Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years.

INTRODUCTION AND AIMS: Esophageal perforation is an uncommon event that is a medical/surgical emergency, with a 15-30% mortality rate. The aim of the present study was to communicate our experience in the management of esophageal perforation, evaluating the different strategies utilized, in an effort to establish measures to guide decision-making in selecting treatment. MATERIALS AND METHODS: A retrospective descriptive study was conducted on patients diagnosed with esophageal perforation at our hospital center, within the time frame of 2000 and 2019. RESULTS: Over the past 19 years, 15 patients were diagnosed with esophageal perforation. Surgical treatment was carried out in 80% of the cases. Primary closure, reinforced with plasty, was performed in 67% of the patients, of whom 62.5% had early diagnosis and a 100% survival rate. Diagnosis was late in 37.5% of the cases, with a 33.3% survival rate. Esophagectomy and gastric pull-up were performed on 25% of the patients, 66.6% of whom had early diagnosis and a 100% survival rate. In the 33.3% that had late diagnosis, the mortality rate was 100%. Esophagectomy, with cervical esophagostomy and feeding jejunostomy, was performed on one of the patients (8.3%) that had early diagnosis and a 100% survival rate. CONCLUSIONS: The main survival predictor in esophageal perforation is the interval of time between the injury and its diagnosis, and in turn, the resulting treatment. Each patient with esophageal perforation should have individualized treatment to adequately manage the condition.

Diagnostic yield of abdominal ultrasonography for the diagnosis of acute appendicitis: A global and subgroup analysis. / Rentabilidad de la ecografía abdominal para el diagnóstico de apendicitis aguda. Análisis global y por subgrupos.

INTRODUCTION AND AIMS: Abdominal ultrasonography is very useful for diagnosing acute appendicitis and has 59-96% sensitivity and 83-98% specificity. The aim of the present study was to determine the diagnostic yield of abdominal ultrasound imaging for acute appendicitis and identify the patient subgroups with the best results. MATERIALS AND METHODS: Patients at a general hospital that underwent appendectomy due to the clinical suspicion of appendicitis, who also had a diagnostic radiologic study, within the time frame of January 2007 to December 2010, were analyzed. Ultrasound studies were considered positive when there were radiologic signs suggestive of acute appendicitis. The sensitivity, specificity, and predictive values of the diagnostic study were determined through the logistic regression method. RESULTS: A total of 646 patients were operated on due to clinical suspicion of acute appendicitis. A diagnostic abdominal ultrasound study was carried out on 383 (59.3%) of those patients, resulting in 79% sensitivity (74-83, 95% CI), 58% specificity (39-75, 95% CI), 95% positive predictive value (92-97, 95% CI), and 20% negative predictive value (13-30, 95% CI). CONCLUSIONS: Abdominal ultrasound imaging in patients with a high suspicion of appendicitis had a mediocre diagnostic yield, but better results could be achieved in different specific subgroups.

[Biliary microbiote in cholecystectomized patients: Review of empirical antibiotherapy]. / Microbiota biliar en pacientes colecistectomizados: Revisión de la antibioterapia empírica.

OBJECTIVE: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSIONS: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies..

Usefulness of the log odds of positive lymph nodes to predict and discriminate prognosis in gastric carcinomas.

BACKGROUND: The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN). METHODS: Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category. RESULTS: Four LNR categories (0, 1-25, 26-75, and >76 %) and four LODDS categories (-5 to -3, > -3 to -1, > -1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11-3.20, p=0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21-1.61, p<0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories. CONCLUSIONS: The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.

Prognosis for gastric carcinomas with an insufficient number of examined negative lymph nodes.

