Search

Purpose The main aim of this study was to identify a possible association between month of birth of colorectal cancer (CCR) patients and overall survival (OS) or disease-free survival (DFS). Methods This observational study included all consecutive adult patients diagnosed with CRC undergoing oncological surgery from January 2005 to December 2019 with a minimum follow-up of 36 months. The outcome variables were locoregional recurrence, death due to cancer progression, OS and DFS. Non-supervised learning techniques (K-means) were conducted to identify groups of months with similar oncologic outcomes. Finally, OS and DFS were analysed using Kaplan-Meier and Cox regression tests. Results A total of 2520 patients were included. Three birth month groups with different oncologic outcomes were obtained. Survival analysis showed between-group differences in OS (p p = 0.03). The multivariable Cox proportional hazards model identified the clusters obtained as independent prognostic factors for OS (p p = 0.031). Conclusion There is an association between month of birth and oncologic outcomes of CRC. Patients born in the months of August, September, and November had better OS and DFS than those born in different months of the year.

Objective: Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results.The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection. Patients and methods: Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DES), and cancer-specific survival (CSS). Results: Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DES, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23-70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39-4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DES and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined. Conclusions: IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival. (C) 2019 Published by Elsevier Espana, S.L.U.

Resumen En el presente trabajo efectuamos un abordaje por diferentes variables que nos permiten comprender el nivel de participación y preferencias políticas de los jóvenes españoles a lo largo de la actual democracia. Unos indicadores de participación electoral que, partiendo de nuestras hipótesis, nos demuestran que los jóvenes participan en elecciones generales en menor porcentaje que los adultos y se ubican ligeramente a la izquierda respecto del resto de grupos etarios. En relación a las preferencias partidarias, el estudio demuestra que los diferentes cambios de color político en España, coinciden con un cambio en las preferencias partidarias de los jóvenes, pero no con aumentos de participación electoral entre aquellos. A propósito de esto último, constatamos en el trabajo la existencia de un “abstencionismo estructural” entre el electorado joven. En suma, el trabajo demuestra el desinterés por la política entre la población joven española, acompañada de una abstención que tiene componente facultativo. Concluimos demostrando el papel protagónico de los jóvenes en las alternancias de poder en España entre 1982 y 2016.

Purpose To analyze short-term outcomes of curative-intent cancer surgery in all adult patients diagnosed with colorectal cancer undergoing surgery from January 2010 to December 2019 and determine risk factors for postoperative complications and mortality. Methods Retrospective study conducted at a single tertiary university institution. Patients were stratified by age into two groups: Results Of the 1486 patients included, 580 were older (≥ 75 years). Older subjects presented more comorbidities and tumors were located mainly in right colon (45.7%). After matching, no between-group differences in surgical postoperative complications were observed. The 30-day mortality rate was 5.3% for the older and 0.8% for the non-older group (p Conclusion Patients aged ≥ 75 years had similar postoperative complications but higher 30-day mortality than their younger counterparts. Patients with peripheral vascular disease, chronic pulmonary disease, or severe liver disease should be informed of higher postoperative complications. But patients aged ≥ 80 suffering cerebrovascular disease, severe liver disease, or needing postoperative transfusion should be warned of significantly increased risk of postoperative mortality.

Background Most of the studies published to date which assess the role of antibacterial sutures in surgical site infection (SSI) prevention include heterogeneous groups of patients, and it is therefore difficult to draw conclusions. The objective of the present study was to investigate whether the use of Triclosan-coated barbed sutures (TCBS) was associated with a lower incidence of incisional SSI and lower duration of hospital stay compared to standard sutures, in elective laparoscopic colorectal cancer surgery. Method Observational including patients who underwent elective colorectal cancer laparoscopic surgery between January 2015 and December 2020. The patients were divided into two groups according to the suture used for fascial closure of the extraction incision, TCBS vs conventional non-coated sutures (CNCS), and the rate of SSI was analysed. The TCBS cases were matched to CNCS cases by propensity score matching to obtain comparable groups of patients. Results 488 patients met the inclusion criteria. After adjusting the patients with the propensity score, two new groups of patients were generated: 143 TCBS cases versus 143 CNCS cases. Overall incisional SSI appeared in 16 (5.6%) of the patients with a significant difference between groups depending on the type of suture used, 9.8% in the group of CNCS and 1.4% in the group of TCBS (OR 0.239 (CI 95%: 0.065–0.880)). Hospital stay was significantly shorter in TCBS group than in CNCS, 5 vs 6 days (p Conclusion TCBS was associated with a lower incidence of incisional SSI compared to standard sutures in a cohort of patients undergoing elective laparoscopic colorectal cancer surgery. Graphical abstract

