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Despite novel medical therapies, colectomy has a role in the management of patients with ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU). This study aimed to determine the incidence of unplanned surgery and initiation of immunomodulatory or biologic therapy (IMBT) after colectomy in patients with UC or IBDU, and identify associated factors.Data of patients with preoperative diagnosis of UC or IBDU who underwent colectomy and were followed up at a single tertiary centre was retrospectively collected. The primary outcome was the risk of unplanned surgery and initiation of IMBT during follow-up after colectomy. Secondary outcomes were development of Crohn's disease-like (CDL) complications and failure of reconstructive techniques.68 patients were included. After a median follow-up of 9.9 years, 32.4% of patients underwent unplanned surgery and IMBT was started in 38.2%. Unplanned surgery-free survival was 85% (95% confidence interval [CI] 73.8-91.6%) at 1 year, 76% (95% CI 63.2-84.9%) at 5 years and 69.1% (95% CI 55-79.6%) at 10 years. IMBT-free survival was 96.9% (95% CI 88.2-99.2%) at 1 year, 77.6% (95% CI 64.5-86.3%) at 5 years and 63.3% (95% CI 48.8-74.7%) at 10 years. 29.4% of patients met criteria for CDL complications. CDL complications were significantly associated to IMBT (hazard ratio 4.5, 95% CI 2-10.1).In a retrospective study, we found a high incidence of unplanned surgery and IMBT therapy initiation after colectomy among patients with UC or IBDU. These results further question the historical concept of surgery as a "definitive" treatment.

Introduction Fournier's gangrene (FG) is a necrotising fasciitis affecting the perineum and urogenital tissue. The mortality rate is high although early detection and aggressive debridement can reduce mortality by up to 16%. The prevalence of sequelae is very high and a colostomy is often necessary to control the perineal wound. Material and Methods A retrospective study was carried out to recruit all patients operated on by the General Surgery and Urology Departments with a diagnosis of GF at the University Hospital over 22 years. Mortality, The Fournier Gangrene Severity Index (FGSI) and fecal diversion (either surgical (colostomy) or straight (Flexi-seal)) are collected. Results A total of 149 patients met the inclusion criteria. FG´s most frequent cause was a perianal abscess (107 patients - 72%). 18 patients (12%) died of a specific cause of FG. Age (p=0,014) and patients with an oncological history (p=0,038), both were the only mortality risk factors for mortality according to logistic regression. 50 patients required some form of fecal diversion in the postoperative period (32 colostomies and 18 flexi-seal). Neither the use of postoperative fecal diversion (surgical or Flexi-seal) nor the timing of its use had any effect on postoperative mortality. Conclusions One in eight patients died in the immediate postoperative period secondary to FG. Despite improved outcomes, 22% required a colostomy during admission. However, neither the performance of a colostomy nor the timing was associated with decreased FG-associated mortality. Non-invasive methods should be used first and surgical bowel diversion should be postponed as long as possible.

Purpose The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. Methods This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale), obtained by personal interview and telephone calls. Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. Results A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (pConclusion Hemorrhoidal RBL as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients.

AIM The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groups - primary perineal closure and reconstruction with a biological mesh. METHOD One hundred and forty-seven consecutive patients who underwent ELAPE for primary rectal cancer between January 2007 and December 2018 in two tertiary referral centres were retrospectively identified from prospective databases. Perineal closure was carried out via primary closure or with a biological mesh (porcine dermal collagen mesh). Outcome measures were perineal hernia and perineal wound morbidity (infection, dehiscence, persistent sinus and chronic pain). RESULTS A total of 139 patients were included in the study. A prophylactic mesh was used in 80 (57.5%) and primary closure was practised in 59 (42.4%) patients. The median follow-up was 30 (interquartile range 46.88) months. Thirty patients (21.6%) developed perineal hernia. No significant differences were found between prophylactic mesh and primary closure (16.3% vs 23.3%, P = 0.07). The median period between surgery and hernia diagnosis was 8 months in the primary closure group and 24 months in the mesh group (P

