Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Se identifican en el presente trabajo los elementos fundamentales de la trama urbana de la ciudad de Toledo. La metodología propuesta se aparta de la utilizada tradicionalmente, debido a las peculiaridades que presenta su ubicación física concreta, intentando enfatizar de forma especial el estudio del medio físico. Para ello se parte de un análisis topográfico y climático del cerro toledano, relacionado con la evolución histórica de la forma urbana, sobre todo con el sistema de murallas. Mediante esta metodología llegan a detectarse cinco ejes estructurantes: el formado por las calles del Barco y Pozo Amargo, el de la puerta de San Sebastián, el de Tendillas y Nuncio Nuevo, el de la calle de la Luz y Azacanes y el del barrio de la Antequeruela. Este esquema se completa con vaguadas secundarias y líneas de deslizamiento. También se detecta un gran colector que se encarga de articular toda esta red y que está formado por las calles del Ángel, Santo Tomé, Trinidad, Hombre de Palo y del Comercio, uniendo entre sí las antiguas puertas interiores de Assuica y de la Sangre

THE ROLE OF INTRAOPERATIVE FROZEN SECTION OF SENTINEL LYMPH NODES IN UPFRONT BREAST CONSERVATION CANCER SURGERY

Objective: Sentinel lymph node biopsy is the standard of care in clinically negative axilla in breast cancer patients for which frozen section (FS) is routinely performed intraoperatively. The objective of this study was to justify the use of FS in terms of number of tests performed and their impact on decision-making and cost saving. Materials and Methods: We retrospectively reviewed our prospectively maintained data from January 2014 to January 2018 for intraoperative FS in upfront breast conservation surgery patients. Results: A total of 357 patients were studied. All were female. Median age was 50 years (24–84). Mean tumour size was 29.11 mm. Numbers of sentinel lymph nodes identified were 1 in 50 (14.2%) patients, 2 in 121 (33.89%) patients and ≥3 in 186 (52%) patients. Number of positive sentinel lymph nodes was 0 in 264 (73.9%) patients, 1 in 62 (17.4%) patients, 2 in 20 (5.6%) patients and ≥3 in 11 (3.08%) patients. Axillary lymph node dissection (ALND) was offered to 30 (8.4%) patients as per the American College of Surgeons Oncology Group Z0011. The results for ALND showed that only 8 (2.3%) out of 30 patients had positive nodes identified in the additional axillary nodes dissected. Sensitivity of FS was 97% and specificity was 98.86%. False-negative rate was 3.22%. Conclusion: Intraoperative FS can be safely omitted in early breast cancer patients undergoing upfront breast conservation cancer surgery due to high sensitivity and specificity leading to low false-negative rates. ALND can be performed as a second operation as warranted only in a minority of patients. Key words: American College of Surgeons Oncology Group Z0011 trial, axillary lymph node dissection, intraoperative frozen section, sentinel lymph node biops