Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes.

BACKGROUND: The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences. AIM: To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications. METHODS: We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice. RESULTS: From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies. CONCLUSION: Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

Respuesta al artículo: La concentración de tratamientos puede mejorar los resultados en cirugía compleja del cáncer / Response to the article: Concentration of treatments can improve clinical results in complex cancer surgery

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La simulación como modelo de enseñanza en cirugía / Simulation as a surgical teaching model

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Reconstrucción perineal con colgajo fasciocutáneo de glúteo mayor en V-Y: experiencia de 5 años / Perineal reconstruction with gluteus maximus fasciocutaneus V-Y flap: 5 years experience

Antecedentes y Objetivos. La cirugía colorrectal y ginecológica precisa a menudo la resección de grandes áreas de tejido en la región perineal. En ocasiones es posible el cierre directo, pero a veces se necesitan técnicas reconstructivas. Una de las más extendidas para la reconstrucción perineal es la utilización de los colgajos fasciocutáneos en V-Y diseñados en la región anatómica del glúteo mayor. Pacientes y Método. Desde 2005 hasta 2011 hemos llevado a cabo reconstrucción del periné con el colgajo fasciocutáneo de avance en V-Y del glúteo mayor basado en sus perforantes en 7 pacientes. El tamaño de los defectos varió desde 50a 400 cm2 . Resultados. La estancia hospitalaria media fue de 36.8 días. Cuatro pacientes sufrieron complicaciones en la zona operada (57%): 2 necesitaron una segunda intervención por sufrir dehiscencia; 1 tuvo una infección de la herida quirúrgica, y 1 desarrolló una fístula perianal. El paciente de más edad (80 años) falleció por complicaciones cardiovasculares durante el postoperatorio Conclusiones. El colgajo fasciocutáneo de avance en V-Y basado sobre la región glútea, es una técnica segura, de fácil ejecución y mínima morbilidad, para la reconstrucción de pequeños y grandes defectos de la región perineal. Si bien en pacientes tratados previamente con radioterapia es aconsejable pensar en el uso de colgajos a distancia (AU)

Background and Objectives. Colorectal and gynecological surgery often demand the resection of large areas of tissue in the perineal region. Sometimes it is possible to perform direct closure of the zone but on other occasions reconstructive procedures are necessary. One of the techniques most widely accepted for perineal reconstruction is the use of V-Y fasciocutaneous flaps designed on the anatomical area of the gluteus maximus. Patients and Methods. We report 7 patients operated between 2005 and 2011, all of them undergoing reconstruction with V-Y fasciocutaneous flaps based on the perforating arteries of the gluteus maximus. The size of the lesions ranged between 50 to 400 cm2 . Results. The mean time spent in hospital was 36.8 days. Four patients developed complications on the operated zone (57%): 2 patients needed a second intervention owing to severe dehiscence; 1 patient developed an infection of the surgical wound; and in 1 patient the complication was an anal fistula. The oldest patient (80 years old) died during the post-operative period owing to cardiovascular problems. Conclusions. The fasciocutaneous V-Y advancement flap based on the gluteal region is a safe technique that is easy to perform and causes minimum morbidity in the reconstruction of small and large defects of the perineal region. However, in patients previously treated with radiotherapy, it is recommended that flaps be harvested from more distant areas (AU)

Formación en cirugía general en España: troncalidad y áreas de capacitación específica / General surgery training in Spain: Core curriculum and specific areas of training

Se ha publicado el R.D. 639/2014 que regula la troncalidad y las áreas de capacitación específica (A.C.E.) que constituyen una norma de gran interés en la especialidad de Cirugía General y del Aparato Digestivo (C.G. y del A.D.)Se pretende exponer y concretar las principales disposiciones y reflexionar sobre sus implicaciones en la especialidad de C.G. y del A.D., para promover iniciativas y regulaciones. Después de una gestación compleja, este R.D. supondrá un hito en nuestra especialidad, que pondrá a prueba su fortaleza, si no es que culmina finalmente con su degradación frente a la emergencia de nuevas especialidades quirúrgicas, como ya sucedió en el pasado. Se inicia una etapa en la que la Asociación Española de Cirujanos deberá implicarse, para definir las bases conceptuales de la C.G. y del A.D. en el siglo XXI, y la creación de las nuevas A.C.E., para seguir manteniendo la «esencia de nuestra especialidad»

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS).The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the «essence of our specialty»

General surgery training in Spain: core curriculum and specific areas of training.

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS). The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the "essence of our specialty".