Ileoanal pouch following restorative proctocolectomy is the treatment for ulcerative colitis after failed medical treatment. Our main aim was to evaluate early and late morbidity associated with restorative proctocolectomy. The secondary aim was to assess risk factors for pouch failure.A retrospective, observational, single-center study was performed. Patients who had undergone restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis from 1983-2015 were included. Early (30 days) and late (30 days) adverse events were analyzed. Pouch failure was defined as the need for pouch excision or when ileostomy closure could not be performed. Univariate and multivariate analyses were performed to assess pouch failure risk factors.The study included 139 patients. One patient subsequently died in the early postoperative period. Mean follow-up was 23 years. Manual anastomoses were performed in 54 patients (39%). Early adverse events were found in 44 patients (32%), 15 of which (11%) had anastomotic fistula. Late adverse events were found in 90 patients (65%), and pouch-related fistulae (29%) were the most commonly found in this group. Pouch failure was identified in 42 patients (32%). In the multivariate analysis, age50 years (p0.01; HR: 5.55), handsewn anastomosis (p0.01; HR: 3.78), pouch-vaginal (p=0.02; HR: 2.86), pelvic (p0.01; HR: 5.17) and cutaneous p=0.01; HR: 3.01) fistulae were the main pouch failure risk factors.Restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis has high morbidity rates. Long-term outcomes could be improved if risk factors for failure are avoided.

Resumen Introduccion La proctocolectomia restauradora con reservorio ileoanal es el tratamiento de eleccion en gran parte de los pacientes con colitis ulcerosa tras el fracaso del tratamiento medico. Nuestro objetivo principal fue analizar la morbilidad asociada a este procedimiento y la viabilidad del reservorio a corto y largo plazo. Como objetivo secundario identificamos los factores de riesgo asociados al fallo del reservorio. Metodos Estudio retrospectivo observacional unicentrico donde se analizan pacientes intervenidos de proctocolectomia total restauradora con reservorio ileoanal tras el diagnostico de colitis ulcerosa entre los anos 1983 y 2015. Se identificaron y analizaron las complicaciones tempranas ( 30 dias). Se considero fallo del reservorio la necesidad de extirpacion del reservorio o la imposibilidad para reconstruir el transito. Se llevo a cabo un analisis univariante y multivariante para identificar los factores asociados al fallo del reservorio ileoanal. Resultados Hubo 139 pacientes analizados. Un paciente fallecio en el postoperatorio. La mediana de seguimiento fue de 12 anos. En 54 pacientes (39%) se realizo anastomosis manual. Presentaron complicaciones inmediatas 44 pacientes (32%), 15 pacientes (11%) con fistula anastomotica. Complicaciones tardias fueron diagnosticadas en 90 pacientes (65%), las mas frecuentes fueron las fistulas asociadas al reservorio (29%). Hubo 42 pacientes (32%) con fallo del reservorio. La edad > 50 anos (p Conclusion La proctocolectomia restauradora es una tecnica con elevada morbilidad a corto y largo plazo. Controlando los factores de riesgo del fallo del reservorio se podrian mejorar los resultados a largo plazo.

Resumen Introduccion La infeccion del sitio quirurgico (SSI) es una de las principales complicaciones quirurgicas, con una incidencia del 10-20% en cirugia colorrectal. Las terapias basadas en presion negativa (NPWT) han mostrado su eficacia en el tratamiento de heridas cronicas, traumaticas, en las dehiscencias de piel, en el uso de colgajos o injertos. El objetivo principal del estudio es valorar la eficacia de NPWT en la prevencion de SSI en cirugia colorrectal. Los objetivos secundarios son valorar la reduccion del ingreso hospitalario y analizar los factores de riesgo de SSI. Metodos Estudio casos y controles prospectivo. Ochenta pacientes intervenidos tras diagnostico de enfermedad colorrectal, de forma programada o urgente durante el ano 2017. Cuarenta pacientes fueron tratados con NPWT preventivo durante una semana. Cuarenta pacientes fueron tratados segun protocolo habitual postoperatorio de cuidado de herida quirurgica. Resultados No se encontraron diferencias entre NPWT y grupo control en variables demograficas, comorbilidades, abordaje quirurgico, indicacion urgente o programada, preparacion colonica o procedimiento quirurgico. Se objetivo SSI con el empleo de NPWT en 3 (8%) pacientes (IC del 95%, 0-17,5). SSI en 10 (25%) pacientes (IC del 95%, 12,5-37,5) (p = 0,034); OR 0,7 (IC del 95% 0,006-0,964). La estancia hospitalaria en el grupo NPWT fue de 8 dias vs. 12 dias en el grupo control (p = 0,22). En el analisis multivariante se encontro como unico factor relacionado con SSI la preparacion colonica (p = 0,047; OR: 0,8, IC 0,45-0,93). Conclusiones El uso de dispositivos NPWT para la cobertura de incisiones cerradas tras cirugia colorrectal puede disminuir la incidencia de SSI.

Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction.This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence.A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P.001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups.Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.

Colonic diverticulosis is primarily seen in the Western population with prevalence increasing with age...

Background: The main purpose was to assess the efficacy of negative pressure wound therapy (NPWT) for surgical site infection (SSI) in elective open and laparoscopic open-assisted colorectal surger...

According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach. Sin financiación 5.742 JCR (2020) Q2, 28/92 Gastroenterology & Hepatology 1.427 SJR (2020) Q1, 26/144 Gastroenterology No data IDR 2020 UEM

Background Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10%–20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. Methods We present a prospective case–control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. Results No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0–17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5–37.5) (P=.034); OR 0.7 (95%CI 0.006–0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (P=.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (P=.047; OR: 0.8, CI 0.45–0.93). Conclusions NPWT is a useful SSI prevention treatment in colorectal surgery.

RESUMEN Introducción: la endoprótesis como puente a cirugía curativa en pacientes con cáncer de colon izquierdo obstructivo es una alternativa al tratamiento clásico. El objetivo de nuestro estudio es evaluar la recidiva de la enfermedad así como la morbimortalidad del tratamiento. Pacientes y métodos: estudio retrospectivo observacional donde se analizan los pacientes que acudieron al Servicio de Urgencias con cuadro de obstrucción intestinal por tumoración en colon izquierdo entre junio de 2006 y enero de 2014. Se incluyó a los pacientes a los cuales se les colocó una endoprótesis por vía endoscópica y posteriormente fueron intervenidos con intención curativa. El periodo de observación fue hasta mayo de 2017. Resultados: cincuenta y tres pacientes fueron tratados con endoprótesis; de ellos, nueve fallecieron en el postoperatorio. Los pacientes fallecidos eran más frecuentemente varones (100% en fallecidos vs. 62% en no fallecidos, p = 0,02), con más edad (81,4 ± 5,1 vs. 71,6 ± 10,8, p < 0,001) y tenían hemoglobinas más bajas al ingreso (12,9 vs. 13,6, p < 0,001), mayor número de leucocitos (12.918 vs. 9.437, p < 0,001) y mayor coagulopatía (INR 1,6 vs. 1, p < 0,001). Tuvieron una recidiva a distancia ocho pacientes con una mediana de supervivencia libre de enfermedad de 19,1 meses. Se compararon las variables en función de la aparición de enfermedad a distancia y la media de edad fue menor en los pacientes que presentaron recidiva (65,9 ± 11,3 vs. 74,9 ± 9,9 p < 0,001). Conclusiones: el uso de endoprótesis como puente a cirugía curativa en los pacientes con cáncer de colon izquierdo obstructivo en nuestro hospital ha presentado unos resultados comparables a estudios previos. ABSTRACT Background: a colonic stent as a bridge to elective surgery for left-sided malignant colonic obstruction is an alternative to the classical treatment. The aim of our study was to evaluate the recurrence rate as well as the morbidity and mortality of this treatment. Patients and methods: patients admitted to the Emergency Department with left-sided malignant colonic obstruction between June 2006 and January 2014 were analyzed in a retrospective observational study. Patients who underwent self-expanding metallic stent placement via endoscopy as a bridge to surgery were included. The observation period was performed until May 2017. Results: fifty-three patients were treated with a colonic stent as a bridge to surgery; nine patients died during the postoperative period. The deceased patients were more frequently male (100% in the deceased vs 62% in the non-deceased, p = 0.02), with a more advanced age (81.4 ± 5.1 vs 71.6 ± 10.8, p < 0.001), lower hemoglobin levels on admission (12.9 vs 13.6 p < 0.001), a greater number of leukocytes (12,918 vs 9,437, p < 0.001) and greater coagulopathy (INR 1.6 vs 1, p < 0.001). Eight patients had a distant relapse with a median disease-free survival of 19.1 months. The variables were compared according to the appearance of distant disease and the mean age was lower in patients with a recurrence (65.9 ± 11.3 vs 74.9 ± 9.9, p < 0.001). Conclusions: the results of the use of a stent as a bridge to curative surgery in patients with obstructive left colon cancer in our hospital is comparable to previous studies.

Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Patients: We retrospectively review four consecutive cases treated in our department, from January 2015 to July 2015. All of them were discussed in a multidisciplinary team meeting. None of them were secondary to an inflammatory process. Results: A Magnetic Resonance Imaging was performed in all the four patients, and as it was not a malignant diagnosis made in any of them, we proceeded to resecate the lesions. None biopsies were performed and the benign diagnoses were confirmed by the pathologist. All the patients underwent a local posterior or perineal approach, because all the lesions (epidermoid cyst, hamartoma, lipoma and an aggressive angiomyxoma) were localized purely in the ischiorectal fossa, under the levator ani muscle and not invading any adjacent structures. In all of them, an R0 resection was performed. Conclusions: Ischiorectal fossa tumors are rare and there are few cases already published. Non-inflammatory lesions located in the ischiorectal fossa, with none invasion of rectum or levator ani muscle, are mainly benign lesions prone to their complete excision by a posterior approach. Biopsy is not always necessary unless there’s a suspicion of a malignancy or invasion of adjacent structures, and only in that case a biopsy should be made, because in some of them, a neo-adjuvant treatment can be useful to reduce the tumor and to perform an R0 resection.

Spontaneous liver rupture is an uncommon and life-threatening condition often associated with high mortality rate. The most common causes are preeclampsia and HELLP syndrome during pregnancy, liver tumours and overdosing of anticoagulant therapy, however, hepatic rupture in the absence of underlying pathology is an extremely rare occurrence. Treatment can include observation, embolization, hepatic artery ligation, hepatic lobectomy, hematoma evacuation and packing, and even liver transplantation has been described.

RESUMEN Introducción: la endoprótesis como puente a cirugía curativa en pacientes con cáncer de colon izquierdo obstructivo es una alternativa al tratamiento clásico. El objetivo de nuestro estudio es evaluar la recidiva de la enfermedad así como la morbimortalidad del tratamiento. Pacientes y métodos: estudio retrospectivo observacional donde se analizan los pacientes que acudieron al Servicio de Urgencias con cuadro de obstrucción intestinal por tumoración en colon izquierdo entre junio de 2006 y enero de 2014. Se incluyó a los pacientes a los cuales se les colocó una endoprótesis por vía endoscópica y posteriormente fueron intervenidos con intención curativa. El periodo de observación fue hasta mayo de 2017. Resultados: cincuenta y tres pacientes fueron tratados con endoprótesis; de ellos, nueve fallecieron en el postoperatorio. Los pacientes fallecidos eran más frecuentemente varones (100% en fallecidos vs. 62% en no fallecidos, p = 0,02), con más edad (81,4 ± 5,1 vs. 71,6 ± 10,8, p < 0,001) y tenían hemoglobinas más bajas al ingreso (12,9 vs. 13,6, p < 0,001), mayor número de leucocitos (12.918 vs. 9.437, p < 0,001) y mayor coagulopatía (INR 1,6 vs. 1, p < 0,001). Tuvieron una recidiva a distancia ocho pacientes con una mediana de supervivencia libre de enfermedad de 19,1 meses. Se compararon las variables en función de la aparición de enfermedad a distancia y la media de edad fue menor en los pacientes que presentaron recidiva (65,9 ± 11,3 vs. 74,9 ± 9,9 p < 0,001). Conclusiones: el uso de endoprótesis como puente a cirugía curativa en los pacientes con cáncer de colon izquierdo obstructivo en nuestro hospital ha presentado unos resultados comparables a estudios previos.

BACKGROUND A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer. OBJECTIVE The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection. DESIGN This was an observational study. SETTINGS The study took place throughout the network of hospitals that compose the National Health Service in Spain. PATIENTS This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed. MAIN OUTCOME MEASURES Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed. RESULTS After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571-1.563; p = 0.825). LIMITATIONS The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project. CONCLUSIONS Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.

