Cirugia espanola最新文献

{"title":"Surgery for rectal cancer beyond the mesorectum: Indications, preparation, limits, and results","authors":"Blas Flor-Lorente,&nbsp;Mario J. de Miguel-Valencia","doi":"10.1016/j.cireng.2025.800202","DOIUrl":"10.1016/j.cireng.2025.800202","url":null,"abstract":"<div><div>Pelvic exenteration (PE) is a potentially curative surgical option for patients with locally advanced rectal cancer (LARC) orlocallyrecurrent rectal cancer (LRRC) involvingmultivisceralstructures. Originally conceived as a palliative procedure, advancements in surgical techniques and multidisciplinary management have broadened its indications, enabling R0 resections in over 60% of cases. Appropriate patient selection, based on advanced imaging and comprehensive functional assessment, is essential to optimize oncologic outcomes. Currently, the surgical indication is primarily determined by the reasonable possibility of achieving an R0 resection with acceptable morbidity in a suitable candidate, which may translate into high survival rates. Surgical planning should follow a compartmental approach and require close collaboration among colorectal, urologic, gynecologic, vascular, orthopedic, plastic, and reconstructive surgeons. Urinary, gynecologic, vascular, osseous, and soft tissue reconstructions are tailored to the tumour’s extent and the patient's individual needs. In selected cases, PE may be performed with palliative intent. Intraoperative radiotherapy (IORT) and minimally invasive approaches have emerged as valuable adjuncts. Long-term oncologic and functional outcomes are closely linked to the achievement of negative margins. While postoperative morbidity remains significant, mortality rates have declined in high-volume centres. Postoperative quality of life has become a key outcome, with increasing emphasis on patient-reported outcome measures (PROMs) to guide clinical decision-making. PE continues to challenge traditional limits of resectability, offering renewed hope to carefully selected patients.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800202"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy assisted skin and nipple preserving mastectomy and immediate reconstruction with prepectoral implant. Prospective study for the evaluation of the feasibility and safety of the technique, quality of life and cosmetic aftermath. Promoter Code: VideoBreast-24","authors":"Benigno Acea-Nebril ,&nbsp;Alejandra García-Novoa ,&nbsp;Sergio Sierra Fernández","doi":"10.1016/j.cireng.2025.800159","DOIUrl":"10.1016/j.cireng.2025.800159","url":null,"abstract":"<div><div>Skin-sparing or nipple-skin-sparing mastectomy (NSSM) with immediate reconstruction with a prepectoral implant is the procedure of choice for women with breast cancer or high risk for breast cancer who require a mastectomy. This procedure can be performed with endoscopic or robotic assistance, however, the complexity of the technique, the increase in surgical time and costs, as well as the lack of prospective studies with long-term follow-up have limited its implementation. The present study aims to evaluate the non-inferiority of NSSM with endoscopic support compared to open NSSM in terms of feasibility and safety of the technique, oncological safety and cosmetic sequelae.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800159"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of indocyanine green-guided lymphatic mapping in the gastric cancer lymphadenectomy: impact of neoadjuvant chemotherapy","authors":"Andrea Carlota Lizarralde Capelastegui,&nbsp;Javier Sánchez González,&nbsp;Pablo Marcos Santos,&nbsp;Martín Bailón Cuadrado,&nbsp;Sandra Veleda Belanche,&nbsp;María Luz Martín Esteban,&nbsp;David Pacheco Sánchez,&nbsp;Miguel Toledano Trincado","doi":"10.1016/j.cireng.2025.800158","DOIUrl":"10.1016/j.cireng.2025.800158","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green (ICG) fluorescence has recently been introduced as an imaging technique to enhance lymphatic mapping in gastric cancer (GC) surgery. This study analyzes the efficacy of this tool in gastric cancer lymphadenectomy and the influence of neoadjuvant chemotherapy (NAC) on its application.</div></div><div><h3>Material and methods</h3><div>This study analyzes seventy-two patients from a Spanish center with gastric adenocarcinoma who underwent gastrectomy between October 2018 and December 2023. Two groups were compared: patients undergoing oncologic gastrectomy with ICG-guided lymphadenectomy versus patients with conventional lymphadenectomy. Primary outcomes were the number of lymph nodes (LN) retrieved and adequate lymphadenectomy rates (≥16 LN).