Improvement in postoperative mortality in elective gastrectomy for gastric cancer: Analysis of predictive factors in 1066 patients from a single centre.

BACKGROUND: Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer. METHODS: This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996-2000, 2001-2005, 2006-2010, and 2011-2014. Univariate and multivariate analyses were applied to identify predictors of 30-day postoperative mortality. RESULTS: We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P = 0.022). In the univariate analysis, age, ASA score, albumin <3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97-51.3; P = 0.005) and multivisceral resection (OR 1.6; CI 1.09-2.36; P = 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30-day mortality (OR 0.55; CI 0.33-0.15; P = 0.030). CONCLUSION: There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.

[Diffuse fatty infiltration of the thyroid gland associated to amyloidosis in a patient with chronic renal failure]. / Infiltración adiposa difusa de la glándula tiroides asociada a amiloidosis en un paciente con insuficiencia renal crónica.

We report a 26 years old male with secondary amyloidosis and chronic renal failure who consulted due to a rapidly growing goiter associated with coarseness and dysphagia. Serum levels of thyroid hormones and TSH were normal and a neck CT scan showed a big mass in the anterior and lateral regions, that compressed neighboring structures. The patient was subjected to a total thyroidectomy and the pathological study revealed a diffuse fatty and amyloid infiltration of the thyroid gland. There was no evidence of malignancy.

[Miliary tuberculosis as a complication of BCG immunotherapy in cancer of the bladder. Case report]. / Tuberculosis miliar como complicacion de inmunoterapia con BCG en el cancer de vejiga. Caso clinico.

Intravesical administration of BCG may be used as an ancillary immunotherapy after endoscopic resection for cancer of the bladder. Local side effects are usually mild. Here is reported a patient who developed miliary tuberculosis after this form of therapy. Radiologic studies of the thorax and liver biopsy confirmed the diagnosis. The patient recovered after treatment with anti-tuberculosis drugs (TA-81 scheme). Epithelial trauma may be invoked as an alteration facilitating this complication. Although it develops infrequently, patients with bladder cancer treated with BCG must be monitored for this complication.