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1.
Cir Cir ; 89(6): 755-762, 2021.
Article in English | MEDLINE | ID: mdl-34851582

ABSTRACT

OBJECTIVE: The aim is to analyze the usefulness of pre-operative COVID-19 screening to detect asymptomatic patients, the capability of our patient selection algorithm to detect patients with more advanced tumors and the results of colorectal cancer surgery managed with a multimodal approach. We propose the use of a preoperative patient selection algorithm to prioritize the surgical treatment of patients with worse oncological prognosis and lower perioperative risk in situations of health system saturation. MATERIAL AND METHODS: Prospective descriptive study including 71 patients operated on for colorectal cancer during COVID-19's high incidence period. A division was made into two periods of time that were later compared with the aim of assessing whether the scale used identified those patients with lower surgical risk and higher oncological priority for their priority scheduling. RESULTS: Post-operative severe acute respiratory syndrome coronavirus 2 infection occurred in one patient (1.4%). Pre-operative polymerase chain reaction detected one asymptomatic patient (3%). Tumor stage was ≥ IIIA in 39% and node positive in 39% of patients in the first period, while 26% and 21% in the second period, respectively (p = 0.320; p = 0.179), without increasing the surgical stay or complications. Median hospital stay was 5 days. Grades III and IV morbidity were 4.4% and 1.4%. CONCLUSION: The use of an algorithm and Patient Selection Scale can detect patients with more advanced tumors to be operated before. Multimodal management/ERAS have a role in achieving short stay and low morbidity.


OBJETIVO: El retraso terapéutico derivado de la saturación del Sistema sanitario conlleva un peor pronóstico oncológico y un aumento de complicaciones en el cáncer colorrectal. Proponemos el usode un algoritmo de selección de pacientes de forma preoperatoria para priorizar el tratamiento quirúrgico de los pacientes con peor pronóstico oncológico y menor riesgo perioperatorio. MATERIAL Y MÉTODOS: Realizamos un estudio descriptivo prospectivo de 71 pacientes intervenidos por cáncer colorrectal durante el periodo de máxima incidencia por COVID. Se realizó una división en dos periodos de tiempo que fueron comparados posteriormente con el objetivo de valorar si la escala utilizada conseguía identificar aquellos pacientes con menor riesgo quirúrgico y mayor prioridad oncológica para su programación prioritaria. RESULTADOS: Utilizando la escala de priorización de pacientes (PSS) observamos que el estadio tumoral fue mayor de IIIA en un 39% de los pacientes con un 39% de ganglios positivos en un primer periodo, frente a un 26% y 21% en un segundo periodo (p = 0.320; p = 0.179) de tiempo, sin aumentar la estancia operatoria ni las complicaciones. Se realizaron dos métodos de cribado de COVID-19 en dos periodos de tiempo, detectando un 3% de pacientes asintomáticos de forma preoperatoria con PCR, y documentando un 1.4% de infección por COVID postoperatoria. CONCLUSIONES: Ante la saturación del sistema sanitario, la utilización de protocolos y algoritmos para selección de pacientes con cáncer colorrectal puede ayudar a dar preferencia quirúrgica a aquellos casos que no deben ser demorados.


Subject(s)
COVID-19 , Colorectal Neoplasms , Colorectal Neoplasms/surgery , Humans , Patient Selection , Prospective Studies , Retrospective Studies , SARS-CoV-2
2.
Surg Oncol Clin N Am ; 27(3): 495-506, 2018 07.
Article in English | MEDLINE | ID: mdl-29935685

ABSTRACT

Different techniques for delivering perioperative intraperitoneal chemotherapy have been described, but no significant differences have been found among them. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a safe treatment for the patient and for the health care workers involved in the procedure provided standard protective and environmental measures are employed.


Subject(s)
Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Chemotherapy, Cancer, Regional Perfusion/adverse effects , Chemotherapy, Cancer, Regional Perfusion/methods , Peritoneal Neoplasms/drug therapy , Humans , Injections, Intraperitoneal , Safety
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