RAS Mutation Decreases Overall Survival After Optimal Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy of Colorectal Peritoneal Metastasis: A Modification Proposal of the Peritoneal Surface Disease Severity Score.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently the most accepted treatment for peritoneal metastases from colorectal cancer. Restrictive selection criteria are essential to obtain the best survival benefits for this complex procedure. The most widespread score for patient selection, the peritoneal surface disease severity score (PSDSS), does not include current biological factors that are known to influence on prognosis. We investigated the impact of including RAS mutational status in the selection criteria for these patients. METHODS: We studied the risk factors for survival by multivariate analysis using a prospective database of consecutive patients with carcinomatosis from colorectal origin treated by CRS and HIPEC in our unit from 2009 to 2017. The risk factors obtained were validated in a multicentre, international cohort, including a total of 520 patients from 15 different reference units. RESULTS: A total of 77 patients were selected for local análisis. Only RAS mutational status (HR: 2.024; p = 0.045) and PSDSS stage (HR: 2.90; p = 0.009) were shown to be independent factors for overall survival. Early PSDSS stages I and II associated to RAS mutations impaired their overall survival with no significant differences with PSDSS stage III overall survival (p > 0.05). These results were supported by the international multicentre validation. CONCLUSIONS: By including RAS mutational status, we propose an updated RAS-PSDSS score that outperforms PSDSS alone providing a quick and feasible preoperative assessment of the expected overall survival for patients with carcinomatosis from colorectal origin undergone to CRS + HIPEC.

HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma.

BACKGROUND: Local relapse and peritoneal carcinomatosis (PC) for pT4 colon cancer is estimated in 15,6% and 36,7% for 12 months and 36 months from surgical resection respectively, achieving a 5 years overall survival of 6%. There are promising results using prophylactic HIPEC in this group of patients, and it is estimated that up to 26% of all T4 colon cancer could benefit from this treatment with a minimal morbidity. Adjuvant HIPEC is effective to avoid the possibility of peritoneal seeding after surgical resection. Taking into account these results and the cumulative experience in HIPEC use, we will lead a randomized controlled trial to determine the effectiveness and safety of adjuvant treatment with HIPEC vs. standard treatment in patients with colon cancer at high risk of peritoneal recurrence (pT4). METHODS/DESIGN: The aim of this study is to determine the effectiveness and safety of adjuvant HIPEC in preventing the development of PC in patients with colon cancer with a high risk of peritoneal recurrence (cT4). This study will be carried out in 15 Spanish HIPEC centres. Eligible for inclusion are patients who underwent curative resection for cT4NxM0 stage colon cancer. After resection of the primary tumour, 200 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously after the primary resection. Mitomycin C will be used as chemotherapeutic agent, for 60 min at 42-43 °C. Primary endpoint is loco-regional control (LC) in months and the rate of loco-regional control (%LC) at 12 months and 36 months after resection. DISCUSSION: We assumed that adjuvant HIPEC will reduce the expected absolute risk of peritoneal recurrence from 36% to 18% at 36 months for T4 colon-rectal carcinoma. TRIAL REGISTRATION: NCT02614534 ( clinicaltrial.gov ) Nov-2015.

New CD3zeta allele showing a 9-bp deletion in the 3'-UT region of the gene.

We report here a non-previously described 9-bp deletion in the 3'-UT region of the CD3zeta gene, located in between two AREs.

Isquemia colónica secundaria a obstrucción intestinal por bariolito / Ischemic colitis secondary to bowel obstruction caused by bariolithes

No disponible

Reparación perineal transvaginal del rectocele sintomático mediante perineorrafia protésica con malla de marlex. Valoraciones anatomoclínicas, fisiológicas y de tratamiento / Transvaginal perineal repair of symptomatic rectocele using a Marlex mesh prosthesis: anatomoclinical, physiological and treatment considerations/assessment

