ETV tras el alta (p < 0,01). Conclusiones: La ETV se presenta tras el alta en la mayoría de los pacientes, especialmente en aquellos con cáncer colorrectal y genitourinario. La EP es más frecuente en los pacientes con ETV precoz que, además, tienen peor pronóstico (AU)

Introduction: Venous thromboembolism (VTE) represents a serious complication after oncologic surgery. Recent studies have shown that the risk of VTE persists several weeks after surgery. This study assesses the form of presentation and time course of VTE after abdominal and pelvic cancer surgery. Methods: Prospective, multicenter, observational study that analyzes data from an international registry (RIETE) that includes consecutive patients with symptomatic VTE. Our study assesses the form and time of presentation of postoperative VTE, as well as main outcomes, in patients operated for abdominopelvic cancer 8 weeks prior to VTE diagnosis. Variables related to the presentation of VTE after hospital discharge are identified. Results: Out of the 766 analyzed patients with VTE, 395 (52%) presented pulmonary embolism (PE). Most VTE cases (84%) were detected after the first postoperative week, and 38% after one month. Among patients with VTE in the first postoperative week, 70% presented PE. VTE presented after hospital discharge in 54% of cases. Colorectal, urologic, and gynecologic tumors, the use of radiotherapy, and blood hemoglobin levels were independently associated with VTE diagnosis after hospital discharge. Complications (thrombosis recurrence, bleeding, and death) occurred in 34% of patients with VTE detected before hospital discharge, compared to 24% in VTE after hospital discharge (P < 0.01). Conclusions: VTE occurs after hospital discharge in most patients, particularly in those operated for colorectal, urologic, and gynecologic cancer. Pulmonary embolism is more frequent in patients who develop early VTE, who also have worse prognosis (AU)

Diagnóstico de la astenia tumoral en Atención Primaria. Propuesta de correlación entre dos escalas / Diagnosis of the tumoral asthenia in a Primary Health Care Center. Proposition about correlation among two scales

Objetivo: Detectar la astenia tumoral (AT) en Atención Primaria, posibilidades de evaluación y gradación de la misma con dos escalas propuestas, la clasificación ICD-10 (ICD-10) adaptada y el índice de Karnosfky (IK) graduado. Diseño: Estudio observacional descriptivo realizado en la Zona básica de Salud de Utrera (Sevilla) que engloba siete centros. Se detectaron 67 pacientes con cáncer, de los cuales participaron61. Criterios de inclusión: aceptación a participar en el estudio, mayor de edad y diagnóstico de cáncer. Criterios de exclusión: no aceptación a participar, evidencia clínica de astenia de origen no tumoral, deterioro cognitivo o trastorno psiquiátrico severo. Parámetros analizados: edad, sexo, tipo de tumor, tratamiento anti-tumoral en los últimos doce meses, enfermedad oncológica terminal, puntuación del IK y grados de la clasificación ICD-10 adaptada para AT. Análisis estadístico: descriptivo, y debido al pequeño tamaño muestral un análisis correlacional e inferencial, ambos no paramétricos. Resultados: La AT según la ICD-10 adaptada está presente en el 70,5% de los casos y un 78,7%según el IK. Al analizar la correlación parcial entre tumores más frecuentes, la ICD-10 adaptado y el IK graduado encontramos diferencias estadísticamente significativas en el cáncer de pulmón, mama, próstata y colorectal, en referencia a la presencia de AT. Entre los criterios establecidos de AT en la ICD-10 adaptado e IK graduado existe una relación lineal e inversa estadísticamente significativa (p = 0,001).Conclusiones: La ICD-10 adaptada permite reconocer y graduar la AT en pacientes oncológicos. El IK puede ser una herramienta complementaria (AU)