BACKGROUND: The optimal system for lymph node (LN) staging in gastric cancer is still a subject of debate. The aim of our study was to analyse the probability of error in negative LN (pN0) gastric carcinomas when a low number of LNs were harvested using a probabilistic model. METHODS: Patients with gastric carcinoma who underwent R0 resection at three university hospitals between 2004 and 2009 were retrospectively included. A Bayesian model was used to analyse the probability of error for negative LNs (pN0) gastric carcinomas. Kaplan-Meier survival curves and the log-rank test were used to compare the overall and specific mortality of prognosis groups. RESULTS: Of the 291 patients included, 123 were classified as pN0 (42%). A significant correlation was found between the extent of the LN dissection performed and the number of the LNs retrieved. According to the Bayesian model the carcinomas with 9 or fewer negative lymph nodes were considered to have a high risk (HR) of misclassification, whereas patients with 10-25 LNs analysed and those with more than 26 negative lymph nodes were considered to have a moderate risk (MR) and low risk (LR), respectively. The log-rank test showed a significant improvement in the disease-specific survival for the MR pN0 (p < 0.001) and LR pN0 (p < 0.04) but not for the HR pN0 patients compared to pN1 patients. CONCLUSIONS: The proposed probabilistic model is clinically useful for differentiating the prognosis in pN0 gastric carcinomas when an insufficient number of negative lymph nodes are retrieved.

[A preliminary experience in the laparoscopic approach to bowel obstruction]. / Experiencia inicial en el abordaje laparoscópico de la obstrucción intestinal.

BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.

[Laparoscopic apendicectomy vs open approach for the treatment of acute appendicitis]. / Apendicectomía laparoscópica frente al abordaje abierto para el tratamiento de la apendicitis aguda.

BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS: A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS: intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS: There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.

Laparoscopy versus open surgery for advanced and resectable gastric cancer: a meta-analysis.

BACKGROUND: There are few studies in the literature comparing laparoscopic versus open Gastrectomy, predominantly for advanced gastric cancer (AGC). Most of the available studies and meta-analysis compare both approaches in the early gastric cancer. The meta-analysis, here presented, compares the clinical outcomes between these two procedures for AGC. OBJECTIVES: To evaluate the current status of both partial and total laparoscopic gastrectomy (LG), with regard to its short and long-term outcomes by comparing it to conventional open gastrectomy (OG) for AGC. DATA SOURCES AND REVIEW METHODS: original articles published in English language from January 1991 to October 2009 were searched in the Medline, Embase, Current Contents, Science Citation Index databases and Cochrane Controlled Trials Register. All articles comparing LG and OG for AGC were included, and those comparing outcomes only for early gastric cancer (EGC) were excluded. Clinical appraisal and data extraction were conducted independently by 3 reviewers. Statistical analysis was carried out following the DerSimonian-Laird random effects model. RESULTS: out of 2,344 studies, 7 studies were selected. One prospective randomized controlled trial, one comparative prospective study and five comparative retrospective studies were analyzed. These studies include a total of 452 patients with gastric cancer, 174 patients in the LG and 278 in the OG. The analyzed result variables were operative time, operative blood loss, hospital postoperative stay, number of dissected lymph nodes and cancer-related mortality risk. Compared to OG, LG was a longer procedure: weighted mean difference (WMD) 44 minutes; 95% confidence interval (CI) 20 to 69; I-squared = 91.6%, but was associated with a lower blood loss (WMD -122 cc; 95% CI -208 to -37; I-squared = 90.8%); this was more significant for hospital operative stay (WMD -6.2 days; 95% CI -9.4 to -2.8; I-squared = 67.8%). Moreover there were no significant differences between the two groups concerning the number of dissected lymph nodes (WMD -1.57; 95% CI -3.41 to 0.26; I-squared = 8.3) and no significant differences for cancer-related mortality risk (adjusted for 60 months of follow-up) although there was a tendency toward a protective effect for LG (Odds Ratio 0.53; 95% CI 0.23 to 1.22; I-squared 41%). CONCLUSION: Laparoscopic total and partial gastrectomy for AGC is associated with a longer operative time but lower blood loss and shorter postoperative hospital stay. Moreover there were similar outcomes between both approaches in terms of number of dissected lymph nodes and long-term follow-up (survival).

Impact of the total number of harvested lymph nodes after colon cancer resections on survival in patients without involved lymph node.

