Machine Learning Risk Prediction Model of 90-day Mortality After Gastrectomy for Cancer.

OBJECTIVE: To develop and validate a risk prediction model of 90-day mortality (90DM) using machine learning in a large multicenter cohort of patients undergoing gastric cancer resection with curative intent. BACKGROUND: The 90DM rate after gastrectomy for cancer is a quality of care indicator in surgical oncology. There is a lack of well-validated instruments for personalized prognosis of gastric cancer. METHODS: Consecutive patients with gastric adenocarcinoma who underwent potentially curative gastrectomy between 2014 and 2021 registered in the Spanish EURECCA Esophagogastric Cancer Registry database were included. The 90DM for all causes was the study outcome. Preoperative clinical characteristics were tested in four 90DM predictive models: Cross Validated Elastic regularized logistic regression method (cv-Enet), boosting linear regression (glmboost), random forest, and an ensemble model. Performance was evaluated using the area under the curve by 10-fold cross-validation. RESULTS: A total of 3182 and 260 patients from 39 institutions in 6 regions were included in the development and validation cohorts, respectively. The 90DM rate was 5.6% and 6.2%, respectively. The random forest model showed the best discrimination capacity with a validated area under the curve of 0.844 [95% confidence interval (CI): 0.841-0.848] as compared with cv-Enet (0.796, 95% CI: 0.784-0.808), glmboost (0.797, 95% CI: 0.785-0.809), and ensemble model (0.847, 95% CI: 0.836-0.858) in the development cohort. Similar discriminative capacity was observed in the validation cohort. CONCLUSIONS: A robust clinical model for predicting the risk of 90DM after surgery of gastric cancer was developed. Its use may aid patients and surgeons in making informed decisions.

Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis.

BACKGROUND: The concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. METHOD: All patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. RESULTS: In total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, "macroscopically complete resection" had the highest compliance (96.5%) while "no serious complications" had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). CONCLUSION: TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.

Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case.

We present a case of congenital diaphragmatic hernia diagnosed in an adult. It is a kind of exceptional pathology outside the pediatric age with few cases reported in the literature. Its presentation is unusual, especially in the form of mechanical intestinal obstruction, requiring surgical treatment.

Oclusión intestinal mecánica secundaria a hernia diafragmática congénita en un adulto. Presentación de un caso / Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case

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Cirugía laparoscópica en al abdomen agudo no traumático / Laparoscopic surgery in non traumatic acute abdomen

Antecedentes: la cirugía videolaparoscópica ha despertado enorme interés en el tratamiento del abdomen agudo quirúrgico, si bien sigue siendo motivo de análisis y controversias. Objetivos: 1. Comunicar la experiencia obtenida en el tratamiento del abdomen agudo por vía laproscópica, 2. Demostrar la utilidad de la laparoscopía, tanto en el diagnóstico como en la resolución del abdomen agudo, 3. Evaluar el tratamiento aplicado en cada caso. Lugar: Hospital Municipal Ciudad de Boulogne. Diseño: estudio observacional retrospectivo. Material y método: 110 pacientes con diagnóstico de abdomen agudo quirúrgico ingresados a la guardia del Hospital desde 01/00 al 12/01. Femenino: 51 (46.4 por ciento), masculino: 59 (53.6 por ciento), edad promedio 29 años. Resultados: sobre un total de 110 pacientes, 107 (97.2 por ciento) se resolvieron por esta vía, siendo el número de conversiones de 3 (2.7 por ciento), y el total de complicaciones 4 (3.6 por ciento), teniendo que realizar nuevas exploraciones en 2 oportunidades (1.8 por ciento). Conclusiones: la cirugía laparoscópica es un método eficaz para resolver el cuadro de abdomen agudo quirúrgico

Cirugía laparoscópica en al abdomen agudo no traumático / Laparoscopic surgery in non traumatic acute abdomen

Antecedentes: la cirugía videolaparoscópica ha despertado enorme interés en el tratamiento del abdomen agudo quirúrgico, si bien sigue siendo motivo de análisis y controversias. Objetivos: 1. Comunicar la experiencia obtenida en el tratamiento del abdomen agudo por vía laproscópica, 2. Demostrar la utilidad de la laparoscopía, tanto en el diagnóstico como en la resolución del abdomen agudo, 3. Evaluar el tratamiento aplicado en cada caso. Lugar: Hospital Municipal Ciudad de Boulogne. Diseño: estudio observacional retrospectivo. Material y método: 110 pacientes con diagnóstico de abdomen agudo quirúrgico ingresados a la guardia del Hospital desde 01/00 al 12/01. Femenino: 51 (46.4 por ciento), masculino: 59 (53.6 por ciento), edad promedio 29 años. Resultados: sobre un total de 110 pacientes, 107 (97.2 por ciento) se resolvieron por esta vía, siendo el número de conversiones de 3 (2.7 por ciento), y el total de complicaciones 4 (3.6 por ciento), teniendo que realizar nuevas exploraciones en 2 oportunidades (1.8 por ciento). Conclusiones: la cirugía laparoscópica es un método eficaz para resolver el cuadro de abdomen agudo quirúrgico