Cirugia Espanola最新文献

英文中文

Apendicitis aguda contenida en hernia umbilical 包含在脐带疝中的急性阑尾炎

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 10.1016/j.ciresp.2025.800252

María Orellana León, Alejandro Moreno Bargueiras, Daniel Pastor Altaba, Pedro Yuste García

引用次数: 0

Cuidados perioperatorios en la cirugía del sarcoma retroperitoneal primario: una encuesta hispano-lusa sobre prácticas actuales 原发性腹膜后肉瘤手术的术后护理：西班牙-俄罗斯现行做法调查

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.ciresp.2025.800283

Pablo Lozano Lominchar , Paula Muñoz , Cristina Ballester , Cristobal Muñoz Casares , Daniel Díaz , Vicente Olivares-Ripoll , Patricia Marrero , Lorena Cambeiro , Irene López , Hugo Vasques , Jose Manuel Asencio , on behalf of the Spanish Society of Surgeons, the Portuguese Sarcoma Group (Society of Surgeons)

Background

Retroperitoneal sarcoma (RPS) is a rare malignancy requiring complex surgical management. While Enhanced Recovery After Surgery (ERAS®) protocols have improved outcomes in various surgical specialties, their implementation in RPS remains inconsistent.

Objective

This study aimed to evaluate current perioperative care practices for RPS surgery across Spain and Portugal, identifying gaps in protocol standardization and assessing the feasibility of consensus-based approaches.

Methods

A structured online survey was distributed to members of the Spanish and Portuguese Societies of Surgeons. The questionnaire encompassed five domains: demographics, preoperative, intraoperative, and postoperative practices, and attitudes toward perioperative consensus.

Results

Among 266 survey accesses, 37 complete responses were analyzed. Only 27% of respondents reported having a dedicated ERAS® protocol for RPS, though 89.2% employed ERAS® pathways for other surgeries. Prehabilitation elements —such as smoking cessation (21.6%), nutritional support (73%), and supervised physical therapy (37.8%)— were inconsistently applied. Intraoperatively, goal-directed fluid therapy was used by 51.4%, while 97.3% adhered to restrictive transfusion thresholds. Postoperative variability was notable in diet resumption, mobilization, and nasogastric tube use. All respondents supported the creation of an RPS-specific perioperative care consensus.

Conclusions

There is marked heterogeneity in perioperative care for RPS across Iberian centers. Standardized, evidence-based guidelines are urgently needed to improve consistency and optimize patient outcomes.

腹膜后肉瘤（RPS）是一种罕见的恶性肿瘤，需要复杂的手术治疗。虽然ERAS （Enhanced Recovery After Surgery）方案改善了各种外科专科的预后，但其在RPS中的实施仍然不一致。目的本研究旨在评估目前西班牙和葡萄牙RPS手术的围手术期护理实践，确定方案标准化方面的差距，并评估基于共识的方法的可行性。方法对西班牙和葡萄牙外科医师协会会员进行结构化的在线调查。调查问卷包括五个方面：人口统计学，术前，术中，术后实践，以及对围手术期共识的态度。结果在266条调查通道中，分析了37条完整回复。只有27%的受访者报告有专门的ERAS®RPS方案，尽管89.2%的受访者采用ERAS®途径进行其他手术。戒烟（21.6%）、营养支持（73%）和有监督的物理治疗（37.8%）等康复要素的应用不一致。术中，51.4%的患者使用目标导向的液体治疗，而97.3%的患者坚持限制性输血阈值。术后在饮食恢复、活动和鼻胃管使用方面的差异是显著的。所有的应答者都支持建立一个特定于rps的围手术期护理共识。结论伊比利亚各中心RPS围手术期护理存在明显的异质性。迫切需要标准化的、以证据为基础的指南，以提高一致性并优化患者的预后。

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引用次数: 0

Protocolo del estudio 3D-PANC: ¿es la tecnología de imagen en tres dimensiones superior a la tomografía computarizada para evaluar la respuesta al tratamiento neoadyuvante en los pacientes con adenocarcinoma de páncreas borderline o localmente avanzado? 3D-PANC研究协议：在评估边缘或局部晚期胰腺腺癌患者对新辅助治疗的反应方面，3D成像技术是否优于CT扫描？

