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Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30–40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible.

Background: Hepatocellular carcinoma is the most common type of primary liver cancer and is the third cause of cancer related deaths; 80% of the HCC are associated with cirrhotic livers or chronic liver diseases, which constitute the main risk factor. Chronic inflammation, necrosis and regeneration due to these conditions produce genetic mutation and development of tumor cells. Yet, 10% develop in non-cirrhotic healthy livers without precipitating factors. Material and methods: We conducted a retrospective analysis of the characteristics and survival of patients with diagnosis of hepatocellular carcinoma in non-cirrhotic liver and absence of a history of liver cirrhosis or chronic liver disease undergoing surgery in two hepato-pancreato-biliary units between January 2007 and January 2016. Results: Mean age was 65 years and 13 patients were men. Abdominal pain was the most common clinical presentation. Liver panel was normal in 60% of the cases and alpha-fetoprotein was elevated in only 16%. The diagnosis was made by imaging tests in 61% of the cases. Mean tumor size was 110.6 cm. All the patients underwent surgery. Complications were observed in 36.8% of the patients and survival at 5 years was 62.3%. Conclusion: hepatocellular carcinoma is usually diagnosed as a large lesion in imaging tests ordered due to abdominal pain. Surgery provides curative treatment, and large resections can be safely performed, with low perioperative morbidity and mortality and low incidence of postoperative liver failure,since the liver remnant is healthy and liver function is maintained.

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications. However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently, two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0 (no complications) to 100 (patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

Introduccion: la cirugia radical en hidatidosis hepatica se asocia con menor morbilidad y recurrencia que la conservadora. Material y metodos: realizamos un estudio observacional retrospectivo de pacientes con cirugia de quiste hidatidico hepatico. Se incluyeron 71 pacientes con 90 quistes entre 2007 y 2017. Se realizo cirugia radical en el 69,01 %. Resultados: no hubo diferencias en morbimortalidad, fuga biliar o recurrencia segun cirugia. Los quistes complicados se asociaron con mayor estancia y morbilidad. Conclusiones: la toma de decisiones debe considerar edad/comorbilidad, caracteristicas del quiste y recursos disponibles. La cirugia radical debe ser aplicada siempre que sea factible, con mejores resultados con una adecuada seleccion de pacientes.

The major symptoms of advanced hepatopancreatic-biliary cancer are biliary obstruction, pain and gastric outlet obstruction (GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decision-making must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation of the patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

Perforation in colorectal cancer is an uncommon condition, and neoplastic invasion of the abdominal wall with local infection is even rarer. Our objective is to present the case of an 84-year-old male with right colon cancer that manifested as an inguinal abscess, and also to perform a systematic review of the literature in PubMed, EMBASE, and Web of Science. A total of 59 cases in retrospective studies were found. Median age was 64 years, thirty cases were men and twenty-nine were women (51% and 49%, respectively). The most common location was the right colon with 27 cases (46%), followed by the left colon with 18 cases (31%), 12 cases in the transverse colon (20%), and 2 cases with colonic synchronous neoplasm (3%). Surgery was performed in two or more occasions for 33 cases (60%), and on one occasion for 21 cases (38%); medical treatment alone was administered in one case (2%). The most common histological type was adenocarcinoma (64%), followed by its mucinous variant (22%). There was recurrence in 33% of cases. Mortality at follow-up was 47%. As a limitation of our study, follow-up was heterogeneous, making it impossible to interpret long-term results regarding the influence of treatment on patient survival, also difficulted by the urgent nature of the condition and its exceptional incidence. Further studies are needed with prospective data collection on the management of colorectal cancer in the emergency setting, standardizing follow-up in order to facilitate an adequate analysis of the prognosis of the disease.

Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.

