Expresión de la metalotionina en el cáncer colorrectal

Se estudia la expresión de la metalotionina en tejido tumoral de tumores colorrectales y en tejido metastásico en ganglios linfáticos. Se correlaciona la expresión con parámetros epidemiológicos, extensión tumoral, recurrencia y supervivencia. Resultados: la metalotionina se expresa tanto en el citoplasma como en el núcleo de las células tumorales. En la mucosa normal próxima al tumor se expresa con mayor intensidad que en la mucosa alejada. No se han encontrado correlaciones con parámetros epidemiológicos. No se ha encontrado correlación con el grado de infiltración tumoral. Existe correlación entre la expresión del tumor primario y de las metástasis ganglionares. No se ha encontrado correlación con la aparición de recidivas. La correlación con la supervivencia es casi significativa en el sentido de menor supervivencia a mayor expresión. No se ha encontrado correlación entre la expresión en metástasis ganglionares y la supervivencia

Estudio multicéntrico nacional sobre pancreatectomías totales

Members of the Group of participating hospitals: Secanella, Lluis; Sánchez Bueno, Francisco; Serrablo, Alejandro; Ferrer Fabrega, Joana; Sánchez Cabus, S.; Gómez Bravo, Miguel Angel; Padillo, Javier; Blanco, Laia; Balcells, J.; Cugat, Esteban; García Domingo, Maribel; Muñoz Bellvis, Luis; Pérez Diaz, Maria Dolores; Santoyo Santoyo, Julio; Sánchez, Belinda; Georgiev, Tihomir; Villegas, Trinidad; Pacho, Silvino; Diez Valladares, Luis; Rebollar, José; Suárez Muñoz, Miguel Angel; Domínguez, Elias; Falgueras, Laia; Artigas, Vicenc; Sabater, Luis; García Gil, Agustín; Miota de Llama, José Ignacio; Manzanet, Gerardo; Pino, Jose Carlos; Rodríguez Sanjuan, Juan Carlos; Lluis, F.; Ausania, Fabio; Alkorta Zuloaga, Maialen; Escartín, Jorge; Salas, Manel; Domingo, Carlos; Sánchez de Rojas, Enrique Artigues; Barreras Mateos, José Antonio; Fernández Cebrián, José Maria; Pérez Cabrera, Beatriz; Padilla Valverde, D.; Sanjuanbenito, Alfonso; Iturburu Belmonte, Ignacio; Bejarano, Natalia; Garcia Borobia, F.; Toral Guinea, Pablo; Lopez Marcano, Aylhin; Asencio Arana, Francisco; Varo, Evaristo; Esteban, Rafael; Blas, Juan L.; Jover Navalón, José M.; Fernández Martínez, Cristina; Daban Collado, Enrique; Calvo Duran, Antonio; Vicens, J. C.; Romero, J.; Badia, J. M.; Sánchez, Raquel; Miguel Ibáñez, Ricardo de; Pardo, Fernando; Francos von Hunefeld, Carlos; Pereira, Fernando; García Molina, Francisco; Rodríguez Prieto, Ignacio; Alonso Poza, Alfredo; Gilsanz, Carlos; Martinez Albert, Jose Miguel; Angel Morcillo, Miguel; Martinez Cortijo, Sagrario; Martin Fernandez, Jose; Baquedano, Jesús; Castell, José; Aguilo, Javier; Bernal, Juan Carlos[EN]: [Introduction] Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature. [Methods] A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1–December 31, 2015. [Results] 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was “mesentery artery first” (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3 most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. [Conclusions] This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.[ES]: [Introducción] La pancreatectomía total (PT) es una intervención infrecuente, con unas indicaciones no claramente definidas y unos resultados postoperatorios no estandarizados. Presentamos un estudio multicéntrico nacional sobre PT y una comparación con la literatura existente. [Métodos]Estudio prospectivo observacional realizado mediante el registro nacional de pacientes operados de duodenopancreatectomía cefálica y PT realizadas por cualquier indicación durante el periodo comprendido entre el 1 enero y el 31 diciembre del 2015. [Resultados] Se incluyó a 1.016 pacientes, pertenecientes a 73 centros; de ellos, 112 correspondían a PT. El porcentaje de PT/número total de casos es del 11%. La edad media fue 63,5 años y eran varones un 57,2%. El diagnóstico radiológico de sospecha más frecuente fue cáncer de páncreas (58/112 casos). La técnica de la PT más habitual fue «arteria mesentérica primero» (43/112 casos). Se efectuaron resecciones venosas en 23 pacientes (20,5%). El porcentaje de complicaciones postoperatorias a 90 días fue 50%, pero las complicaciones mayores (>IIIA) solo el 20,7%. La mortalidad global a 90 días fue del 8% (9 pacientes). La estancia media fue 20,7 días. Los 3 diagnósticos histológicos definitivos más frecuentes fueron: adenocarcinoma de páncreas, neoplasia mucinosa papilar intraductal y pancreatitis crónica. La tasa de R0 fue del 67,8%. [Conclusiones] Este estudio demuestra que los resultados de morbimortalidad de la PT en España son similares o superiores a los publicados previamente. Es necesario un estudio más específico sobre PT centrado en complicaciones específicas, como la insuficiencia endocrina

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this