Prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-neutrophil (PN) index in locally advanced rectal cancer patients: a retrospective cohort study.

Introduction: In locally advanced rectal cancers (LARC), tumour node metastasis (TNM) staging is far from optimal. The authors aimed to investigate the value of previously described circulating biomarkers as predictors of prognosis. Methods: Retrospective analysis of 245 LARC patients diagnosed between January 2010 and December 2022, who underwent neoadjuvant chemoradiotherapy and surgery at two centres. A Cox regression and Kaplan-Meier analysis were performed. Results: Post-treatment platelet-to-lymphocyte ratio (PLR) predicted pathological complete response. The neutrophil-to-lymphocyte ratio (NLR) in two timepoints of the treatment significantly predicted overall survival, whereas the platelet-neutrophil (PN) index significantly predicted disease-free survival. In pathological stage II, the PN index predicted patients with a higher risk of disease-free survival. Conclusion: Blood parameters might allow the definition of subgroups of risk beyond TNM for the application of different therapeutic strategies.

Can pretreatment blood biomarkers predict pathological response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer?

Aims: To investigate the value of previously described pretreatment hematological and biochemical biomarkers as predictors of pathological response. Methods: The authors performed a retrospective analysis of 191 patients with locally advanced rectal cancer who underwent long-course neoadjuvant chemoradiotherapy at two Portuguese centers. The authors performed logistic regression analysis to search for predictive markers of pathological complete and good response. Results: High platelet-neutrophil index (p = 0.042) and clinical tumor stage >2 (p = 0.015) were predictive of poor response. None of the analyzed biomarkers predicted pathological complete response in this study. Conclusion: A high platelet-neutrophil index before neoadjuvant chemoradiotherapy could help predict poorer pathological response in patients with locally advanced rectal cancer. However, no other blood biomarker predicted incomplete or poor response in this study.

[Differences between Patients Undergoing Laparoscopic Cholecystectomy with Discharge at the End of the Day Versus Overnight Stay: A Retrospective Study]. / Diferenças entre os Doentes Submetidos a Colecistectomia Laparoscópica com Alta ao Final do Dia Versus Pernoita: Um Estudo Retrospectivo.

INTRODUCTION: Although laparoscopic cholecystectomy is an increasingly performed technique in the outpatient setting, it is not done in some Units due to lack of overnight stay. The objectives of this study are to identify the differences between patients with discharge at the end of the day versus overnight stay and the factors predicting overnight stay. MATERIAL AND METHODS: A retrospective analysis of the pre, peri and postoperative data of patients operated between January/2014 and December/2017 was performed, and a statistical analysis of the variables. RESULTS: A total of 311 patients were included, 33.4% of whom stayed overnight. Of these, 81.7% were operated after 2pm. As predictors factors of overnight stay, the age (p = 0.001) was identified in the morning group, with a greater possibility of overnight stay (15.3%) from 61.50 years (Younden index = 0.396) and the surgery start time (p < 0.0001) in the afternoon group, with a greater possibility of overnight stay (77.1%) from 4:30 pm (Younden index = 0.492). DISCUSSION: Most patients stayed overnight due to the time at which recovery was completed, since no cause was identified (84.7%). If our unit would not have an overnight stay we would have an overall hospitalization rate of 8.4%, which corresponds to patients with an identified cause for overnight stay, and to admitted patients. CONCLUSION: Ambulatory cholecystectomy can be performed in units that cannot cater for an overnight stay, provided that surgeries are performed during the morning period, patients are carefully selected and there is the possibility of admission.