BACKGROUND: The total number of harvested lymph nodes has been demonstrated to be of prognostic significance for colon cancer. Differences can occur in the total number of harvested lymph nodes between different specialists (surgeons and pathologists). OBJECTIVE: The aim of this study was to analyse if, in our centre, the number of analysed lymph nodes in patients with colon cancer that are classified as pN0 is also related to survival. MATERIAL AND METHODS: A retrospective study was designed, where 148 patients with colon adenocarcinoma (pN0 of TNM classification) who underwent elective surgery between 1 January 1995 and 31 December 2001, with curative intent were included. Three groups were created according to the number of analysed lymph nodes ( < 7, 7-14, > 14 lymph nodes). For survival analysis the Kaplan-Meier and CUSUM curves methods were used. RESULTS: The total number of analysed lymph nodes was 1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes; 7-14 lymph nodes: 80.6% and those with > 14 lymph nodes: 91.8% (p < 0.01). Prognostic significance was also present for multivariate analysis. CONCLUSION: In our centre, harvesting a larger number of lymph nodes is related to improved rates of 5-years survival for patients with colon cancer staged as pN0. It seems reasonable to recommend obtaining as many lymph nodes as possible, and not to establish a minimum number of lymph nodes to be harvested.

Influencia del número total de ganglios analizados tras cirugía de resección en el cáncer de colon sobre la supervivencia en pacientes sin afectación ganglionar / No disponible

Introducción: el número total de ganglios analizados ha demostradosu influencia pronóstica en el cáncer de colon. Puedenexistir grandes diferencias en el número de ganglios obtenidos pordiferentes especialistas (cirujanos y anatomopatólogos).Objetivo: el objetivo del presente estudio fue analizar si, ennuestro medio, el número de ganglios analizados en pacientes concáncer de colon clasificados como pN0 se relaciona también conla supervivencia.Material y métodos: estudio retrospectivo, con inclusión de148 pacientes con adenocarcinoma de colon (pN0 de la clasificaciónTNM) intervenidos de forma programada con intención curativaentre 1 de enero de 1995 y 31 de diciembre de 2001. Se establecieron3 grupos según el número de ganglios analizados (< 7,7-14, > 14 ganglios). Para el análisis de la supervivencia se utilizaronel método de Kaplan Meier y las gráficas CUSUM.Resultados: el número total de ganglios analizados fue 1.493(media 10,1 ganglios por paciente). La supervivencia a 5 años fuedel 63,0% en el grupo con < 7 ganglios; del 80,6% en el grupocon 7-14; y del 91,8% en el grupo con > 14 ganglios analizados(p < 0,01). La influencia pronóstica se mantuvo en el análisis multivariante.Conclusión: en nuestro medio, la obtención de un mayor númerode ganglios analizados se relaciona con una mayor supervivenciaa los 5 años en pacientes con cáncer de colon clasificadoscomo pN0. Parece razonable recomendar la obtención de tantosganglios como sea posible en este tipo de cirugía y no recomendarun número mínimo de ganglios que se deberían analizar(AU)

Background: the total number of harvested lymph nodeshas been demonstrated to be of prognostic significance forcolon cancer. Differences can occur in the total number of harvestedlymph nodes between different specialists (surgeons andpathologists).Objective: the aim of this study was to analyse if, in our centre,the number of analysed lymph nodes in patients with coloncancer that are classified as pN0 is also related to survival.Material and methods: a retrospective study was designed,where 148 patients with colon adenocarcinoma (pN0 of TNMclassification) who underwent elective surgery between 1 January1995 and 31 December 2001, with curative intent were included.Three groups were created according to the number of analysedlymph nodes (< 7, 7-14, > 14 lymph nodes). For survival analysisthe Kaplan-Meier and CUSUM curves methods were used.Results: the total number of analysed lymph nodes was1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes;7-14 lymph nodes: 80.6% and those with > 14 lymph nodes:91.8% (p < 0.01). Prognostic significance was also present formultivariate analysis.Conclusion: in our centre, harvesting a larger number oflymph nodes is related to improved rates of 5-years survival forpatients with colon cancer staged as pN0. It seems reasonableto recommend obtaining as many lymph nodes as possible, andnot to establish a minimum number of lymph nodes to be harvested(AU)

Gallstone ileus: management options and results on a series of 40 patients.

INTRODUCTION: Controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. MATERIAL AND METHODS: Retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. RESULTS: A total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15 vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. CONCLUSION: One-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up.