Objective: Diagnosis of fatigue in cancer patients in primary health care centre, an opportunity for assessment and grading the fatigue with two scales, International Classification of Diseases(ICD-10) criteria and Karnosfky Index (KI).Design: Descriptive observational study conducted in the Basic zone of Health of Utrera (Seville), includes seven care centres. We studied 67 patients suffering from cancer disease, only61 were included. Inclusion criteria: agreement to participate in the study, adult and cancer diagnosis. Exclusion criteria: no agreement to participate, clinical evidence of non-tumour origin fatigue, cognitive impairment or severe psychiatric disorder. Personal interview recording: age, sex, type of tumour, antitumour specific treatment in the last twelve months, terminaloncological disease, KI and tumour asthenia valuation according to ICD-10 adapted, gradations being established between both scales. Statistical analysis: descriptive, and because of thesmall sample size, correlational and inferential analysis, both non-parametric. Results: Fatigue, according to adapted ICD-10 criteria, is found in 70.5% of the cases. 78.7% presents a minor or equal KI. In analyzing the partial correlation between most common tumours, the adapted ICD-10 and graduated KI statistically significant differences in lung cancer, breast, prostate and colon and rectum, referring to the presence of fatigue in cancer patients. There is a negative relationship between these two tests (coefficient of correlation of -0.902) as for breast, lung and prostate statistically significant (p=0.001), proving a linear and inversecorrelation between the established for adapted ICD-10 and graduated KI by the authors. Conclusions: Adapted ICD-10 criteria can assessment and graduate fatigue in cancer patients.KI can be a complementary tool (AU)

Etiología y sensibilidad antimicrobiana en las infecciones urinarias bajas de la embarazada en España / Etiology and antibiotic susceptibility in urinary tract infections during pregnancy in Spain

Introducción: Para optimizar el tratamiento de las infecciones del tracto urinario (ITU) bajo en embarazadas, se necesita conocer los patógenos más frecuentes y sus sensibilidades. Métodos: Estudio prospectivo realizado entre marzo y junio de 2004, con participación de 15 laboratorios de microbiología nacionales. Éstos procesaron las orinas siguiendo su metodología habitual. Resultados: Sólo en 1.521 casos quedó constancia de la presencia o no de gestación y de ellos 150 correspondían a mujeres embarazadas. El patógeno más frecuente en gestantes fue Escherichia coli (54,6%), seguido por Streptococcus agalactiae (24,3%). La incidencia de patógenos grampositivos (32,2%) resultó significativamente superior en embarazadas (p < 0,001). Destacar la alta sensibilidad de E. coli frente a fosfomicina (98,8%), cefixima (96,2%) y nitrofurantoína (97,6%), y escasa a ampicilina (41,6%). Conclusiones: E. coli es el principal uropatógeno en la gestante. Conocidas las complicaciones materno-fetales de esta infección en embarazadas, sería necesario considerar alternativas terapéuticas para disminuir las elevadas resistencias frente a antibióticos útiles en sepsis neonatales

Introduction: To improve antibiotic use in the treatment of urinary tract infections during pregnancy, knowledge of the most frequent pathogens and their susceptibilities is required. Methods: Between march and july 2004, a prospective multicenter study was conducted in 15 national microbiology laboratories. The laboratories used their standard methods to process the samples. Results: Pregnancy or non-pregnancy was recorded in only 1521 women; of these, 150 women were pregnant. The most frequent pathogen in pregnant women was Escherichia coli (54.6%), followed by Streptococcus agalactiae (24.3%). Isolation of gram positive strains (32.2%) was significantly more frequent in pregnant women (p < 0.001). The susceptibility rates of E. coli were 98.8% for fosfomycin, 96.2% for cefixime, and 97.6% for nitrofurantoin; these rates were lower for ampicillin (41.6%). Conclusions: E. coli is the main uropathogen during pregnancy, because of the materno-fetal complications of urinary tract infections during pregnancy, alternative antibiotics should be used to reduce the high resistance to antibiotics that are useful in neonatal sepsis