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Galvez A, Biondo S, Trenti L, Espin E, Kraft M, Farres R, Codina-Cazador A, Flor B, Garcia-Granero E, Enriquez-Navascues JM, Borda-Arrizabalaga N, Kreisler E. Prognostic Value of the Circumferential Resection Margin After Curative Surgery for Rectal Cancer: A Multicenter Propensity Score-Matched Analysis. Dis Colon Rectum 2023; 66:887-897. [PMID: 35348529 DOI: 10.1097/dcr.0000000000002294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, positive circumferential resection margin has been found to be an indicator of advanced disease with a high risk of distant recurrence rather than local recurrence. OBJECTIVE The study aimed to analyze the prognostic impact of the circumferential resection margin on long-term oncological outcomes in patients with rectal cancer. DESIGN This was a multicenter, propensity score-matched (2:1) analysis comparing the positive and negative circumferential resection margins. SETTINGS The study was conducted at 5 high-volume centers in Spain. PATIENTS Patients who underwent total mesorectal excision with curative intent for middle-low rectal cancer between 2006 and 2014 were included. MAIN OUTCOME MEASURES The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. RESULTS The unmatched initial cohort consisted of 1599 patients, of whom 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with a negative circumferential margin and 78 with a positive circumferential margin). The median follow-up period was 52.5 (22.0-69.5) months. Local recurrence was significantly higher in patients with a positive circumferential margin (33.3% vs 11.5%; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; p = 0.14). Disease-free survival was lower in patients with a positive circumferential margin (36.1% vs 52.3%; p = 0.026). LIMITATIONS This study was limited by its retrospective design. The different neoadjuvant treatment options were not included in the propensity score. CONCLUSIONS The positive circumferential resection margin was associated with a higher local recurrence rate and worse disease-free survival in comparison with the negative circumferential resection margin. However, the positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950 . VALOR PRONSTICO DEL MARGEN DE RESECCIN CIRCUNFERENCIAL DESPUS DE LA CIRUGA CURATIVA PARA EL CNCER DE RECTO UN ANLISIS MULTICNTRICO EMPAREJADO POR PUNTAJE DE PROPENSIN ANTECEDENTES:En los últimos años, se ha encontrado que el margen de resección circunferencial positivo es un indicador de enfermedad avanzada con alto riesgo de recurrencia a distancia más que de recurrencia local.OBJETIVO:El objetivo fue analizar el impacto pronóstico del margen de resección circunferencial sobre la recidiva local, a distancia y las tasas de supervivencia en pacientes con cáncer de recto.DISEÑO:Este fue un análisis multicéntrico emparejado por puntaje de propensión 2: 1 que comparó el margen de resección circunferencial positivo y negativo.AJUSTES:El estudio se realizó en 5 centros Españoles de alto volumen.PACIENTES:Se incluyeron pacientes sometidos a escisión total de mesorrecto con intención curativa por cáncer de recto medio-bajo entre 2006-2014. Las características clínicas e histológicas se utilizaron para el emparejamiento.PRINCIPALES MEDIDAS DE RESULTADO:Los resultadoes principales fueron la recurrencia local, la recurrencia a distancia, la supervivencia global y libre de enfermedad.RESULTADOS:La cohorte inicial no emparejada consistió en 1599 pacientes; El 4,9% tuvo un margen de resección circunferencial positivo. Tras el emparejamiento se incluyeron 234 pacientes (156 con margen circunferencial negativo y 78 con margen circunferencial positivo). La mediana del período de seguimiento fue de 52,5 meses (22,0-69,5). La recurrencia local fue significativamente mayor en pacientes con margen circunferencial positivo, 33,3% vs 11,5% [HR 3,2; IC 95%: 1,83-5,43; p < 0,001]. La recidiva a distancia fue similar en ambos grupos (46,2 % frente a 42,3 %) [HR 1,09, IC 95 %: 0,78-1,90; p = 0,651]. No hubo diferencias significativas en la supervivencia global a 5 años (48,6 % frente a 43,6 %) [HR 1,09, IC 95 %: 0,92-1,78; p = 0,14]; La supervivencia libre de enfermedad fue menor en pacientes con margen circunferencial positivo, 36,1% vs 52,3% [HR 1,5; IC 95%: 1,05-2,06; p = 0,026].LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo. Las diferentes opciones de tratamientos neoadyuvantes no se han incluido en la puntuación de propensión.CONCLUSIONES:El margen de resección circunferencial positivo se asocia con una mayor tasa de recurrencia local y peor supervivencia libre de enfermedad en comparación con el margen de resección circunferencial negativo. Sin embargo, el margen de resección circunferencial positivo no fue un indicador pronóstico de recidiva a distancia ni de supervivencia global. Consulte el Video del Resumen en http://links.lww.com/DCR/B950 . (Traducción- Dr. Yesenia Rojas-Khalil ).
