Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study.

Background: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results: The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study: The study has been registered at clinicaltrials.gov Code: nct04632446.

[Treatment of retroperitoneal sarcoma]. / Tratamiento de los sarcomas retroperitoneales.

AIM: To evaluate the results of treatment of retroperitoneal sarcomas. PATIENTS AND METHODS: We evaluated clinical, diagnostic, surgical and histological parameters as well as adjuvant therapy and evolution in 15 patients with retroperitoneal sarcoma. RESULTS: All patients presented abdominal tumors at diagnosis. Imaging revealed retroperitoneal origin. Complete surgical resection was carried out in seven patients (47%), reduction in size of tumor mass in five (33%) and exploratory laparotomy in three (20%). Histological analysis revealed 12 liposarcoma (80%), two leiomyosarcoma (13%) and one fibrosarcoma. Adjuvant therapy was given to two patients. Of the patients who underwent complete surgical resection, four survived without relapse (1, 2, 5 and 5 years respectively). With the other treatments, there were no survivals at 2 years. Adjuvant therapy did not influence survival. CONCLUSIONS: Retroperitoneal sarcoma is diagnosed late. Prognosis is poor due to tumor relapse and only complete surgical removal produces a "cure".