Pub Date : 2025-11-05DOI: 10.1016/j.cireng.2025.800245
Alberto Cabañero Sánchez, Luis Gorospe Sarasúa, Nicolás Moreno Mata
{"title":"Applications of radiomics in thoracic surgery: Enhancing precision and personalization of treatment.","authors":"Alberto Cabañero Sánchez, Luis Gorospe Sarasúa, Nicolás Moreno Mata","doi":"10.1016/j.cireng.2025.800245","DOIUrl":"10.1016/j.cireng.2025.800245","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800245"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472609","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800225
Hanna Cholewa , Pablo Guerrero-Antolino , David Quevedo , Jorge Sancho-Muriel , Matteo Frasson , Blas Flor-Lorente
The following systematic review aimed to present the current status of immunotherapy in colorectal cancer, in the neoadjuvant, adjuvant and metastatic setting. Pubmed, Cochrane and Embase databases were searched up to April 2024 and the PICO framework, as well as the following inclusion criteria (clinical studies in English published ≥2000 per year, both retrospective and prospective, including abstracts from relevant congresses, yet excluding case reports, letters, phase I clinical trials and radioimmunotherapy) were applied. MINORS and RoB2 were used to assess quality and risk of bias. Due to heterogeneity of the studies, a descriptive analysis was performed. In total, 99 studies (including 11 226 patients) were analysed, concluding that immunotherapy application, although encouraging, still needs refinement, most importantly in terms of patient and treatment regimen selection. The review was registered on the PROSPERO platform (ID: CRD42023417537) and funded by a grant by the Spanish Association of Surgery (AEC).
{"title":"The current status of immunotherapy in colorectal cancer: A systematic review","authors":"Hanna Cholewa , Pablo Guerrero-Antolino , David Quevedo , Jorge Sancho-Muriel , Matteo Frasson , Blas Flor-Lorente","doi":"10.1016/j.cireng.2025.800225","DOIUrl":"10.1016/j.cireng.2025.800225","url":null,"abstract":"<div><div>The following systematic review aimed to present the current status of immunotherapy in colorectal cancer, in the neoadjuvant, adjuvant and metastatic setting. Pubmed, Cochrane and Embase databases were searched up to April 2024 and the PICO framework, as well as the following inclusion criteria (clinical studies in English published ≥2000 per year, both retrospective and prospective, including abstracts from relevant congresses, yet excluding case reports, letters, phase I clinical trials and radioimmunotherapy) were applied. MINORS and RoB2 were used to assess quality and risk of bias. Due to heterogeneity of the studies, a descriptive analysis was performed. In total, 99 studies (including 11 226 patients) were analysed, concluding that immunotherapy application, although encouraging, still needs refinement, most importantly in terms of patient and treatment regimen selection. The review was registered on the PROSPERO platform (ID: CRD42023417537) and funded by a grant by the Spanish Association of Surgery (AEC).</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800225"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276930","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800233
Enrique Biel , Luis Grande , Manuel Pera
Background
Main treatment options for pharyngoesophageal diverticulum are the surgical excision or diverticulopexy, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series.
Methods
Observational study of patients who underwent open surgery (2004–2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges.
Results
During the study period, 40 patients (73% male) were operated on, with a mean age of 72 ± 11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1–20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically.
Conclusions
Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.
{"title":"Surgical treatment for pharyngo-esophageal diverticulum: Consecutive series over 20 years","authors":"Enrique Biel , Luis Grande , Manuel Pera","doi":"10.1016/j.cireng.2025.800233","DOIUrl":"10.1016/j.cireng.2025.800233","url":null,"abstract":"<div><h3>Background</h3><div>Main treatment options for pharyngoesophageal diverticulum are the surgical excision or diverticulopexy, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series.</div></div><div><h3>Methods</h3><div>Observational study of patients who underwent open surgery (2004–2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges.</div></div><div><h3>Results</h3><div>During the study period, 40 patients (73% male) were operated on, with a mean age of 72 ± 11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1–20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically.</div></div><div><h3>Conclusions</h3><div>Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800233"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331046","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800227
Antonio Ríos , Beatriz Domínguez-Gil
Traditionally, organ transplantation has relied on donation after brain death (DBD). However, the growing demand for organs has driven the search for alternatives to expand the donor pool. In this context, donation after the circulatory determination of death (DCD) has experienced significant growth throughout the current century, particularly in cases of death following the withdrawal of life-sustaining treatments (Maastricht type III donation). Although still limited to a small number of countries, the volume of DCD in Spain is similar to that of DBD, and it is the only country that has successfully transplanted all types of organs from this type of donor. Living organ donation also makes a meaningful contribution to overall transplant activity, and it must be firmly grounded in comprehensive donor protection. In Spain, 10% of kidney transplants are performed using organs from living donors.
