Estado actual del tratamiento quirúrgico del cáncer colorrectal / State of the art in colorectal cancer surgery

El cáncer colorrectal es en la actualidad una de las enfermedades más importantes en los países occidentales y representa una causa muy significativa de morbilidad y mortalidad por cáncer. Es la segunda forma más común de cáncer y la segunda causa de muerte por enfermedad oncológica tomando en conjunto ambos sexos. En los últimos años, el aumento de la incidencia, su alta prevalencia en el anciano y el envejecimiento de la población han hecho despertar un considerable interés por el tratamiento de esta enfermedad. La cirugía es el único tratamiento curativo y en el momento de la presentación aproximadamente el 50 por ciento de los pacientes son tributarios de una "resección curativa", aunque la mortalidad ha cambiado poco en los últimos 50 años pues, desafortunadamente, cerca de la mitad de los pacientes mueren por enfermedad metastásica o recurrencia. La posición de la cirugía en el tratamiento y curación del cáncer colorrectal está bien establecida pero, además, continúan siendo objeto de controversia el tratamiento del cáncer complicado, otras enfermedades colónicas simultáneas, las metástasis, la recurrencia, el cáncer del tercio distal del recto y la colectomía laparoscópica (AU)

[A cost analysis of laparoscopic cholecystectomy compared with the open technic]. / Análisis de costes de la colecistectomía laparoscópica en comparación con la abierta.

OBJECTIVE: The aim of this study was to compare the cost of laparoscopic cholecystectomy with that of open cholecystectomy. DESIGN: We analyzed the cost of both procedures regarding hospital stay, days of work lost and the cost derived from the morbidity of the complications of each technique in two groups of patients. With these data we were able to calculate direct and indirect costs of both procedures and compare them. RESULTS: Morbidity was similar in both groups and had no influence in the cost; cost of the material used for laparoscopic cholecystectomy was higher; hospital stay and days of lost work were significantly lower for the laparoscopic procedure than for the open one. The total cost of laparoscopic cholecystectomy was 23% cheaper than that of open cholecystectomy. CONCLUSIONS: Laparoscopic cholecystectomy appears to be cheaper than open cholecystectomy. As the laparoscopic technique becomes more widespread its cost might decrease even further.

Proximal gastric vagotomy. A prospective study of 829 patients with four-year follow-up.

A prospective controlled trial of proximal gastric vagotomy (PGV) in 829 patients at three surgical services is presented. Peroperative tests of vagotomy completeness were made in two of the three groups of patients. The follow-up period was four to six years. The hospital stay after PGV averaged 9.2 days. The postoperative mortality rate was 0.2%. The reduction of gastric acidity was maintained four years after PGV. Postoperatively no patient had severe diarrhoea. The incidence of dumping after PGV was 1.5% and of gastric stasis 7.3%. Though 7% of the patients reported pyrosis after PGV, only a few required treatment. Transient dysphagia was reported by 2.5% of the patients. In about 4% of the series there were relatively mild ulcer-like symptoms postoperatively, without confirmation of ulcer. Duodenal ulcer recurred in 2% of cases during the observation period and gastric ulcer appeared in 1.5%. According to the Visick classification, 74% of the series showed grade I clinical result, 18% grade II, 4% grade III and 4% grade IV. There were no intergroup differences in Visick grades.