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Affiliation(s)
- Ana Galvez
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Loris Trenti
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Eloy Espin
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miquel Kraft
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramón Farres
- Colorectal Unit, Department of General and Digestive Surgery, Josep Trueta University Hospital, Gsirona, Spain
| | - Antonio Codina-Cazador
- Colorectal Unit, Department of General and Digestive Surgery, Josep Trueta University Hospital, Gsirona, Spain
| | - Blas Flor
- Colorectal Unit, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - Eduardo Garcia-Granero
- Colorectal Unit, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - Jose M Enriquez-Navascues
- Colorectal Unit, Department of General and Digestive Surgery, Donostia University Hospital, San Sebastian, Spain
| | - Nerea Borda-Arrizabalaga
- Colorectal Unit, Department of General and Digestive Surgery, Donostia University Hospital, San Sebastian, Spain
| | - Esther Kreisler
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
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Julià Bergkvist D, Gómez Romeu N, Pigem A, Busquets D, Farrés R, Codina-Cazador A. Robotic modified Kono-S anastomosis after ileocecal resection for Crohn's disease. Tech Coloproctol 2023; 27:335. [PMID: 36307742 DOI: 10.1007/s10151-022-02717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Affiliation(s)
- D Julià Bergkvist
- Servei de Cirurgia General i Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Avda de França S/N, 17007, Girona, Catalonia, Spain.
| | - N Gómez Romeu
- Servei de Cirurgia General i Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Avda de França S/N, 17007, Girona, Catalonia, Spain
| | - A Pigem
- Servei de Cirurgia General i Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Avda de França S/N, 17007, Girona, Catalonia, Spain
| | - D Busquets
- Servei de Digestologia, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - R Farrés
- Servei de Cirurgia General i Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Avda de França S/N, 17007, Girona, Catalonia, Spain
| | - A Codina-Cazador
- Servei de Cirurgia General i Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Avda de França S/N, 17007, Girona, Catalonia, Spain
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Pellino G, Alós R, Biondo S, Codina-Cazador A, Enríquez-Navascues JM, Espín-Basany E, Roig-Vila JV, Cervantes A, García-Granero E. Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project. Eur J Surg Oncol 2020; 47:276-284. [PMID: 32950316 DOI: 10.1016/j.ejso.2020.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/25/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. METHOD This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II. RESULTS Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. CONCLUSION There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
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Affiliation(s)
- Gianluca Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain; Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Rafael Alós
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Antonio Codina-Cazador
- Department of General and Digestive Surgery--Colorectal Unit, Josep Trueta University Hospital, Girona, Spain
| | | | - Eloy Espín-Basany
- Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Andrés Cervantes
- CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Eduardo García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain.
