[Translated article] Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review. / [Artículo traducido] Fasciotomía proximal de gemelo interno en pacientes con fascitis plantar crónica: una revisión sistemática.

INTRODUCTION: Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal medial gastrocnemius release (PMGR) has increased to treat chronic plantar fasciitis. MATERIAL AND METHODS: Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. RESULTS: Three articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. CONCLUSION: Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Benign prostatic hyperplasia. / Hiperplasia benigna de próstata.

Benign prostatic hyperplasia (BPH) is a histopathologic definition associated with enlargement of the prostate gland that causes obstruction of the lower urinary tract and manifests clinically with characteristic symptoms that are what bring patients for consultation. Urinary tract symptoms are common, especially in an increasingly aging population. Diagnosis and the decision on when and how to treat depend on the patient's quality of life and objective clinical parameters. An individualized, risk-based approach is necessary to guide conservative, pharmacologic, or surgical treatment.

Survival analysis of the surgical treatment of hepatocellular carcinoma at a tertiary care center.

INTRODUCTION AND AIMS: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. MATERIALS AND METHODS: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. RESULTS: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4 ±â€¯37.2 and 27.4 ±â€¯28.7 months, respectively (p = 0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. CONCLUSIONS: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making.

Whipple's cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study.

INTRODUCTION: Controversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric preservation (PP-CPD) or Whipple's technique (with antrectomy [W-CPD]), the former being associated with a higher frequency of delayed gastric emptying (DGE). METHODS: Retrospective and comparative study between PP-CPD technique (n = 124 patients) and W-CPD technique (n = 126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. RESULTS: Surgical time was longer, although not significant, with the W-CPD technique. Pancreatic and peripancreatic tumor invasion (p = 0.031) and number of lymph nodes resected (p < 0.0001) reached statistical significance in W-CPD, although there was no significant difference between the groups in terms of lymph node tumor invasion. Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien-Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. CONCLUSIONS: Postoperative morbidity and mortality and long-term survival were not significantly different with PP-CPD and W-CPD, but POPF grade B/C was a risk factor for DGE grade C.

Resección de metástasis pancreáticas: análisis de resultados quirúrgicos y oncológicos. Estudio de cohorte retrospectiva / Pancreatic resections for metastases in the pancreas: analysis of surgical and oncologic outcomes. A retrospective cohort study

RESUMEN Antecedentes: las metástasis pancreáticas, si bien son poco frecuentes, representan una entidad clínica cuyo diagnóstico probablemente se incrementará en el futuro por el aumento de los programas de seguimiento oncológico. Objetivo: describir los resultados quirúrgicos y oncológicos de una serie de pacientes operados por metástasis pancreáticas. Materiales y métodos: se realizó un estudio de cohorte retrospectivo, descriptivo, multicéntrico, de los pacientes sometidos a resecciones pancreáticas por metástasis entre enero de 2016 y diciembre de 2022, en tres efectores de salud por el mismo grupo quirúrgico. Resultados: fueron operados 19 pacientes, con una media de edad de 59 años (45-79), 11 de sexo femenino, en buen estado general y sin otra evidencia de enfermedad oncológica. El origen de los tumores primarios fue 14 en riñón (7 diagnosticados durante el seguimiento), uno carcinoma mamario, uno melanoma, uno testicular, uno colorrectal y uno de cuello de útero. Las técnicas quirúrgicas empleada fueron: 7 esplenopancreatectomías (5 videolaparoscópicas y 2 convencionales), 4 enucleaciones (3 convencionales y 1 videolaparoscópica), 3 duodenopancreatectomías cefálicas convencionales, 2 duodenopancreatectomías totales convencionales, 2 pancreatectomías centrales convencionales, y una pancreatectomía corporocaudal con preservación del bazo. No se registró mortalidad operatoria (dentro de los 90 días posoperatorios), y presentaron una supervivencia global y libre de enfermedad de 58 y 53 meses, respectivamente. Conclusión: la resección de metástasis pancreáticas, en casos seleccionados, con un abordaje multidisciplinario, y en centros de alto volumen de patología hepatobiliopancreática, es segura y permite buenos resultados oncológicos y de supervivencia global.