BACKGROUND: Validated rectal cancer staging groups T3 tumours in a single stage and depth of mesorectal invasion subclassification is not standard practice. Our aim is to report concordance between magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) for preoperative staging of T3 rectal tumours using a 5-mm cut-off point and possible survival implications. METHODS: Prospective cohort study including patients staged preoperatively as cT3 by ERUS or magnetic resonance imaging. The maximum depth of penetration beyond the outer longitudinal muscle layer was measured according to a 5-mm cut-off point. Concordance rate and Kappa coefficient were calculated for both techniques. Primary end-points were disease free survival and overall survival (OS) for both groups. RESULTS: A total of 97 patients were included. Disease-free survival in depth of mesorectal invasion ≤5 and >5 mm measured by ERUS was 130.80 (119.20–142.30) vs. 88.38 (56.13–120.64) months (P=0.020), respectively, and 129.90 (117.90–141.90) vs. 93.60 (64.50–122.70) months (P=0.045) when measured by magnetic resonance imaging. Depth of mesorectal invasion ≤5 mm measured by ERUS and MRI was a prognostic factor for both OS [ERUS P=0.009; MRI P=0.019] and DFS (ERUS P=0.026; MRI P=0.054) after Cox regression analysis. CONCLUSIONS: T3 subclassification above and below 5mm is feasible by ERUS, shows good concordance with validated magnetic resonance and can easily be incorporated into the diagnostic workup for these patients with possible survival implications.

At the histological level, tumor budding in colon cancer is the result of cells undergoing at least partial epithelial-to-mesenchymal transition. The microRNA 200 family is an important epigenetic driver of this process, mainly by downregulating zinc-finger E-box binding homeobox (ZEB) and transforming growth factor beta (TGF-β) expression. We retrospectively explored the expression of the miR200 family, and ZEB1 and ZEB2, and their relationship with immune resistance mediated through PD-L1 overexpression. For this purpose, we analyzed a series of 125 colon cancer cases and took samples from two different tumor sites: the area of tumor budding at the invasive front and from the tumor center. We found significant ZEB overexpression and a reduction in miR200 in budding areas, a profile compatible with epithelial-to-mesenchymal transition. In multivariate analysis of the cases with localized disease, low miR200c expression in budding areas, but not at the tumor center, was an adverse tumor-specific survival factor (hazard ratio: 0.12; 95% confidence interval: 0.03-0.81; p = 0.02) independent of the clinical stage of the disease. PD-L1 was significantly overexpressed in the budding areas and its levels correlated with a mesenchymal transition profile. These results highlight the importance of including budding areas among the samples used for biomarker evaluation and provides relevant data on the influence of mesenchymal transition in the immune resistance mediated by PD-L1 overexpression.

Background Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for colorectal cancer resection. Materials and methods A prospective study was carried out in patients with colorectal cancer scheduled for surgery at a tertiary care center. Wait list time was defined as the time from completion of diagnostic workup to definitive surgery and divided into 2-week intervals from 0 to 6 weeks. The outcome variables were 2-year and 5-year disease-free survival. Results A total of 602 patients, 364 (60.5%) male, median age 73 years (range = 71) were defined. The median wait list time was 28 days (range = 99). Two and 5-year disease-free survival rates were 521 (86.5%) and 500 (83.1%) respectively. There were no differences in 2-year or 5-year disease-free survival for the whole cohort or by tumor stage between wait list time intervals except for AJCC stage II tumors which showed a higher 5-year disease-free survival for the 2–4 and 4–6-week wait list time interval (p = 0.021). Conclusions Time from diagnosis to definitive surgery up to 6 weeks is not associated with a decrease in 2-year or 5-year disease-free survival (DFS) in AJCC stage I through III colorectal cancer patients. These are important findings in the light of the COVID-19 pandemic and offer a window of opportunity for preoperative optimization and prehabilitation.