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Espin Basany E, Solís-Peña A, Pellino G, Kreisler E, Fraccalvieri D, Muinelo-Lorenzo M, Maseda-Díaz O, García-González JM, Santamaría-Olabarrieta M, Codina-Cazador A, Biondo S. Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol 2020; 5:729-738. [DOI: 10.1016/s2468-1253(20)30075-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
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Salvador-Rosés H, López-Ben S, Casellas-Robert M, Planellas P, Gómez-Romeu N, Farrés R, Ramos E, Codina-Cazador A, Figueras J. Oncological strategies for locally advanced rectal cancer with synchronous liver metastases, interval strategy versus rectum first strategy: a comparison of short-term outcomes. Clin Transl Oncol 2017; 20:1018-1025. [PMID: 29273957 DOI: 10.1007/s12094-017-1818-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/09/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goal of treatment for patients with synchronous liver metastases (SLM) from rectal cancer is to achieve a complete resection of both tumor locations. For patients with symptomatic locally advanced rectal cancer with resectable SLM at diagnosis, our usual strategy has been the rectum first approach (RF). However, since 2014, we advocate for the interval approach (IS) that involves the administration of chemo-radiotherapy followed by the resection of the SLM in the interval of time between rectal cancer radiation and rectal surgery. METHODS From 2010 to 2016, 16 patients were treated according to this new strategy and 19 were treated according RF strategy. Data were collected prospectively and analyzed with an intention-to-treat perspective. Complete resection rate, duration of the treatment and morbi-mortality were the main outcomes. RESULTS The complete resection rate in the IS was higher (100%, n = 16) compared to the RF (74%, n = 14, p = 0.049) and the duration of the strategy was shorter (6 vs. 9 months, respectively, p = 0.006). The incidence of severe complications after liver surgery was 14% (n = 2) in the RF and 0% in the IS (p = 1.000), and after rectal surgery was 24% (n = 4) and 12% (n = 2), respectively (p = 1.000). CONCLUSION The IS is a feasible and safe strategy that procures higher level of complete resection rate in a shorter period of time compared to RF strategy.
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Affiliation(s)
- H Salvador-Rosés
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain.
- University of Barcelona, Barcelona, Spain.
| | - S López-Ben
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
| | - M Casellas-Robert
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
- University of Barcelona, Barcelona, Spain
| | - P Planellas
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
| | - N Gómez-Romeu
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
| | - R Farrés
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
| | - E Ramos
- Department of Digestive Surgery, Bellvitge Hospital, University of Barcelona, Barcelona, Spain
| | - A Codina-Cazador
- Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain
- University of Barcelona, Barcelona, Spain
| | - J Figueras
- University of Barcelona, Barcelona, Spain
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Planellas Giné P, Rodríguez-Hermosa JI, Codony Bassols C, Marinello F, Salvador Roses H, Gil Garcia J, Gómez Romeu N, Julià Bergkvist D, Farrés Coll R, Codina-Cazador A. Role of derivative colostomy in Fournier’s gangrene: Analysis of 46 cases. Surg Pract 2017. [DOI: 10.1111/1744-1633.12255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Pere Planellas Giné
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
| | | | - Clara Codony Bassols
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
| | - Franco Marinello
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
| | | | - Júlia Gil Garcia
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
| | - Núria Gómez Romeu
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
| | | | - Ramon Farrés Coll
- Department of Colorectal Surgery; University Hospital Dr Josep Trueta; Girona Spain
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Biondo S, Miquel J, Espin-Basany E, Sanchez JL, Golda T, Ferrer-Artola AM, Codina-Cazador A, Frago R, Kreisler E. A Double-Blinded Randomized Clinical Study on the Therapeutic Effect of Gastrografin in Prolonged Postoperative Ileus After Elective Colorectal Surgery. World J Surg 2016; 40:206-14. [PMID: 26446450 DOI: 10.1007/s00268-015-3260-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Postoperative ileus is a common problem with significant clinical and economic consequences. We hypothesized that Gastrografin may have therapeutic utility by accelerating the recovery of postoperative ileus after colorectal surgery. The aim of this trial was to study the impact of oral Gastrografin administration on postoperative prolonged ileus (PPI) after elective colorectal surgery. METHODS The main endpoint of this randomized, double-blinded, controlled trial was time of resolution of PPI. The secondary endpoints were overall hospital length of stay, time to start oral intake, time to first passage of flatus or stools, time of need of nasogastric tube, and need of parenteral nutrition. Included criteria were patients older than 18 years, operated for colonic neoplasia, inflammatory bowel disease, or diverticular disease. There were two treatments: Gastrografin administration and placebo. The sample size was calculated taking into account the average length of postoperative ileus after colorectal resection until tolerance to oral intake. Statistical analysis showed that 29 subjects in each group were needed. RESULTS Twenty-nine patients per group were randomized. Groups were comparable for age, gender, ASA Physical Status Classification System, stoma construction, and surgical technique. No statistical differences were observed in mean time to resolution between the two groups, 9.1 days (CI 95%, 6.51-11.68) in Gastrografin group versus 10.3 days (CI 6.96-10.29) in Placebo group (P = 0.878). Even if not statistically significant, time of resolution of PPI, overall length of stay, time of need of nasogastric tube, and time to tolerance of oral intake were shorter in the G group. CONCLUSIONS Gastrografin does not accelerate significantly the recovery of prolonged postoperative ileus after elective colorectal resection when compared with placebo. However, it seems to clinically improve all the analyzed variables.