Íleo biliar: opciones terapéuticas y resultados en una serie de 40 casos / Gallstone ileus: management options and results on a series of 40 patients

Introducción: todavía existe gran controversia sobre el mejor tratamiento del íleo biliar. Algunos autores proponen la enterotomía aislada, mientras otros defienden la reparación de la fístula bilioentérica en el mismo acto quirúrgico. El objetivo del presente estudio fue analizar las opciones terapéuticas en estos pacientes y estudiar sus resultados. Material y métodos: estudio retrospectivo y descriptivo, con revisión de las historias clínicas de los pacientes diagnosticados de íleo biliar desde 1987 hasta 2008. Se recogieron las fechas de ingreso, de intervención y del alta, edad, sexo, antecedentes patológicos, diagnóstico preoperatorio o intraoperatorio, tratamiento, lugar de la fístula y lugar de la obstrucción. Como variables de resultado se utilizaron las complicaciones postoperatorias, mortalidad, complicaciones en el seguimiento y complicaciones biliares. Resultados: se incluyeron 40 pacientes sobre 46.648 ingresos. La edad, la comorbilidad y el diagnóstico intraoperatorio se relacionaron con peores resultados a corto y largo plazo. El porcentaje de complicaciones postoperatorias fue similar para el grupo con abordaje de la fístula y para el grupo con enterotomía aislada. La mortalidad fue superior en el grupo con abordaje de la fístula (15 frente a 25%). Las complicaciones biliares fueron más frecuentes en el grupo sin abordaje de la fístula biliar (11 frente a 0%). El sexo, lugar de la fístula o el lugar de la obstrucción no demostraron diferencias. Conclusión: la cirugía en un solo tiempo se relaciona con mayor mortalidad que la enterotomía aislada. No obstante, añadir la reparación de la fístula reduce el número de complicaciones biliares en el seguimiento(AU)

Introduction: controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. Material and methods: retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. Results: a total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. Conclusion: one-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up(AU)

New technologies in cancer and their assessment. The clinical surgeon's point of view

The assessment of new technologies in oncological surgery is an important part of clinical research in cancer. The special characteristics of surgeons and surgical techniques determine particular problems. In this review, from the perspective of efficacy, effectiveness and efficiency, problematic specific aspects are discussed for diagnostic and therapeutic technologies (AU)

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[Influence of surgeon specialization upon the results of colon cancer surgery. Usefulness of propensity scores]. / Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon. Utilidad de los índices de propensión (propensity scores).

INTRODUCTION: surgeon influence on colorectal cancer surgery outcomes has been repeatedly studied in the scientific literature, but conclusions have been contradictory. Here we study whether surgeon specialization is a determinant factor for outcome in these patients. The importance of propensity scores (PS) in surgical research is also studied. PATIENTS AND METHODS: a retrospective study was performed and medical records were reviewed for 236 patients who were intervened for colon cancer in Castellon General Hospital (Spain). Cases were divided into two groups (specialist and non-specialist surgeons), and both 5-year surveillance and disease free survival were compared. Comparisons were first made with no adjustments, and then subsequently using PS analysis. RESULTS: the initial (non-adjusted) analysis was clearly favourable for the specialist surgeon group (5-year surveillance, 64.3 vs. 79.3%, p = 0.028). After adjusting for PS no statistical significance was obtained. CONCLUSIONS: surgeon specialization had no significant impact on patient outcome after colon cancer surgery. Propensity score analysis is an important tool in the analysis of surgical non-randomized studies, particularly when events under scrutiny are rare.

Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon. Utilidad de los índices de propensión (propensity scores) / No disponible

