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Introduction: The use of the N category of the TNM staging system, lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in predicting overall survival (OS) and disease-free survival (DFS) in patients with rectal cancer is still controversial., Material and Methods: A retrospective study of 445 patients with rectal cancer who underwent surgery between 2008 and 2017 in the University Complex Hospital of Vigo was performed. Patients were stratified according to number of lymph nodes examined (NLNE), N staging, LNR and LODDS. The analysis was performed using the log-rank test, Kaplan-Meier functions, Cox regression and ROC curves., Results: Five-year OS and DFS were 73.7% and 62.5%, respectively. No statistically significant differences were observed depending on NLNE. Increased LNR and LODDS were associated with shorter OS and DFS, independently of NLNE. Multivariate analysis showed that N stage, LNR and LODDS were independently associated with OS and DFS; however, the LODDS system obtained the best area under the curve, with greater predictive capacity for OS (AUC: 0.679) and DFS (AUC: 0.711)., Conclusion: LODDS and LNR give prognostic information that is not related to NLNE. LODDS provides better prognostic accuracy in patients with negative nodes than LNR and N stage., (Copyright © 2024. Published by Elsevier España, S.L.U.)

During the last years, social media use has increased in the surgical community. Social Media in surgery has created new challenges such as surgical education, patient privacy, professionalism, and the difference between the private and public virtual life. Facebook, YouTube or WebSurg are some of the main social media in the surgical field. Nevertheless, Twitter is the most common and relevant Media for surgeons. Some Twitter Hashtag such as #SoMe4Surgery or #colorectalsurgery went viral and had a significant influence in the surgical community. Some of the uses of social media in surgery are education of younger surgeons, surgical research, and relationship between surgeons. However, not everything in social media is positive. Some negative issues of social media use in surgery are, for example, lack of privacy, intellectual property conflicts, conflicts of interest and mistakes in the published information. In this article, the main social media, the use of these media, the advantages and the possible risks and negative issues of social media are discussed., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: Treatment of patients with Coronavirus Disease 2019 (COVID-19) has affected the management of patients with colorectal cancer (CRC). The aim of this study was to compare the diagnosis delay, symptoms, and stage of patients with CRC during the pandemic with a control cohort., Material and Methods: Patients referred to the CRC multidisciplinary team between September 2019 and January 2020 (cohort 1, control group) were compared with those who presented between September 2020 and March 2021 (cohort 2, pandemic group)., Results: 389 patients were included, 169 in cohort 1 and 220 in cohort 2. No differences were observed in the main characteristics of the patients. CRC screening and anaemia were the most common causes leading to the diagnosis of the tumour in cohort 1 and 2, respectively ( p  < 0.001). Diagnostic and therapeutic delay was longer in cohort 2 [6.4 (95% CI 5.8-6.9) vs. 4.8 (95% CI 4.3-5.3) months, p  < 0.001]. More patients required non-elective treatment in the pandemic cohort (15.5% vs. 9.5%, p  = 0.080). The tumour stage was more advanced in patients in cohort 2 [positive nodes in 52.3% vs. 36.7% ( p  = 0.002), and metastatic disease in 23.6% vs. 16.6% ( p  = 0.087)]., Conclusion: CRC patients in the pandemic cohort had a longer diagnostic and therapeutic delay and less patients were diagnosed because of CRC screening. In addition, patients with CRC during the pandemic needed non-elective treatment more frequently than patients in the control cohort, and their tumour stage tended to be more advanced., (© 2022 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Treatment of patients with Coronavirus Disease 2019 (COVID-19) has affected the management of patients with colorectal cancer (CRC). The aim of this study was to compare the diagnosis delay, symptoms, and stage of patients with CRC during the pandemic with a control cohort., Material and Methods: Patients referred to the CRC multidisciplinary team between September 2019 and January 2020 (cohort 1, control group) were compared with those who presented between September 2020 and March 2021 (cohort 2, pandemic group)., Results: 389 patients were included, 169 in cohort 1 and 220 in cohort 2. No differences were observed in the main characteristics of the patients. CRC screening and anaemia were the most common causes leading to the diagnosis of the tumour in cohort 1 and 2, respectively (p<0.001). Diagnostic and therapeutic delay was longer in cohort 2 [6.4 (95% CI 5.8-6.9) vs. 4.8 (95% CI 4.3-5.3) months, p<0.001]. More patients required non-elective treatment in the pandemic cohort (15.5% vs. 9.5%, p=0.080). The tumour stage was more advanced in patients in cohort 2 [positive nodes in 52.3% vs. 36.7% (p=0.002), and metastatic disease in 23.6% vs. 16.6% (p=0.087)]., Conclusion: CRC patients in the pandemic cohort had a longer diagnostic and therapeutic delay and less patients were diagnosed because of CRC screening. In addition, patients with CRC during the pandemic needed non-elective treatment more frequently than patients in the control cohort, and their tumour stage tended to be more advanced., (Copyright © 2022 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year., Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10)., Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (P = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (P = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic., Conclusions: The AEC Virtual Classroom has had very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year., Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10)., Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 ( p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 ( p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic., Conclusions: The AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over., (© 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Aim: The objective of this study is to analyze the impact of the congresses of the American College of Surgeons (ACSCC2020) and the National Surgery Congress of the Spanish Association of Surgeons (CNC2020) in virtual format due to the SARS-CoV2 pandemic according to the fingerprint., Material and Methods: The Twitter hashtags # ACSCC20 and # CNCirugia2020 were studied to determine tweets, retweets, users and impressions. The data on the