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Affiliation(s)
- Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Jordi Miquel
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jose Luis Sanchez
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Thomas Golda
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Ana Maria Ferrer-Artola
- Department of Pharmacy, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Antonio Codina-Cazador
- Colorectal Unit, Department of General and Digestive Surgery, Josep Trueta University Hospital, Girona, Spain
| | - Ricardo Frago
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Esther Kreisler
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Ortiz H, Ciga MA, Armendariz P, Kreisler E, Codina-Cazador A, Gomez-Barbadillo J, Garcia-Granero E, Roig JV, Biondo S. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg 2014; 101:874-82. [PMID: 24817654 DOI: 10.1002/bjs.9522] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide 'extralevator APE (ELAPE)', there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE. METHODS A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II-III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes. RESULTS From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7.9 and 7.7 per cent of patients during APE and ELAPE respectively (P = 0.902), and there was CRM involvement in 13.1 and 13.6 per cent (P = 0.846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52.3 versus 48.1 per cent; P = 0.209), need for reoperation (7.7 versus 7.0 per cent; P = 0.703), perineal wound problems (26.0 versus 21.9 per cent; P = 0.141), mortality rate (2.0 versus 2.0 per cent; P = 1.000) and local recurrence rate at 2 years (2.7 versus 5.6 per cent; P = 0.664). CONCLUSION ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.
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Affiliation(s)
- H Ortiz
- Departments of Surgery, Public University of Navarra and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Biondo S, Kreisler E, Fraccalvieri D, Basany EE, Codina-Cazador A, Ortiz H. Risk factors for surgical site infection after elective resection for rectal cancer. A multivariate analysis on 2131 patients. Colorectal Dis 2012; 14:e95-e102. [PMID: 21883813 DOI: 10.1111/j.1463-1318.2011.02798.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM Surgical site infection (SSI) is the most common cause of morbidity after colorectal surgery. The aim of this study was to analyze risk factors for SSI in patients who had undergone surgery for rectal cancer. METHOD A multicentre observational study was carried out on 2131 patients operated on for rectal cancer between May 2006 and May 2009. Twenty-nine centres were involved. SSI included wound infection and organ space infection within 30 days after the operation. Univariate and multivariate analyses were carried out to study possible risk factors for SSI. RESULTS Wound infection and organ space infection were diagnosed in 8.9% and 10%, respectively, of patients. The anastomotic leakage rate was 8%. Multivariate analysis showed that wound infection was related to tumour stage, a converted laparoscopic procedure and open surgery. Organ space infection was related to Stage IV tumour, a tumour < 11 cm from the anal verge, low anterior resection and Hartmann's procedure. CONCLUSION Rectal surgery for malignant disease is associated with a considerable rate of SSI. Wound infection and organ space infection are related to different factors and therefore should be evaluated separately.
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Affiliation(s)
- S Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain.
