{"title":"Dilatación cervical masiva: riesgos y desafíos en el manejo de complicaciones de la coloplastia retroesternal","authors":"Lucía Lavín Montoro, Elías Rodríguez Cuéllar, Inés Marcos Cortés, Eduardo Ferrero Herrero","doi":"10.1016/j.ciresp.2025.800192","DOIUrl":"10.1016/j.ciresp.2025.800192","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 10","pages":"Article 800192"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340483","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}
Pub Date : 2025-10-01DOI: 10.1016/j.ciresp.2025.800199
Miguel A. Bonilla-Cozar , Anabel Garcia-Leon , Carlos J. Garcia-Sanchez , M. Luisa Reyes-Diaz , Irene Ramallo-Solis , Fernando De la Portilla , Javier Padillo , Rosa M. Jimenez-Rodriguez
Background
In daily clinical practice, patients with similar risk profiles often show varied oncologic outcomes, including differing responses to neoadjuvant therapy and surgery. In this study, we seek to analyze the relationship of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios with survival and recurrence in patients treated for locally advanced rectal cancer.
Material and methods
We have conducted a retrospective analysis of patients operated on due to rectal cancer with neoadjuvant long-course radiotherapy and sensitizing chemotherapy. After neoadjuvant therapy and before surgery, these immunomarker indices were analyzed. Each index was assigned a cut-off point to assess their association with overall survival (OS) and disease-free survival (DFS).
Results
A total of 156 patients were analyzed with a median follow-up of 71.5 months (51–89). The NLR index was identified as an independent predictor of 5-year OS and DFS. Values above the 6.3 cut-off point showed an OS of 58.9% (P = .019); in patients with values above 4.72, DFS was 57.4% (P = .034). Patients whose 3 indices (NLR, PLR, MLR) were elevated had a 5-year OS of 25% (HR 3.16, 95% CI [1.45−6.87], P = .004); and a 5-year DFS of 39.4% (HR 2.88, 95% CI [1.35–6.17], P = .006).
Conclusions
Elevated preoperative immunomarker values are related to worse outcomes in terms of OS and DFS in those patients with locally advanced rectal cancer after neoadjuvant therapy. The combination of the three indices is more accurate in predicting OS and DFS. These immunomarkers may be useful in choosing an individualized therapeutic strategy.
在日常临床实践中，具有相似风险特征的患者往往表现出不同的肿瘤预后，包括对新辅助治疗和手术的不同反应。在这项研究中，我们试图分析中性粒细胞与淋巴细胞（NLR）、血小板与淋巴细胞（PLR）和单核细胞与淋巴细胞（MLR）比例与局部晚期直肠癌患者的生存率和复发率的关系。材料与方法回顾性分析直肠癌手术患者接受新辅助长期放疗和增敏化疗的情况。在新辅助治疗后和手术前对这些免疫指标进行分析。每个指标被分配一个截止点来评估它们与总生存期（OS）和无病生存期（DFS）的关联。结果共分析156例患者，中位随访71.5个月（51 ~ 89）。NLR指数被确定为5年OS和DFS的独立预测因子。高于6.3分界点的OS为58.9% (P = 0.019)；高于4.72的患者，DFS为57.4% （P = 0.034）。3项指标（NLR、PLR、MLR）升高的患者5年OS为25% (HR 3.16, 95% CI [1.45 ~ 6.87], P = 0.004)；5年DFS为39.4% （HR 2.88, 95% CI [1.35-6.17], P = 0.006）。结论局部进展期直肠癌患者经新辅助治疗后，术前免疫标志物水平升高与较差的OS和DFS有关。3个指标联合应用预测OS和DFS更为准确。这些免疫标记物可能有助于选择个体化治疗策略。
{"title":"Immunomarkers could predict overall survival and disease-free survival after neoadjuvant therapy and surgery due to locally advanced rectal cancer","authors":"Miguel A. Bonilla-Cozar , Anabel Garcia-Leon , Carlos J. Garcia-Sanchez , M. Luisa Reyes-Diaz , Irene Ramallo-Solis , Fernando De la Portilla , Javier Padillo , Rosa M. Jimenez-Rodriguez","doi":"10.1016/j.ciresp.2025.800199","DOIUrl":"10.1016/j.ciresp.2025.800199","url":null,"abstract":"<div><h3>Background</h3><div>In daily clinical practice, patients with similar risk profiles often show varied oncologic outcomes, including differing responses to neoadjuvant therapy and surgery. In this study, we seek to analyze the relationship of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios with survival and recurrence in patients treated for locally advanced rectal cancer.