Purpose Determine differences in pathologic outcomes between laparoscopic (LAP) and open surgery (OPEN) for mid and low rectal cancer and its influence in long-term oncological outcomes. Methods Retrospective case matched study at a tertiary institution. Adults with rectal cancer below 12 cm from the anal verge operated between January 2005 and September 2018 were included. Primary outcomes were quality of specimen, overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Results The study included 311 patients, LAP = 108 (34.7%), OPEN = 203 (65,3%). A successful resection was accomplished in 81% of the LAP group and in 84.5% of the OPEN (p = 0.505). No differences in free distal margin (LAP = 100%, OPEN = 97.5%; p = 0.156) or circumferential resection margin (LAP = 95.2%, OPEN = 93.2%; p = 0.603) were observed. However, mesorectum quality was incomplete in 16.2% for LAP and in 8.1% for OPEN (p = 0.048). OS was 91.1% for LAP and 81.1% for OPEN (p = 0.360). DFS was 81.4% for LAP and 77.5% for OPEN (p = 0.923). Overall, LR was 2.3% without differences between groups. Conclusions Laparoscopic approach could affect the quality of surgical specimen due to technical aspects. However, if principles of surgical oncology are respected, minor pathologic differences in the quality of the mesorectum may not influence on the long-term oncologic outcomes.

BACKGROUND: Chemical sphincterotomy avoids the risk of permanent incontinence in the treatment of chronic anal fissure, but it does not reach the efficacy of surgery and recurrence is high. Drug combination has been proposed to overcome these drawbacks.; OBJECTIVE: This study aimed to compare the clinical, morphological, and functional effects of combined therapy with botulinum toxin injection and topical diltiazem in chronic anal fissure and to assess the long-term outcome after healing.; DESIGN: This is a randomized, controlled, double-blind, 2-arm, parallel-group trial with a long-term follow-up.; SETTINGS: This study was conducted at a tertiary care center.; PATIENTS: A total of 70 consecutive patients were referred to the gastroenterology department of a hospital in Valencia, Spain.; INTERVENTION: After botulinum toxin injection (20 IU), patients were randomly assigned to local diltiazem (diltiazem group) or placebo gel (placebo group) for 12 weeks.; MAIN OUTCOME MEASURES: The primary outcome was fissure healing (evaluated by video register by 3 independent physicians). Secondary outcomes included symptomatic relief (30-day diary), effect on anal sphincters (manometry), safety, and long-term recurrence (24 months and 10 years).; RESULTS: Healing was achieved per protocol in 13 of 25 (52%) patients of the diltiazem group and 11 of 30 (36.7%) patients of the placebo group (p = 0.25); on an intention-to-treat basis in 37.1% and 31.4% (p = 0.61). Both groups displayed significant reduction of anal pressures. Thirty percent reported minor and transitory incontinence, without differences between groups. Nine (69.2%) of the diltiazem group and 6 (54.5%) of the placebo group experienced a relapse at 24 months (p = 0.67). The overall recurrence rate at 10 years was 83.3% (20/24 patients).; LIMITATIONS: This study was limited by the loss of patients during the trial. The low healing rate led to a small cohort to assess recurrence.; CONCLUSIONS: Combined botulinum toxin injection and topical diltiazem is not superior to botulinum toxin injection in the treatment of chronic anal fissure. Both options offer suboptimal healing rates. Long-term recurrence is high (>80% at 10 years) and might appear at any time after healing. See Video Abstract at http://links.lww.com/DCR/B527.; INYECCIN DE TOXINA BOTULNICA MS DILTIAZEM TPICO EN FISURA ANAL CRNICA UN ENSAYO CLNICO ALEATORIZADO DOBLE CIEGO Y RESULTADOS A LARGO PLAZO: ANTECEDENTES:La esfinterotomia quimica evita el riesgo de incontinencia permanente en el tratamiento de la fisura anal cronica, pero no alcanza la eficacia de la cirugia y la recurrencia es alta. Se ha propuesto la combinacion de farmacos para superar estos inconvenientes.OBJETIVO:Comparar los efectos clinicos, morfologicos y funcionales de la terapia combinada con inyeccion de toxina botulinica y diltiazem topico en fisura anal cronica y evaluar el resultado a largo plazo despues de la cicatrizacion.DISENO:Ensayo aleatorizado, controlado, doble ciego, de dos brazos, de grupos paralelos con un seguimiento a largo plazo.ESCENARIO:Estudio realizado en un centro de atencion terciaria.PACIENTES:Un total de 70 pacientes consecutivos referidos al servicio de gastroenterologia de un hospital de Valencia, Espana.INTERVENCION:Despues de la inyeccion de toxina botulinica (20UI), los pacientes fueron asignados al azar a diltiazem local (grupo de diltiazem) o gel de placebo (grupo de placebo) durante 12 semanas.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la cicatrizacion de la fisura (evaluado por registro de video por tres medicos independientes). Los resultados secundarios incluyeron alivio sintomatico (diario de 30 dias), efecto sobre los esfinteres anales (manometria), seguridad y recurrencia a largo plazo (24 meses y 10 anos).RESULTADOS:La curacion se logro por protocolo en 13/25 (52%) en el grupo de Diltiazem y 11/30 (36,7%) en el grupo de Placebo (p = 0.25); por intencion de tratar en el 37.1% y el 31.4%, respectivamente (p = 0.61). Ambos grupos mostraron una reduccion significativa de las presiones anales. El 30% refirio incontinencia leve y transitoria, sin diferencias entre grupos. 9 (69.2%) del grupo de Diltiazem y 6 (54.5%) del grupo de placebo recurrieron a los 24 meses (p = 0.67). La tasa global de recurrencia a los 10 anos fue del 83.3% (20/24 pacientes).LIMITACIONES:La perdida de pacientes a lo largo del ensayo. La baja tasa de curacion llevo a una pequena cohorte para evaluar la recurrencia.CONCLUSIONES:La inyeccion combinada de toxina botulinica y diltiazem topico no es superior a la inyeccion de TB en el tratamiento de la fisura anal cronica. Ambas opciones ofrecen tasas de curacion suboptimas. La recurrencia a largo plazo es alta (> 80% a los 10 anos) y puede aparecer en cualquier momento despues de la curacion. Consulte Video Resumen en http://links.lww.com/DCR/B527. Copyright © The ASCRS 2021.