</div></div><div><h3>Results</h3><div>The study population comprised 72 patients, of whom 36 belonged to the ICG group and 36 to the non-ICG group. Both groups had similar mean age, BMI, sex ratios, comorbidities, and staging. The rate of adequate lymphadenectomy was significantly higher after intraoperative ICG guidance (86.1% vs. 58.3%; p = 0.009), although this association was not significant after NAC. There were no differences in the mean number of lymph nodes retrieved. A greater number of postoperative complications was observed in the ICG group, although no statistically significant differences were found. None of these complications were directly related to indocyanine green instillation. There were also no differences in the length of hospital stay between the two groups.</div></div><div><h3>Conclusion</h3><div>ICG-guided lymphatic mapping appears to be a safe and effective tool for achieving adequate lymphadenectomy in gastric cancer compared to conventional lymphadenectomy. However, NAC may limit the effectiveness of the technique.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800158"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pudendal neuropathy due to apocrine cystadenoma: A literature review","authors":"Belén Hernández Roca ,&nbsp;María Jesús Segura Jiménez ,&nbsp;Vidina Rodrigo Amador ,&nbsp;Enrique Fernández Rodríguez ,&nbsp;José Manuel Ramia Angel","doi":"10.1016/j.cireng.2025.800193","DOIUrl":"10.1016/j.cireng.2025.800193","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800193"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D reconstructions in rectal cancer. New tools for better diagnosis and surgical planning","authors":"Álvaro García-Granero ,&nbsp;Sebastián Jerí-McFarlane ,&nbsp;Aina Ochogavía ,&nbsp;Margarita Gamundí-Cuesta ,&nbsp;Eduardo Garcia-Granero ,&nbsp;Francisco Xavier González-Argenté","doi":"10.1016/j.cireng.2025.800198","DOIUrl":"10.1016/j.cireng.2025.800198","url":null,"abstract":"<div><div>Surgical planning in locally advanced rectal cancer (LARC) is essential to reduce morbidity and mortality and to achieve negative surgical margins. However, magnetic resonance imaging (MRI), the standard modality for local staging, has limitations when used as a tool for surgical planning. Three-dimensional imagen processing and reconstruction (3-IPR) applied to medical imaging enables precise and interactive visualization of anatomical and tumor structures, facilitating an individualized surgical strategy. This technology allows assessment of tumor infiltration volume, simulation of resections with oncological margins, and customization of the surgical approach. Two representative clinical cases are described in which 3D-IPR provided key information to determine the extent of resection, avoid unnecessary exenterations, or define surgical pathways in tumors involving the lateral compartment. Despite limitations such as cost and processing time, 3D-IPR emerges as a promising tool to enhance surgical precision in LARC. Future applications include artificial intelligence, radiomics, educational simulation, and augmented reality for safer, more precise, and personalized surgery.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800198"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal bleeding secondary to multiple duodenojejunal GISTs in a patient with neurofibromatosis type 1","authors":"Franciso Castillejos Ibañez ,&nbsp;M-Carmen Fernández-Moreno ,&nbsp;Carolina Martinez Ciarpaglini ,&nbsp;Ricardo Gadea Mateo ,&nbsp;Maria Eugenia Barrios Carvajal","doi":"10.1016/j.cireng.2025.800191","DOIUrl":"10.1016/j.cireng.2025.800191","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800191"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coexistence of Morgagni and Bochdalek hernias in an asymptomatic adult","authors":"Yener Aydin,&nbsp;Ali Bilal Ulas,&nbsp;Atilla Eroglu","doi":"10.1016/j.cireng.2025.800188","DOIUrl":"10.1016/j.cireng.2025.800188","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800188"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic resection of an ectopic mediastinal parathyroid adenoma in the aortopulmonary space guided by 3D model-based planning","authors":"Anna Vidal Carné ,&nbsp;Pau Moreno Santabárbara ,&nbsp;Elisenda Garsot Savall ,&nbsp;José María Balibrea del Castillo","doi":"10.1016/j.cireng.2025.800153","DOIUrl":"10.1016/j.cireng.2025.800153","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800153"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approach and postoperative outcomes after left pancreatectomy (Spandispan prospective project)","authors":"Belén Hernández-Roca ,&nbsp;José M. Ramia ,&nbsp;Juli Busquets ,&nbsp;Luis Secanella ,&nbsp;Nuria