Introdução: Apesar da colecistectomia laparoscópica ser uma técnica cada vez mais realizada em regime de ambulatório, não é praticada em algumas unidades por ausência de pernoita. São objetivos deste estudo identificar as diferenças entre os doentes com alta ao final do dia versus pernoita e os fatores preditores de pernoita.Material e Métodos: Realizámos uma análise retrospetiva dos dados pré, peri e pós-operatório dos doentes operados entre janeiro de 2014 e dezembro de 2017, tendo-se procedido à análise estatística das variáveis.Resultados: Foram incluídos 311 doentes, sendo que apenas 33,4% pernoitaram. Destes, 81,7% foram operados depois das 14 horas. Como fatores preditores de pernoita foram identificados a idade (p = 0,001) no grupo da manhã, havendo a partir dos 61,50 anos (Younden index = 0,396) uma maior possibilidade de pernoita (15,3%) e a hora de início da cirurgia (p < 0,0001) no grupo da tarde, sendo que os doentes operados após as 16 horas e trinta minutos (Younden index = 0,492) têm maior possibilidade de pernoita (77,1%).Discussão: Grande parte dos doentes pernoitou devido à hora em que completou o recobro, uma vez que não se identificou uma causa para tal (84,7%). Caso a nossa Unidade não dispusesse de pernoita teríamos uma taxa global de internamento de 8,4%, que corresponde aos doentes com causa identificada para a pernoita e os doentes internados.Conclusão: A colecistectomia em ambulatório pode ser realizada em unidades que não disponham de pernoita, desde que as cirurgias decorram no período da manhã, os doentes sejam selecionados de forma criteriosa e exista a possibilidade de internamento.

Initial presentation of a giant gastrointestinal stromal tumour of the stomach with recurrent spontaneous intra-peritoneal haemorrhage.

INTRODUCTION: Gastrointestinal stromal tumours are a rare group of tumours of the digestive tract. In the majority of cases, at the time of the diagnosis, tumours are usually small and patients are asymptomatic or have non-specific symptoms. The occurrence of digestive haemorrhage is relatively common; however, the manifestation with a spontaneous hemoperitoneum is extremely rare, specially if chronic and non-emergent. CASE REPORT: We report an unusual case of a 65-year-old man with a history of alcohol abuse, presenting with abdominal distension due to ascites and a constitutional syndrome. He was found to have a gastrointestinal stromal tumour (GIST) of the stomach associated with a chronic hemoperitoneum, due to recurrent spontaneous haemorrhage. In an elective setting, the lesion was resected completely without rupturing the tumour pseudo-capsule and the patient had an uneventful postoperative course. The tumour was classified as a moderate-risk lesion for aggressive biological behaviour, and imatinib mesylate was initiated as an adjuvant to treatment. No evidence of disease recurrence after one year was noted. DISCUSSION AND CONCLUSION: GISTs are uncommon and rarely present with spontaneous intra-peritoneal haemorrhage, which may be life threatening. In our understanding, this is the first reported case of the reviewed literature presenting with a chronic hemoperitoneum, due to recurrent brisk episodes of tumour haemorrhage. Tumour rupture and large tumour size are two poor independent prognostic tumour factors for recurrence. Despite this, the patient remains free of disease after surgery and instituted adjuvant imatinib mesylate.

Non-Alpine thyroid angiosarcoma.

INTRODUCTION: Angiosarcoma is a very rare entity of soft tissue neoplasm with an aggressive and destructive biological behavior. Thyroid angiosarcoma is usually reported in Alpine regions, with only exceptionally rare cases arising in non-mountainous areas. In the Alpine regions it constitutes 2-10% of all malignant thyroid tumors. PRESENTATION OF CASE: We report a case of a thyroid non-Alpine angiosarcoma in a 71-year-old female with a 10 years old multinodular goiter. The cervical mass underwent rapid growth in the last year, and she was referred for surgical treatment. A 15cm mass was found on the right side of the neck invading adjacent tissues and displacing the trachea without obvious invasion of this organ. Fine needle aspiration cytology showed "carcinoma". Lung metastasis were present. Although difficult, total thyroidectomy was possible with resection of an esophageal implant. Post-operatively, she had respiratory failure that eventually recovered, but, on 39th post-operative day, she died of violent hemoptysis, probably due to invasion by mediastinal metastasis. DISCUSSION: A clear distinction between angiosarcoma and anaplastic carcinoma of the thyroid is considerably difficult, despite treatments and prognosis are practically the same. However, in recent years, a thyroid malignancy exhibiting phenotypical features of endothelial differentiation was described. Keratin positivity cannot be reported as necessarily indicative of epithelial differentiation. CONCLUSION: Optimal treatment for thyroid angiosarcoma remains unclear, not only because the prognosis is poor, despite multimodal therapeutic efforts, but also because it is a very rare entity.