espanolObjetivo: el objetivo de este estudio es evaluar los motivos y el momento de reingreso hospitalario despues de colecistectomia comparando los pacientes en base a la realizacion de una colangiopancreatografia retrograda endoscopica (CPRE) previa o no. Metodo: retrospectivamente, se revisaron todos los pacientes sometidos a colecistectomia en el Servicio de Cirugia General y del Aparato Digestivo del Hospital Universitario de Guadalajara entre enero de 2011 y diciembre de 2016. Se incluyeron pacientes sometidos a colecistectomia reingresados en cualquier servicio del hospital en los 90 dias posteriores a la cirugia. Los criterios de exclusion fueron: colecistectomia asociada a otros procedimientos, patologia oncologica activa en el momento de la colecistectomia, ingresos programados previamente por otra patologia no relacionada y presencia de histologia tumoral en la pieza de colecistectomia. Resultados: se estudiaron 1.714 pacientes, de los cuales 80 pacientes fueron readmitidos durante los 90 dias posteriores al alta de la colecistectomia. La tasa de readmision fue del 4,67%. La realizacion de CPRE previa a la cirugia se asocio a un aumento de la morbilidad postoperatoria (40% vs. 21,54%). La realizacion previa de una CPRE disminuyo la aparicion de complicaciones de tipo biliar en los 90 dias posteriores a la colecistectomia. Se observo tambien un aumento del numero de dias hasta que se produce el reingreso en estos pacientes (22 dias con CPRE vs. siete dias sin CPRE). Conclusion: en nuestra serie, los pacientes que precisaron una CPRE previa a la colecistectomia presentaron mayor morbilidad postoperatoria. Sin embargo, los pacientes que no precisaron CPRE presentaron mas complicaciones biliares y tuvieron reingresos mas tempranos. EnglishAim: the aim of this study was to assess the reasons for and the time of hospital readmissions after cholecystectomy, according to whether an endoscopic retrograde cholangiopancreatography (ERCP) was performed. Method: all patients that underwent cholecystectomy at the Service of Digestive Diseases and General Surgery of the Hospital Universitario de Guadalajara between January 2011 and December 2016 were retrospectively reviewed. Patients who underwent cholecystectomy and were readmitted to any hospital service within 90 days of surgery were included. The following cases were excluded: patients that underwent cholecystectomy in combination with other procedures, an active oncological pathology at the time of cholecystectomy, admissions previously scheduled for another unrelated pathology and those with tumor histology in the cholecystectomy specimen. Results: of a total of 1,714 patients, 80 were readmitted within 90 days of discharge after cholecystectomy, which equates to a readmission rate of 4.6%. The performance of an ERCP prior to surgery was associated with an increase in postoperative morbidity (40% vs 21.54%). A prior ERCP reduced the rate of biliary complications during the 90 days after cholecystectomy. Furthermore, there was an increase in the number of days prior to readmission in these cases, with a mean period of 22 days with ERCP vs seven days without ERCP. Conclusion: patients in our series who required an ERCP prior to cholecystectomy had a greater postoperative morbidity. However, those that did not require ERCP had more biliary complications and were readmitted earlier.

To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015.We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT.In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1).Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.

Congenital or acquired obstruction of the inferior vena cava may lead to the development of collateral pathways with tributary vein to portal system. We present a patient with intrahepatic cavoportal collateral pathway due to hepatic hydatid cyst.

Aim To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. Methods We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. Results We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of 4.99%. Sixty-four point seven nine percent occurred after elective surgery (cholelithiasis or vesicular polyps) and 35.21% after emergency surgery (acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. Conclusion The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

ResumenAntecedentesLa hidatidosis es una zoonosis producida por las larvas del parásito Echinococcus, endémica en muchos países del Mediterráneo. Puede afectar a cualquier órgano. Las localizaciones más frecuentes son: el hígado (70%) y el pulmón (20%). La hidatidosis esplénica es la tercera localización más habitual. Otras localizaciones como la ósea, cutánea o renal son excepcionales.ObjetivoPresentar nuestra experiencia en hidatidosis extrahepática y extrapulmonar.Material y métodosEl periodo de este estudio fue de mayo de 2007 a diciembre de 2014. En una población de 251,000 habitantes. En dicho periodo en la Unidad de Cirugía Hepatobiliopancreática fue evaluado un total de 136 pacientes con hidatidosis; 18 pacientes presentaron hidatidosis extrahepática y extrapulmonar (13%). Se revisaron retrospectivamente las historias clínicas, estudios de laboratorio (serologías) y gabinete, métodos diagnósticos y medidas terapéuticas, realizadas en todos los pacientes. Además, se realizó una ecografía y tomografía axial computada abdominal, y serología hidatídica.ResultadosLa edad media de los pacientes era de 44.5 años, rango: 33–80 años. La mitad de los pacientes (50%) presentaron hidatidosis hepática concomitante. De los 18 pacientes, 13 fueron intervenidos quirúrgicamente (12 con cirugía radical) y a uno se le realizó punción, aspiración, instilación y reaspiración+colangiopancreatografía retrógrada endoscópica; los 4 restantes no fueron operados por negativa del paciente (3) o neoplasia avanzada (1). No se observó ninguna recidiva.ConclusionesEl tratamiento quirúrgico de elección es la quistectomía total cerrada, para evitar la recidiva, excepto en el bazo, que es la esplenectomía. Las técnicas conservadoras están indicadas en casos de hidatidosis múltiple y en pacientes con alto riesgo quirúrgico.AbstractBackgroundCystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional.ObjectiveTo present our experience in extrahepatic and extrapulmonary hydatidosis.Material and methodsPeriod: May 2007-December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients.ResultsThe mean age of the patients was 44.5 years, with a range of 33-80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography)+puncture, aspiration, injection and re-aspiration. The remaining 4did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed.ConclusionThe best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.