Peláez ,&nbsp;Maialen Alkorta ,&nbsp;Itziar De Ariño Hervas ,&nbsp;Mª Mar Achalandabaso ,&nbsp;Enrique Toledo ,&nbsp;Fernando Rotellar ,&nbsp;Pablo Marti-Cruchaga ,&nbsp;Miguel Ángel Gómez-Bravo ,&nbsp;Gonzalo Suárez ,&nbsp;Marina Garcés ,&nbsp;Luis Sabater ,&nbsp;Gabriel García Plaza ,&nbsp;Francisco Javier Alcalá ,&nbsp;Enrique Asensio ,&nbsp;David Pacheco ,&nbsp;Esteban Cugat ,&nbsp;Cándido Alcazar","doi":"10.1016/j.cireng.2025.800197","DOIUrl":"10.1016/j.cireng.2025.800197","url":null,"abstract":"<div><h3>Introduction</h3><div>Left pancreatectomy (LP) is a surgical technique with low mortality but high morbidity (30%), particularly pancreatic fistula (PF). Its minimally invasive (MI) approach has become popular, but its implementation in Spain remains unknown. We present a national multicentre study on LP to determine morbidity-mortality, PF incidence, and the percentage of MI approach.</div></div><div><h3>Methods</h3><div>A descriptive, observational, prospective, and multicentre study on LP. Study period: 02/01/2022–02/28/2023. Inclusion criteria: Elective LP. Exclusion criteria: LP following pancreaticoduodenectomy, with celiac trunk resection, or performed as an emergency. Major complications (MC): Clavien–Dindo ≥ IIIA.</div></div><div><h3>Results</h3><div>A total of 41 centres participated, including 313 patients. Women accounted for 53.4%. Mean age: 63.4 years. The most common indications for LP were neuroendocrine tumours (32.6%), pancreatic adenocarcinoma (28%), and IPMN (15.7%). The surgical approach was laparoscopic (53%), open (30.7%), and robotic (16.3%). The most frequently performed techniques were distal splenopancreatectomy (72.2%) and radical antegrade modular pancreatosplenectomy (RAMPS) (14.4%). Complications occurred in 57.5% of patients, with 21.1% classified as MC. The most frequent was PF (38.3%), with 52.5% of PFs classified as B–C (20.1% of the total). The 90-day mortality rate was 1.6%. The use of a protective sleeve and the absence of drains were associated with the absence of PF in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>In our series, the MI approach was significantly higher than expected (70%). The MC rate was 21.1%, and mortality was 1.6%, confirming that LP is a procedure with low mortality but high morbidity.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 9","pages":"Article 800197"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunomarkers could predict overall survival and disease-free survival after neoadjuvant therapy and surgery due to locally advanced rectal cancer.","authors":"Miguel A Bonilla-Cozar, Anabel Garcia-Leon, Carlos J Garcia-Sanchez, M Luisa Reyes-Diaz, Irene Ramallo-Solis, Fernando De la Portilla, Javier Padillo, Rosa M Jimenez-Rodriguez","doi":"10.1016/j.cireng.2025.800199","DOIUrl":"10.1016/j.cireng.2025.800199","url":null,"abstract":"<p><strong>Background: </strong>In daily clinical practice, patients with similar risk profiles often show varied oncologic outcomes, including differing responses to neoadjuvant therapy and surgery. In this study, we seek to analyze the relationship of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios with survival and recurrence in patients treated for locally advanced rectal cancer.</p><p><strong>Material and methods: </strong>We have conducted a retrospective analysis of patients operated on due to rectal cancer with neoadjuvant long-course radiotherapy and sensitizing chemotherapy. After neoadjuvant therapy and before surgery, these immunomarker indices were analyzed. Each index was assigned a cut-off point to assess their association with overall survival (OS) and disease-free survival (DFS).</p><p><strong>Results: </strong>A total of 156 patients were analyzed with a median follow-up of 71.5 months (51-89). The NLR index was identified as an independent predictor of 5-year OS and DFS. Values above the 6.3 cut-off point showed an OS of 58.9% (P = .019); in patients with values above 4.72, DFS was 57.4% (P = .034). Patients whose 3 indices (NLR, PLR, MLR) were elevated had a 5-year OS of 25% (HR 3.16, 95% CI [1.45-6.87], P = .004); and a 5-year DFS of 39.4% (HR 2.88, 95% CI [1.35-6.17], P = .006).</p><p><strong>Conclusions: </strong>Elevated preoperative immunomarker values are related to worse outcomes in terms of OS and DFS in those patients with locally advanced rectal cancer after neoadjuvant therapy. The combination of the three indices is more accurate in predicting OS and DFS. These immunomarkers may be useful in choosing an individualized therapeutic strategy.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800199"},"PeriodicalIF":0.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}