Cirugia espanola最新文献

{"title":"SEPAR–SECT recommendations for perioperative invasive mediastinal staging of non-small cell lung cancer","authors":"Sergi Call,&nbsp;Maribel Botana-Rial,&nbsp;Rosa Cordovilla,&nbsp;Carlos Gálvez,&nbsp;David Gómez de Antonio,&nbsp;Virginia Leiro-Fernández,&nbsp;Carlos Martínez-Barenys,&nbsp;José Luís Recuero-Díaz,&nbsp;José Sanz-Santos,&nbsp;Pere Serra-Mitjà,&nbsp;Ramón Rami-Porta","doi":"10.1016/j.cireng.2026.800335","DOIUrl":"10.1016/j.cireng.2026.800335","url":null,"abstract":"<div><div>Accurate mediastinal nodal staging is essential for the management of non-small cell lung cancer (NSCLC), as it refines prognosis, guides multimodal treatment, and improves survival. This joint consensus document from the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Thoracic Surgeons (SECT) updates and expands the 2011 SEPAR guidelines, incorporating the 9th edition of the TNM classification and extending recommendations to the entire perioperative setting, including both preoperative and intraoperative mediastinal staging. The recommendations were developed through a structured review of the literature and multidisciplinary expert consensus. This document synthesizes current evidence on the role of endoscopic and surgical approaches for perioperative invasive staging, including endobronchial and oesophageal ultrasound-guided techniques, mediastinoscopy and its variants, transcervical lymphadenectomies and intraoperative lymphadenectomies. In addition, the consensus integrates the International Association for the Study of Lung Cancer (IASLC) definitions of completeness of resection and proposes quality standards for intraoperative lymphadenectomy. A practical staging algorithm is provided, stratifying tumours according to risk factors of occult mediastinal disease such as tumour size and radiological nodal involvement. The new recommendations emphasise that invasive mediastinal staging is not required for T1a and T1b tumours without radiological evidence of nodal disease, regardless of their location. Conversely, particular attention is given to the role of N1 disease, which is now recognised as a setting associated with a high risk of unsuspected mediastinal involvement. For cases with intermediate suspicion of mediastinal disease, surgical staging techniques demonstrate superior accuracy compared with endosonography alone. Overall, these recommendations aim to harmonize perioperative invasive staging across disciplines, minimize under- and overstaging, and support precise therapeutic decision-making in the evolving era of targeted and immune-based treatments for NSCLC.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800335"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355121","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":"From trial to practice: real-world outcomes of neoadjuvant chemoimmunotherapy versus chemotherapy ± radiotherapy in resectable locally advanced NSCLC","authors":"Cristina E. Rivas Duarte,&nbsp;María Teresa Gómez-Hernández,&nbsp;Mario Manama,&nbsp;Francisco Gómez,&nbsp;Carmen Taboada,&nbsp;Marta G. Fuentes,&nbsp;Oscar Colmenares,&nbsp;Marcelo F. Jiménez","doi":"10.1016/j.cireng.2026.800330","DOIUrl":"10.1016/j.cireng.2026.800330","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Neoadjuvant chemotherapy combined with immune checkpoint inhibitors (ChT–ICI) has shown promising efficacy in resectable locally advanced non-small cell lung cancer (NSCLC), but real-world data comparing it with conventional chemotherapy or chemoradiotherapy (ChT/ChT–RT) are limited. This study evaluated perioperative safety and oncologic outcomes of both approaches in a real-world setting.</div></div><div><h3>Methods</h3><div>A single-center retrospective analysis included consecutive patients with locally advanced NSCLC who received neoadjuvant therapy and underwent pulmonary resection between January 2017 and October 2025. Patients were grouped as ChT–ICI or ChT/ChT–RT. Primary endpoints were overall and cardiopulmonary morbidity; secondary endpoints included pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS).</div></div><div><h3>Results</h3><div>Eighty-two patients were analyzed (36 ChT–ICI, 46 ChT/ChT–RT). Overall complications occurred in 36.1% and 43.5%, and cardiopulmonary morbidity in 8.3% and 15.2%, respectively (adjusted OR 0.359; <em>P</em> = .211). pCR was significantly higher with ChT–ICI (33.3% vs 8.7%; adjusted OR 4.53; <em>P</em> = .021). No significant differences were observed in OS or DFS.</div></div><div><h3>Conclusions</h3><div>In this real-world cohort, neoadjuvant ChT–ICI demonstrated similar perioperative safety and a significantly higher pCR rate than conventional regimens, supporting its feasibility and therapeutic potential in resectable locally advanced NSCLC.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800330"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535181","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":"Current status of robotic thoracic surgery in Spain: Results from a national survey","authors":"Alejandra Libreros Niño,&nbsp;Anna Minasyan,&nbsp;Carlos Martinez Barenys,&nbsp;José Luis Recuero Díaz,&nbsp;Giovanna Foschini Martínez,&nbsp;Carlos Déniz Armengol,&nbsp;Alba María Fernández González,&nbsp;Patricia Carmona Soto,&nbsp;José Soro García,&nbsp;Lucía Milla Collado,&nbsp;Rudith Guzmán Portillo,&nbsp;Paloma Rofso Raboso,&nbsp;Héctor Milián Goicoechea,&nbsp;Sergio Maroto Molina,&nbsp;John A. Villamil,&nbsp;Andrés Obeso,&nbsp;Andrea Lora Ibarra","doi":"10.1016/j.cireng.2026.800340","DOIUrl":"10.1016/j.cireng.2026.800340","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to conduct the first national survey to characterize the current practice, training and perceived barriers associated with robotic-assisted thoracic surgery (RATS) among thoracic surgeons in Spain.</div></div><div><h3>Methods</h3><div>Between February and March 2025, a nationwide electronic survey was distributed to thoracic surgeons through a scientific society. The questionnaire assessed institutional demographic variables, the volume and types of robotic procedures, perceived benefits and barriers, training models and access to the technology.