Estudio prospectivo randomizado comparando anastomosis latero-lateral isoperistáltica versus antiperistáltica tras hemicolectomia derecha laparoscópica por cáncer

La principal complejidad de la hemicolectomía derecha se encuentra en la realización de la anastomosis ileocólica debido a la escasa estandarización de la técnica. Existen multitud de artículos comparando la disposición de las asas, técnica de sutura y lugar de realización, pero no existen estudios bien diseñados acerca del papel de la peristalsis en esta anastomosis. Los objetivos de este estudio son: comparar resultados a corto y largo plazo en términos de morbimortalidad postoperatoria y comparar la calidad de vida entre ambos grupos utilizando para ello el Cuestionario de Calidad de Vida Gastrointestinal (GIQLI). Para ello se ha realizado un estudio prospectivo aleatorizado, en pacientes intervenidos de forma programada por cáncer de colon derecho con hemicolectomía derecha laparoscópica y anastomosis ileocólica iso o antiperistaltica. Se han incluido 108 pacientes, 54 por rama de tratamiento. No existieron diferencias significativas en las variables demográficas. En cuanto a las variables quirúrgicas, no se hallaron diferencias en la tasa de conversión (p=0.500) ni tampoco en el tiempo quirúrgico total (130[120-150]min. en isoperistáltica vs 140[127-160] en antiperistaltica, p=0.481)ni en el tiempo anastomótico (19[17-22] vs. 20[16-25], p=0,207). En cuanto a complicaciones posquirúrgicas: un 37,0% de pacientes en el grupo isoperistaltico y un 40,7% en el grupo en antiperistaltico presentaron algún tipo de complicación, sin diferencias entre ambos (p=0.693). Aunque no se encontraron diferencias significativas, el grupo isoperistáltico presentó una mayor tasa de ileo paralitico con respecto al antiperistaltico (14.8% vs. 5.6%). Durante el postoperatorio, el grupo antiperistaltico presentó mejores resultados con menor tiempo hasta el primer flato y hasta la primera deposición (p=0.004 y p=0.017), sin embargo, este hecho no se tradujo en una menor estancia hospitalaria (p=0.236). A largo plazo, no existen diferencias significativas en las complicaciones ni en la tasa de diarrea crónica al año de la cirugía (p=0.541). Las puntuaciones del test GIQLI fueron similares entre ambos grupos al mes, 6 meses y año, sin diferencias entre ambos grupos (p=0,154, p=0.498 y p=0.683 respectivamente). En conclusión la anastomosis ileocólica isoperistáltica y la antiperistáltica son igual de seguras y factibles no encontrándose diferencias en las variables de seguridad postoperatorias ni tampoco en los resultados del test de calidad de vida. The main complexity of the right hemicolectomy is in the performance of the ileocolic anastomosis due to the scarce standardization of the technique. There are many articles comparing the disposition of bowel loops, suture technique and place of execution, but there are no well-designed studies about the role of peristalsis in this anastomosis. A prospective randomized study was conducted in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and reconstruction with iso- or antiperistaltic ileocolic anastomosis. Primary endopoint was to compare short and long term results in terms of postoperative morbidity and mortality. Secondary endpoint was to compare quality of life between both groups using the Gastrointestinal Quality Life Index (GIQLI). One hundred and eight patients were included (54 per treatment branch). There were no significant differences in the demographic variables. Regarding surgical variables, no differences were found in conversion rate (p = 0.500) nor in the total surgical time (130 [120-150] min in isoperistaltic vs 140 [127-160] in antiperistaltic, p = 0.481) or anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207). Regarding postsurgical complications 37.0% of patients in the isoperistaltic group and 40.7% in the antiperistaltic group had some type of complication, without differences between them (p = 0.693). Although no significant differences were found, the isoperistaltic group presented a higher rate of paralytic ileus compared to the antiperistaltic one (14.8% vs. 5.6%). During the postoperative period, the antiperistaltic group showed better results with shorter time until first flatus and until first deposition (p = 0.004 and p = 0.017). However, this did not mean a shorter hospital stay (p = 0.236). In the term results, there are no significant differences in complications or in chronic diarrhea rates one year after surgery (p = 0.541). GIQLI scores were similar between both groups at month, 6 months and a year after surgery, without differences between both groups (p = 0.154, p = 0.498 and p = 0.683 respectively). In conclusion, isoperistaltic and antiperistaltic ileocolic anastomosis are as safe and feasible as there are no differences in the postoperative safety variables or in the results of the quality of life test

Early postmortem gene expression and its relationship to composition and quality traits in pig Longissimus dorsi muscle

[EN] An mRNA expression study has been performed in 20-to 25-min postmortem-obtained samples from Longissimus dorsi muscle of 59 Duroc x Landrace/Large White (LD/LW) pigs to search for gene sequences related to meat quality (pH(24), pH(45), "Lab" color coordinates, curing yield, and exudation at 3 different times) or meat composition [intramuscular fat, content of several fatty acids (C16:0, C18:0, C18:1, and C18:2), ratio of saturated, monounsaturated, and polyunsaturated fatty acids, and protein and humidity contents] traits to find targets for selection. Gene ontology analysis, biological pathway, and gene network studies all show that many more differentially expressed genes (506 vs. 279) are related to meat quality (Group P or perimortem characters) than to meat composition traits (Group L or whole life traits). The difference between the number of gene ontology terms annotated, biological pathways, and gene networks in groups P and L is notable due to the differences in the complexity of the "generation process" of P-traits and involvement of other tissues or organs in the generation of variability of L-traits. Also, interactions between differentially expressed genes were found in extracellular matrix (ECM)-receptor interaction, tumor growth factor (TGF)-beta signaling pathway, fatty acid elongation in mitochondria, and adipocytokine signaling pathway, indicating that a substantial fraction of the gene networks could be associated with interactions between differentially expressed genes related to traits under study. A large number of the most overexpressed genes are related to muscle development and functionality and repair mechanisms; they could be good candidates for breeding programs in which the main goal is to enhance meat quality.This work was supported by projects Diputacion General de Aragon PI043/09 to Luis Varona Aguado and AGL2008-01487 ALI to Pascual Lopez Buesa. Almudena Galve thanks the Diputacion General de Aragon for a predoctoral fellowship.Cánovas, A.; Varona, L.; Burgos, C.; Galve, A.; Carrodeguas, JA.; Ibáñez-Escriche, N.; Martin-Burriel, I.... (2012). Early postmortem gene expression and its relationship to composition and quality traits in pig Longissimus dorsi muscle. Journal of Animal Science. 90(10):3325-3336. https://doi.org/10.2527/jas.2011-4799S332533369010Alexeyenko, A., & Sonnhammer, E. L. L. (2009). Global networks of functional coupling in eukaryotes from comprehensive data integration. 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