ABSTRACT Background: Pancreatic metastases are rare but are likely to be diagnosed more frequently in the future due to the increase in oncology surveillance programs. Objective: The aim of this study was to describe the surgical and oncologic outcomes of a series of patients undergoing surgery for pancreatic metastases. Materials and methods: We conducted a retrospective, descriptive, and multicenter cohort study on patients who underwent pancreatic resections for metastases in the pancreas by the same surgical group between January 2016 and December 2022 in three healthcare providers. Results: A total of 19 patients were operated on, mean age was 59 years (45-79), and 11 were women with good performance status and no other evidence of oncologic disease. Clear cell renal cell carcinoma was the primary tumor in 14 cases (7 diagnosed during surveillance), and the remaining primary tumors were one case of breast ductal carcinoma, one testicular cancer, one colorectal cancer, one melanoma and one cervical cancer. The surgical techniques used were pancreatectomies and splenectomies in 7 patients (5 via laparoscopy and 2 conventional procedures), 4 enucleations (3 conventional procedures and 1 laparoscopic surgery), 3 conventional cephalic pancreaticoduodenectomies, 2 conventional central pancreatectomies and one spleen-preserving distal pancreatectomy. No deaths were reported within 90 days of surgery, and overall survival and disease-free survival were 58 and 53 months, respectively. Conclusion: Resection of pancreatic metastases is safe and provides good oncologic outcomes and overall survival when performed with a multidisciplinary approach in centers with a high volume of hepatobiliary and pancreatic surgeries and in selected cases.

A comparison of whole-mount and conventional sections for pathological mesorectal extension and circumferential resection margin assessment after total mesorectal excision.

INTRODUCTION: The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat. METHODS: This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student's t-test for paired samples, Pearson's correlation coefficient, and the Bland-Altman method comparison analysis. RESULTS: Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (t-test P = 0.8, r = 0.92) and the depth of mesorectal infiltration (t-test P = 0.6, r = 0.95). CONCLUSIONS: Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging.

Resección no planificada en sarcomas de partes blandas del aparato locomotor / Unplanned excision of soft tissue sarcomas of the musculoskeletal system

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system / Resección no planificada en sarcomas de partes blandas del aparato locomotor

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

Unplanned excision of soft tissue sarcomas of the musculoskeletal system. / Resección no planificada en sarcomas de partes blandas del aparato locomotor.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.

Isquemia mesentérica aguda: un desafío de la medicina. Reporte de un caso

La isquemia intestinal aguda es una emergencia vascular provocada por fenómenos oclusivos y no oclusivos de la circulación mesentérica arterial y venosa, de difícil diagnóstico y pronóstico ominoso. Su incidencia va en aumento paulatino con el decurso de los años, asociada fundamentalmente al envejecimiento de la población. La tasa de mortalidad es elevada a pesar de los avances en el campo de la imagenología. Suele diagnosticarse de forma tardía, cuando está establecido el daño isquémico intestinal de carácter irreversible. El elemento imprescindible e indispensable lo constituye el tiempo que trascurre hasta la cirugía, por lo que su diagnóstico sigue siendo un reto clínico. El tratamiento exige medidas médicas intensivas, al igual que cirugía de revascularización y resección del intestino necrosado. Por desdicha, el examen físico y los hallazgos de laboratorio no son sensibles ni específicos para su diagnóstico. Teniendo en cuenta estos elementos, se presenta el caso de una paciente de 38 años con clínica difusa de vómitos, diarrea y dolor abdominal progresivo, que requirió intervención quirúrgica de urgencia con diagnóstico transoperatorio de isquemia mesentérica aguda. Durante su estancia hospitalaria se relaparotomizó en dos ocasiones, mantuvo soporte ventilatorio e inotrópico por fallo multiorgánico en la Unidad de Cuidados Intensivos, mostrando una adecuada evolución posquirúrgica. El objetivo de esta presentación es enfatizar en la clínica como elemento fundamental para abordar de forma correcta esta entidad en un medio hospitalario de limitados recursos diagnósticos imagenológicos, al abordar conceptos teóricos recientes y facilitar una adecuada actuación en la toma de decisiones.

