Cirugia espanola最新文献

英文中文

Male breast cancer: A multicenter study in Aragon over 27 years 男性乳腺癌：阿拉贡 27 年来的一项多中心研究。

Cirugia espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.cireng.2024.09.001

Olga Dobato Portoles , Daniel Aparicio Lopez , Reyes Ibañez Carreras , Elena Aguirre Ortega , Beatriz Eizaguirre Zarza , Carmen García Mur , Aurora Carrasquer Puyal , María Pilar Cebollero Benito , Laura Isabel Comín Novella , Marta Allue Cabañuz , Fernando Martinez Ubieto , Ramón Sousa Domínguez , Javier Torcal Aznar , Carmen Casamayor Franco

Introduction

Male breast cancer accounts for 1% of all breast cancers. Its low frequency leads to a lack of awareness, resulting in significant diagnostic delays. Additionally, this limits the available evidence, which primarily uses diagnostic-therapeutic algorithms based on women.

Objectives

To analyze the prevalence, clinical presentation, anatomical and pathological characteristics, and prognosis of male breast cancer using one of the largest series available. Secondarily, to compare our data with studies conducted in women.

Materials and methods

A multicenter, observational, descriptive, retrospective study was conducted in the autonomous community of Aragon, Spain, from 1995 to 2022 including men with a pathological diagnosis of breast cancer.

Results

A total of 148 patients were included, with a prevalence of 1%. The most common clinical presentation was a palpable retroareolar mass. Invasive ductal carcinoma was the most frequent type (88.89%), and luminal B was the predominant subtype (47.76%). Surgery was the most utilized treatment; mastectomy was performed in 90.34% and AL in 46.89%. At diagnosis, 52.46% had extramammary involvement. The recurrence rate was 24.1%, and the mortality attributed to the disease was 14.6%.

Conclusions

There is a high rate of metastatic involvement at diagnosis, a high percentage of mutilating surgeries, and a high number of recurrences compared to available studies on males. Additionally, a worse prognosis is observed compared to breast cancer in women, despite these tumors having a less aggressive molecular subtype. These findings highlight the importance of conducting studies focused on men to develop specific protocols.

导言男性乳腺癌占所有乳腺癌的 1%。由于发病率低，人们对其缺乏认识，导致诊断严重延误。此外，这也限制了现有的证据，因为现有证据主要使用基于女性的诊断治疗算法：目的：利用现有最大规模的系列研究之一，分析男性乳腺癌的发病率、临床表现、解剖和病理特征以及预后。其次，将我们的数据与针对女性的研究进行比较：从 1995 年到 2022 年，我们在西班牙阿拉贡自治区开展了一项多中心、观察性、描述性和回顾性研究，研究对象包括病理诊断为乳腺癌的男性患者：共纳入 148 名患者，发病率为 1%。最常见的临床表现是可扪及乳晕后肿块。浸润性导管癌是最常见的类型（88.89%），管腔 B 是最主要的亚型（47.76%）。手术是最常用的治疗方法；90.34%的患者接受了乳房切除术，46.89%的患者接受了AL术。确诊时，52.46%的患者有乳腺外受累。复发率为 24.1%，死亡率为 14.6%：结论：与现有的男性研究相比，乳腺癌的诊断转移率高，切除手术比例高，复发率高。此外，与女性乳腺癌相比，尽管这些肿瘤的分子亚型侵袭性较低，但预后较差。这些发现凸显了开展以男性为重点的研究以制定特定方案的重要性。

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引用次数: 0

Impact of sarcopenic obesity on surgical complications and oncologic outcomes of upper gastrointestinal tumors: A systematic review and meta-analysis. 肌肉松弛性肥胖对上消化道肿瘤手术并发症和肿瘤治疗效果的影响：系统回顾和荟萃分析。