accounts with the greatest influence and the historical evolution of the congresses between 2015 and 2020 were analyzed. We used the symplur software to collect and analyze the data., Results: Between 2015 and 2017 there was a consistent increase in the number of tweets, participants and impressions. Between 2018 and 2020, the ACS maintains the number of impressions with the fewest number of tweets. However, the CNC continues to grow and achieves its best metrics in 2020. We found statistically significant differences between the most prolific accounts of the ACSCC versus the CNC (P < .002) but there are no differences between the 10 most influential accounts (P = ,19) or the accounts with the highest number of impressions (P = .450) CONCLUSIONS: Virtual congresses generate a global impact through the use of Twitter for the dissemination of knowledge. In the present 2020, the growth of the impact on social networks has been proportionally greater in the CNC than in the ACSCC. However, the ACS virtual congress generated the greatest impact on social networks measured by the number of users, tweets and impressions between 2015 and 2020., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC)., Methods: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05., Results: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Differences in post-surgical mortality (32% vs 55%) and overall mortality (20% vs 15%) were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61% vs 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD., Conclusions: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes., (Copyright © 2020 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Aim: The objective of this study is to analyze the impact of the American College of Surgeons Clinical Congress (ACSCC2020) and the National Surgery Congress of the Spanish Association of Surgeons (CNC2020) in virtual format due to the SARS-CoV-2 pandemic according to the fingerprint., Material and Methods: The Twitter hashtags # ACSCC20 and # CNCirugia2020 were studied to determine tweets, retweets, users and impressions. The data on the accounts with the greatest influence and the historical evolution of the congresses between 2015 and 2020 were analyzed. We used the symplur software to collect and analyze the data., Results: Between 2015 and 2017 there was a consistent increase in the number of tweets, participants and impressions. Between 2018 and 2020, the ACS maintains the number of impressions with the fewest number of tweets. However, the CNC continues to grow and achieves its best metrics in 2020. We found statistically significant differences between the most prolific accounts of the ACSCC versus the CNC (P<.002) but there are no differences between the 10 most influential accounts (P=.19) or the accounts with the highest number of impressions (P=.450)., Conclusions: Virtual congresses generate a global impact through the use of Twitter for the dissemination of knowledge. In the present 2020, the growth of the impact on social networks has been proportionally greater in the CNC than in the ACSCC. However, the ACS virtual congress generated the greatest impact on social networks measured by the number of users, tweets and impressions between 2015 and 2020., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC)., Methods: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P <0.05., Results: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P <0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P <0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD., Conclusions: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation., (Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Morbid obesity is a serious health problem whose prevalence is increasing. Expensive co-morbidities are associated to these patients, as well as a reduction in the survival. Bariatric surgery resolves the co-morbidities (type 2 diabetes mellitus, 86.6%; cardiovascular risk, 79.0%; obstructive sleep apnea syndrome, 83.6%; hypertension, 61.7%), reduces the mortality rate (among 31-40%), and increases the morbid obese patients survival over a 10-years period. It provides significant savings for the National Health System. The obese patients consume a 20% plus of health resources and 68% plus of drugs than general population. Bariatric surgery requires an initial investment (diagnosis-related group cost: 7,468 €), but it is recovered in a cost-effectiveness ratio of 2.5 years. Significant savings are obtained from the third year. To the direct economic benefits associated with reduced health expenditures it should be added an increase in tax collection (sick leave and unemployment reduction is estimated in 18%, with a productivity increase of 57% for self-employed people). Bariatric surgery is one of the most cost-effective procedures in the healthcare system., (Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: The aim of this study was to analyze factors related to morbidity and mortality after gastric bypass and to evaluate lower-risk alternatives in selected patients., Patients and Methods: A prospective cohort of 761 patients who underwent gastric bypass was included. Prognostic factors were studied using a logistic regression model with SPSS 11.0. Independent variables were age, sex, body mass index (BMI), comorbidities, and the laparoscopic approach. Dependent variables consisted of medical complications, surgical complications, and mortality. We performed a preliminary descriptive study of morbidity and weight loss at 3 months after sleeve gastrectomy., Results: In the postoperative period, 2.8% of patients presented medical complications and 5.4% presented surgical complications. Mortality was 0.52%. Surgical complications were significantly associated with age > 45 years (P = .04; OR = 2.00 [1.03-3.8]) and male sex (P = .041; OR = 2.40 [1.12-5.14]). Medical complications were significantly associated with a BMI of > 50 kg/m2 (P = .012; OR = 3.32 [1.23-8.98]), and mortality was significantly associated with a BMI of > 50 kg/m2 (P = .006) and male sex (P = .006). Sleeve gastrectomy was performed in eight patients with a BMI of > 60 kg/m2, in three patients with a BMI of > 50 kg/m2, cardiopulmonary disease and android fat distribution, and in four patients with a BMI of between 35 and 40 kg/m2 and major comorbidity. Morbidity consisted of self-limited febrile syndrome in one patient. There was no mortality. Weight loss at 3 months was 39.8 +/- 5.36% of excess BMI in superobese patients (n = 4) and was 50.2 +/- 11.05% of excess BMI in morbidly obese patients (n = 4)., Conclusions: Postoperative morbidity and mortality was significantly higher in male patients, in patients aged more than 45 years, and in those with a BMI of > 50 kg/m2. Sleeve gastrectomy in selected patients could be a lower-risk alternative.