Resumen Introduccion El Proyecto del Cancer de Recto de la Asociacion Espanola de Cirujanos se inicio en el ano 2006. El objetivo principal de este estudio observacional ha sido evaluar los resultados conseguidos por los hospitales formados en el periodo 2006-2011 para valorar si esta iniciativa ha permitido conseguir los estandares de calidad observados en el Norwegian Rectal Cancer Project. Metodos Entre marzo de 2006 y junio de 2012 se ha incluido en el registro una cohorte de 10.006 pacientes tratados por 79 hospitales incluidos en el proyecto entre 2006 y 2011. En 8.706 (94,5%) se practico una reseccion del recto. La reseccion se considero paliativa en 1.156 pacientes, con metastasis en el diagnostico o porque la reseccion fue R2. El numero de resecciones de recto con intencion curativa analizado fue 7.396 (80,3%). Las medidas de resultado fueron: las tasas de recidiva local, metastasis y supervivencia. Resultados Con una mediana de seguimiento de 19,0 (rango intercuartilico [8,00-33,0]) meses, la tasa de recidiva local fue 7,7 (9,1-6,2), la de metastasis en el seguimiento de 23,4 (25,6-21,1) y la de mortalidad 25,9 (28,1-23,7). Conclusion Este estudio ha permitido conocer que los resultados oncologicos de los hospitales espanoles que participan en el Proyecto del Cancer de Recto de la Asociacion Espanola de Cirujanos son similares a los observados en el Norwegian Colon and Rectal Cancer Project .

Resumen Jose Goyanes fue un cirujano espanol muy renombrado. Se hace un breve resumen biografico de su figura con los puestos que ocupo y los galardones que recibio. Fue pionero mundial de la cirugia vascular con grandes aportaciones, muchas de ellas pioneras en esta especialidad y publicadas, algunas, previamente a las de Alexis Carrel, premio Nobel de Medicina. Tambien fue una autoridad en materia oncologica y domino la mayor parte de las tecnicas quirurgicas en uso en su epoca. Fue escritor, historiador, ensayista y viajero notable, lo que le valio la calificacion de “Hombre Universal”. No ha sido plenamente reconocido como hombre de ciencia.

Resumen Objetivo Revisar las indicaciones de la cirugia no amputativa en los sarcomas oseos de las extremidades, a proposito de un caso intervenido. Caso clinico Varon de 70 anos diagnosticado en marzo de 2001 de un condrosarcoma de alto grado (grado 3) del femur izquierdo e intervenido tras presentar una fractura patologica por la zona tumoral en mayo de 2001 en el M.D. Anderson Hospital de Texas, realizandole reseccion segmentaria de los dos tercios distales del femur y colocacion de una endoprotesis de titanio. Tras presentar recidiva tumoral y metastasis pulmonares bilaterales, en diciembre de 2001 se realiza desarticulacion coxofemoral paliativa. Discusion Contraindicaciones a cirugia no amputativa de los sarcomas oseos de las extremidades son: a) destruccion masiva osea o invasion importante de tejidos blandos peritumorales, b) sarcomas oseos de alto grado o indiferenciados, c) invasion de vasos o nervios principales de la extremidad, y d) fracturas patologicas principalmente.