</div></div><div><h3>Material and methods</h3><div>We have conducted a retrospective analysis of patients operated on due to rectal cancer with neoadjuvant long-course radiotherapy and sensitizing chemotherapy. After neoadjuvant therapy and before surgery, these immunomarker indices were analyzed. Each index was assigned a cut-off point to assess their association with overall survival (OS) and disease-free survival (DFS).</div></div><div><h3>Results</h3><div>A total of 156 patients were analyzed with a median follow-up of 71.5 months (51–89). The NLR index was identified as an independent predictor of 5-year OS and DFS. Values above the 6.3 cut-off point showed an OS of 58.9% (<em>P</em> = .019); in patients with values above 4.72, DFS was 57.4% (<em>P</em> = .034). Patients whose 3 indices (NLR, PLR, MLR) were elevated had a 5-year OS of 25% (HR 3.16, 95% CI [1.45−6.87], <em>P</em> = .004); and a 5-year DFS of 39.4% (HR 2.88, 95% CI [1.35–6.17], <em>P</em> = .006).</div></div><div><h3>Conclusions</h3><div>Elevated preoperative immunomarker values are related to worse outcomes in terms of OS and DFS in those patients with locally advanced rectal cancer after neoadjuvant therapy. The combination of the three indices is more accurate in predicting OS and DFS. These immunomarkers may be useful in choosing an individualized therapeutic strategy.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 10","pages":"Article 800199"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340478","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}
Pub Date : 2025-10-01DOI: 10.1016/j.ciresp.2025.800210
Luisana Riba-Combatti , Alejandro Bravo-Salvá , Montserrat Juvany-Gómez , José Antonio Pereira Rodríguez
Introduction
Inguinoscrotal hernia (ISH) represents an advanced form of inguinal hernia, with greater technical complexity and higher risk of complications. Despite its significant prevalence, its management remains heterogeneous in Spain. This study evaluates clinical practice and adherence to the recommendations of the European Hernia Society (EHS).
Methods
A cross-sectional observational study was conducted through an online survey distributed among members of the Spanish Association of Surgery (AEC). Demographic variables and specific data on the diagnostic and therapeutic management of ISH were collected. Subgroup analyses were performed based on age and specialization in abdominal wall surgery.
Results
Out of 3014 surveys distributed, 392 complete responses were obtained (13%). While 60.2% had an Abdominal Wall Unit, only 11.7% centralized all inguinal hernia cases. Open surgery remains the most frequent approach (96.4%). In ISH cases, the use of minimally invasive surgery (MIS) is lower (38.6%), with TAPP being the predominant technique. Surgeons specialized in abdominal wall procedures used more posterior and endoscopic techniques. Adherence to EHS guidelines was partial (58.8%).
Conclusions
The treatment of ISH in Spain lacks proper centralization in specialized units, which limits the adoption of advanced techniques and adherence to international guidelines. Promoting specific training, European certification, and the creation of specialized units could improve clinical outcomes and the quality of life for these patients.