Introducción: la influencia del factor cirujano en el cáncer colorrectalse ha estudiado de manera reiterada en literatura científica,pero los resultados han sido contradictorios. Se plantea eneste estudio si la especialización del cirujano es un factor determinantedel pronóstico en estos pacientes. Asimismo, se valora laimportancia de los índices de propensión (PS) en el análisis de losresultados.Pacientes y métodos: se planteó un estudio retrospectivocon revisión de las historias clínicas de 236 pacientes sometidos acirugía por cáncer de colon en el Hospital General de Castellón.Se establecieron dos grupos de cirujanos (especialista y no especialista),comparando los resultados en cuanto a supervivencia yen cuanto a intervalo libre de enfermedad a los 5 años. Inicialmente,se realizaron las comparaciones sin el ajuste de los resultadosy, posteriormente, utilizando los PS.Resultados: el primer análisis de los resultados (sin ajuste) fueclaramente favorable al grupo de cirujanos especialistas (supervivenciaa los 5 años del 64,3 frente al 79,3%, p = 0,028). No obstante,cuando se ajustó mediante los PS, no se obtuvo dicha significaciónestadística.Conclusiones: no se ha podido demostrar que la especializacióndel cirujano sea un factor determinante del pronóstico en lospacientes sometidos a cirugía por cáncer de colon. Los índices depropensión pueden ser de gran utilidad para el ajuste de los resultadosen estudios retrospectivos no aleatorizados, especialmentecuando el factor de estudio es poco frecuente

Introduction: surgeon influence on colorectal cancer surgeryoutcomes has been repeatedly studied in the scientific literature,but conclusions have been contradictory. Here we study whethersurgeon specialization is a determinant factor for outcome in thesepatients. The importance of propensity scores (PS) in surgicalresearch is also studied.Patients and methods: a retrospective study was performedand medical records were reviewed for 236 patients who were intervenedfor colon cancer in Castellon General Hospital (Spain).Cases were divided into two groups (specialist and non-specialistsurgeons), and both 5-year surveillance and disease free survivalwere compared. Comparisons were first made with no adjustments,and then subsequently using PS analysis.Results: the initial (non-adjusted) analysis was clearly favourablefor the specialist surgeon group (5-year surveillance, 64.3 vs.79.3%, p = 0.028). After adjusting for PS no statistical significancewas obtained.Conclusions: surgeon specialization had no significant impacton patient outcome after colon cancer surgery. Propensity scoreanalysis is an important tool in the analysis of surgical non-randomized studies, particularly when events under scrutiny are rare (AU)

[Subcutaneous seeding of hepatocellular carcinoma after fine-needle percutaneous biopsy]. / Implante subcutáneo de un carcinoma hepatocelular tras la punción aspiración con aguja fina.

Subcutaneous tumor seeding after fine-needle percutaneous biopsy for hepatocellular carcinoma is a rarely seen complication. The authors describe a case of subcutaneous neoplastic seeding in a 70-year-old woman with chronic hepatitis C virus complicated by hepatocellular carcinoma. Ultrasonically guided fine-needle aspiration biopsy was performed in segment II of the liver. The neoplastic seeding developed along the needle track used to carry out the fine-needle biopsy. The subcutaneous tumor was excised, and histological examination revealed a well-differentiated hepatocellular carcinoma.

Adenocarcinoma de esófago 36 años después de una estenosis hipertrófica de píloro / Esophageal adenocarcinoma 36 years later of a hypertrophic stenosis of the pylorus

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Implante subcutáneo de un carcinoma hepatocelular tras la punción aspiración con aguja fina / Subcutaneous seeding of hepatocellular carcinoma after fine-needle percutaneous biopsy

Los implantes subcutáneos son una complicación rara tras la punción aspiración con aguja fina de los carcinomas hepatocelulares. Los autores describen un caso de implante subcutáneo neoplásico en una mujer de 70 años con cirrosis hepática por virus C complicada con un carcinoma hepatocelular. Se efectuó una punción aspiración con aguja fina en el segmento II hepático. El implante tumoral se desarrolló en el trayecto de la punción aspiración. La tumoración subcutánea fue extirpada quirúrgicamente y el estudio anatomopatológico confirmó que se trataba de un carcinoma hepatocelular bien diferenciado

Subcutaneous tumor seeding after fine-needle percutaneous biopsy for hepatocellular carcinoma is a rarely seen complication. The authors describe a case of subcutaneous neoplastic seeding in a 70-year-old woman with chronic hepatitis C virus complicated by hepatocellular carcinoma. Ultrasonically guided fine-needle aspiration biopsy was performed in segment II of the liver. The neoplastic seeding developed along the needle track used to carry out the fine-needle biopsy. The subcutaneous tumor was excised, and histological examination revealed a well-differentiated hepatocellular carcinoma