Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2023.08.006
Introduction
Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.
Methods
Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.
Results
The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621–3284) in 2018, and 3484 (IQR: 2306–4156) in 2022 (p: .000). These differences remained significant after adjusting for the number of available positions (p: .000).
The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Paediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers.
Conclusion
The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018–2022. The increase in the number of available positions has not been associated with a proportional increase in demand.
{"title":"Delay in the residents’ choice for General and Digestive Surgery: Analysis of the period 2018–2022","authors":"","doi":"10.1016/j.cireng.2023.08.006","DOIUrl":"10.1016/j.cireng.2023.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.</p></div><div><h3>Methods</h3><p>Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.</p></div><div><h3>Results</h3><p>The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621–3284) in 2018, and 3484 (IQR: 2306–4156) in 2022 (<em>p</em>: .000). These differences remained significant after adjusting for the number of available positions (<em>p</em>: .000).</p><p><span>The choice of Urology<span><span>, Thoracic Surgery<span>, Cardiovascular Surgery, </span></span>Gastroenterology, and </span></span>Paediatrics<span><span> also declined during this period, while Plastic Surgery, Dermatology, </span>Ophthalmology<span>, Anesthesiology<span>, and Endocrinology improved their numbers.</span></span></span></p></div><div><h3>Conclusion</h3><p>The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018–2022. The increase in the number of available positions has not been associated with a proportional increase in demand.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 8","pages":"Pages 408-416"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296797","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 : 2024-08-01DOI: 10.1016/j.cireng.2024.01.008
Introduction
The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat.
Methods
This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student’s t-test for paired samples, Pearson’s correlation coefficient, and the Bland-Altman method comparison analysis.
Results
Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (t-test P = 0.8, r = 0.92) and the depth of mesorectal infiltration (t-test P = 0.6, r = 0.95).
Conclusions
Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging.
简介该研究的目的是比较两种直肠癌标本组织学处理技术（即大块全切与传统的小块取样），以对直肠间质切除边缘状态和肿瘤侵犯直肠间质脂肪的深度进行病理评估：这是一项前瞻性研究，包括 27 份直肠癌直肠间质全切除标本，这些标本来自 2020 年至 2022 年期间在结直肠专科多学科病房接受治疗的原发性直肠癌患者。在每份直肠直肠间全切标本中，选择 2 个连续的有代表性的肿瘤切片，采用全切片和小块宏观解剖技术进行比较分析，以便在同一手术标本中进行比较。通过配对样本的学生 t 检验、皮尔逊相关系数和 Bland-Altman 方法对比分析，评估了两种技术在评估肿瘤与周缘切除边缘的距离以及肿瘤侵犯深度方面的一致性：结果：8%的病例可观察到完整的直肠系膜切除。仅有一例（4%）观察到环形切除边缘受累。当我们评估与周缘切除边缘的距离（t 检验 P = .8，r=0.92）和直肠系膜浸润深度（t 检验 P = .6，r=0.95）时，全层解剖技术和小块解剖技术获得了相似的结果：结论：在直肠癌分期中，两种大体解剖技术（整块解剖与多块小盒解剖）在评估直肠癌周缘切除边缘距离和直肠系膜脂肪浸润深度方面是等效和可靠的。
{"title":"A comparison of whole-mount and conventional sections for pathological mesorectal extension and circumferential resection margin assessment after total mesorectal excision","authors":"","doi":"10.1016/j.cireng.2024.01.008","DOIUrl":"10.1016/j.cireng.2024.01.008","url":null,"abstract":"<div><h3>Introduction</h3><p>The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat.</p></div><div><h3>Methods</h3><p>This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student’s <em>t</em>-test for paired samples, Pearson’s correlation coefficient, and the Bland-Altman method comparison analysis.</p></div><div><h3>Results</h3><p>Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (<em>t</em>-test <em>P</em> = 0.8, <em>r</em> = 0.92) and the depth of mesorectal infiltration (<em>t</em>-test <em>P</em> = 0.6, <em>r</em> = 0.95).</p></div><div><h3>Conclusions</h3><p>Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 8","pages":"Pages 417-425"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173507724000498/pdfft?md5=f41bccc446f3a1db19922647d908ae8a&pid=1-s2.0-S2173507724000498-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.03.003
{"title":"Tools and resources for conducting systematic reviews and meta-analyses","authors":"","doi":"10.1016/j.cireng.2024.03.003","DOIUrl":"10.1016/j.cireng.2024.03.003","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 8","pages":"Pages 444-445"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717073","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 : 2024-08-01DOI: 10.1016/j.cireng.2024.03.010
{"title":"Assessment of heterogeneity in meta-analysis","authors":"","doi":"10.1016/j.cireng.2024.03.010","DOIUrl":"10.1016/j.cireng.2024.03.010","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 8","pages":"Pages 448-450"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874059","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 : 2024-07-25DOI: 10.1016/j.cireng.2024.06.008
N Lluís, C Villodre, P Zapater, M Cantó, L Mena, J M Ramia, F Lluís
Background: The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life.
Methods: The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis.
Results: The study included 212 patients (84 years [81-86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6-13]; laparoscopic, 5 days [4-8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30-day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed.
Conclusions: Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenarians with acute cholecystitis undergoing cholecystectomy.
{"title":"Laparoscopic vs open approach for acute cholecystitis in octogenarians. A prospective multicenter observational nationwide study.","authors":"N Lluís, C Villodre, P Zapater, M Cantó, L Mena, J M Ramia, F Lluís","doi":"10.1016/j.cireng.2024.06.008","DOIUrl":"10.1016/j.cireng.2024.06.008","url":null,"abstract":"<p><strong>Background: </strong>The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life.</p><p><strong>Methods: </strong>The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis.</p><p><strong>Results: </strong>The study included 212 patients (84 years [81-86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6-13]; laparoscopic, 5 days [4-8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30-day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed.</p><p><strong>Conclusions: </strong>Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenarians with acute cholecystitis undergoing cholecystectomy.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790356","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 : 2024-07-24DOI: 10.1016/j.cireng.2024.06.009
Verónica Albarrán Vidal, Lidia Sotillo Valenzuela, Paula Hernández Mateo, Elena Fernández Martín
{"title":"Incidental discovery of pulmonary arteriovenous fistula in a patient with long-standing palpitations: A case report.","authors":"Verónica Albarrán Vidal, Lidia Sotillo Valenzuela, Paula Hernández Mateo, Elena Fernández Martín","doi":"10.1016/j.cireng.2024.06.009","DOIUrl":"https://doi.org/10.1016/j.cireng.2024.06.009","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768354","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 : 2024-07-08DOI: 10.1016/j.cireng.2024.06.007
Marina Iniesta-Sepúlveda, José Antonio Pereira-Rodríguez
{"title":"Effect size in meta-analysis.","authors":"Marina Iniesta-Sepúlveda, José Antonio Pereira-Rodríguez","doi":"10.1016/j.cireng.2024.06.007","DOIUrl":"10.1016/j.cireng.2024.06.007","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581873","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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