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Puig-Costa M, Oliveras-Ferraros C, Flaquer S, Llopis-Puigmarti F, Pujol-Amado E, Martin-Castillo B, Vazquez-Martin A, Cufí S, Ortiz R, Roig J, Codina-Cazador A, Menendez JA. Antibody microarray-based technology to rapidly define matrix metalloproteinase (MMP) signatures in patients undergoing resection for primary gastric carcinoma. J Surg Oncol 2011; 104:106-9. [PMID: 21308687 DOI: 10.1002/jso.21887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/11/2011] [Indexed: 01/01/2023]
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Biondo S, Ortiz H, Lujan J, Codina-Cazador A, Espin E, Garcia-Granero E, Kreisler E, de Miguel M, Alos R, Echeverria A. Quality of mesorectum after laparoscopic resection for rectal cancer - results of an audited teaching programme in Spain. Colorectal Dis 2010; 12:24-31. [PMID: 19175653 DOI: 10.1111/j.1463-1318.2008.01720.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this prospective observational study was to compare the quality of total mesorectal excision between laparoscopic and open surgery for rectal cancer. METHOD In April 2006, the Spanish Association of Surgeons started an audited teaching programme. The project was similar to the Norwegian one and several training courses were arranged. Patients were classified into two groups: laparoscopic rectal resection (LR) and open rectal resection (OR). The quality of the mesorectum was scored: complete, nearly complete or incomplete. The circumferential margin (CRM) was considered positive, if tumour was located 1 mm or less from the surface of the specimen. RESULTS Between 2006 and 2008, 604 patients underwent rectal resection with total mesorectal excision for rectal cancer: 209 patients were included in the LR group and 395 patients in the OR group. There were no differences in terms of number of lymph nodes affected, distance of the tumour from CRM. The mesorectum was complete in 464 (76.8%), nearly complete in 91 (15.1%) and incomplete in 49 patients (8.1%). CRM was negative in 534 patients (88.4%). No differences were observed between the two groups. The overall postoperative morbidity rate was 38.8% in LR group and 44.6% in OR group (P = 0.170). Overall postoperative mortality rate was 2.5%. One patient died (0.5%) in the LR group and 14 patients died (3.5%) in the OR group (P = 0.021). CONCLUSION Laparoscopic resection for rectal cancer is feasible with the quality of mesorectal excision and postoperative outcomes similar to those of open surgery.
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Affiliation(s)
- S Biondo
- Department of Surgery, Colorectal Unit, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain.
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13
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Rodríguez-Hermosa JI, Cañete N, Artigau E, Gironès J, Planellas P, Codina-Cazador A. Small bowel perforation by an unusual foreign body. Rev esp enferm dig 2009; 101:639-41. [DOI: 10.4321/s1130-01082009000900007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Rodríguez-Hermosa JI, Roig J, Ortuño P, Recasens M, Planellas P, Codina-Cazador A. [Adrenal Cushing's syndrome]. Rev Esp Enferm Dig 2008; 100:788-789. [PMID: 19222339 DOI: 10.4321/s1130-01082008001200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J I Rodríguez-Hermosa
- Servicios de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona
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15
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Figueras J, Codina-Barreras A, López-Ben S, Falgueras L, Daniel González H, Albiol M, Soriano J, Figa M, Pardina B, González-Huix F, Maroto A, Codina-Cazador A. Resultados de la cirugía hepatobiliopancreática en un servicio de cirugía de un hospital de segundo nivel según los GRD durante el bienio 2005-2006. Cir Esp 2008; 84:146-53. [DOI: 10.1016/s0009-739x(08)72156-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Rodríguez-Hermosa JI, Codina-Cazador A, Sirvent JM, Martín A, Gironès J, Garsot E. Surgically treated perforations of the gastrointestinal tract caused by ingested foreign bodies. Colorectal Dis 2008; 10:701-7. [PMID: 18005196 DOI: 10.1111/j.1463-1318.2007.01401.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Intestinal perforation due to foreign body (FB) ingestion is rare (1%). We describe our experience in treating these lesions surgically. METHOD From 1995 to 2006, data were collected prospectively in 33 patients (18 women and 15 men; mean age 64 years) operated on for intestinal perforation due to an ingested FB. The type of object, preoperative diagnosis, perforation site, treatment, morbidity and mortality were reviewed. RESULTS Foreign body ingestion was predominantly involuntary (88%). The mean time from ingestion to perforation was 10.4 days. The most frequently ingested objects were dietary FB (n = 21) and toothpicks (n = 6). The most frequent predisposing factors were dentures or an orthodontic appliance (73%). The most common preoperative diagnoses were acute abdomen of uncertain origin (n = 7), acute appendicitis (n = 7) and acute diverticulitis (n = 5). Pneumoperitoneum was observed in 10 cases. The diagnosis was reached during laparotomy in 30 (91%) cases. The most frequent perforation site was the colorectal region (n = 18, 54.5%), followed by the terminal ileum (n = 7, 21.2%); intraperitoneal perforation was the most common (n = 30, 91%). All cases had abdominal contamination and 22 (66.7%) had diffuse peritonitis. Treatment was always by surgery and antibiotics. Thirteen patients required a colostomy. Morbidity was 57.6% (n = 19) and mortality 6.1% (n = 2). CONCLUSION Intestinal perforation by a foreign body is rare and normally affects the sigmoid colon, rectum or distal ileum. Dentures are a common risk factor. Patients are rarely aware of foreign body ingestion. Dietary FB and toothpicks are the most commonly ingested objects. Treatment consists of surgery and antibiotics. Appendicitis and acute diverticulitis should be considered in the differential diagnosis.