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.ciresp.2025.800256

Marina Garcés Albir , Francisco García García , Isabel Mora Oliver , Elena Muñoz Forner , Luis Sabater Orti , Dimitri Dorcaratto , GRUPO 3D-PANC Integrantes Grupo 3D-PANC

Neoadjuvant chemotherapy followed by surgery represents the treatment of choice for patients with borderline and locally advanced pancreatic adenocarcinoma (PAC). Despite being the diagnostic technique of choice for PAC staging, computed tomography (CT) has very low accuracy in identifying patients who may benefit from surgical resection after neoadjuvant therapy. Consequently, the study of new image processing technologies is gaining significant importance. However, no prospective validation studies of these new technologies currently exist. The 3D-PANC study is a multicenter prospective study that will include patients with borderline or locally advanced PAC undergoing neoadjuvant chemotherapy and surgical exploration with curative intent. The objective is to compare the accuracy of the 3D-MSP (Model for Surgery Planning) model versus conventional CT for preoperative diagnosis of vascular involvement after neoadjuvant treatment (NAT) in patients with borderline or locally advanced PAC. This will be achieved by analyzing the accuracy variables of both techniques against the gold standard (surgical outcomes and histopathological analysis).

新辅助化疗后手术是交界性和局部晚期胰腺腺癌（PAC）患者的治疗选择。尽管计算机断层扫描（CT）是PAC分期的首选诊断技术，但在确定新辅助治疗后可能受益于手术切除的患者时，其准确性非常低。因此，研究新的图像处理技术变得越来越重要。然而，目前还没有对这些新技术进行前瞻性验证研究。3D-PANC研究是一项多中心前瞻性研究，将包括接受新辅助化疗和手术探查的边缘性或局部晚期PAC患者。目的是比较3D-MSP（手术计划模型）模型与传统CT在边缘性或局部晚期PAC患者新辅助治疗（NAT）后血管受损伤的术前诊断的准确性。这将通过分析两种技术与金标准（手术结果和组织病理学分析）的准确性变量来实现。

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引用次数: 0

Manejo del cáncer de recto: el futuro ya es presente 直肠癌管理：未来就在眼前

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-29 DOI: 10.1016/j.ciresp.2025.800280

Carlos Cerdán-Santacruz , Matteo Frasson

引用次数: 0

Impacto asistencial y seguridad quirúrgica de la mastectomía endoscópica en mujeres con cáncer de mama y de alto riesgo. Resultados preliminares del estudio VideoBreast-24 内镜乳房切除术对高危乳腺癌妇女的护理影响和手术安全性。VideoBreast-24研究初步结果

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-02-05 DOI: 10.1016/j.ciresp.2026.800290

Benigno Acea-Nebril, Alejandra García-Novoa, Sergio Sierra, Lucía Santos, Carmen Cereijo Garea

Introduction

Skin and nipple-sparing mastectomy with immediate reconstruction has become the standard treatment for women requiring a mastectomy. The objective of this article is to describe endoscopic mastectomy and analyze the initial results after its implementation in terms of care impact and post-surgical complications.

Methods

Preliminary results of the VideoBreast-24 in terms of safety and feasibility of the technique. VideoBreast-24 is a non-inferiority study that compares MPPP-E with immediate reconstruction with a polyurethane implant versus skin-sparing or skin-and-nipple mastectomy using the open technique performed within the framework of the PreQ-20 study.

Results

60 MPPP-E were performed on 42 women, 92.9% of whom were oncological patients. The average surgery time was 213.7 minutes. The average implant volume is 322cc, with the largest volume being 545cc. There were no implant losses.

Conclusions

Endoscopic mastectomy is a technique with a low incidence of postoperative complications, surgical reintervention and readmission. Surgical time is longer than that of open mastectomy, although it can be optimized 11 the learning curve has passed.

