Resultados iniciales de la esofaguectomía robótica en el cáncer de esófago / Initial results of robotic esophagectomy for esophageal cancer

INTRODUCCIÓN: La experiencia con la esofaguectomía robótica en el cáncer de esófago y de la unión esofagogástrica es limitada. El objetivo de este estudio es presentar nuestra experiencia actual. PACIENTES Y MÉTODOS: Estudio prospectivo, de vigilancia observacional, de las primeras 32 esofaguectomías mínimamente invasivas por cáncer con toracoscopia robótica entre septiembre de 2011 y junio de 2014. La plastia gástrica se realizó por vía laparoscópica. La toracoscopia robótica se llevó a cabo con el paciente en decúbito prono y la anastomosis intratorácica, siempre de forma manual. Se evaluaron las siguientes variables: características clínicas y patológicas, técnica quirúrgica, resultados a corto plazo (morbimortalidad) y resultados oncológicos (radicalidad y ganglios extirpados). RESULTADOS: A 32 pacientes con una edad media de 58 años (rango 34-74) se les realizó una esofaguectomía mínimamente invasiva en su totalidad: laparoscopia y toracoscopia robótica (11 McKeown y 21 Ivor Lewis). En 29 casos se administró quimiorradioterapia neoadyuvante. No hubo conversiones a cirugía abierta. El tiempo medio de consola fue 218 min (rango 190-285) y la pérdida de sangre fue de 170 ml (rango 40-255). Un paciente falleció por causa cardiológica y 9 presentaron complicaciones mayores (grado II o más de Dindo-Clavien). No hubo complicaciones respiratorias ni parálisis recurrencial. Hubo 5 fístulas intratorácicas, 4 radiológicas y una clínica, 3 quilotórax, 2 fístulas cervicales y una necrosis de la plastia. La mediana de la estancia hospitalaria fue 12 días (rango 8-50). Todas las resecciones fueron R0 y se extirparon una mediana de 16 (rango 2-23) ganglios linfáticos. CONCLUSIONES: Nuestros resultados indican inicialmente que la esofaguectomía mínimamente invasiva con toracoscopia robótica es segura y respeta los principios oncológicos

INTRODUCTION: There is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. PATIENTS AND METHODS: Observational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. RESULTS: Thirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218 minutes (190-285). Blood loss was 170 ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). CONCLUSIONS: Our results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards

[Initial results of robotic esophagectomy for esophageal cancer]. / Resultados iniciales de la esofaguectomía robótica en el cáncer de esófago.

INTRODUCTION: There is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. PATIENTS AND METHODS: Observational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. RESULTS: Thirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). CONCLUSIONS: Our results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.

Masas abdominales en la infancia / Abdominal mases in childhood

Las masas abdominales en la infancia se presentan con relativa frecuencia, siendo en su mayoría hallazgos casuales en el curso de una revisión de rutina o exploraciones por otra causa. En el periodo neonatal tiene importancia el diagnóstico por ecografías prenatales que diagnostican con elevada sensibilidad este tipo de patologías. Con frecuencia se trata de masas de naturaleza quística, habitualmente benignas que se resuelven con actitudes conservadoras o quirúrgicas poco agresivas. Los métodos diagnósticos fundamentales son los estudios de imagen (ecografía, tomografía axial, resonancia magnética y recientemente la TAC helicoidal con reconstrucciones bidimensionales), y los estudios de laboratorio específicos de cada patología, especialmente la tumoral (AU)