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Affiliation(s)
- J I Rodríguez-Hermosa
- Department of Colorectal and General Surgery, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
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17
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Flikier-Zelkowicz B, Codina-Cazador A, Farrés-Coll R, Olivet-Pujol F, Martín-Grillo A, Pujadas-de Palol M. Morbilidad y mortalidad en relación con el cierre de ileostomías derivativas en la cirugía del cáncer de recto. Cir Esp 2008; 84:16-9. [DOI: 10.1016/s0009-739x(08)70598-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Rodríguez-Hermosa JI, Roig J, Ortuño P, Quiles AM, Recasens M, Codina-Cazador A. [A large adrenal tumor]. Rev Esp Enferm Dig 2008; 100:363-364. [PMID: 18752367 DOI: 10.4321/s1130-01082008000600010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- J I Rodríguez-Hermosa
- Servicios de Cirugia General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona
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19
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Figueras J, Codina-Barreras A, López-Ben S, Maroto A, Torres-Bahí S, Daniel González H, Albiol M, Falgueras L, Pardina B, Soriano J, Codina-Cazador A. Duodenopancreatectomía cefálica en tumores periampulares. Disección de la arteria mesentérica superior como abordaje inicial. Descripción de la técnica y evaluación de nuestra experiencia inicial. Cir Esp 2008; 83:186-93. [DOI: 10.1016/s0009-739x(08)70545-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Rodríguez-Hermosa JI, Roig J, Ortuño P, Quiles AM, Recasens M, Codina-Cazador A. [Adrenal metastasis from lung carcinoma]. Rev Esp Enferm Dig 2008; 100:45-6. [PMID: 18358060 DOI: 10.4321/s1130-01082008000100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J I Rodríguez-Hermosa
- Servicios de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona
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21
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Figueras J, Planellas P, Albiol M, López-Ben S, Soriano J, Codina-Barreras A, Pardina B, Rodríguez-Hermosa JI, Falgueras L, Ortiz R, Maroto A, Codina-Cazador A. Papel de la ecografía intraoperatoria y la tomografía computarizada con multidetectores en la cirugía de las metástasis hepáticas: estudio prospectivo. Cir Esp 2008; 83:134-8. [DOI: 10.1016/s0009-739x(08)70528-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Codina-Cazador A, Espín E, Biondo S, Luján J, de Miguel M, Alós R, García-Granero E, Echeverría-Balda A, Ortiz H. Proceso docente auditado del tratamiento del cáncer de recto en España: resultados del primer año. Cir Esp 2007; 82:209-13. [DOI: 10.1016/s0009-739x(07)71708-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
OBJECTIVE The discovery of foreign bodies (FB) in the rectum is an infrequent clinical problem. Most commonly, FB are introduced through the anal passage or reach the rectum after oral ingestion. We describe our experience in the diagnosis and treatment of FB retained in the rectum. METHOD From 1997 to 2004, data were collected prospectively in 30 patients (20 men and 10 women; median age 42.5 years). Extraction method, size and type of object, and postextraction evolution were reviewed. RESULTS The FB was introduced anally in 16 cases and by oral ingestion in 14. Principal associated factors were: mental disorder in 11, penitentiary confinement in two, and drug and alcohol intake in two. Recent sexual activity had taken place in 14 cases. The size and nature of the FB were varied. The most frequent symptom was constipation with or without pelvic or anal discomfort (n = 23, 77%). Treatment consisted of spontaneous ejection (n = 2), digital extraction with or without enemas (n = 10), digital extraction under local/regional anaesthesia after fragmentation (n = 11) and regional exploratory laparotomy under general anaesthesia (n = 7). Grade I rectal trauma was the most common (n = 23, 77%). Six patients required colostomy. Four patients (13.5%) suffered complications and none died. Only 17 patients were hospitalized, with a mean stay of 6 days. All patients recovered without sequelae. CONCLUSION The diagnosis of rectal FB should be suspected when faced with low pelvic or perianal abdominal pain and/or rectal haemorrhage within the context of an unconvincing story in patients without a history of recent instrumental rectal exploration for therapeutic or diagnostic purposes. Because of potential complications, FB in the rectum should be considered a serious condition that must be treated without delay.