790 Background: The role of adjuvant chemotherapy (AC) after chemoradiotherapy and surgery in stage II and III of rectal cancer is not well defined. Neither the regimen nor the duration is clear. Besides, guidelines from different expert groups are conflicting. Methods: 224 patients diagnosed from January 2003 to December 2013 with rectal adenocarcinoma T3/T4 and/or positive node staged by ultrasound or magnetic resonance imaging was collected retrospectively from the Pathology Department data base. Results: Of the 224 patients 61.6% were male, median of age at diagnosis 68.6 years (range 31.3-85.4). All of them received 50.4 Gy with different concomitant regimens (capecitabine, continuous infusion of fluoracil or bolus of fluoracil-leucovorin). 13.4% of patients achieved a pathological complete response. 76.8% of the cohort received adjuvant chemotherapy. The main reasons for not receiving chemotherapy were ECOG ≥ 2, surgery complications and a decision of the patient. 51.2% of patients received an oxaliplatin based regimen and the median time of chemotherapy duration was 4 months (range 1-6 months). Local relapse was diagnosed in 6.3% of patients while a systemic relapse was found in 22.3%. Patients without AC had a mean overall survival (OS) of 85.5 months (CI 95% 70.7-100.4) versus 119.8 monts (CI 95% 110.8-128.8) in the AC cohort (p 0.002) without reaching the median after 58 months (range 8-153.9) median follow-up. Disease free survival (DFS) was also better in the AC cohort with a mean DFS of 104 months (CI 95% 94.3-113.6) versus 71.4 months (CI 95% 55.4-87.4), p = 0.01. Conclusions: AC after chemoradiotherapy and surgery in stage II and III rectal cancer as a standard does not exist. In our cohort, AC showed a significant improve in OS and DFS, but the limitations of a retrospective study should be considered, as well as the impact of surgery on metastasis and salvage chemotherapies. Randomized studies are clearly needed.

Consulta de Alto Riesgo de Cancer Colorrectal. Unidad de Endoscopia. Department of Gastroenterology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Endoscopy Division. National Cancer Center Hospital. Tokyo, Japan. Department of Gastroenterology. Fujita Health University University School of Medicine. Aichi, Japan. Department of Gastroenterology. Hospital Virgen de la Arrixaca. Murcia, Spain. Department of Pathology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Departmento of General and Digestive Surgery. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain PICTURES IN DIGESTIVE PATHOLOGY

e15145Background: Data of outcomes of elderly patients ( ≥ 70) with stage II and III rectal cancer treated with multimodal treatment (neoadjuvant chemoradiotherapy, surgery and adjuvant chemotherap...

The aim of total anorectal reconstruction after anorectal extirpation is to restore normal physiological function and body image to the greatest extent possible. This chapter outlines the approach toward total anorectal reconstruction in selected patients who have undergone abdominoperineal excision, discussing techniques and outcomes of sphincter substitution and reinforcement procedures.

Introducción: la incidencia de la hidatidosis hepática ha disminuido notablemente en los últimos años gracias a las medidas de prevención adoptadas para interrumpir la transmisión del parásito. Con todo, la cirugía continúa siendo el tratamiento de elección, si bien su modalidad es todavía motivo de controversia. Objetivos: el objetivo de este trabajo es evaluar los resultados obtenidos en el tratamiento de esta patología a lo largo de más de dos décadas, atendiendo a la modalidad quirúrgica empleada ya fuese cirugía radical o no radical. Material y métodos: se analizaron un total de 372 pacientes intervenidos por quiste hepático hidatídico (QHH) entre 1983-2005 en el Hospital Ramón y Cajal. En 162 se efectúa una cirugía radical (43,5%) y en 210 una no radical (56,5%). Resultados: tanto la estancia media hospitalaria (8,65 días vs. 14,9 días) como la morbilidad (13,3 vs. 31,4 %, p < 0,001) y la mortalidad (0 vs. 3,8%, p < 0,01) fueron menores en el grupo de cirugía radical. La tasa de recidiva fue del 1,85% tras un abordaje radical frente al 11,9% en los abordajes no radicales (p < 0,0001). Conclusión: la cirugía radical se asocia con una menor morbimortalidad, menor estancia hospitalaria y menor recidiva, constituyendo la técnica de elección en la hidatidosis hepática. Sin embargo, su aplicación debe atenerse a las características del paciente, la anatomía del quiste y el grado de experiencia del equipo quirúrgico.

