Héctor Ortiz Hurtado

Comparación de colostomías e ileostomías como estomas derivativos tras resección anterior baja

Resumen Objetivo Valorar si es mejor la colostomia transversa o la ileostomia como estomas derivativos tras reseccion anterior baja. Material y metodo Se ha llevado a cabo una revision bibliografica para intentar comparar ambos estomas desde la construccion hasta su cierre. Resultados En el momento de la construccion no es facil sacar conclusiones, ya que es dificil distinguir las complicaciones especificas secundarias a la construccion del estoma de las ocasionadas por la reseccion anterior. Durante el tiempo en que el paciente es portador del estoma, la colostomia transversa parece tolerarse peor. El cierre de la colostomia parece tener mas complicaciones septicas, aunque esta por aclarar la frecuencia real de obstruccion intestinal tras el cierre de ileostomia. Conclusiones Dadas las caracteristicas de los estudios previos, no es posible establecer en terminos generales que estoma derivativo es mejor. La ileostomia parece mejor tolerada por el paciente y se asocia a una menor tasa de complicaciones tras el cierre (quedando pendiente de evaluar la obstruccion intestinal). Son necesarios estudios prospectivos aleatorizados con un mayor numero de pacientes para poder responder a la pregunta planteada.

Analysis of the quality of surgical treatment of colorectal cancer, in 2008. A national study

Abstract Objectives A national study conducted for the Spanish Association of Surgeons with the aim of analysing the surgical treatment of colorectal cancer (CRC) in Spain and to compare it with scientific literature. Material and methods A multicentre, descriptive, prospective and longitudinal study of patients with CRC who were treated by elective surgery. A total of 50 hospitals in 15 Autonomous Regions took part, with 496 treated cases in 2008. A total of 88 variables were collected. Results The median age was 72 years, increase in ASA III patients; correct preoperative studies, 4% with no staging in the rectum. There was a tendency not to use the colon cleansing or to do it only one day. The percentage of complications is within the ranges in the literature, with the exception of surgical wound infections (19%). Mean of resected lymph nodes: 13.2; 4.3% no mesorectal resection. Mechanical anastomosis: 80.8%, 65.9% of the operations performed by a colorectal surgeon. Preoperative radiotherapy in 43.5% of rectal cancers. Chemotherapy: 32.9%. Laparoscopy: 35.1% of cases, conversion rate 13.8%. Use of antibiotics: 37.1%, blood transfusion: 20.6% and parenteral nutrition: 26.5%. Conclusions Surgical treatment of CRC in Spain has a level of quality and peri-operative results similar to the rest of Europe. Compared to previous studies, it was observed that there were advances in preparation of the patient, preoperative studies, imaging techniques, and improvements in surgical techniques with adoption of mesorectal excision, appropriate lymphadenectomies and preservation of sphincters. There are areas for improvement, such as a reduction in surgical wound infections, increase use of protective stoma, appropriate use of antibiotics, parenteral nutrition or neoadjuvants and complete colonoscopies.

Resultados oncológicos según el tipo de resección en el tratamiento del cáncer de recto

OBJECTIVE This multicentre observational study aimed to compare outcomes of anterior resection (AR) and abdominal perineal resection (APR) in patients treated for rectal cancer. METHODS Between March 2006 and March 2009 a cohort of 1,598 patients diagnosed with low and mid rectal cancer were operated on in the first 38 hospitals included in the Spanish Rectal Cancer Project. In 1,343 patients the procedure was considered curative. Clinical and outcome results were analysed in relation to the type of surgery performed. All patients were included in the analysis of clinical results. The analysis of outcomes was performed only on patients treated by a curative procedure. RESULTS Of the 1,598 patients, 1,139 (71.3%) underwent an AR and 459 (28.7%) an APR. In 1,343 patients the procedure was performed with curative intent; from these 973 (72.4%) had an AR and 370 (27.6%) an APR. There were no differences between AR and APR in mortality (29 vs. 18 patients; P=.141). After a median follow up of 60.0 [49.0-60.0] months there were no differences in local recurrence (HR 1.68 [0.87-3.23]; P=.12), metastases (HR 1.31 [0.98-1.76]; P=.064). However, overall survival was worse after APR (HR 1.37 [1.00-1.86]; P=.048). CONCLUSION This study did not identify abdominoperineal excision as a determinant of local recurrence or metastases. However, patients treated by this operation have a decreased overall survival.OBJECTIVE This multicentre observational study aimed to compare outcomes of anterior resection (AR) and abdominal perineal resection (APR) in patients treated for rectal cancer. METHODS Between March 2006 and March 2009 a cohort of 1,598 patients diagnosed with low and mid rectal cancer were operated on in the first 38 hospitals included in the Spanish Rectal Cancer Project. In 1,343 patients the procedure was considered curative. Clinical and outcome results were analysed in relation to the type of surgery performed. All patients were included in the analysis of clinical results. The analysis of outcomes was performed only on patients treated by a curative procedure. RESULTS Of the 1,598 patients, 1,139 (71.3%) underwent an AR and 459 (28.7%) an APR. In 1,343 patients the procedure was performed with curative intent; from these 973 (72.4%) had an AR and 370 (27.6%) an APR. There were no differences between AR and APR in mortality (29 vs. 18 patients; P=.141). After a median follow up of 60.0 [49.0-60.0] months there were no differences in local recurrence (HR 1.68 [0.87-3.23]; P=.12), metastases (HR 1.31 [0.98-1.76]; P=.064). However, overall survival was worse after APR (HR 1.37 [1.00-1.86]; P=.048). CONCLUSION This study did not identify abdominoperineal excision as a determinant of local recurrence or metastases. However, patients treated by this operation have a decreased overall survival.