Cirugia espanola

Pub Date : 2024-09-27 DOI: 10.1016/j.cireng.2024.09.005

Luz Divina Juez, Ana Del Carmen Ortega, Pablo Priego, Juan Carlos García Pérez, José María Fernández-Cebrián, Jose I Botella-Carretero

Sarcopenic obesity (SO) is a new entity whose definition encompasses the diagnosis of overweight in malnourished patients. The aim of the review was to assess the impact of body composition in patients with esophago-gastric tumors (EGT) on perioperative and oncological outcomes. This systematic review was conducted under the PRISMA guidelines. MEDLINE (PubMed), Embase, Web of Science and SCOPUS databases were searched until January 2024. Sixteen articles were identified for analysis analyzing 5,378 patients. The prevalence of SO was 10% (95%CI: 6-16; I² = 94%). Preoperative diagnosis of SO was associated with a twofold increased risk of severe postoperative complications (OR 2.32 [95%CI 1.41-3.82] I² = 70%). Meta-analysis of overall survival outcomes identified that SO was associated with worse overall survival (HR 2.30; 95%CI 1.46-3.61).

肌营养不良性肥胖（Sarcopenic obesity，SO）是一种新的疾病，其定义包括营养不良患者的超重诊断。本综述旨在评估食管胃肿瘤（EGT）患者的身体成分对围手术期和肿瘤治疗效果的影响。本系统性综述根据 PRISMA 指南进行。检索了MEDLINE（PubMed）、Embase、Web of Science和SCOPUS数据库，检索期至2024年1月。最终确定了 16 篇文章，对 5378 名患者进行了分析。SO的患病率为10%（95%CI：6-16；I2 = 94%）。术前诊断出 SO 与严重术后并发症风险增加两倍有关（OR 2.32 [95%CI 1.41-3.82] I2 = 70%）。总体生存结果的 Meta 分析表明，SO 与总体生存率降低有关（HR 2.30；95%CI 1.46-3.61）。

引用次数: 0

Robotic approach for remnant cholelithiasis and CBD exploration for gallstones removal. 机器人方法治疗残余胆石症，CBD探查术取出胆结石。

Cirugia espanola

Pub Date : 2024-09-27 DOI: 10.1016/j.cireng.2024.08.004

Aram Rojas, Pierce Paterakos, Sarah B Hays, Melissa E Hogg

引用次数: 0

Embolize, supercharge, resect: Embolization to enhance hepatic vascularization prior to en-bloc pancreas and arterial resection. 栓塞、增压、切除：在胰腺全层和动脉切除术之前，通过栓塞增强肝脏血管。

Cirugia espanola

Pub Date : 2024-09-18 DOI: 10.1016/j.cireng.2024.08.001

Juli Busquets, Luis Secanella, Thiago Carnaval, Maria Sorribas, Mónica Serrano-Navidad, Esther Alba, Elena Escalante, Sandra Ruiz-Osuna, Núria Peláez, Juan Fabregat

Introduction: Embolization could increase the resectability of pancreatic tumors by supercharging visceral arterial perfusion prior to pancreatic surgery with arterial en-bloc resection. Its indications, however, are controversial.

Methods: We retrospectively analyzed the results of a single-center database of patients undergoing pancreatic surgery with arterial resection (AR) after preoperative arterial embolization (PAE) to increase hepatic vascular flow and spare arterial reconstruction.

Results: PAE was planned in 15 patients with arterial involvement due to pancreatic tumors. Three patients were excluded due to the finding of irresectable disease during surgery. Twelve cases were resected because of pancreatic cancer (10), distal cholangiocarcinoma (1), and pancreatic neuroendocrine tumor (1). Arterial involvement in these cases required embolization of the substitute right hepatic artery (RHA) (5), left hepatic artery (1), and common hepatic artery (CHA) (6) to enhance liver vascularization. Two patients presented migration of the vascular plug after PAE. Six pancreatoduodenectomies and 6 distal pancreatectomies were performed, the latter associated with en-bloc celiac trunk and CHA resection. R0 was achieved in 7 out of 12 patients, and pathological vascular involvement was confirmed in 8. Postoperative complications included one patient who developed gastric ischemia and underwent gastrectomy, and one patient who underwent reoperation for acute cholecystitis with liver abscesses.