{"title":"Manejo de la hernia inguinoescrotal en España. Resultados de una encuesta nacional","authors":"Luisana Riba-Combatti , Alejandro Bravo-Salvá , Montserrat Juvany-Gómez , José Antonio Pereira Rodríguez","doi":"10.1016/j.ciresp.2025.800210","DOIUrl":"10.1016/j.ciresp.2025.800210","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinoscrotal hernia (ISH) represents an advanced form of inguinal hernia, with greater technical complexity and higher risk of complications. Despite its significant prevalence, its management remains heterogeneous in Spain. This study evaluates clinical practice and adherence to the recommendations of the European Hernia Society (EHS).</div></div><div><h3>Methods</h3><div>A cross-sectional observational study was conducted through an online survey distributed among members of the Spanish Association of Surgery (AEC). Demographic variables and specific data on the diagnostic and therapeutic management of ISH were collected. Subgroup analyses were performed based on age and specialization in abdominal wall surgery.</div></div><div><h3>Results</h3><div>Out of 3014 surveys distributed, 392 complete responses were obtained (13%). While 60.2% had an Abdominal Wall Unit, only 11.7% centralized all inguinal hernia cases. Open surgery remains the most frequent approach (96.4%). In ISH cases, the use of minimally invasive surgery (MIS) is lower (38.6%), with TAPP being the predominant technique. Surgeons specialized in abdominal wall procedures used more posterior and endoscopic techniques. Adherence to EHS guidelines was partial (58.8%).</div></div><div><h3>Conclusions</h3><div>The treatment of ISH in Spain lacks proper centralization in specialized units, which limits the adoption of advanced techniques and adherence to international guidelines. Promoting specific training, European certification, and the creation of specialized units could improve clinical outcomes and the quality of life for these patients.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 10","pages":"Article 800210"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340479","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}
Pub Date : 2025-10-01DOI: 10.1016/j.ciresp.2025.800212
Salvador Pous-Serrano , Jose Bueno-Lledó , Jesús Martínez-Hoed , Omar Carreño-Sáenz , Providencia García-Pastor , Santiago Bonafé-Diana , Belén Porrero Guerrero , Guillermo Lillo-Albert , Member of the AEC Abdominal Wall Division
The performance of progressive pneumoperitoneum in hernias with loss of domain is a common practice in surgical units with a special focus on abdominal wall surgery. The main objective of this article is to describe a consensus proposal on the utility of the procedure, its indications, contraindications, the description of the different catheter placement techniques for insufflation, the recommendation of insufflation protocols, and the potential complications arising from the procedure. Additionally, an informed consent proposal endorsed by the Abdominal Wall Group of the Spanish Association of Surgeons (AEC) is included.
{"title":"Conditioning of the abdominal wall with progressive pneumoperitoneum in hernias with loss of domain. A consensus proposal","authors":"Salvador Pous-Serrano , Jose Bueno-Lledó , Jesús Martínez-Hoed , Omar Carreño-Sáenz , Providencia García-Pastor , Santiago Bonafé-Diana , Belén Porrero Guerrero , Guillermo Lillo-Albert , Member of the AEC Abdominal Wall Division","doi":"10.1016/j.ciresp.2025.800212","DOIUrl":"10.1016/j.ciresp.2025.800212","url":null,"abstract":"<div><div>The performance of progressive pneumoperitoneum in hernias with loss of domain is a common practice in surgical units with a special focus on abdominal wall surgery. The main objective of this article is to describe a consensus proposal on the utility of the procedure, its indications, contraindications, the description of the different catheter placement techniques for insufflation, the recommendation of insufflation protocols, and the potential complications arising from the procedure. Additionally, an informed consent proposal endorsed by the Abdominal Wall Group of the Spanish Association of Surgeons (AEC) is included.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 10","pages":"Article 800212"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340481","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ciresp.2025.800197
Belén Hernández-Roca , José M. Ramia , Juli Busquets , Luis Secanella , Nuria Peláez , Maialen Alkorta , Itziar de Ariño Hervas , M. Mar Achalandabaso , Enrique Toledo , Fernando Rotellar , Pablo Marti-Cruchaga , Miguel Ángel Gómez-Bravo , Gonzalo Suárez , Marina Garcés , Luis Sabater , Gabriel García Plaza , Francisco Javier Alcalá , Enrique Asensio , David Pacheco , Esteban Cugat , Cándido Alcazar
Introduction
Left pancreatectomy (LP) is a surgical technique with low mortality but high morbidity (30%), particularly pancreatic fistula (PF). Its minimally invasive (MI) approach has become popular, but its implementation in Spain remains unknown. We present a national multicenter study on LP to determine morbidity-mortality, PF incidence, and the percentage of MI approach.
Methods
A descriptive, observational, prospective, and multicenter study on LP. Study period: 02/01/2022–02/28/2023. Inclusion criteria: Elective LP. Exclusion criteria: LP following pancreaticoduodenectomy, with celiac trunk resection, or performed as an emergency. Major complications (MC): Clavien-Dindo ≥ IIIA.