Introducción. El propósito de este estudio es valorar el tratamiento de los rectoceles sintomáticos, en un grupo seleccionado de pacientes, mediante una técnica diseñada personalmente, en función de su etiología (fallo de la fascia de Denonvilliers), y con la colocación de una malla de Marlex. Pacientes y métodos. Se seleccionaron exclusivamente 12 pacientes en las cuales existía una historia de estreñimiento grave y que, además del uso diario de laxantes, recurrían a la digitación como única solución para la evacuación rectal. Se realizó un abordaje quirúrgico perineal transvaginal, colocándose una malla de Marlex anclada sobre la fascia de Denonvilliers y posteriormente una colpectomía romboidal posterior de la pared redundante. Resultados. Todas las pacientes notaron una mejoría inmediata de los síntomas con una evacuación sin necesidad de digitación, a la vez que desapareció el prolapso vaginal posterior. La rectificación del rectocele fue perfecta y se normalizaron los parámetros anatómicos, fisiológicos y radiológicos. Conclusiones. La perineorrafia protésica transvaginal mejora de forma definitiva los síntomas del rectocele de gran tamaño, tratando a la vez los dos parámetros anatomoclínicos, de distensión rectal anterior y prolapso vaginal posterior (AU)

[Effect of preoperative radiotherapy in the detection of lymphatic metastasis of rectal cancer]. / Efecto de la radioterapia preoperatoria en la detección de las metástasis ganglionares del cáncer de recto.

The purpose of this study was to assess whether the understaging of rectal tumors seen after preoperative radiotherapy is due to the biological effect of the irradiation or reflect the difficulties of the pathologists in identifying lymph nodes from radiated specimens. To study this question a retrospective non randomized study was undertaken including 31 patients with rectal cancer and oncological resection, 16 after preoperative administration of 36 Gy and 15 without radiotherapy. Metastatic lymph nodes were found in 37% of patients of the radiated group and in 58% of no irradiated group, being de difference between them of 16% with a confidence interval from -15% to 40%. A mean of 13 and 18 lymph nodes were identified in the radiated and non radiated group respectively, being the difference between means of 5 with a confidence interval from -0.6 to 10. A 80% and 57% of the pathological reports in no radiated and radiated group respectively accomplished the criteria of reliability (> 13 lymph modes isolated), being the difference between proportions of 27% with a confidence interval from -3% to 57%. Based on the above stated results no conclusive answer can be addressed to the proposed question; both effects could participate in the downstaging. More studies including more patients are needed to give a reliable answer to the proposed question.

[Is the introduction and realization of the Japanese system of staging and surgical treatment for stomach cancer possible in Spain?]. / Es posible la implantación y realización, en nuestro país, del sistema de estadiaje y tratamiento quirúrgico japonés para el cáncer de estómago?

Discrepancies in the five-year survival rates after treatment of gastric cancer between the West and the East have been attributed to differences in the biological behavior of the tumor or in the incidence of early cancer. Alternatively, the better staging system and the national standardization of the diagnosis and treatment used in the East may explain their findings. Poor definition of stages and curability, scarce interest in standardization of techniques, and lack of basic information in many pathological reports are frequent in Western countries. Between May 1988 and April 1991 a prospective study on a consecutive series of 89 patients diagnosed of gastric carcinoma in the Hospital "Príncipe de Asturias" using the directions given by the Japanese Research Society for Gastric Cancer has been made. Our results support the use of the Japanese system in a General Hospital of our country and confirm its accuracy in defining the type of surgery performed, the later being its main advantage over the TNM staging system.

[Spontaneous and simultaneous external and internal double biliary fistula]. / Doble fístula biliar interna-externa espontánea simultánea.

An exceptional case is presented of double biliary fistula, internal (to duodenum) and external (to the abdominal wall) in a patient with cholelithiasis of long evolution. The diagnosis of suspicion was made by CAT and was confirmed in the surgical act. Treatment was cholecystectomy, closure of the duodenal communication and external drainage of the parietal abscess. The postoperative evolution coursed without complications.

[Perforated diverticulitis of the colon: diagnosis and treatment]. / Diverticulitis del colon perforada: diagnóstico y tratamiento.

Twelve cases are presented of perforated diverticulitis that required emergency surgical intervention. The present guidelines for surgical action are indicated for the different situations originated by perforated diverticulitis: localized peritonitis (pericolonic abscess), suppurated peritonitis and fecaloid peritonitis. The Hartman technique is explained as the method of choice for patients with generalized peritonitis.