737 Background: There is some evidence relating delay of surgery (DS) by more than 8 weeks after the end of chemoradiotherapy and achievement of complete pathological response (ypCR). However, the relationship with overall survival (OS) seems to be negative. Methods: Records of 171 patients diagnosed from January 2003 to December 2011 with rectal adenocarcinoma T3/T4 and/or positive node staged by ultrasound or MRI were collected retrospectively from the Pathology Department database. Results: Of the 171 patients, 62% were male, median age at diagnosis 69.3 years (31.3 years -85.3 years). All of them received 50.4 Gy with different concomitant regimens (capecitabine, continuous infusion of fluoracil or bolus of fluoracil-leucovorin). 72.5% of the cohort received adjuvant chemotherapy. 13% of patients achieved ypCR, independently of DS (13.7% in DS vs 11.8%, p 0.722). OS was significantly worse among DS patients (67.9 months vs 54.8 months, p 0.016). In addition, more sphincter preservations (SP) were not achieved (60.8% in DS vs 57.1%, p 0.881). Conclusions: In contrast with published literature, in our cohort DS failed to show higher rates of ypCR. Neither an improvement in OS or SP was observed with DS. It is recommended that clinical trials be designed in order to establish ideal surgical timing.

Management of the short bowel syndrome is a multidisciplinary and very complex problem. The authors report the successful long-term results of an original combination of autologous gastrointestinal reconstruction in a boy who at the age of 16 years lost all but 5 cm of the small bowel. This case demonstrates that lengthening and antipropulsive interposition of a long segment of the colon can be another alternative to early transplantation in exceptional cases.

e14539 Background: The role of adjuvant chemotherapy (AC) after chemo-Rt and surgery in stage II and III of rectal cancer is not well defined. Neither the regimen nor the duration is clear. Besides...

e21104 Background: Cancer stem cells (CSCs) are a subset of tumor cells with capacity to self-renew and generate the diverse cells that comprise the tumor. They are considered cancer (Ca) initiating cells responsible for tumor recurrence and maintenance. These cells express pluripotency markers (CD133 and NANOG) and do not express markers of differentiation as cytokeratin 20 (CK20). The potential prognostic value of CSCs in colorectal cancer has been studied with conflicting results. However some of these series were based on heterogeneous situations, involving rectal and colon cancer (CC) and different tumor stages (I-IV). The aim of this study is to evaluate the prognostic value of CSCs in a highly homogeneous population of stage II CC. Methods: One hundred stage II CC patients (pts) treated by the same surgical team at Ramon y Cajal University Hospital between 1977 and 2005 were retrospectively analyzed. None of the pts received adjuvant chemotherapy. Inmunohistochemistry expression of CD133, NANOG and CK20 was scored on paraffin sections using four levels: 50% positivity. Kaplan-Meier analysis and log rank test were used to compare survival. Results: Median age: 68 years (45-92). Median follow up: 5.8 years. Recurrent disease: 17 (17%). Expression of CD133 was shown in 60% of the tumors, in 95% for NANOG and 78% for CK20. No correlation was found among expression levels of CD133, NANOG or CK 20 and relapse-free survival (RFS) and overall survival (OS). However, a statistical significant correlation was found between established pathological prognostic factors and RFS and OS. Conclusions: Stem Cell quantification defined by CD133 and NANOG expression has no correlation with RFS or OS in this cohort of Stage II CC. However, a correlation with established prognostic pathological factors was found. Therefore, our results suggest that CSCs may not play a major role in early phases of CC.

A clinical case of primary peritoneal serous adenocarcinoma is presented. A woman 66 years old with abdominal pain and ascitis. Clinical, radiologic and cytology data suggested a peritoneal carcinomatosis of an unknown primary adenocarcinoma.

Patients and methods: Data of all patients with UC or CD on treatment with AZA due to steroid-dependency for at least 12 months were recorded. Response was described as clinical remission free of steroids for at least 6 months during the first 12 months of starting AZA. Clinical data at diagnosis, at the beginning of AZA and during the follow-up were recorded. Smoking status was obtained from clinical story or for telephonic recall. Results: 163 patients (103 CD, 60 UC) were included. 55% of CD and 16% of UC patients were active smokers at the onset of AZA therapy. AZAwas withdrawn for intolerance in 15% of them (20% of CD, 6% of UC). 72% of CD and 61% of UC patients achieved initial response. Tobacco did not influence on the time elapsed from diagnosis to AZA therapy, the initial response to AZA, the need for rescue therapies, or the development of penetrating or structuring complications (CD) or proximal extension (UC). However, CD patients who continued smoking required more courses of steroids during the follow-up. UC patients showed a lower incidence of AZA intolerance as compared to CD patients. Conclusions: Active smoking does not seem to influence AZA efficacy in steroid-dependent IBD.