Cirugia Espanola最新文献

英文中文

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 : 2026-01-15 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。

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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 : 2026-01-15 DOI: 10.1016/j.ciresp.2025.800268

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

引用次数: 0

A modified Federle score is superior to injury grade in predicting the need for splenectomy in patients with isolated blunt splenic trauma 改良的Federle评分在预测孤立性钝性脾损伤患者是否需要脾切除术方面优于损伤等级

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800262

Corrado P. Marini , Patrizio Petrone , Francesca Izzo , David A. Lieb II , Srinivas H. Reddy , John McNelis

Background

This study assessed whether there is a correlation between the grade of splenic injury and the semiquantitative assessment of the amount of the hemoperitoneum (HP) by a modified Federle score (mFS), and which of the 2 factors is more predictive of the need for intervention in adult patients with isolated blunt splenic injury (iBSI).

Methods

Retrospective cohort study of patients admitted (1/1/2019−12/31/2022) with iBSI. Continuous data are presented as means ± standard deviation and non-parametric data as frequencies with percentages. A test-retest analysis for intra- and inter-class reliability of HP assessment was done in a 10-patient subgroup.

Results

Among the 62 patients, 47 (75.8%) were managed nonoperatively (23 observation, 24 splenic artery embolization [SAE]), and 15 underwent splenectomy. The grade of splenic injury and mFS scores were 3.6 ± 1.3 and 4.1 ± 1.9, respectively. The 22 patients who underwent SAE were more severely injured in terms of grade of splenic injury (4.0 ± 1.2 vs 2.6 ± 1.1), amount of HP by mFS (4.1 ± 1.8 vs 3.1 ± 1.7) and ISS (21 ± 11 vs 15 ± 12) compared to the observed patients (P < .05). Mortality was 8%. SAE and splenectomy groups differed only by the quantity of HP (4.1 ± 1.8 vs 5.5 ± 1.3). While there was a correlation between AAST grade and mFS, only mFS was predictive of splenectomy.

Conclusion

The quantity of HP as assessed by mFS may be more predictive than the grade of splenic injury regarding the need for splenectomy in patients with iBSI.

背景：本研究评估脾脏损伤等级与改良Federle评分（mFS）半定量评估腹腔积血（HP）量之间是否存在相关性，以及这两个因素中哪一个更能预测成人孤立性钝性脾损伤（iBSI）患者是否需要干预。方法对2019年1月1日至2022年12月31日住院的iBSI患者进行回顾性队列研究。连续数据以平均值±标准差表示，非参数数据以频率和百分比表示。在10例患者亚组中，对HP评估的类内和类间可靠性进行了重测分析。结果62例患者中，非手术治疗47例（75.8%），其中观察23例，脾动脉栓塞24例，脾切除术15例。脾损伤分级和mFS评分分别为3.6±1.3分和4.1±1.9分。22例SAE患者在脾损伤等级（4.0±1.2 vs 2.6±1.1）、mFS HP（4.1±1.8 vs 3.1±1.7）和ISS（21±11 vs 15±12）方面均较观察患者损伤更严重（P < 0.05）。死亡率为8%。SAE组和脾切除术组仅在HP数量上有差异（4.1±1.8 vs 5.5±1.3）。虽然AAST分级与mFS之间存在相关性，但只有mFS可预测脾切除术。结论mFS评价的HP值可能比脾损伤程度更能预测iBSI患者是否需要脾切除术。

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引用次数: 0

The impact of microsatellite instability and tumor characteristics on survival of patients with right-sided colon cancer 微卫星不稳定性及肿瘤特征对右侧结肠癌患者生存的影响

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800272

Ozgur Ekinci , Ataturk Nurullayev , Muhammet Ali Aydemir , Aysegul Ergun , Tunc Eren , Orhan Alimoglu

Aim

This study aimed to explore the clinical and pathological differences between microsatellite instability-high (MSI-H) and microsatellite stable (MSS) tumors in right-sided colon cancer patients, as well as to evaluate the prognostic significance of MSI status on survival outcomes.

Methods

Historical records of patients who underwent surgery for right-sided colon cancer between 2016 and 2024 were evaluated retrospectively. Immunohistochemistry was used for the determination of MSI status, and data on tumor characteristics, lymph node metastasis, carcinoembryonic antigen (CEA) levels, and survival outcomes were analyzed. Comparisons were performed to assess differences between the MSI-H and MSS groups, where P < .05 was considered statistically significant.

Results

The study included 100 patients, consisting of 52 men and 48 women with a median age of 72 (range: 63–79). Tumors with MSI-H status were significantly larger (median: 6.50 cm vs 4.50 cm; P < .001) and demonstrated higher rates of mucinous carcinoma (52.9% vs 24.2%; P = .008) compared to MSS tumors. Poor differentiation was more common in MSI-H tumors (20.6% vs 3.03%: P = .003). Overall survival (OS) and disease-free survival (DFS) did not differ significantly between MSI-H and MSS groups (P = .466 and P = .337, respectively). Elevated postoperative CEA levels at 6, 12, 18 and 24 months were significantly associated with poorer survival outcomes (P < .01).

