Valentín Vega

Prognosis of patients with thyroid cancer who do not undergo surgical treatment: a SEER database analysis.

BackgroundThe treatment for thyroid cancer is surgical. However, some patients do not undergo operations because of comorbidities or other reasons. There is little information about the prognosis of these patients. The aim of the present study was to describe patients with well differentiated thyroid carcinoma who did not undergo surgical treatment and to identify differences in prognostic variables and survival compared with patients treated surgically.MethodsWe conducted a retrospective review of a prospective cohort collected by the National Cancer Institute obtained from the Surveillance, Epidemiology and End Results (SEER) Program. All patient fi les with a diagnosis of thyroid cancer were selected (38,493 cases). Finally, 12,416 cases were used for the analysis. Treatment was divided into surgical or nonsurgical groups. Five-year survival rates were estimated and classifi ed by the SEER stage.ResultsEighty-six patients did not receive surgical treatment. These patients were older, had more advanced tumours and their treatment was less associated with complementary radiotherapy. Five-year overall survival rates were 96.7% for surgical patients vs. 56.8% for nonsurgical patients (p<0.001). The overall survival in the nonsurgery group for localised tumours decreased 14.9%, for regional tumours decreased 49.9% and for distant tumours decreased 61.8%.DiscussionThe patients who did not undergo surgical treatment showed less than 5-year overall survival. The SEER database does not offer information about comorbidities that could explain these differences.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia

OBJECTIVE Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis

0.05 incremental cost-effectiveness ratio. CONCLUSION Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

The evolution of laparoscopy in abdominal surgery: A meta-analysis of the effect on infectious outcomes

INTRODUCTION Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. MATERIAL AND METHODS A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. RESULTS In a deterministic analysis, the cost, utility and cost-utility ratio was COP

Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis.

12.981.801, 44.5 and COP

Early laparoscopy for the evaluation of nonspecific abdominal pain: a critical appraisal of the evidence

291.310 for total thyroidectomy and COP

Tiroidectomía total basada en la evidencia, análisis de impacto presupuestario

14.309.889, 42.0 and

Soporte nutricional del paciente adulto Resultados de la reunión de consenso de la Asociación Colombiana de Nutrición Clínica

340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -

Validación de la escala diagnóstica de Alvarado en pacientes con dolor abdominal sugestivo de apendicitis en un centro de segundo nivel de complejidad

535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective. CONCLUSION Under a common range of complications, and considering the patients preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns.

Tiempo de evolución de la apendicitis y riesgo de perforación

Abstract Background: Laparoscopic surgery has been recommended as an effective strategy because of its advantages in decreasing abdominal surgical site infections (SSIs). The aim of this study was to assess the effect of laparoscopy on superficial and organ/space SSIs compared with open surgery in hollow-viscus procedures over time. Study design: Data on SSIs from randomized-controlled trials (RCTs) evaluating open versus laparoscopic abdominal surgeries were extracted from the Cochrane Database Reviews. Re-analysis of these data was performed to assess infections. Heterogeneity was also explored. A subgroup analysis was performed according to elective/emergency surgery status. Results: Data from 72 RCTs including 8218 patients were collected (4116 patients in the laparoscopic group and 4102 patients in the open group). For superficial SSI, the pooled RD was -4.4% (95% CI: -5.4% to -3.3%), which indicated a lower risk in the laparoscopic group. For organ/space SSI, the pooled RD was 0.5% (95% CI: -0.1% to 1%), which indicated similar rates between the groups. Changes in SSI frequency had occurred over time. Conclusion: Laparoscopic surgery significantly decreases the risk of superficial SSI but does not affect the risk of organ/space SSI. Experience with technique improves outcomes.