保留皮肤和乳头乳房切除术并立即重建已成为需要乳房切除术的妇女的标准治疗方法。本文的目的是描述内窥镜乳房切除术，并从护理影响和术后并发症方面分析其实施后的初步结果。方法对VideoBreast-24技术的安全性和可行性进行初步评价。videbreast -24是一项非劣效性研究，比较了在PreQ-20研究框架内使用聚氨酯植入物进行MPPP-E即刻重建与使用开放技术进行皮肤保留或皮肤乳头乳房切除术。结果42例女性共行MPPP-E检查60次，其中肿瘤患者占92.9%。平均手术时间213.7分钟。种植体平均体积为322cc，最大体积为545cc。无种植体丢失。结论内镜下乳房切除术是一种术后并发症发生率低、手术再介入率低、再入院率低的手术方法。手术时间比开放式乳房切除术长，虽然可以优化，但学习曲线已经过去。

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引用次数: 0

Hernias de hiato complejas. Recomendaciones de manejo diagnóstico y terapéutico 复杂的间歇性疝。诊断和治疗管理建议

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-28 DOI: 10.1016/j.ciresp.2025.800279

Marcos Bruna , María Asunción Acosta , Silvia Carbonell , Luis Gómez , Marian Mayo , Salvador Morales-Conde , Aitana Garcia-Tejero , Silvia Aguas , David Ruíz de Angulo , Vicente Munitiz , Luisa Martínez de Haro , Vanessa Concepción , Fernando Mingol , Miriam Menéndez , Gabriel Salcedo , Esteban Martín , Ana Senent , Alexis Luna , Dulce Momblán , Pablo Priego , Mónica Miró

Hiatal hernia (HH) is a relatively prevalent condition in our setting, yet there is little clinical evidence or guidelines establishing precise recommendations for its diagnostic and therapeutic management.

In order to establish clinical recommendations for the diagnostic and therapeutic management of patients with complex hiatal hernia, defined as a primary type III or IV mixed hernia, a large one with >30% of the gastric contents in the thoracic cavity, or a recurrence. This document was prepared based on current scientific evidence and the experience of a group of 28 expert surgeons, using GRADE methodology in order to establish recommendations on 13 controversial aspects related to this pathology.

Although the quality of evidence and the degree of recommendation are high in some areas, high-quality prospective clinical studies are needed to clarify certain unresolved points of controversy.

裂孔疝（HH）是一个相对普遍的条件在我们的设置，但很少有临床证据或指南建立其诊断和治疗管理的精确建议。复杂裂孔疝定义为原发性III型或IV型混合性疝，大疝且胸腔胃内容物占30%，或复发，为复杂裂孔疝的诊断和治疗管理提供临床建议。本文件是根据目前的科学证据和28位专家外科医生的经验编写的，使用GRADE方法对与该病理相关的13个有争议的方面提出建议。虽然证据质量和推荐程度在某些领域很高，但需要高质量的前瞻性临床研究来澄清某些未解决的争议点。

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引用次数: 0

Evidencia clínica del uso de Hemopatch® en la reducción del sangrado y fístula biliar tras resección hepática. Estudio prospectivo aleatorizado en cirugía programada Hemopatch®用于肝脏切除后减少出血和胆囊瘘的临床证据。预定手术的随机前瞻性研究

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-15 DOI: 10.1016/j.ciresp.2025.800270

Andrea Boscà Robledo , Eva M. Montalvá Orón , Ana Navío Seller , Javier Maupoey Ibáñez , Ana Hernando Sanz , David Calatayud Mizrahi , Francisco J. Orbis Castellanos , Rafael López Andújar

Background

There is abundant scientific literature on the use of haemostatics and sealants in liver surgery, but there is a lack of evidence due to the difficulty to apply adequate methodologies without conflicts of interest.

This prospective randomized study with the main objective is to determine the efficacy of the local haemostatic Hemopatch® in the incidence of bleeding and biliary fistula in patients undergoing elective liver resection.

Methods

This was a single-center study where 222 patients were analyzed: 115 patients had been randomized to the control group and 107 to the experimental group. The patients after liver resection are randomized to place Hemopatch® or not on the transection liver surface. Patients with all types of liver resections and with laparotomic and laparoscopic approaches were included. During postoperative follow-up, an abdominal drain is placed, and hemoglobin and bilirubin are analyzed during the first three days.

