Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients.

AIM: Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. METHOD: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. RESULTS: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). CONCLUSION: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.

[Pancreatitis caused by hypercalcemia of malignant origin]. / Pancreatitis por hipercalcemia de origen maligno.

Malignant hypercalcemia is seldom the cause of an acute pancreatitis; this complication is more frequent when hypercalcemia is due to hyperparathyroidism. We present a case of acute pancreatitis triggered by a malignant hypercalcemia as the first sign of the neoplastic process. Solid tumors with bone extension can produce hypercalcemia and may be the origin of hypercalcemic pancreatitis.

[Muscular tumors of the digestive tract]. / Tumores musculares del tracto digestivo.

We report the experience of the General Surgery Service of Segovia General Hospital. In a 15-years-period (1976-1991), we have cared for 32 patients with muscular tumors of the gastrointestinal tract, including 22 leiomyomas and 11 leiomyosarcomas. These tumors were localized in stomach (46.8%), small intestine (40.6%), esophagus (9.3%) and colon-rectum (3.1%). A histologic study was developed on the basis of the mitosis number in 10 high power fields. Clinical manifestations, histological dates, treatment, and prognosis factors, outstanding the histological grade, size lesser than 10 cm, and tumor origin localization, are reviewed.