Conclusion: Preoperative arterial embolization before pancreatic surgery with hepatic arterial resection enables surgeons to precondition hepatic vascularization and prevent hepatic ischemia. In addition, this avoids having to perform arterial anastomosis in the presence of pancreatic suture.

导言：栓塞术可在胰腺手术前通过动脉全切增加内脏动脉灌注，从而提高胰腺肿瘤的可切除性。然而，其适应症还存在争议：我们回顾性分析了单中心数据库中接受动脉切除术（AR）的胰腺手术患者术前动脉栓塞（PAE）以增加肝脏血管流量和备用动脉重建的结果：15例因胰腺肿瘤导致动脉受累的患者计划进行PAE。结果：15 例因胰腺肿瘤导致动脉受累的患者计划进行 PAE，其中 3 例患者因手术中发现无法切除的疾病而被排除。12例患者因胰腺癌（10例）、远端胆管癌（1例）和胰腺神经内分泌肿瘤（1例）而被切除。这些病例的动脉受累需要栓塞替代的右肝动脉（RHA）（5 例）、左肝动脉（1 例）和肝总动脉（CHA）（6 例），以增强肝脏血管。两名患者在 PAE 术后出现血管栓塞移位。共进行了6例胰十二指肠切除术和6例远端胰腺切除术，后者与腹腔干和CHA全切术相关。12例患者中有7例实现了R0，8例患者的病理血管受累得到证实。术后并发症包括一名患者出现胃缺血而接受胃切除术，一名患者因急性胆囊炎合并肝脓肿而再次手术：结论：在进行胰腺手术和肝动脉切除术之前进行术前动脉栓塞，可使外科医生对肝脏血管进行预处理，防止肝脏缺血。此外，这还避免了在胰腺缝合时进行动脉吻合。

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引用次数: 0

Diathermy versus scalpel in midline abdominal incision: A systematic review and meta-analysis of randomized controlled trials. 腹部中线切开术中的热疗与手术刀：随机对照试验的系统回顾和元分析》。

Cirugia espanola

Pub Date : 2024-09-18 DOI: 10.1016/j.cireng.2024.09.002

Nicole Dos Santos Pimenta, Ana Clara Felix de Farias Santos, João Pedro Costa Esteves Almuinha Salles, Juliana Millani de Oliveira, Pedro Henrique Costa Matos da Silva, Renan Carlo Colombari

Introduction: Our study aimed to compare the midline abdominal incision with scalpel and diathermy.

Methods: PubMed, EMBASE, and Cochrane were searched through January 2024 following PRISMA guidelines (PROSPERO, ID: CRD42024516771), and only randomized controlled trials were included. Heterogeneity was assessed using Cochran's Q test and the I² heterogeneity index. Statistical analysis was performed using Review Manager 5.4 software.

Results: Six randomized controlled trials were included, from which 469 patients (51.5%) received diathermy incision and 442 patients (48.5%) underwent the scalpel technique. Patients treated with the electrocautery approach had less incision blood loss (MD -17.57 mL; P < .01). No statistically significant differences were found between groups regarding wound infection incidence, incision time, incision area or first-day postoperative pain.

Conclusion: Diathermy use in midline abdominal incision may be advocated as it demonstrated a significant reduction in incision-related blood loss, with no differences in wound infection or early postoperative pain incidences compared to the scalpel.