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Affiliation(s)
- J I Rodríguez-Hermosa
- Department of Colorectal and General Surgery, Hospital Universitari de Girona Dr josep Trueta, Girona, Spain.
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Rubió J, Marcos-Gragera R, Ortiz MR, Miró J, Vilardell L, Gironès J, Hernandez-Yagüe X, Codina-Cazador A, Bernadó L, Izquierdo A, Colomer R. Population-based incidence and survival of gastrointestinal stromal tumours (GIST) in Girona, Spain. Eur J Cancer 2006; 43:144-8. [PMID: 17055254 DOI: 10.1016/j.ejca.2006.07.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 06/18/2006] [Accepted: 07/19/2006] [Indexed: 01/05/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GIST) are rare malignancies characterised by their association with KIT oncogene mutations. Until now, population-based reports of the incidence or survival of kit-confirmed GIST have been rare, and none have originated in Southern Europe. MATERIALS AND METHODS We used the Girona Cancer Registry to identify malignant mesenchymal tumours of the digestive tract between 1994 and 2001, and performed c-kit testing in the tumour samples. Age-adjusted incidence rates and survival rates were calculated, and they were also analysed by sex and NIH risk categories. RESULTS Forty-six cases were categorised as GIST. Fifty percent were localised in the stomach, 43.5% in small intestine, 4.3% in the omentum, and 2.2% in colon. Thirty-seven percent were classified as high risk of an aggressive behaviour, 30.4% as intermediate risk and 32.6% as low or very low risk. Only one patient received treatment with imatinib mesilate. The annual incidence by 100,000 inhabitants in crude rate, European age-standardised rate and world age-standardised rate was, respectively, 1.09, 0.90 and 0.65 cases. The relative 5-year survival rate was 74.7% for the entire cohort, and it was markedly lower in the high-risk cases (20.3%). CONCLUSIONS We report the first population-based study of GIST incidence and survival in Southern Europe. The incidence rate is low and comparable with that of cancer registries from Northern Europe. Survival was favourable in our pre-imatinib population although it was low in high risk cases. Prognostic discrimination of the cases with intermediate, low, or very low risk is inadequate, and these categories should be considered jointly in the future. Our results will help researchers in establishing baseline values against which they can compare, in the future, the impact of imatinib and other Kit tyrosine inhibitors on survival.
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Affiliation(s)
- J Rubió
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Josep Trueta, Avda. França s/n, 17007 Girona, Spain.
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Abstract
Mortality from colorectal trauma decreased from the end of the 19th Century, when death was the rule, to the 21st Century, when mortality is 5%. The greatest advances were produced during wars, mainly due to improved transport conditions, antisepsis, advances in operating and anesthetic techniques, the management of fluids, blood and blood products, the use of antibiotics, exteriorization of wounds, and the use of colostomy. Injuries to the anus, rectum and colon are infrequent. Their prevalence is difficult to establish because they can be caused by several factors. In Spain, the most frequent causes are traffic accidents and iatrogenic lesions, while in America the most common causes are stab or gunshot wounds. Although the etiology of these injuries is diverse, two major groups of colorectal trauma can be established: accidental injuries and iatrogenic trauma. Clinical symptoms vary, ranging from abdominal, pelvic, perianal or anal pain, sometimes associated with rectorrhagia, to peritonismus or shock. Diagnosis is based on physical and rectal examination and laboratory, radiological, and endoscopic investigations. Laparoscopy can also be used on occasions. Treatment should be individualized, depending on the patient's history, current status, the time elapsed since injury, the status of the injured intestine, the degree of fecal contamination, associated lesions, and the surgeon's experience.