Acute intestinal ischemia is a vascular emergency caused by occlusive and non-occlusive phenomena of the mesenteric arterial and venous circulation of difficult diagnosis and ominous prognosis. Its incidence is gradually increasing over the years, mainly associated with the ageing of the population. The mortality rate is high despite advances in the field of imaging. It is usually diagnosed late, when irreversible ischemic intestinal damage is established. The essential and indispensable element is the time that elapses until surgery, so its diagnosis continues to be a clinical challenge. Treatment requires intensive medical measures, as well as revascularization surgery and resection of the necrotic intestine. Unfortunately, physical examination and laboratory findings are neither sensitive nor specific for its diagnosis. Taking these elements into account, the authors present the case of a 38-year-old female patient with diffuse symptoms of vomiting, diarrhea and progressive abdominal pain that required emergency surgery with intraoperative diagnosis of acute mesenteric ischemia. During her hospital stay, she underwent re-laparotomy twice, maintained ventilatory and inotropic support due to multi-organ failure in the Intensive Care Unit, showing an adequate post-surgical evolution. The objective of this presentation is to emphasize in the clinic as a fundamental element to correctly address this entity in a hospital environment with limited imaging diagnostic resources by addressing recent theoretical concepts and facilitating adequate action in decision-making.

Resección venosa en cirugía oncológica pancreática: opciones técnicas ante situaciones diversas / Venous resection in pancreatic oncologic surgery: Different techniques for different situations

Introducción: Análisis de los resultados de resección venosa en cirugía pancreática oncológica de 2 centros de referencia. Se analiza el tipo de intervención realizada, los tipos de reconstrucción vascular, el estudio anatomopatológico, la morbimortalidad postoperatoria y la supervivencia a 3 y 5 años. Métodos: Análisis retrospectivo, transversal y comparativo. Se incluyen 41 pacientes intervenidos de lesiones neoplásicas pancreáticas desde 2003 hasta 2021 que requirieron resección venosa por afectación vascular. Resultados: La técnica quirúrgica más frecuente fue la duodenopancreatectomía cefálica tipo Whipple, realizada en 35 de los 41 pacientes (85%). Uno de los casos se realizó por acceso laparoscópico. La reconstrucción vascular tipo 1 (sutura simple) se realizó en 11 pacientes (27%), la tipo 2 (patch de falciforme) en 4 casos (10%), la tipo 3 (sutura término-terminal) en 23 casos (56%) y la reconstrucción tipo 4 (injerto autógeno) en 3 casos (7%). La longitud media del segmento venoso resecado fue de 21mm (11-46) y el tiempo quirúrgico medio fue de 290min (220-360). El 90% (37/41) fueron adenocarcinoma de páncreas. El 83% se consideraron R0 y hubo afectación en el tramo vascular resecado en el 41% de los casos. Hubo morbilidad Clavien-Dindo>3 en 4 pacientes y no hubo ningún caso de mortalidad postoperatoria. La supervivencia a 3 años fue del 48% y a 5 años del 20%. Conclusiones: La resección venosa con reconstrucción para asegurar una resección R0 es una técnica factible, con una aceptable tasa de morbimortalidad y supervivencia global. (AU)

Introduction: To report the clinical results of patients with malignant pancreatic lesions who underwent oncological surgery with vascular resection. The type of intervention performed, the types of vascular reconstruction, the pathological anatomy results, postoperative morbidity and mortality, and survival at 3 and 5 years were analysed. Methods: Retrospective, cross-sectional and comparative analysis. We include 41 patients with malignant pancreatic lesions who underwent surgery with vascular resection due to vascular involvement, from 2013 to 2021. Results: The most performed surgery was the cephalic pancreaticoduodenectomy (Whipple procedure) using median laparotomy, in 35 of the 41 patients (85%). One of the cases in the series was performed laparoscopically. Type 1 reconstruction (simple suture) was performed in 11 (27%) patients, type 2 in 4 (10%) cases, type 3 (T–T suture) in 23 (56%) cases, and type 4 reconstruction by autologous graft in 3 (7%) cases. The mean length of the resected venous segment was 21 (11–46)mm and the mean surgical time was 290 (220–360)min. 90% (37/41) were pancreatic adenocarcinoma. 83% were considered R0 and there was involvement in the resected vascular section in 41% of the cases. Four patients had Clavien-Dindo morbidity>3 and there were no cases of postoperative mortality. Survival at 3 years was 48% and at 5 years was 20%. Conclusions: The aggressive surgical treatment with venous resection in pancreatic malignant lesions to ensure R0 and its vascular reconstruction is a feasible technique, with an acceptable morbid-mortality rate and overall survival. (AU)

Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicenter Latin American experience / Factores de riesgo para complicaciones mayores posteriores al tratamiento quirúrgico de la enfermedad de Crohn con afectación ileocecal. Trabajo retrospectivo, multicéntrico en América Latina

Introduction: Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures. Materials and methods: We conducted a retrospective analysis of patients treated surgically for Crohn's disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo>II), the “postoperative complication” (POC) group; and those who did not, the “no postoperative complication” (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC. Results: In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs 17.83; p=0.026), who presented more preoperative anemia (33.33 vs 17.48%; p=0.009), required more urgent care (37.25 vs 22.38; p=0.023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs 143.86min; p=0.005), more intraoperative complications (17.65 vs 4.55%; p<0.001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications. (AU)

Introducción: Las complicaciones posteriores a resección ileocecal por enfermedad de Crohn (EC) son frecuentes. El objetivo de este estudio fue analizar los factores de riesgo para presentar complicaciones postoperatorias después de estos procedimientos. Materiales y métodos: Se realizó un análisis retrospectivo de los pacientes operados por EC limitada a la región ileocecal durante un período de 8 años en 10 centros especializados en enfermedad inflamatoria intestinal (EII) de América Latina. Los pacientes fueron divididos en 2 grupos, los que presentaron complicaciones postoperatorias mayores (Clavien-Dindo>II) (denominado grupo de complicaciones postoperatorias [POC]) y los que no (grupo sin complicaciones postoperatorias [NPOC]). Se analizaron las características preoperatorias y las variables intraoperatorias para identificar posibles factores relacionados con las POC. Resultados: Se incluyeron 337 pacientes, 51 (15,13%) en el grupo con POC. El grupo POC presentó mayor índice de tabaquismo (31,37 vs. 17,83; p=0,026), quienes presentaron más anemia preoperatoria (33,33 vs. 17,48%; p=0,009), urgencias (37,25 vs. 22,38; p=0,023) y menores niveles de albúmina. Los procedimientos por enfermedad complicada se asociaron con una mayor morbilidad postoperatoria. Los pacientes con POC tuvieron un tiempo operatorio más largo (188,77 vs. 143,86min; p=0,005), más complicaciones intraoperatorias (17,65 vs. 4,55%; p<0,001) y menores tasas de anastomosis primaria. En el análisis multivariado, tanto tabaquismo como complicaciones intraoperatorias se asociaron de forma independiente con la aparición de complicaciones mayores postoperatorias. (AU)

Diagnóstico mediante resección endoscópica de una entidad extraña / Gastric lymphangioma. Diagnosis by endoscopic resection of a foreign entity

The lymphangioma is a rare and very uncommon benign tumor at the gastric level. Its diagnosis typically involves imaging tests and endoscopy, and its treatment usually involves surgery. We present a case of an 82-year-old patient who presented with chronic anemia, with a large gastric polyp detected during the initial gastroscopy. Subsequently, an endoscopic resection was performed, confirming histologically that it was a lymphangioma.(AU)

Incidencia y manejo fisioterápico del síndrome de resección anterior bajo / Incidence and physiotherapeutic management of low anterior resection syndrome