Background Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. Objective To present our experience in extrahepatic and extrapulmonary hydatidosis. Material and methods Period: May 2007–December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. Results The mean age of the patients was 44.5 years, with a range of 33–80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography) + puncture, aspiration, injection and re-aspiration. The remaining 4 did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. Conclusion The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.

Acute severe pancreatitits may be complicated by the development of 'walled-off pancreatic necrosis' (WOPN), which is characterised by a mixture of solid components and fluids on imaging studies as a consequence of organised pancreatic tissue necrosis. We present here an overview of the definition, clinical features, and diagnostic and therapeutic management of this clinical condition, which is mostly based on consensus as adequate clinical trials are lacking.

UNLABELLED Hydatidosis of the spleen (SH) is an extremally rare condition. The aim of the study was to present our experience and discuss diagnostic methods and therapeutical options in cases of spleen hydatidosis. MATERIAL AND METHODS Between 1993 and 2008, 8 patients were diagnosed with SH, 6 of whom were operated on (4 males and 2 females). Their average age was 44.5 years (the age range 30-59 years). Four patients presented isolated SH, one had a spleen and liver hydatidosis and there was also a case of one spleen, liver and peritoneal hydatidosis. RESULTS The main symptom of the condition was abdominal pain and hydatidosis serology was always positive. The average hydatidisis cyst size was 13.3 cm (range: 7-18 cm). Splenectomy was performed in 5 cases and a partial cystectomy in one case. A left lateral sectionectomy was required in 1 case, a segment III subsegmentectomy was delivered in 1 case and multiple cystectomies in the case of the patient with disseminated hydatisis. In the follow-up period of the above mentioned surgical procedures no mortality among the treated patients was reported. The majority of patients did not present any symptoms of morbidity (4 patients). We registered one wound infection and one cavity abscess solved with percutaneous drainage in the patient following partial cystectomy. The hospitalisation period avaraged to 5 days (within the range of 5 to 12 days). The patients' follow-up was 98 months on average (range: 19-190 months) without any traced relapse. CONCLUSIONS Total splenectomy is the treatment of choice of SH. Other surgical techniques could be employed in special cases.

To retrospectively review a series of 12 patients operated on in our department for stromal tumor of the stomach. Clinical and morphological data, and the patients' postoperative course, were analyzed.Medical records for 12 patients (mean age 63.3 years) were retrospectively reviewed to obtain data on clinical presentation, diagnosis and treatment. Surgical morbidity and mortality were analyzed. A pathologist reviewed the resected specimens to determine the morphological factors of prognostic value. The biological nature of the tumor was reclassified based exclusively on mitotic index, and all tumors were staged according to the TGM system. Recurrence and survival rates were also calculated.The most frequent clinical presentation was abdominal pain and gastrointestinal bleeding. The most sensitive diagnostic methods were computerized tomography and echographic endoscopy. Operability and resectability rates were 100% and 91.6% respectively. Local resection was done in 5 patients, partial gastrectomy in 5, and extended total gastrectomy in 1. Histologically, 6 cases were muscular tumors (2 leiomyomas, 3 low-grade leiomyosarcomas and 1 high-grade leiomyosarcoma), 2 were gastrointestinal autonomic nerve (GAN) tumors, and 4 were pure stomal tumors. The morbidity rate was 33.3% and the mortality rate was 8.3% (1 patient). All patients were followed up: 1 patient each died after 9 months and 4 years, 1 developed liver metastases after a disease-free interval of 14 months, and the other 9 patients were still alive and free of disease after intervals ranging from 4 months to 7 years.Stromal tumors include a group of tumors which may present muscular differentiation (the most frequent type), neural differentiation (GAN tumors) or no differentiation at all (pure stromal tumors). The mitotic index is the most valid parameter to determine biological nature, considering that classification as a benign tumor requires the total absence of mitoses. Treatment was mostly surgical, and local resection with adequate safety margins was effective. Prognosis was relatively good, but long-term follow-up is needed to assess the malignant potential of these tumors.