简介我们的研究旨在比较腹部中线切口与手术刀和电热疗法：按照 PRISMA 指南（PROSPERO，ID：CRD42024516771）检索了 PubMed、EMBASE 和 Cochrane，检索期至 2024 年 1 月，仅纳入了随机对照试验。异质性采用 Cochran's Q 检验和 I2 异质性指数进行评估。使用Review Manager 5.4软件进行统计分析：共纳入了 6 项随机对照试验，其中 469 名患者（51.5%）接受了电热切口术，442 名患者（48.5%）接受了手术刀技术。采用电灼法治疗的患者切口失血量较少（MD -17.57 mL; P 结论：电灼法在中线腹腔镜手术中的应用可减少切口失血量：腹部中线切开术中使用电热疗法可显著减少切口相关失血量，与手术刀相比，伤口感染或术后早期疼痛发生率没有差异，因此值得提倡。

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引用次数: 0

Hemoglobinuria following reabsorbed hemoperitoneum. 重吸收性腹腔积血后出现血红蛋白尿。

Cirugia espanola

Pub Date : 2024-09-18 DOI: 10.1016/j.cireng.2024.08.003

Owen Korn, Álvaro Morales, Sebastián Sapiain, María Jesús Vial

引用次数: 0

Non-inferiority clinical trial. Features and practical considerations. 非劣效性临床试验。特点和实际考虑因素。

Cirugia espanola

Pub Date : 2024-09-02 DOI: 10.1016/j.cireng.2024.07.008

Xavier Serra-Aracil, Marc Fradera

引用次数: 0

Clinical trial on nurse training through virtual reality simulation of an operating room: assessing satisfaction and outcomes 通过虚拟现实模拟手术室进行护士培训的临床试验：评估满意度和成果

Cirugia espanola

Pub Date : 2024-09-01 DOI: 10.1016/j.cireng.2024.04.012

Introduction

Virtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures.

Methods

This is an open parallel-group randomized clinical trial. One group received basic formation followed by an assessment module. The experimental group received the same basic formation, followed by thoracic surgery training and an assessment module.

Results

Fifty-six nurses participated in the study (51 females), with a mean age of 41.6 years. Participants achieved a median evaluation mode score of 480 points (IQR = 32 points). The experimental group (520 points) achieved an overall higher score than the control group (440 points; P = .04). Regarding age, women in the second quartile of age among the participants (35–41 years) achieved significantly better results than the rest (P = .04). When we evaluated the results based on the moment of practice, exercises performed in the last 10 min obtained better results than those performed in the first 10 min (1064 points versus 554 points; P < .001). Regarding adverse effects blurred vision was the most frequent. The overall satisfaction rating with the experience was 8.5 out of 10.

Conclusion

Virtual reality is a useful tool for training operating room nurses. Clinical trial with ISRCTN16864726 registered number.

引言虚拟现实（VR）通过不同程度的沉浸感提供了第一手的主动学习体验。本研究旨在评估将 VR 用作培训手术室护士执行胸外科手术的潜在工具。一组接受基础培训，然后是评估模块。结果56名护士（51名女性）参加了研究，平均年龄41.6岁。参与者的评估模式得分中位数为 480 分（IQR = 32 分）。实验组（520 分）的总分高于对照组（440 分；P = .04）。在年龄方面，参与者中年龄处于第二四分位数（35-41 岁）的女性取得的成绩明显优于其他女性（P = .04）。当我们根据练习的时间来评估结果时，最后 10 分钟进行的练习比前 10 分钟进行的练习效果更好（1064 分对 554 分；P <.001）。关于不良反应，最常见的是视力模糊。结论虚拟现实技术是培训手术室护士的有用工具。注册号为 ISRCTN16864726 的临床试验。

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引用次数: 0

Prospective study about the security and efficacy of treatment without antibiotic therapy of patients diagnosed with acute uncomplicated diverticulitis after launching a protocol at a tertiary hospital 一项前瞻性研究，探讨在一家三级医院启动一项方案后，对确诊为急性无并发症憩室炎的患者进行无抗生素治疗的安全性和有效性。

Cirugia espanola

Pub Date : 2024-09-01 DOI: 10.1016/j.cireng.2024.04.019

Introduction

The main objective of our study is to analyze the results in our hospital after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis.

