Cirugia espanola最新文献

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.

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.

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.

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 multicentre 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 analysing the accuracy variables of both techniques against the gold standard (surgical outcomes and histopathological analysis).