{"title":"Beyond the donor after brain death: Donation in asystole and living donor. Spanish experience and perspective","authors":"Antonio Ríos , Beatriz Domínguez-Gil","doi":"10.1016/j.cireng.2025.800227","DOIUrl":"10.1016/j.cireng.2025.800227","url":null,"abstract":"<div><div>Traditionally, organ transplantation has relied on donation after brain death (DBD). However, the growing demand for organs has driven the search for alternatives to expand the donor pool. In this context, donation after the circulatory determination of death (DCD) has experienced significant growth throughout the current century, particularly in cases of death following the withdrawal of life-sustaining treatments (Maastricht type III donation). Although still limited to a small number of countries, the volume of DCD in Spain is similar to that of DBD, and it is the only country that has successfully transplanted all types of organs from this type of donor. Living organ donation also makes a meaningful contribution to overall transplant activity, and it must be firmly grounded in comprehensive donor protection. In Spain, 10% of kidney transplants are performed using organs from living donors.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800227"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319050","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800230
Natalia González Alcolea , M. Dolores Martín Arranz , Blanca Monje Vera , Mario Álvarez Gallego , Jesús Díez Sebastián , Isabel Pascual Miguelañez
Introduction
Perianal fistula is a common and disabling complication of Crohn’s disease, with a significant impact on patients’ quality of life. Although structured protocols exist in some centres, no universally accepted management guideline is currently available. In this context, we developed and implemented a protocol in our centre aimed at reducing suppuration, preserving continence, and improving quality of life.
Methods
A single-centre prospective study was conducted, including 38 patients treated at La Paz University Hospital between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.
Results
Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; P < .001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.
Conclusions
Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient’s experience as a core component of the therapeutic process.
{"title":"Multidisciplinary management of perianal fistula in Crohn’s disease: Protocol implementation and its clinical and quality of life outcomes","authors":"Natalia González Alcolea , M. Dolores Martín Arranz , Blanca Monje Vera , Mario Álvarez Gallego , Jesús Díez Sebastián , Isabel Pascual Miguelañez","doi":"10.1016/j.cireng.2025.800230","DOIUrl":"10.1016/j.cireng.2025.800230","url":null,"abstract":"<div><h3>Introduction</h3><div>Perianal fistula is a common and disabling complication of Crohn’s disease, with a significant impact on patients’ quality of life. Although structured protocols exist in some centres, no universally accepted management guideline is currently available. In this context, we developed and implemented a protocol in our centre aimed at reducing suppuration, preserving continence, and improving quality of life.</div></div><div><h3>Methods</h3><div>A single-centre prospective study was conducted, including 38 patients treated at La Paz University Hospital between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.</div></div><div><h3>Results</h3><div>Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; <em>P</em> < .001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.</div></div><div><h3>Conclusions</h3><div>Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient’s experience as a core component of the therapeutic process.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800230"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319075","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800235
Enrique Javier Grau Talens , Ángel A. Osorio Manyari , Desirée Diestro Gallego , Carlos A. Celis Pinilla , Octavio López Sánchez , Osama Aburedwan , Enrique del Cojo Peces , Francisco Gabriel Onieva González , Javier Arias Díaz
Introduction
Laparoscopic cholecystectomy is widely performed in ambulatory surgery, whereas minilaparotomy approaches remain underreported. This study evaluates the outcomes of transcylindrical cholecystectomy (TCC), performed with a cylindrical retractor, in an outpatient setting under different anesthetic techniques.
Methods
Prospective observational study of 1626 patients with cholelithiasis or related complications who underwent right transrectal epigastric minilaparotomy (4.5 cm), using a cylindrical retractor with a methacrylate plunger for direct visualization and stable exposure of the hepatocystic triangle. Anesthetic modality (general, supraglottic device, local with sedation, or spinal) was tailored to each patient. Intraoperative cholangiography was selectively performed.
Results
A total of 1626 patients underwent TCC: 916 with orotracheal intubation, 152 with supraglottic device, 503 under local anaesthesia with sedation, and 55 with spinal anaesthesia. Mean age: 59 years; BMI: 30; operative time: 40 min. The substitution index was 69%. Conversion occurred in 15 cases (0.9%), with 90 unplanned admissions (5.5%), 8 postoperative bile leaks (0.5%), 37 wound infections (2.2%), 2 deaths (0.1%), and 1 major bile duct injury (0.06%). There were 15 readmissions (0.9%) and 8 reoperations (0.5%). At 24 h, 78% of patients reported good or excellent physical condition.
Conclusions
Transcylindrical cholecystectomy is a fast, safe, and cost-effective technique for treating cholelithiasis in the ambulatory setting. It is feasible under minimally invasive anaesthesia, with low complication rates, and may be particularly valuable in resource-limited environments.