Background Several risk factors for anastomotic leakage (AL) following colorectal surgery have been described. Improvement in devices for performing anastomosis is a modifiable factor that could reduce AL rates. The aim of this study was to assess the impact of technical improvements in the Echelon Circular (TM) powered stapler (ECPS) on the left-sided colorectal AL rate compared to current manual circular staplers (MCS). Methods A cohort study was carried out on consecutive patients between January 2017 and February 2020 in whom left-sided stapled colorectal anastomosis above 5 cm from anal verge was performed. The primary end point was the risk of AL depending on the type of circular stapler used. The ECPS cases were matched to MCS cases by propensity score matching to obtain comparable groups of patients. Results Two hundred seventy-nine patients met the inclusion criteria. A MCS anastomosis was performed in 218 patients and ECPS anastomosis in 61 (21.9%). Overall, AL was observed in 25 (9%) cases. Factors significantly associated with AL were American Society of Anesthesiologists score (p = 0.025) and type of circular stapler used (p = 0.021). After adjusting the cases with propensity score matching (119 cases MCS versus 60 ECPS), AL was observed in 14 (11.8%) patients in MCS group and in 1 (1.7%) patient in the ECPS group (p = 0.022). AL in the MCS group required reoperation in seven cases (5.8%), the remaining seven patients were treated conservatively. The patient in the ECSP group required an urgent Hartmann's procedure Conclusions The ECPS device could have a positive impact by reducing AL rates in left-sided colorectal anastomosis. Multicenter controlled trials are needed for stronger evidence to change practice.