Conclusion

Right-sided colon cancers with MSI-H status were associated with larger tumor size, mucinous histology, and poor differentiation but did not significantly affect survival outcomes. Postoperative CEA monitoring provides critical prognostic information. Further large-scale studies are required to confirm these findings and refine therapeutic approaches.

目的探讨右侧结肠癌患者微卫星不稳定-高（MSI- h）与微卫星稳定（MSS）肿瘤的临床及病理差异，并评价MSI状态对生存结局的预后意义。方法回顾性分析2016年至2024年间右侧结肠癌手术患者的历史资料。采用免疫组织化学方法测定MSI状态，并分析肿瘤特征、淋巴结转移、癌胚抗原（CEA）水平和生存结果等数据。比较MSI-H组和MSS组之间的差异，其中P <； 0.05被认为具有统计学意义。结果纳入100例患者，男性52例，女性48例，中位年龄72岁（63-79岁）。与MSS肿瘤相比，MSI-H状态的肿瘤明显更大（中位数：6.50 cm vs 4.50 cm; P < 0.001），并且粘液癌的发生率更高（52.9% vs 24.2%; P = 0.008）。分化差在MSI-H肿瘤中更为常见（20.6% vs 3.03%: P = 0.003）。总生存期（OS）和无病生存期（DFS）在MSI-H组和MSS组之间无显著差异（P = 0.466和0.337）。术后6、12、18和24个月CEA水平升高与较差的生存结果显著相关（P < 0.01）。结论MSI-H状态的右侧结肠癌肿瘤体积较大，黏液组织学和分化差，但对生存结果无显著影响。术后CEA监测提供了重要的预后信息。需要进一步的大规模研究来证实这些发现并改进治疗方法。

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引用次数: 0

Prevalence and clinical significance of appendiceal diverticulosis: An 11-year retrospective study 阑尾憩室病的发病率及临床意义：一项11年回顾性研究

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800263

Ramazan Serdar Arslan , Resad Beyoglu , Yavuz Savas Koca , Ahmet Emre Yenipazar

Background

Appendiceal diverticulosis is a rare and often underdiagnosed entity with significant clinical implications. Limited data are available regarding its incidence, clinicopathological features, and optimal management strategies.

Methods

We retrospectively reviewed 6836 appendectomy specimens at our institution between January 2013 and December 2024. Cases diagnosed with appendiceal diverticulosis were identified, and their demographic, clinical, radiological, and pathological data were analyzed. The incidence, presentation, complications, and association with neoplasms were assessed.

Results

Nineteen cases (0.27%) of appendiceal diverticulosis were identified, with a male predominance (68.4%) and a mean age of 49.7 ± 16.8 years. Preoperative diagnosis of AD was challenging; ultrasonography and computed tomography often failed to differentiate AD from conventional appendicitis. The perforation rate in AD cases was 26.3%, significantly higher than typical appendicitis. Neoplastic lesions were observed in 10.5% of AD specimens, although no malignancies were detected during the follow-up period. All patients underwent appendectomy, including those with incidentally discovered AD.

Conclusions

Appendiceal diverticulosis is a rare but clinically significant condition associated with increased risk of perforation and potential neoplastic transformation. Early surgical intervention is recommended for all cases, including incidental findings, to prevent complications. Our findings contribute to the limited body of literature on AD and highlight the importance of routine histopathological examination of appendectomy specimens.

阑尾憩室病是一种罕见且常被误诊的疾病，具有重要的临床意义。关于其发病率、临床病理特征和最佳治疗策略的资料有限。方法回顾性分析我院2013年1月至2024年12月6836例阑尾切除术标本。对诊断为阑尾憩室病的病例进行分析，并对其人口学、临床、放射学和病理资料进行分析。评估其发生率、表现、并发症及与肿瘤的关系。结果本组共发现阑尾憩室病19例（0.27%），男性占68.4%，平均年龄49.7±16.8岁。AD的术前诊断具有挑战性；超声和计算机断层扫描常常不能区分AD与常规阑尾炎。AD病例的穿孔率为26.3%，明显高于典型阑尾炎。在10.5%的AD标本中观察到肿瘤病变，尽管在随访期间未发现恶性肿瘤。所有患者均行阑尾切除术，包括那些偶然发现AD的患者。结论阑尾憩室病是一种罕见但临床意义重大的疾病，其穿孔和潜在肿瘤转化的风险增加。建议对所有病例进行早期手术干预，包括意外发现，以防止并发症。我们的发现弥补了关于AD的文献有限的不足，并强调了阑尾切除标本常规组织病理学检查的重要性。

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引用次数: 0

Manejo laparoscópico de laceración esplénica iatrogénica. Reporte de un caso 腹腔镜治疗肌裂。案例报告

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800271

María Ramón-Baviera Martínez, Ramón Gómez Contreras, Antonio Melero Abellán, Ezequiel Enrique Irigoytia Gutiérrez