{"title":"Ambulatory transcylindrical cholecystectomy via minilaparotomy under different anesthetic techniques","authors":"Enrique Javier Grau Talens , Ángel A. Osorio Manyari , Desirée Diestro Gallego , Carlos A. Celis Pinilla , Octavio López Sánchez , Osama Aburedwan , Enrique del Cojo Peces , Francisco Gabriel Onieva González , Javier Arias Díaz","doi":"10.1016/j.cireng.2025.800235","DOIUrl":"10.1016/j.cireng.2025.800235","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic cholecystectomy is widely performed in ambulatory surgery, whereas minilaparotomy approaches remain underreported. This study evaluates the outcomes of transcylindrical cholecystectomy (TCC), performed with a cylindrical retractor, in an outpatient setting under different anesthetic techniques.</div></div><div><h3>Methods</h3><div>Prospective observational study of 1626 patients with cholelithiasis or related complications who underwent right transrectal epigastric minilaparotomy (4.5 cm), using a cylindrical retractor with a methacrylate plunger for direct visualization and stable exposure of the hepatocystic triangle. Anesthetic modality (general, supraglottic device, local with sedation, or spinal) was tailored to each patient. Intraoperative cholangiography was selectively performed.</div></div><div><h3>Results</h3><div>A total of 1626 patients underwent TCC: 916 with orotracheal intubation, 152 with supraglottic device, 503 under local anaesthesia with sedation, and 55 with spinal anaesthesia. Mean age: 59 years; BMI: 30; operative time: 40 min. The substitution index was 69%. Conversion occurred in 15 cases (0.9%), with 90 unplanned admissions (5.5%), 8 postoperative bile leaks (0.5%), 37 wound infections (2.2%), 2 deaths (0.1%), and 1 major bile duct injury (0.06%). There were 15 readmissions (0.9%) and 8 reoperations (0.5%). At 24 h, 78% of patients reported good or excellent physical condition.</div></div><div><h3>Conclusions</h3><div>Transcylindrical cholecystectomy is a fast, safe, and cost-effective technique for treating cholelithiasis in the ambulatory setting. It is feasible under minimally invasive anaesthesia, with low complication rates, and may be particularly valuable in resource-limited environments.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800235"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331131","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}
Pectus carinatum is a chest wall deformity characterized by a protrusion. For its correction, the flexibility of the chest wall is essential, as it will determine the possibility of correction through orthopedic or surgical treatment.
Orthopedic treatment has experienced a boom in recent years thanks to the development of a dynamic compression system (vest) that applies pressure to the area.
This effect can be limited by the rigidity of the chest wall (which increases with age) or by the presence of pronounced depressions of abnormally positioned cartilage (limiting cartilage). In these cases, we propose combining the use of the vest with limited partial chondrectomies to facilitate the vest's effect after this surgery. We have called this combination of vest-chondrectomy-vest the “3-Cs” technique.
We present a description of the technique and its application in the first patients we have treated in thus manner.
{"title":"Innovation in the correction of pectus carinatum: A combination of orthopedic and surgical treatment (the “3-Cs” technique)","authors":"José Marcelo Galbis Caravajal , Miriam Estors Guerrero , Nestor Martinez Hernández , Inmaculada Sabariego Arenas","doi":"10.1016/j.cireng.2025.800240","DOIUrl":"10.1016/j.cireng.2025.800240","url":null,"abstract":"<div><div>Pectus carinatum is a chest wall deformity characterized by a protrusion. For its correction, the flexibility of the chest wall is essential, as it will determine the possibility of correction through orthopedic or surgical treatment.</div><div>Orthopedic treatment has experienced a boom in recent years thanks to the development of a dynamic compression system (vest) that applies pressure to the area.</div><div>This effect can be limited by the rigidity of the chest wall (which increases with age) or by the presence of pronounced depressions of abnormally positioned cartilage (limiting cartilage). In these cases, we propose combining the use of the vest with limited partial chondrectomies to facilitate the vest's effect after this surgery. We have called this combination of vest-chondrectomy-vest the “3-Cs” technique.</div><div>We present a description of the technique and its application in the first patients we have treated in thus manner.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800240"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427250","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 : 2025-11-01DOI: 10.1016/j.cireng.2025.800234
Josep M. Garcia-Alamino , Manuel Lopez-Cano
{"title":"The European Health Data Space and its impact on 21st-century surgery","authors":"Josep M. Garcia-Alamino , Manuel Lopez-Cano","doi":"10.1016/j.cireng.2025.800234","DOIUrl":"10.1016/j.cireng.2025.800234","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 11","pages":"Article 800234"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331110","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 : 2025-10-16DOI: 10.1016/j.cireng.2025.800228
Benito Manuel Flores Pastor, Miguel González Valverde
{"title":"Perceived quality and satisfaction. The patient experience as a key factor in our surgical practice.","authors":"Benito Manuel Flores Pastor, Miguel González Valverde","doi":"10.1016/j.cireng.2025.800228","DOIUrl":"10.1016/j.cireng.2025.800228","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800228"},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319046","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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