Antecedentes y objetivos El cáncer colorrectal es el tercer cáncer más frecuente a nivel mundial. Las nuevas técnicas quirúrgicas, la radioterapia y quimioterapia han aumentado significativamente la supervivencia, pero alterando la funcionalidad del colon. El síndrome de resección anterior baja (LARS) puede conllevar incontinencia a gases y líquidos, urgencia defecatoria, lo que condiciona la calidad de vida. El LARS puede mejorar con la aplicación de técnicas fisioterápicas. El objetivo del trabajo es conocer la incidencia, distribución y gravedad del LARS en nuestra área de salud para identificar a sujetos susceptibles de tratamiento fisioterápico. Pacientes Estudio observacional descriptivo de pacientes operados por cáncer de recto entre enero de 2017 y septiembre de 2021, tras aceptación del estudio por el Comité de Ética de la Investigación. Se realizó una valoración clínica y de la calidad de vida con el cuestionario LARS score. Resultados De los 79 pacientes detectados, fueron incluidos en el estudio 21 divididos en 2grupos. No hubo diferencias significativas en las variables estudiadas, si bien la incidencia de LARS alcanzó el 68,4%, que fue de la forma mayor en el 61,5% y afectó más frecuentemente a mujeres de edad inferior a los que presentaban una forma más leve. Los pacientes refirieron gran repercusión sobre la conducta y sensación de vergüenza. No existen protocolos de prevención o manejo activo para ellos. Conclusiones La incidencia de LARS bajo afecta a 2 terceras partes de nuestra población, con predominio de la forma mayor (AU)

Background and objective Colorectal cancer is the third most common cancer worldwide. New surgical techniques, radiotherapy and chemotherapy have significantly increased survival but altering the functionality of the colon. Low anterior resection syndrome (LARS), it can lead to gas and liquid incontinence, defecation urgency conditioning the quality of life. This can improve with the application of physiotherapy techniques. The objective of the work is to know the incidence, distribution and severity of the LARS in our health area, which allows us to identify subjects susceptible to physiotherapy treatment. Patients Descriptive observational study of patients operated on for rectal cancer between January 2017 and September 2021, after acceptance of the study by Research Ethics Committee. A clinical and quality of life assessment was performed using the LARS score questionnaire. Results Of the 79 patients detected, 21 were included in the study, divided into 2groups. There were no significant differences in the variables studied, although the incidence of LARS reached 68.4%, being higher in 61.5%, more frequently affecting younger women than those who presented a milder form. The patients reported a great repercussion on their behavoir and the feeling of shame that their lifestyle had, and there were no prevention and/or active management protocols for them. Conclusions The incidence of low anterior resection syndrome affects 2thirds of our population, with a predominance of the major form (AU)

Metástasis vertebrales. Tratamiento en bloque / Vertebral metastases. En bloc treatment

La resección en bloque de metástasis en columna vertebral ha sido objeto de estudio en la literatura médica debido a su impacto en la calidad de vida de los pacientes y su efectividad en el control local de la enfermedad. Este análisis bibliográfico examina los hallazgos y perspectivas de estudios publicados en relación con la resección en bloque de oligometástasis vertebrales. La técnica, que implica la extirpación completa del tumor junto con una porción del hueso circundante, ha demostrado mejorar el control local del tumor, reducir la recurrencia y potencialmente prolongar la supervivencia de los pacientes en comparación con las técnicas convencionales de descompresión y estabilización. Sin embargo, la resección en bloque también presenta riesgos y complicaciones, como la morbilidad quirúrgica y el mayor tiempo de recuperación. La selección adecuada de pacientes, la planificación preoperatoria y el enfoque multidisciplinario son fundamentales para optimizar los resultados. A medida que se desarrollan nuevas técnicas y avances en el tratamiento adyuvante, la resección en bloque de oligometástasis vertebrales sigue siendo un área de interés en la investigación oncológica.(AU)

En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients’ quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilization techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimize outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.(AU)

[Translated article] Vertebral metastases. En bloc treatment / Metástasis vertebrales. Tratamiento en bloque