引用次数: 0

Preservación del órgano en cáncer de recto: fundamentos clínicos de la estrategia watch-and-wait 直肠癌中的器官保存：观察和等待战略的临床基础

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800248

Rosa M. Jimenez-Rodriguez , Fátima Aguilar-del-Castillo , Felipe Quezada-Diaz , Julio García-Aguilar

Locally advanced rectal cancer has traditionally been treated with neoadjuvant chemoradiotherapy, followed by total mesorectal excision (TME)—a technique that is effective but associated with high morbidity and functional impairment. The identification of patients with a clinical complete response (cCR) after treatment has driven the adoption of the “Watch-and-Wait” (W&W) strategy, aimed at avoiding surgery without compromising oncologic safety. Current evidence, drawn from international series, multicenter registries, and clinical trials, supports that W&W offers overall survival and disease-free survival rates comparable to those of radical surgery, with clear advantages in organ preservation and quality of life. However, this strategy requires careful patient selection, standardized reevaluation protocols, and intensive follow-up in specialized centers. In summary, W&W has become a valid and safe alternative to surgical treatment in selected patients with rectal cancer following neoadjuvant therapy.

局部晚期直肠癌传统上采用新辅助放化疗，然后进行全肠系膜切除(TME) -一种有效但与高发病率和功能损害相关的技术。治疗后临床完全缓解（cCR）患者的识别推动了“观察和等待”（W&；W）策略的采用，旨在避免手术而不影响肿瘤安全性。目前来自国际系列、多中心登记和临床试验的证据支持W&；W提供与根治性手术相当的总生存率和无病生存率，在器官保存和生活质量方面具有明显优势。然而，这一策略需要谨慎的患者选择，标准化的再评估方案，以及在专业中心的密切随访。综上所述，在新辅助治疗后，W&；W已成为特定直肠癌患者手术治疗的有效且安全的替代方法。

引用次数: 0

“Current Use and Clinical Applications of Intraoperative Radiotherapy in Soft Tissue Sarcomas: Insights from a National Survey in Spain” 术中放疗在软组织肉瘤中的应用现状及临床应用：来自西班牙全国调查的见解

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800244

Paula Muñoz-Muñoz , Irene López-Rojo , Amaia Ilundain-Idoate , Pedro Bretcha-Boix , Rosa M. Cañon , Felipe A. Calvo , Jose Manuel Asencio-Pascual

Soft tissue sarcomas (STS) require a multidisciplinary approach that balances oncologic control with functional preservation. Adjuvant external beam radiotherapy (EBRT) improves local control but is often limited by its toxicity. Intraoperative radiotherapy (IORT) allows for precise delivery of a single high dose during surgery, minimizing radiation exposure to adjacent tissues. This study reviews the role of IORT to treat sarcoma in the extremities and retroperitoneum, while also evaluating current clinical applications, prognosis and usage trends in Spain, based on a national survey that collected responses from all centers currently using IORT. IORT is employed in STS treatment in 11 Spanish hospitals (mostly electron-based systems), but the volume of patients treated is very low (63.6% use IORT in ≤10 cases per year). Despite favorable local control rates and reduced morbidity, access to IORT remains inconsistent at sarcoma referral centers. Broader integration and standardized protocols are needed, alongside future prospective studies on neoadjuvant EBRT and IORT.

软组织肉瘤（STS）需要多学科的方法来平衡肿瘤控制与功能保存。辅助外束放射治疗（EBRT）改善了局部控制，但往往受到其毒性的限制。术中放疗（IORT）允许在手术中精确地提供单次高剂量，最大限度地减少对邻近组织的辐射暴露。本研究回顾了IORT治疗四肢和腹膜后肉瘤的作用，同时也评估了西班牙目前的临床应用、预后和使用趋势，该研究基于一项全国调查，收集了目前使用IORT的所有中心的反馈。西班牙有11家医院（主要是电子系统）采用IORT治疗STS，但接受治疗的患者数量非常低（63.6%的患者每年≤10例使用IORT）。尽管当地控制率良好，发病率降低，但在肉瘤转诊中心，IORT的可及性仍然不一致。需要更广泛的整合和标准化的协议，以及未来对新辅助EBRT和IORT的前瞻性研究。

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引用次数: 0

Anomalous pulmonary vein drainage into the innominate vein diagnosed by 3D reconstruction prior to vats lobectomy 大桶肺叶切除术前三维重建诊断异常肺静脉引流至无名静脉

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2026-01-01 DOI: 10.1016/j.ciresp.2025.800258

Cristina Rivas Duarte , Clara Forcada Barreda , Oscar Colmenares Mendoza , María Teresa Gómez Hernández

引用次数: 0

PEComa gigante retroperitoneal: una neoplasia extraordinariamente rara 巨大的腹膜后PEComa:一种罕见的肿瘤

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-12-03 DOI: 10.1016/j.ciresp.2025.800251

Fátima Aguilar del Castillo, Daniel Aparicio-Sánchez, Carlos González de Pedro, Jaime Alonso Gómez, Daniel Diaz Gómez

引用次数: 0

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