BACKGROUND: Colon cancer (CC) is a heterogeneous disease. Novel prognostic factors beyond pathological staging are required to accurately identify patients at higher risk of relapse. Integrating these new biological factors, such as plasma circulating tumour DNA (ctDNA), CDX2 staining, inflammation-associated cytokines and transcriptomic consensus molecular subtypes (CMS) classification, into a multimodal approach may improve our accuracy in determining risk of recurrence.; METHODS: One hundred and fifty patients consecutively diagnosed with localised CC were prospectively enrolled in our study. ctDNA was tracked to detect minimal residual disease by droplet digital PCR. CDX2 expression was analysed by immunostaining. Plasma levels of cytokines potentially involved in disease progression were measured using ELISAs. A 96 custom gene panel for nCounter assay was used to classify CC into colorectal cancer assigner and CMS.; RESULTS: Most patients were classified into CMS4 (37%) and CMS2 (28%), followed by CMS1 (20%) and CMS3 (15%) groups. CDX2-negative tumours were enriched in CMS1 and CMS4 subtypes. In univariable analysis, prognosis was influenced by primary tumour location, stage, vascular and perineural invasion together with high interleukin-6 plasma levels at baseline, tumours belonging to CMS 1 vs CMS2 +CMS3, ctDNA presence in plasma and CDX2 loss. However, only positive ctDNA in plasma samples (HR 13.64; p=0.002) and lack of CDX2 expression (HR 23.12; p=0.001) were found to be independent prognostic factors for disease-free survival in the multivariable model.; CONCLUSIONS: ctDNA detection after surgery and lack of CDX2 expression identified patients at very high risk of recurrence in localised CC. © Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.

The surgical treatment of splenic flexure colon cancer (SFCC) is somehow not yet well standardized. Postoperative and oncological results of the three surgical techniques most commonly used to treat SFCC: extended right colectomy (ERC), egmental left colectomy (SLC), and left colectomy (LC) were evaluated. The study included all patients with stage I-III SFCC treated by ERC, SLC, or LC between 2005 and 2016. Postoperative and long-term outcomes after the different surgical techniques were analyzed: Propensity score matching (PSM) was performed to compare the outcomes between these surgical techniques and survival analyses were performed using the Kaplan-Meier method and log-rank tests. A total of 170 SFCC patients were operated; ERC was performed in 71 (41.76%), SLC in 36 (21.18%), and LC in 63 (37.06%). There were no significant differences in the short and long-term postoperative outcomes. Three comparison groups were developed so that PSM could be performed between the surgical technique cases: ERC (n = 59) vs. LC (n = 50); ERC (n = 50) vs. SLC (n = 33); and SLC (n = 32) vs. LC (n = 44). No differences in the short or long-term outcomes of these techniques were observed. The short and long-term outcomes between ERC, SLC, and LC are similar. SLC should be considered oncologically as appropiate as the other more extensive resections.

Resumen Introduccion El uso de un stent metalico autoexpandible como puente a la cirugia del cancer de colon izquierdo en oclusion se ha senalado como tratamiento alternativo a la cirugia de urgencia. El objetivo del presente estudio fue comparar la morbimortalidad, el coste-beneficio y los resultados oncologicos a largo plazo de ambas opciones terapeuticas. Metodos Se trata de un estudio prospectivo, comparativo, controlado y no aleatorizado (2005-2010) realizado en una unidad especializada. El estudio agrupo a 82 pacientes con cancer de colon izquierdo en oclusion tratados mediante stent como puente a la cirugia (n = 27) o cirugia de urgencia (n = 55), intervenidos con intencion curativa local. Las principales variables del estudio (morbimortalidad postoperatoria, coste-beneficio, tasa de estomas y resultados oncologicos a largo plazo) fueron comparados sobre la base de un analisis «con intencion de tratar». Resultados No se encontraron diferencias estadisticamente significativas entre los dos grupos en terminos de datos preoperatorios y caracteristicas tumorales. La tasa de exito tecnico en la colocacion de la endoprotesis fue del 88,9% (con un 11,1% de perforaciones derivadas del stent), y el exito clinico fue del 81,4%. No se observo diferencia alguna en cuanto a los indices de morbimortalidad postoperatoria. La tasa de anastomosis primaria fue superior en el grupo «stent como puente a la cirugia», en comparacion al grupo «cirugia de urgencia» (77,8% frente a 56,4%; p = 0,05). Los costes medios por paciente en el grupo «cirugia de urgencia» resultaron ser mas elevados (+1.391,9 €) que en el grupo «stent como puente a la cirugia». No se produjeron diferencias estadisticamente significativas en cuanto a resulados oncologicos a largo plazo. Conclusiones El uso de stents metalicos autoexpandibles como puente a la cirugia constituye una opcion segura para el tratamiento urgente del cancer de colon izquierdo en oclusion, con resultados oncologicos similares a largo plazo en comparacion a la cirugia de urgencia, con menor coste economico y una tasa superior de anastomosis primarias, evitando numerosos estomas.

