Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.

Malignización de quiste de colédoco en edad adulta: una entidad poco frecuente / Malignization of a choledocal cyst in the adult: A rare entity

No disponible

Metastasis of the gallbladder in clear cell renal carcinoma.

Metastasis of the gallbladder due to renal cell tumors is rare. We present a case of gallbladder and metachronous left adrenal metastasis at six months follow-up, which demonstrates the importance of radiological tests and histology when making a definitive diagnosis. Clinical findings are not specific enough to arrive at a final diagnosis. However, immunohistochemistry is necessary to differentiate between primary and secondary metastatic tumors. Cholecystectomy should be performed to obtain a definitive diagnosis and to improve survival in cases of single lesions in the gallbladder.

¿Están los servicios de cirugía general y del aparato digestivo preparados para ofrecer docencia de calidad acorde con los nuevos planes de formación? / Are the general and digestive surgery services prepared to offer a quality training according to the new teaching plans?

Introducción En los últimos meses se ha asistido a una actualización del programa formativo de los residentes y a una regulación de los aspectos importantes de su formación. Un elemento fundamental del proceso de formación son las unidades docentes, a las que se debe exigir que cumplan con los requisitos indispensables adaptados a los nuevos tiempos, como garantía de calidad. Objetivo Identificar los aspectos mejorables en la formación y conocer con qué recursos parten las unidades docentes para afrontar el cumplimiento del nuevo programa de formación. Material y método El estudio se ha realizado en todas las unidades docentes acreditadas para la formación de residentes en la Comunidad Valenciana mediante formularios enviados tanto a los tutores como a los residentes y reuniones mantenidas con los residentes. Resultados La tasa de participación fue elevada (el 100% de tutores y el 92% de residentes). Se han detectado deficiencias en los requisitos de las unidades docentes y en la calidad de la formación percibida por los residentes, sobre todo en los campos de la investigación y en la actividad docente. Se constatan importantes diferencias entre hospitales. Conclusiones Se debe incidir en el cumplimiento de todos los requisitos necesarios para la acreditación de las unidades docentes y hacer hincapié en la actividad docente e investigadora. La implementación de los nuevos planes de formación requiere de una supervisión que corrija las diferencias encontradas entre los distintos servicios (AU)

Introduction In recent months we have witnessed an update of the residents training program and the regulation of important training aspects. Teaching units are an important aspect of the training process, which should be required to comply with the prerequisites adapted to changing times as a guarantee of quality. Aim To identify areas for improvement in training, and the baseline resources of the units to deal with the implementation of the new training program. Material and methods The study was carried out in all units with accredited educational programs in the Valencian Community with questionnaires answered by tutors and residents, and meetings held with them. Results T he participation rate was high (100% of tutors and 92% of residents). Some deficiencies in the requirements of the surgical units and in the quality of the training felt by the residents are detected, mainly in the research and educational activity fields. Huge differences between hospitals are found. Conclusions More attention must be paid to fulfilling all the requirements needed for the accreditation of the teaching units, with an emphasis on educational and research activities. The implementation of the new training program requires monitoring to minimise the differences found between the units (AU)