Sequential closure of the abdominal wall with continuous fascia traction (using mesh or suture) and negative pressure therapy.

The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of patients left with an open abdomen (or peritoneostomy). Gigantic hernias are among the dreaded consequences of damage control and the impossibility of closing the abdomen during the initial hospital admission. To minimize this sequela, the literature has proposed many different strategies. In order to explore this topic, the "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT -TACS) conducted a literature review and critically appraised the most relevant articles on the topic. No commercially available systems for the closure of peritoneostomies were analyzed, except for negative pressure therapy. Three relevant and recently published studies on the sequential closure of the abdominal wall (with mesh or sutures) plus negative pressure therapy were appraised. For this appraisal 2 retrospective and one prospective study were included. The EBT-TACS meeting was attended by representatives of 6 Universities and following recommendations were generated: (1) the association of negative pressure therapy and continuous fascia traction with mesh or suture and adjusted periodically appears to be a viable surgical strategy to treat peritoneostomies. (2) the primary dynamic abdominal closure with sutures or mesh appears to be more efficient and economically sound than leaving the patient with a gigantic hernia to undergo complex repair at a later date. New studies including larger number of patients classified according to their different presentations and diseases are needed to better define the best surgical treatment for patients with peritoneostomies.

Fechamento sequencial da parede abdominal com tração fascial contínua (mediada por tela ou sutura) e terapia a vácuo / Sequential closure of the abdominal wall with continuous fascia traction (using mesh or suture) and negative pressure therapy

Na última década multiplicaram-se as publicações e a utilização da cirurgia de controle de danos, resultando num número crescente de pacientes deixados com o abdome aberto (ou peritoneostomia). Uma das consequências nefastas do abdome aberto são as hérnias ventrais gigantes que resultam da impossibilidade de se fechar o abdome durante a internação hospitalar do paciente. Para minimizar esta sequela têm surgido na literatura diferentes tipos de abordagem. Para abordar este tópico, a reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) optou por não analisar sistemas comerciais de fechamento abdominal dinâmico, com exceção da terapia de pressão negativa ou vácuo. O grupo fez uma avaliação crítica dirigida de três artigos mais relevantes publicados recentemente sobre fechamento sequencial da parede abdominal (com tela ou sutura) mais vácuo. Nesta avaliação foram incluídos dois estudos retrospectivos mais um estudo prospectivo. Baseados na análise crítica desses 3 estudos mais a discussão que contou com a participação de representantes de 6 Universidades e realizada via telemedicina, são feitas as seguintes recomendações: (1) a associação de terapia de pressão negativa com tração fascial constante mediada por tela ou sutura, ajustada periodicamente, parece ser uma ótima estratégia cirúrgica para o tratamento de peritoneostomias. (2) O fechamento abdominal primário dinâmico com sutura e mediada por tela parece ser mais econômico e eficiente do que deixar o paciente com uma hérnia gigante e planejar uma reconstrução complexa tardiamente. Novos estudos com grupos maiores de pacientes separados de acordo com as diferentes apresentações e doenças são necesários para definir qual o melhor método cirúrgico para o tratamento de peritoneostomias.

The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of patients left with an open abdomen (or peritoneostomy). Gigantic hernias are among the dreaded consequences of damage control and the impossibility of closing the abdomen during the initial hospital admission. To minimize this sequela, the literature has proposed many different strategies. In order to explore this topic, the "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT -TACS) conducted a literature review and critically appraised the most relevant articles on the topic. No commercially available systems for the closure of peritoneostomies were analyzed, except for negative pressure therapy. Three relevant and recently published studies on the sequential closure of the abdominal wall (with mesh or sutures) plus negative pressure therapy were appraised. For this appraisal 2 retrospective and one prospective study were included. The EBT-TACS meeting was attended by representatives of 6 Universities and following recommendations were generated: (1) the association of negative pressure therapy and continuous fascia traction with mesh or suture and adjusted periodically appears to be a viable surgical strategy to treat peritoneostomies. (2) the primary dynamic abdominal closure with sutures or mesh appears to be more efficient and economically sound than leaving the patient with a gigantic hernia to undergo complex repair at a later date. New studies including larger number of patients classified according to their different presentations and diseases are needed to better define the best surgical treatment for patients with peritoneostomies.