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Resumen Introduccion Existe controversia respecto a la tecnica ideal de reconstruccion pancreatico-yeyunal posreseccion duodeno-pancreatica. La tutorizacion externa del Wirsung se ha considerado por muchos autores como una tecnica con menor incidencia de fistulas y morbimortalidad. Analizamos nuestra experiencia con esta tecnica. Pacientes y metodos Analisis retrospectivo de la morbimortalidad, de una serie de 80 pacientes consecutivos intervenidos, durante 6,5 anos, por tumores pancreaticos cefalicos o periampulares realizando reseccion y pancreatico-yeyunostomia con tutorizacion externa del Wirsung. Resultados La edad media de los pacientes fue 68,3 ± 9 anos y la tasa de resecabilidad del 78%. La consistencia del pancreas era blanda en 51,2% de pacientes y dura en 48,8%. Se preservo el piloro en 43,8%. El tumor mas frecuente fue el adenocarcinoma (68,8%) y se consiguio un R0 en 70%. La fistula bioquimica se presento en 11,2%, la fistula pancreatica grado B en 12,5% y la C en 2,5%, mientras que la tasa de reintervencion abdominal fue del 10%. La mediana de estancia hospitalaria fue de 16 dias y la mortalidad postoperatoria y a 90 dias fue del 2,5%. La tasa de retraso del vaciamiento gastrico fue del 36,3%, diabetes de novo del 12,5% e insuficiencia exocrina del 30%. La supervivencia a uno, tres y cinco anos fue 80,2, 53,6 y 19,2%. Conclusiones Aunque nuestras tasas de morbimortalidad con la tutorizacion externa del Wirsung son bajas, coincidiendo con series mas amplias recientemente publicadas, se precisa un analisis comparativo con otras tecnicas reconstructivas, con mas casos, para elegir la mejor opcion despues de una duodenopancreatectomia cefalica.

Introduction There is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique. Patients and methods A retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting. Results Mean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2%, 53.6% and 19.2%, respectively. Conclusions Although our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy.

Aim The purpose of this report is to store the information of the pre-planning and compare this data with the actual data of the procedure. Background Currently, intraoperative electron beam radiotherapy clinical practice lacks a treatment planning system. Materials and methods The RADIANCE concept approaches treatment planning by providing the user with a navigation platform based on a three-dimensional imaging system in which the radiation oncologist can target the tumor and risk areas in different sections (axial, coronal, sagittal), while a volume rendering engine displays a 3D image that is automatically updated as we make any changes of the space. Finally, the user may select the parameters of the applicator, energy and dose of treatment to optimize the procedure. Six cases are clinically described and illustrated. Results RADIANCE is a useful tool in planning IOERT. Tumor segmentation and risk areas with minimal guide in the selection of parameters for the applicator. Complex locations are challenging, where the experience and skill of the radiation oncologist is necessary to optimize the process. New developments include imaging innovated uses. Intraoperative imaging will approach reality and allow real time, dosimetry estimations, stereotactic recognition of patient and tumor bed position, will guide automatization of radiation beam recognition and pre-robotic arrangements with linear accelerator movements. Conclusions RADIANCE offers a new imaging expansion for IOERT, in the context of a multidisciplinary approach to optimize and define the treatment parameters to approximate the actual treatment radiotherapy procedure.

BackgroundIntraoperative radiotherapy (IORT) refers to the delivery of a high dose of radiation at the time of surgery.AimTo analyze clinical and research-oriented innovative activities developed in a 17-year period using intraoperative electron-radiation therapy (IOeRT) as a component of treatment in a multidisciplinary approach for cancer management.Materials and methodsFrom 01/1995 to 03/2012 IOeRT procedures were registered in a specific Hospital-based database. Research and developments in imaging and recording for treatment planning implementation are active since 2006.Results1004 patients were treated and 1036 IORT procedures completed. Median age of patients was 61 (range 5 months to 94 years). Gender distribution was male in 54% of cases and female in 46%. Disease status at the time of IORT was 796 (77%) primary and 240 (23%) recurrent. Cancer type distribution included: 62% gastrointestinal, 18% sarcoma, 5% pancreas, 2% paediatric, 3% breast, 77 7% oligotopic recurrences, 2% other. IORT technical characteristics were: Applicator size 5cm 22%, 6cm 21%, 7cm 21%, 8cm 15%, 9cm 6%, 10cm 7% 12cm 5% 15cm 3%. Electron energies: 6MeV 19%, 8MeV 15%, 10MeV 15%, 12MeV 23%, 15MeV 19%, 18MeV 6%, other 3%. Multiple fields: 108 (11%). Dose: 7.5Gy 3%, 10Gy 35%, 12Gy 3%, 12.5Gy 49%, 15Gy 5%, other 5%.ConclusionAn IORT programme developed in an Academic Hospital based on practice-oriented medical decisions is an attractive interdisciplinary oncology initiative proven to be able to generate an intensive clinical activity for cancer patient quality care and a competitive source of scientific patient-oriented research, development and innovation.

IntroductionTen years after the beginning of the donation after cardic death (DCD) programme in the University Hospital 12 de Octubre, we study the evolution of the results of said programme over time.ObjectivesTo compare the results of liver transplantation (LT) using grafts obtained from donors af

AimTo use a platform to analyze a subgroup specialized in evaluation of patients candidates to IOERT.BackgroundMedting is a project that was initiated to support daily clinical activity, knowledge management and medical education by sharing information with other physicians. The project began at the “Hospital General Universitario Gregorio Marañón”, which has a dedicated oncology physician's multi-specialist committee. There are many scientific social networks all over the world. Medting is the only platform that specializes in healthcare and has been developed for hospital purposes.Materials and methodsMedting brings all together the relevant clinical information from electronic medical records and picture archiving about the patient to study. Subplatform Medting-IORT was created on February 2, 2012 at the Hospital General Universitario Gregorio Marañon. It has 23 members, have been registered 18 cases with 238 multimedia images.ResultsMedting started with 28 physicians and five departments. After 6 months, proof of concept period, there are 225 physicians, more than 120 medical students and 39 departments in 3 hospitals using the scientific social network. Furthermore, the project is being extended on three more hospitals in Madrid.ConclusionMedting gives the opportunity to oncology physicians to access all relevant clinical information with the ability to discuss case notes and view images at any time. The impact of the Medting platform in a subgroup working team to evaluate IOERT patients candidates is included in the analysis. The use of a constantly updated repository based on real cases and the documentation of the internal activity of the tumor committee beyond the medical record, has become an extraordinary tool for teaching, training and learning.