Results

Clinically postoperative bleeding occurred in 3.5% of the patients in the control group and in 2.8% of the experimental group (P = .409). The incidence of postoperative biliary fistula was 17.4% in the control group and 23.4% in the experimental group (P = .269). There were also no differences in the rest of the parameters analyzed.

Conclusions

The results on the use of Hemopatch® in liver resection to prevent hemorrhage and biliary fistula are inconclusive. It cannot be routinely recommended and surgeons should be more demanding with the scientific evidence to justify the systematic use of haemostatics agents.

关于在肝脏手术中使用止血剂和密封剂的科学文献很多，但由于难以在没有利益冲突的情况下应用适当的方法，缺乏证据。这项前瞻性随机研究的主要目的是确定局部止血Hemopatch®对择期肝切除术患者出血和胆瘘发生率的疗效。方法222例患者为单中心研究，其中115例随机分为对照组，107例随机分为实验组。肝切除术后的患者随机选择在肝断面表面放置或不放置Hemopatch®。所有类型的肝切除和剖腹和腹腔镜入路的患者都被包括在内。在术后随访中，放置腹腔引流管，并在前三天分析血红蛋白和胆红素。结果临床术后出血发生率对照组为3.5%，实验组为2.8% （P = .409）。对照组术后胆瘘发生率为17.4%，实验组术后胆瘘发生率为23.4% （P = 0.269）。在分析的其他参数中也没有差异。结论在肝切除术中应用Hemopatch®预防出血和胆瘘的效果尚无定论。它不能被常规推荐，外科医生应该更严格地要求科学证据来证明系统使用止血剂的合理性。

{"title":"Evidencia clínica del uso de Hemopatch® en la reducción del sangrado y fístula biliar tras resección hepática. Estudio prospectivo aleatorizado en cirugía programada","authors":"Andrea Boscà Robledo , Eva M. Montalvá Orón , Ana Navío Seller , Javier Maupoey Ibáñez , Ana Hernando Sanz , David Calatayud Mizrahi , Francisco J. Orbis Castellanos , Rafael López Andújar","doi":"10.1016/j.ciresp.2025.800270","DOIUrl":"10.1016/j.ciresp.2025.800270","url":null,"abstract":"<div><h3>Background</h3><div>There is abundant scientific literature on the use of haemostatics and sealants in liver surgery, but there is a lack of evidence due to the difficulty to apply adequate methodologies without conflicts of interest.</div><div>This prospective randomized study with the main objective is to determine the efficacy of the local haemostatic Hemopatch® in the incidence of bleeding and biliary fistula in patients undergoing elective liver resection.</div></div><div><h3>Methods</h3><div>This was a single-center study where 222 patients were analyzed: 115 patients had been randomized to the control group and 107 to the experimental group. The patients after liver resection are randomized to place Hemopatch® or not on the transection liver surface. Patients with all types of liver resections and with laparotomic and laparoscopic approaches were included. During postoperative follow-up, an abdominal drain is placed, and hemoglobin and bilirubin are analyzed during the first three days.</div></div><div><h3>Results</h3><div>Clinically postoperative bleeding occurred in 3.5% of the patients in the control group and in 2.8% of the experimental group (<em>P</em>  =.269). There were also no differences in the rest of the parameters analyzed.</div></div><div><h3>Conclusions</h3><div>The results on the use of Hemopatch® in liver resection to prevent hemorrhage and biliary fistula are inconclusive. It cannot be routinely recommended and surgeons should be more demanding with the scientific evidence to justify the systematic use of haemostatics agents.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 2","pages":"Article 800270"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shunt íleo-cava intraoperatorio transitorio en la resección de adenocarcinoma de cabeza de páncreas localmente avanzado: ¿rompiendo un techo? 局部晚期胰腺头腺癌切除术中暂时性油腔分流术：突破天花板？