La resección en bloque de metástasis en columna vertebral ha sido objeto de estudio en la literatura médica debido a su impacto en la calidad de vida de los pacientes y su efectividad en el control local de la enfermedad. Este análisis bibliográfico examina los hallazgos y perspectivas de estudios publicados en relación con la resección en bloque de oligometástasis vertebrales. La técnica, que implica la extirpación completa del tumor junto con una porción del hueso circundante, ha demostrado mejorar el control local del tumor, reducir la recurrencia y potencialmente prolongar la supervivencia de los pacientes en comparación con las técnicas convencionales de descompresión y estabilización. Sin embargo, la resección en bloque también presenta riesgos y complicaciones, como la morbilidad quirúrgica y el mayor tiempo de recuperación. La selección adecuada de pacientes, la planificación preoperatoria y el enfoque multidisciplinario son fundamentales para optimizar los resultados. A medida que se desarrollan nuevas técnicas y avances en el tratamiento adyuvante, la resección en bloque de oligometástasis vertebrales sigue siendo un área de interés en la investigación oncológica.(AU)

En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients’ quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilization techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimize outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.(AU)

Metástasis pulmonares aisladas de adenocarcinoma ductal de páncreas: una población con supervivencia prolongada / Isolated pulmonary metastases from pancreatic ductal adenocarcinoma: a population with prolonged survival

RESUMEN La incidencia de metástasis pulmonares aisladas en adenocarcinoma ductal de páncreas es aproximadamente del 13%. La resección de estas metástasis es infrecuente; sin embargo, los pacientes que se presentan únicamente con metástasis pulmonares tienen una mejor supervivencia comparadas con otras localizaciones. Presentamos el caso de una paciente a quien se le realizó una lobectomía pulmonar por metástasis de adenocarcinoma ductal de páncreas. Luego de la resección, el período libre de recurrencia y la supervivencia libre de enfermedad específica fueron de 84 y 152 meses, respectivamente. Consideramos que el siguiente paso en el tratamiento de esta subpoblación es poder seleccionar a los pacientes con una biología tumoral favorable y que una estrategia de tratamiento enérgica estaría justificada.

ABSTRACT The incidence of isolated pulmonary metastases in pancreatic ductal adenocarcinoma is about 13%. Resection of these metastases is uncommon; however, patients presenting only with pulmonary metastases have better survival compared to those with metastases on other locations. We report the case of a female patient who underwent lobectomy for metastases from pancreatic ductal adenocarcinoma. After resection, disease-free interval and specific diseases-free survival were 84 and 152 moths, respectively. We consider that the next step in the treatment of this subpopulation of patients is to select those patients with favorable tumor biology who would benefit from a more aggressive approach.

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia.

OBJECTIVES: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks. METHODS: Pre-operative, post-operative 1st and 6th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared. RESULTS: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1st- and 6th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively. CONCLUSION: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

OBJETIVOS: La termoterapia bipolar por radiofrecuencia es uno de los métodos adoptados en pacientes con alto riesgo quirúrgico. El objetivo de este estudio es comparar el efecto de la termoterapia de radiofrecuencia bipolar y los métodos de RTUP en los síntomas de vaciado y en las tasas de complicaciones posoperatorias, especialmente en pacientes con alto riesgo quirúrgico. MÉTODOS: Se compararon el IPSS, el Qmax, la calidad de vida, los volúmenes de próstata y las complicaciones posoperatorias de los pacientes sometidos a RTUP y RF para la HBP preoperatorios, posoperatorios al primer y sexto mes. RESULTADOS: En el grupo de RF, la mediana preoperatoria del IPSS fue de 30, el volumen prostático de 41.5 cc, el PVR de 80 ml y el Qmax de 5.85 ml/seg.; En el grupo RTUP estos fueron 29, 40 cc, 85 ml y 5.3 ml/seg, respectivamente. En el grupo de RF bipolar, los valores medianos postoperatorios del primer y sexto mes fueron IPSS 18, 21; volumen de próstata 40, 40; PVR 40, 35; Qmax 10.9, 9.15 y en el grupo TURP IPSS 9, 8; volumen de próstata 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectivamente. CONCLUSIÓN: La termoterapia de RF bipolar es un método de tratamiento aplicable para pacientes con HPB con alto riesgo quirúrgico.