Introduction: The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options. Methods: This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n = 27) or emergency surgery (n = 55) operated with local curative intention. The main outcome measures (postoperative morbimortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat'' analysis. Results: There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P =.05). The mean costs in the emergency surgery group resulted to be (Sic)1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes. Conclusions: The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis. (C) 2017 AEC. Published by Elsevier Espanna, S.L.U. All rights reserved.

A high percentage of patients diagnosed with localized colon cancer (CC) will relapse after curative treatment. Although pathological staging currently guides our treatment decisions, there are no biomarkers determining minimal residual disease (MRD) and patients are at risk of being undertreated or even overtreated with chemotherapy in this setting. Circulating-tumor DNA (ctDNA) can to be a useful tool to better detect risk of relapse.One hundred and fifty patients diagnosed with localized CC were prospectively enrolled in our study. Tumor tissue from those patients was sequenced by a custom-targeted next-generation sequencing (NGS) panel to characterize somatic mutations. A minimum variant allele frequency (VAF) of 5% was applied for variant filtering. Orthogonal droplet digital PCR (ddPCR) validation was carried out. We selected known variants with higher VAF to track ctDNA in the plasma samples by ddPCR.NGS found known pathological mutations in 132 (88%) primary tumors. ddPCR showed high concordance with NGS (r = 0.77) for VAF in primary tumors. Detection of ctDNA after surgery and in serial plasma samples during follow-up were associated with poorer disease-free survival (DFS) [hazard ratio (HR), 17.56; log-rank P = 0.0014 and HR, 11.33; log-rank P = 0.0001, respectively]. Tracking at least two variants in plasma increased the ability to identify MRD to 87.5%. ctDNA was the only significantly independent predictor of DFS in multivariable analysis. In patients treated with adjuvant chemotherapy, presence of ctDNA after therapy was associated with early relapse (HR 10.02; log-rank P 0.0001). Detection of ctDNA at follow-up preceded radiological recurrence with a median lead time of 11.5 months.Plasma postoperative ctDNA detected MRD and identified patients at high risk of relapse in localized CC. Mutation tracking with more than one variant in serial plasma samples improved our accuracy in predicting MRD.

Background Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration. Methods Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP. Results 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction. Conclusions HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.

En el presente trabajo efectuamos un análisis cualitativo relativo a los movimientos políticos del siglo XXI encuadrados bajo los términos de “populistas” o “neopopulistas” que han ido emergiendo en diferentes países de América Latina y Europa. Tratamos de demostrar la existencia de una dimensión o base emocional que esencia a la identidad de los mismos. Para ello partimos desarrollando una propuesta metodológica consistente en una clasificación operativa de características en la cual plasmamos las identidades esenciales de estos movimientos en base a cuatro dimensiones de análisis: su procedencia, su relación con la democracia representativa y, especialmente, el estilo de liderazgo y el tipo de retórica que emplean. De estas dimensiones subyace el nexo o base emocional común que constituye una esencialidad inherente a tales movimientos políticos (H1). Los resultados constatan la existencia de comportamientos y apelaciones de tipo afectivas tanto en la toma de decisiones como en las formas de comunicar y de relacionarse con los diferentes actores de las democracias representativas. En cómputo, constituyen una serie de características comunes con fuerte anclaje emocional que pormenorizamos y sustentamos empíricamente en el trabajo y que aguardan una vía común: la comunicación y forma de proyectar su idiosincrasia. In the present work we carry out a qualitative analysis related to the political movements of the 21st century framed under the terms of “populists” or “neopopulists” that have been emerging in different countries of Latin America and Europe. We try to demonstrate the existence of a dimension or emotional basis that is essential to their identity. For this we start by developing a methodological proposal consisting of an operational classification of characteristics in which we shape the essential identities of these movements based on four dimensions of analysis: their origin, their relationship with representative democracy and, especially, the style of leadership and the kind of rhetoric they use. From these dimensions lies the common emotional link or basis that constitutes an essentiality inherent to such political movements (H1). The results confirm the existence of affective behaviors and appeals both in decision-making and in the ways of communicating and relating to the different actors of representative democracies. In computation, they constitute a series of common characteristics with strong emotional anchoring that we detail and support empirically in the work and that await a common path: communication and the way of projecting their idiosyncrasies..