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.ciresp.2025.800249

Juli Busquets , Núria Peláez , Luis Secanella , Maria Sorribas , Elena Iborra

The resection of locally advanced adenocarcinoma of the pancreatic head with occlusion of the superior mesenteric vein and involvement of the splenomesentericportal confluent (EMP) sometimes requires prolonged venous clamping with risk of intestinal ischemia. The use of intraoperative venous shunts has been published by reference groups to allow successful resection. In our center we performed a total pancreatoduodenectomy for locally advanced pancreatic head adenocarcinoma with superior mesenteric vein occlusion (SMV) and splenomesentericportal confluent. The use of a transient ileo-caval shunt via a venous graft allowed resection of the tumor without repercussion on the bowel. The surgery ended with closure of the shunt, anastomosis of the graft to the portal vein and digestive reconstruction. The patient presented good tolerance to surgery and was discharged on the 7 th postoperative day. The pathology report described pancreatic adenocarcinoma ypT1N0(R0) regression grade GRT2/IIa, with 0/30 affected adenopathies.

切除局部晚期胰头腺癌合并肠系膜上静脉阻塞及累及脾、肠、门汇合处（EMP）有时需要延长静脉夹紧时间，并有肠缺血的风险。术中静脉分流术的使用已被参考组公布，以允许成功切除。在我们的中心，我们为局部晚期胰头腺癌合并肠系膜上静脉阻塞（SMV）和脾、肠、门汇合处进行了全胰十二指肠切除术。通过静脉移植物进行短暂回肠-腔静脉分流术，可以切除肿瘤而不会对肠道产生影响。手术结束后关闭分流，将移植物与门静脉吻合，并进行消化道重建。患者对手术耐受性良好，术后第7天出院。病理报告描述了胰腺腺癌的ypT1N0（R0）退化等级GRT2/IIa， 0/30受影响的腺病变。

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引用次数: 0

Características de los ensayos clínicos españoles en cirugía digestiva completados en 2009-2024 2009-2024年完成的西班牙消化外科临床试验的特点

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-15 DOI: 10.1016/j.ciresp.2025.800268

Rafael Dal-Ré , Elena García-Méndez , Ignacio Mahillo-Fernández

引用次数: 0

Manejo quirúrgico del adenocarcinoma gástrico estadio IV: revisión sistemática y recomendaciones del Grupo de Tratamiento de los Tumores Digestivos y la Asociación Española de Cirujanos 胃腺癌IV期手术管理：消化肿瘤治疗小组和西班牙外科医生协会的系统综述和建议

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-28 DOI: 10.1016/j.ciresp.2025.800254

Paula Jimenez-Fonseca , Marcos Bruna , Javier Gallego , Mónica Miró , Mireia Gil , Fernando Pereira , Gema Marín , Delia Cortés , Roberto Pazo , Mariagiulia Dal Cero , Elena Martín , Fernando Rivera

This manuscript presents a systematic review and expert consensus from oncology and surgery on the management of metastatic gastric cancer. A literature search was conducted in PubMed and Google Scholar, selecting 28 relevant studies (21 clinical trials and 7 systematic reviews), along with international guidelines. The objective was to assess the role of surgery and locoregional therapies in patients with peritoneal, hepatic, pulmonary, or nodal metastases, and to establish multidisciplinary recommendations. Cytoreductive surgery associated to HIPEC may offer benefits in selected patients with limited peritoneal carcinomatosis (Peritoneal Carcinomatosis Index ≤6), an absence of distant metastasis, an adequate response to systemic chemotherapy and an ECOG performance status of 0-1. Resection of non-peritoneal metastases may also be considered in specific contexts. Prospective clinical trials are required to confirm these findings and define optimal selection criteria.

本文介绍了肿瘤和外科治疗转移性胃癌的系统综述和专家共识。在PubMed和b谷歌Scholar上进行文献检索，选择28项相关研究（21项临床试验和7项系统综述）以及国际指南。目的是评估手术和局部治疗在腹膜、肝、肺或淋巴结转移患者中的作用，并建立多学科建议。与HIPEC相关的细胞减少手术可能对局限性腹膜癌（腹膜癌指数≤6）、无远处转移、对全身化疗有足够反应、ECOG表现状态为0-1的患者有益。在特定情况下也可以考虑切除非腹膜转移灶。需要前瞻性临床试验来证实这些发现并确定最佳选择标准。

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引用次数: 0

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