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Affiliation(s)
- Antonio Codina-Cazador
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Dr. Josep Trueta, Girona, Spain.
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Roig-García J, Gironès-Vilà J, Pujades de Palol M, Codina-Barreras A, Blanco J, Ignacio Rodríguez-Hermosa J, Codina-Cazador A. Respuesta de los autores. Cir Esp 2005. [DOI: 10.1016/s0009-739x(05)70891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
INTRODUCTION The therapeutic alternatives in emergency surgery of the colon are a constant subject of debate and the Hartmann procedure is one of the most controversial techniques. The aim of the present study was to analyze when, why and in whom this procedure is performed, as well as its results. PATIENTS AND METHOD We performed a descriptive analysis of 105 emergency Hartmann procedures. Clinical variables (age, sex, antecedents, symptoms, risk factors, preoperative diagnosis) were analyzed and correlated with surgical variables (surgical findings, surgeon) indicating the Hartmann procedure depending on general and local factors. RESULTS The mean age was 69.3 years and 56% of the patients were men. Seventy-three percent had personal antecedents. Presenting symptoms were occlusion in 48%, acute abdomen in 30% and septic shock in 12%. Seventy-eight percent were ASA III-IV. The most frequent surgical findings were intestinal occlusion (39%), purulent peritonitis (22%) and fecal peritonitis (18%). Perforation of the colon was found in 14%. Morbidity was 51% and mortality was 11%. Sixty-three percent of the procedures were performed by general surgeons and 37% by specialists in colorectal surgery. In 20 patients intestinal continuity was restored after a mean wait of 9 months. Retrospective evaluation of the indications for the Hartmann procedure revealed that 50.5% of the patients could have undergone anastomosis and the reasons for not performing this procedure were analyzed. CONCLUSION In our experience the Hartmann procedure is performed primarily for factors related to the patient (risk factors, general status and local status of the abdomen) and secondly due to factors related to the duty surgeon.
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Affiliation(s)
- Antonio Codina-Cazador
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. J. Trueta, Girona, Spain.
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Roig-García J, Gironès-Vilà J, Pujades-de Palol M, Codina-Barreras A, Blanco J, Rodríguez-Hermosa J, Codina-Cazador A. Cirugía laparoscópica en el cáncer de esófago. Cir Esp 2005; 77:70-4. [PMID: 16420890 DOI: 10.1016/s0009-739x(05)70810-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION For the last year we have substituted laparotomy with laparoscopy for the abdominal stage of esophageal cancer surgery. We report our experience of the introduction of video-assisted surgery in the treatment of esophageal cancer. PATIENTS AND METHOD We report our experience of nine patients diagnosed with esophageal cancer. In seven patients laparoscopy was preceded by right thoracotomy and esophageal dissection. Then, a left anterolateral cervicotomy was performed to remove the specimen and to construct the esophagogastroanastomosis. In two patients the laparoscopic technique was performed first and the Ivor Lewis procedure was completed by right thoracotomy. RESULTS Due to the reduced number of operated patients, the results are of little significance. Morbidity was 38.3%. The mean duration of the surgical procedure in laparoscopic patients was 4 h 50 min. However, perioperative blood loss, postoperative complications, analgesic requirements and mean length of hospital stay were reduced. CONCLUSIONS Video-assisted esophagectomy can be performed as safely as conventional esophagectomy and has considerable perioperative advantages. The introduction of the laparoscopic procedure is the first step in using video-assisted surgery at all stages of esophageal cancer surgery.
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Affiliation(s)
- José Roig-García
- Unidad de Cirugía Gastroesofágica, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España.
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