Results
A total of 41 centers participated, including 313 patients. Women accounted for 53.4%. Mean age: 63.4 years. The most common indications for LP were neuroendocrine tumors (32.6%), pancreatic adenocarcinoma (28%), and IPMN (15.7%). The surgical approach was laparoscopic (53%), open (30.7%), and robotic (16.3%). The most frequently performed techniques were distal splenopancreatectomy (72.2%) and radical antegrade modular pancreatosplenectomy (RAMPS) (14.4%). Complications occurred in 57.5% of patients, with 21.1% classified as MC. The most frequent was PF (38.3%), with 52.5% of PFs classified as B-C (20.1% of the total). The 90-day mortality rate was 1.6%. The use of a protective sleeve and the absence of drains were associated with the absence of PF in multivariate analysis.
Conclusion
In our series, the MI approach was significantly higher than expected (70%). The MC rate was 21.1%, and mortality was 1.6%, confirming that LP is a procedure with low mortality but high morbidity.
{"title":"Tipo de abordaje y complicaciones postoperatorias tras pancreatectomia izquierda (estudio prospectivo SPANDISPAN)","authors":"Belén Hernández-Roca , José M. Ramia , Juli Busquets , Luis Secanella , Nuria Peláez , Maialen Alkorta , Itziar de Ariño Hervas , M. Mar Achalandabaso , Enrique Toledo , Fernando Rotellar , Pablo Marti-Cruchaga , Miguel Ángel Gómez-Bravo , Gonzalo Suárez , Marina Garcés , Luis Sabater , Gabriel García Plaza , Francisco Javier Alcalá , Enrique Asensio , David Pacheco , Esteban Cugat , Cándido Alcazar","doi":"10.1016/j.ciresp.2025.800197","DOIUrl":"10.1016/j.ciresp.2025.800197","url":null,"abstract":"<div><h3>Introduction</h3><div>Left pancreatectomy (LP) is a surgical technique with low mortality but high morbidity (30%), particularly pancreatic fistula (PF). Its minimally invasive (MI) approach has become popular, but its implementation in Spain remains unknown. We present a national multicenter study on LP to determine morbidity-mortality, PF incidence, and the percentage of MI approach.</div></div><div><h3>Methods</h3><div>A descriptive, observational, prospective, and multicenter study on LP. Study period: 02/01/2022–02/28/2023. Inclusion criteria: Elective LP. Exclusion criteria: LP following pancreaticoduodenectomy, with celiac trunk resection, or performed as an emergency. Major complications (MC): Clavien-Dindo ≥ IIIA.</div></div><div><h3>Results</h3><div>A total of 41 centers participated, including 313 patients. Women accounted for 53.4%. Mean age: 63.4 years. The most common indications for LP were neuroendocrine tumors (32.6%), pancreatic adenocarcinoma (28%), and IPMN (15.7%). The surgical approach was laparoscopic (53%), open (30.7%), and robotic (16.3%). The most frequently performed techniques were distal splenopancreatectomy (72.2%) and radical antegrade modular pancreatosplenectomy (RAMPS) (14.4%). Complications occurred in 57.5% of patients, with 21.1% classified as MC. The most frequent was PF (38.3%), with 52.5% of PFs classified as B-C (20.1% of the total). The 90-day mortality rate was 1.6%. The use of a protective sleeve and the absence of drains were associated with the absence of PF in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>In our series, the MI approach was significantly higher than expected (70%). The MC rate was 21.1%, and mortality was 1.6%, confirming that LP is a procedure with low mortality but high morbidity.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 9","pages":"Article 800197"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049947","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ciresp.2025.800187
Leonidas Alejandro Landero Ascencio, Raúl Guerrero Lopez, Marc Perez Xaus, Sara Fernandez Planas, Hellena Vallverdú Cartié
{"title":"Severe bacterial soft tissue infection in the chest due to S. pyogenes: A case series","authors":"Leonidas Alejandro Landero Ascencio, Raúl Guerrero Lopez, Marc Perez Xaus, Sara Fernandez Planas, Hellena Vallverdú Cartié","doi":"10.1016/j.ciresp.2025.800187","DOIUrl":"10.1016/j.ciresp.2025.800187","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 9","pages":"Article 800187"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050668","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ciresp.2025.800198
Álvaro García-Granero , Sebastián Jerí-McFarlane , Aina Ochogavía , Margarita Gamundí-Cuesta , Eduardo Garcia-Granero , Francisco Xavier González-Argenté
