Pub Date : 2026-01-01DOI: 10.1016/j.cireng.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, multicentre records, and clinical trials, supports the view 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, standardised re-evaluation protocols, and intensive follow-up in specialised centres. In summary, W&W has become a valid and safe alternative to surgical treatment in selected patients with rectal cancer following neoadjuvant therapy.
{"title":"Organ preservation in rectal cancer: Clinical basis of the watch-and-wait strategy","authors":"Rosa M. Jimenez-Rodriguez , Fátima Aguilar-del-Castillo , Felipe Quezada-Diaz , Julio García-Aguilar","doi":"10.1016/j.cireng.2025.800248","DOIUrl":"10.1016/j.cireng.2025.800248","url":null,"abstract":"<div><div>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, multicentre records, and clinical trials, supports the view 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, standardised re-evaluation protocols, and intensive follow-up in specialised centres. In summary, W&W has become a valid and safe alternative to surgical treatment in selected patients with rectal cancer following neoadjuvant therapy.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800248"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cireng.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%）（23例观察，24例脾动脉栓塞[SAE]）， 15例脾切除术。脾损伤分级和mFS评分分别为3.6±1.3分和4.1±1.9分。与观察的患者相比，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）方面的损伤更严重(P结论：mFS评估的HP数量可能比脾损伤等级更能预测iBSI患者是否需要脾切除术。
{"title":"A modified Federle score is superior to injury grade in predicting the need for splenectomy in patients with isolated blunt splenic trauma","authors":"Corrado P. Marini , Patrizio Petrone , Francesca Izzo , David A. Lieb II , Srinivas H. Reddy , John McNelis","doi":"10.1016/j.cireng.2025.800262","DOIUrl":"10.1016/j.cireng.2025.800262","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800262"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cireng.2025.800242
Arkaitz Perfecto , Mikel Prieto , Alfonso Sánchez-Mayoral , Álex Bausela , Mikel Gastaca
{"title":"Low recurrence rate of hepatocellular carcinoma in patients undergoing liver transplantation during the transitional period of indication from the Milan criteria to the alpha-fetoprotein model","authors":"Arkaitz Perfecto , Mikel Prieto , Alfonso Sánchez-Mayoral , Álex Bausela , Mikel Gastaca","doi":"10.1016/j.cireng.2025.800242","DOIUrl":"10.1016/j.cireng.2025.800242","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800242"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cireng.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.
{"title":"Prevalence and clinical significance of appendiceal diverticulosis: An 11-year retrospective study","authors":"Ramazan Serdar Arslan , Resad Beyoglu , Yavuz Savas Koca , Ahmet Emre Yenipazar","doi":"10.1016/j.cireng.2025.800263","DOIUrl":"10.1016/j.cireng.2025.800263","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800263"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cireng.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：本研究旨在探讨右侧结肠癌患者微卫星不稳定性高（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 - 2024年间右侧结肠癌手术患者的历史记录。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：该研究纳入100例患者，其中男性52例，女性48例，中位年龄72岁（范围：63-79）。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：伴有MSI-H状态的右侧结肠癌与较大的肿瘤大小、粘液组织学和较差的分化相关，但对生存结果没有显著影响。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。
{"title":"The impact of microsatellite instability and tumor characteristics on survival of patients with right-sided colon cancer","authors":"Ozgur Ekinci , Ataturk Nurullayev , Muhammet Ali Aydemir , Aysegul Ergun , Tunc Eren , Orhan Alimoglu","doi":"10.1016/j.cireng.2025.800272","DOIUrl":"10.1016/j.cireng.2025.800272","url":null,"abstract":"<div><h3>Aim</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>P</em> < .05 was considered statistically significant.</div></div><div><h3>Results</h3><div>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; <em>P</em> < .001) and demonstrated higher rates of mucinous carcinoma (52.9% vs 24.2%; <em>P</em> = .008) compared to MSS tumors. Poor differentiation was more common in MSI-H tumors (20.6% vs 3.03%: <em>P</em> = .003). Overall survival (OS) and disease-free survival (DFS) did not differ significantly between MSI-H and MSS groups (<em>P</em> = .466 and <em>P</em> = .337, respectively). Elevated postoperative CEA levels at 6, 12, 18 and 24 months were significantly associated with poorer survival outcomes (<em>P</em> < .01).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800272"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cireng.2025.800236
David Ruiz de Angulo, Vicente Munitiz Ruiz
{"title":"‘Siewert type IV’: A 21st-century disease with a 20th-century surgical treatment","authors":"David Ruiz de Angulo, Vicente Munitiz Ruiz","doi":"10.1016/j.cireng.2025.800236","DOIUrl":"10.1016/j.cireng.2025.800236","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 1","pages":"Article 800236"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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