</div></div><div><h3>Results</h3><div>A total of 120 responses from thoracic surgeons representing 55 hospitals were analyzed. Among these, 103 respondents (85.8%) worked in centers with an active RATS program and were included in analyses related to robotic activity. Most respondents practiced within the public healthcare system (87.4%).</div><div>Although more than 63% of RATS programs had been established for at least 2 years, only 27.2% of survey participants reported that most surgeons in their department were trained as console surgeons. At the institutional level, 69.9% indicated that all types of thoracic procedures were performed using RATS, and 31.1% reported more than 200 accumulated robotic cases. However, in over half of the hospitals, robotic surgery accounted for less than 25% of total thoracic surgical activity.</div></div><div><h3>Conclusions</h3><div>This study provides the first national overview of the status of RATS in Spain, highlighting its potential as well as the challenges limiting broader clinical consolidation. Standardized training, particularly among residents, and equitable access to robotic platforms have emerged as key priorities for the nationwide consolidation of RATS.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800340"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950333","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":"Neoadjuvant immunotherapy in locally advanced mismatch repair-deficient (dMMR) colon cancer: Initial experience at a referral center","authors":"Raquel Orfila Gamundí,&nbsp;Álvaro García-Granero,&nbsp;Mónica Guillot Morales,&nbsp;Margarita Gamundí Cuesta,&nbsp;Francisco Xavier González-Argenté","doi":"10.1016/j.cireng.2026.800348","DOIUrl":"10.1016/j.cireng.2026.800348","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800348"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977441","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":"Reply to the Letter to the Editor: Response — Management of inguinoscrotal hernia in Spain. Results of a national survey","authors":"Alejandro Bravo-Salvá,&nbsp;Luisana Riba-Combatti,&nbsp;Montserrat Juvany-Gómez,&nbsp;José Antonio Pereira Rodríguez","doi":"10.1016/j.cireng.2026.800345","DOIUrl":"10.1016/j.cireng.2026.800345","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800345"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950381","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":"Reply — Management of inginoscrotal hernia in Spain. Results of a national survey","authors":"Antonio Ríos","doi":"10.1016/j.cireng.2026.800344","DOIUrl":"10.1016/j.cireng.2026.800344","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 8","pages":"Article 800344"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944159","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":"Herniation of pulmonary hydatid cyst from the intercostal space to the neck.","authors":"Yener Aydin, Hayri Ogul, Coskun Daharli","doi":"10.1016/j.cireng.2026.800367","DOIUrl":"10.1016/j.cireng.2026.800367","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800367"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564083","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 thoracic surgery: association between operative time and complications in 454 patients","authors":"Inés Serratosa,&nbsp;Carlos Déniz,&nbsp;Iván Macia,&nbsp;Francisco Rivas,&nbsp;Anna Muñoz,&nbsp;Marina Paradela,&nbsp;Samuel García-Reina,&nbsp;Amaia Ojanguren","doi":"10.1016/j.cireng.2026.800329","DOIUrl":"10.1016/j.cireng.2026.800329","url":null,"abstract":"<div><h3>Introduction</h3><div>The relationship between operative time and postoperative complications in robotic-assisted thoracic surgery (RATS) remains unclear. This study analyzes that association, focusing on prolonged air leak (PAL) and other early complications.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on 454 consecutive patients with non-small cell lung cancer who underwent robotic-assisted anatomical pulmonary resection between 2019 and 2024. The association between operative time and the incidence of PAL was evaluated, as well as other postoperative complications within the first 30 days. We applied a logistic regression model adjusted for age, BMI, FEV₁, DLCO, smoking status, neoadjuvant therapy, tumor size and type of resection, assessing its discriminative ability using pseudo R² and ROC curve analysis.</div></div><div><h3>Results</h3><div>The incidence of PAL was 33.3%. Operative time was longer in PAL cases (210 vs 190 min; Mann–Whitney <em>P</em> = .006). In the multivariable model, operative time was not an independent predictor of PAL (OR 1.003 per min; <em>P</em> = .081), whereas higher BMI was protective (OR 0.935; <em>P</em> = .007) and FEV₁ showed a borderline protective association (OR 0.989; <em>P</em> = .059); segmentectomy had lower odds than lobectomy (OR 0.379; <em>P</em> = .006). Model performance was AUC = 0.676 with Nagelkerke’s R² = 0.105. Weak correlations were observed between operative time and respiratory failure, reoperation, and readmission. No differences in PAL or other complications were found according to the number of ports used (uniportal, biportal, multiportal).</div></div><div><h3>Conclusion</h3><div>In RATS, operative time appears to be a surrogate of case complexity rather than a stand-alone target. Prevention of PAL should prioritize modifiable technical and perioperative factors and preoperative optimization within ERAS pathways, supported by a multifactorial risk assessment approach.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800329"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535230","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":"Image revolution in surgery: from the eye to the agorithm in the digital age","authors":"María Asunción Acosta-Mérida","doi":"10.1016/j.cireng.2026.800355","DOIUrl":"10.1016/j.cireng.2026.800355","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800355"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977871","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":"Commentary on: The cost of prolonged surgical training—Time is money","authors":"Ernesto Barzola Navarro,&nbsp;Miguel Pera Román","doi":"10.1016/j.cireng.2026.800332","DOIUrl":"10.1016/j.cireng.2026.800332","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800332"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535246","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}