{"title":"Reconstrucciones 3 D en cáncer de recto. Nuevas herramientas para un mejor diagnóstico y planificación operatoria","authors":"Álvaro García-Granero , Sebastián Jerí-McFarlane , Aina Ochogavía , Margarita Gamundí-Cuesta , Eduardo Garcia-Granero , Francisco Xavier González-Argenté","doi":"10.1016/j.ciresp.2025.800198","DOIUrl":"10.1016/j.ciresp.2025.800198","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 9","pages":"Article 800198"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049951","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ciresp.2025.800202
Blas Flor-Lorente, Mario Javier de Miguel Valencia
Pelvic exenteration (PE) is a potentially curative surgical option for patients with locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) involving multivisceral structures. Originally conceived as a palliative procedure, advancements in surgical techniques and multidisciplinary management have broadened its indications, enabling R0 resections in over 60% of cases. Appropriate patient selection, based on advanced imaging and comprehensive functional assessment, is essential to optimize oncologic outcomes. Currently, the surgical indication is primarily determined by the reasonable possibility of achieving an R0 resection with acceptable morbidity in a suitable candidate, which may translate into high survival rates.
Surgical planning should follow a compartmental approach and require close collaboration among colorectal, urologic, gynecologic, vascular, orthopedic, plastic, and reconstructive surgeons. Urinary, gynecologic, vascular, osseous, and soft tissue reconstructions are tailored to the tumor's extent and the patient's individual needs. In selected cases, PE may be performed with palliative intent. Intraoperative radiotherapy (IORT) and minimally invasive approaches have emerged as valuable adjuncts.
Long-term oncologic and functional outcomes are closely linked to the achievement of negative margins. While postoperative morbidity remains significant, mortality rates have declined in high-volume centers. Postoperative quality of life has become a key outcome, with increasing emphasis on patient-reported outcome measures (PROMs) to guide clinical decision-making. PE continues to challenge traditional limits of resectability, offering renewed hope to carefully selected patients.
{"title":"Cirugía por cáncer de recto más allá del mesorrecto: indicaciones, preparación límites y resultados","authors":"Blas Flor-Lorente, Mario Javier de Miguel Valencia","doi":"10.1016/j.ciresp.2025.800202","DOIUrl":"10.1016/j.ciresp.2025.800202","url":null,"abstract":"<div><div>Pelvic exenteration (PE) is a potentially curative surgical option for patients with locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) involving multivisceral structures. Originally conceived as a palliative procedure, advancements in surgical techniques and multidisciplinary management have broadened its indications, enabling R0 resections in over 60% of cases. Appropriate patient selection, based on advanced imaging and comprehensive functional assessment, is essential to optimize oncologic outcomes. Currently, the surgical indication is primarily determined by the reasonable possibility of achieving an R0 resection with acceptable morbidity in a suitable candidate, which may translate into high survival rates.</div><div>Surgical planning should follow a compartmental approach and require close collaboration among colorectal, urologic, gynecologic, vascular, orthopedic, plastic, and reconstructive surgeons. Urinary, gynecologic, vascular, osseous, and soft tissue reconstructions are tailored to the tumor's extent and the patient's individual needs. In selected cases, PE may be performed with palliative intent. Intraoperative radiotherapy (IORT) and minimally invasive approaches have emerged as valuable adjuncts.</div><div>Long-term oncologic and functional outcomes are closely linked to the achievement of negative margins. While postoperative morbidity remains significant, mortality rates have declined in high-volume centers. Postoperative quality of life has become a key outcome, with increasing emphasis on patient-reported outcome measures (PROMs) to guide clinical decision-making. PE continues to challenge traditional limits of resectability, offering renewed hope to carefully selected patients.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 9","pages":"Article 800202"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049952","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}
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