Methods

Our observational, prospective, single-center study was developed after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis (AUD) in January 2021. The follow-up period was from January 1, 2021 to September 30, 2023. Variables evaluated by the study have included demographic and analytical variables, as well as those related to diagnosis and whether the patients needed to start antibiotic treatment, inpatient treatment, or surgical procedures.

Results

In total, 199 patients were diagnosed with AUD, 75 of whom were treated without antibiotic therapy as outpatients. Seven of these patients needed to start antibiotic treatment because of adverse evolution; none of these patients required surgical procedures. The need for inpatient treatment, urgent care, or surgical procedures is similar to the group of patients treated with antibiotics.

The main risk factor of failure of outpatient treatment without antibiotic therapy identified by the study was the presence of bacteriuria at diagnosis.

Conclusions

Our results confirm previous reports, observing that treatment without antibiotic therapy in selected patients with AUD is safe.

导言本研究的主要目的是分析我院对急性无并发症憩室炎患者实施无抗生素治疗方案后的效果：我们的观察性、前瞻性、单中心研究是在 2021 年 1 月对诊断为急性无并发症憩室炎 (AUD) 的患者启动无抗生素治疗方案后开展的。随访期为 2021 年 1 月 1 日至 2023 年 9 月 30 日。研究评估的变量包括人口统计学变量和分析变量，以及与诊断和患者是否需要开始抗生素治疗、住院治疗或外科手术有关的变量：共有 199 名患者被诊断为 AUD，其中 75 名患者在门诊接受了无抗生素治疗。其中 7 名患者因不良反应而需要开始抗生素治疗；这些患者中没有人需要接受手术治疗。需要住院治疗、紧急护理或手术治疗的患者与接受抗生素治疗的患者相似。研究发现，不使用抗生素治疗的门诊治疗失败的主要风险因素是诊断时存在菌尿：我们的研究结果证实了之前的报道，即对选定的 AUD 患者不使用抗生素治疗是安全的。

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引用次数: 0

Standardization of the definition of the types of oncological colectomy. Delphi method for consensus of experts of the Spanish Association of Surgeons 肿瘤结肠切除术类型定义的标准化。西班牙外科医生协会专家通过德尔菲法达成共识。

Cirugia espanola

Pub Date : 2024-09-01 DOI: 10.1016/j.cireng.2024.05.012

There is no international consensus on the definition of the type of oncological resection that corresponds to each of the colectomies existing in the current literature.

The objective is to define for each colectomy described in the literature: embryological dissection plane, vascular pedicles in which to perform central ligation, the extent of the colectomy, and the need for resection of the greater momentum.

A consensus of experts is carried out through the Delphi methodology through two rounds from the Coloproctology Section of the Spanish Association of Surgeons. Study period: November 2021-January 2023. 120 experts were surveyed.

Degrees of consensus: Very strong: >90%, Strong: 80%–90%, Moderate: 50%–80%, No consensus: <50%.

The definition for each oncological colectomy was established by very strong, and strong recommendations.

Each oncological colectomy was established as Right hemicolectomy (RHC), RHC with D3 lymphadenectomy, Extended-RHC, transverse colon segmental colectomy, splenic flexure segmental colectomy, subtotal colectomy, total colectomy, left hemicolectomy (LHC), extended-LHC, sigmoidectomy.

对于目前文献中每种结肠切除术所对应的肿瘤切除类型的定义，国际上尚未达成共识。我们的目标是为文献中描述的每种结肠切除术定义：胚胎学解剖平面、进行中央结扎的血管蒂、结肠切除术的范围以及是否需要切除大动量。西班牙外科医生协会结肠直肠分会的专家们通过德尔菲法进行了两轮讨论，达成了共识。研究期限：2021 年 11 月至 2023 年 1 月。120 名专家接受了调查。共识程度：非常一致：>90%，较强：80-90%，中等：50-80%，无共识：50-80%：50-80%，无共识：

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