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To evaluate the feasibility, early toxicity, and clinical outcomes of early-breast cancer patients in a single-arm, phase I/II study of an ultra-accelerated, four-fraction schedule of minimal breast irradiation (4f-AMBI) using a multicatheter, minimally-invasive, intraoperative tumor bed implant (MITBI) during breast-conserving surgery (BCS).Eligible women aged40 years with clinically and radiologically confirmed, unifocal invasive or in situ ≤3 cm tumors were considered as potential candidates for MITBI during BCS. After the pathology report, patients who met APBI criteria received ultra-accelerated four-fractions irradiation (6.2 Gy BID x 4fx over 2 days) with perioperative HDR-brachytherapy (PHDRBT). Early complications, toxicity, clinical outcomes, and cosmetic results were analyzed.Of 89 patients initially implanted, 60(67.4%) were definitively included in the 4f-AMBI-protocol. The median age was 64.4 years; the median CTV was 32.1 cc (6.9-75.4 cc), and the external-VUltra-accelerated, four-fraction, minimal breast irradiation (4f-AMBI) using a minimally-invasive tumor bed implant procedure is safe, dosimetrically feasible, and shows small irradiated volumes. This program provides low toxicity rates and excellent short-term clinical and cosmesis outcomes.

Although neoadjuvant chemoradiotherapy (NCRT) and surgery are accepted as treatments for pancreatic ductal adenocarcinoma (PDAC), some authors have highlighted the risks of delaying surgery. Our objective was to analyze the impact of prolonging the time interval between NCRT and surgery (NCRT-TTS) in PDAC.Patients treated with NCRT and pancreatoduodenectomy (PD) were identified. Clinical, histopathological variables were analyzed on whether NCRT-TTS was greater or less 50 days Five- and 10-year overall survival (OS) and disease-free survival (DFS) were analyzed depending on whether the delay was greater than 50 days or not.100 (8.3%) of 120 eligible patients underwent PD: 61 male, median age of 63.7 years. In 71 (71%) patients the median NCRT-TTS was 39 (24-50) days and in 29 (29%) 61 days. There were no differences between the two groups except for CA 19-9 levels, the incidence of cholangitis, ASA score, intraoperative blood transfusions and degree of histopathologic response (all p0.001). Median DFS when the NCRT-TTS was less than 50 days was higher than when the interval exceeded 50 days - 51.0 months (95% CI 20.3-81.6) vs 17.0 months (95% CI 10.9-23.0); HR (95% CI 1.08-3.46), p=0.026. Five-year DFS was higher in the subgroup with the NCRT-TTS of less than 50 days compared to the group with an interval of more than 50 days - 43.5% vs 23.65% (HR 1.812 95% CI 1.001-3.280), p= 0.050 Conclusions. An increase in the NCRT-TTS50 days is associated with poorer OS and DFS in patients with localized PDAC treated with NCRT and PD.

Purpose To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) to deliver peri-operative high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost). Material and methods Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT). Results Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (p = 0.034). Conclusions The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins.

Background Endometrial cancer is the most common malignancy of the female genital tract. For cancers detected at an advanced stage or intraperitoneal relapse, the prognosis is poor. Optimal cytoreductive surgery (CRS) is the most accepted treatment; however, patients with advanced intraperitoneal disease might benefit from hyperthermic intraoperative peritoneal chemotherapy (HIPEC). The aim of this study was to analyze recurrence-free survival (RFS) after CRS and HIPEC in a large series of patients with peritoneal metastases from endometrial cancer. Methods Patients with a diagnosis of endometrial cancer with primary or recurrent peritoneal dissemination were included. All patients underwent CRS plus HIPEC. Data were prospectively collected in the Spanish Group of Peritoneal Oncological Surgery (GECOP) database. Results Forty-three patients with endometrial cancer and peritoneal metastasis were included. Fifteen patients (35%) were diagnosed with G3 endometrioid carcinomas and 28 (65%) with other non-endometroid histologies. A completeness of cytoreduction score of CC-0 was achieved in 41 patients (95%). RFS at 5 years was 23%, being factors related to worse RFS: treatment with preoperative chemotherapy (p = 0.027), resection of more than three peritoneal areas (p = 0.010), cytoreduction of the upper abdominal space (p = 0.023), HIPEC treatment with paclitaxel (p = 0.013), and the presence of metastatic lymph nodes (p = 0.029). Conclusions Better RFS rates after CRS and HIPEC were observed for patients with the following characteristics: cytoreductive surgery without preoperative chemotherapy, complete surgery performed with limited surgical maneuvers, treated with cisplatin, and no lymph node metastases. Synopsis Endometrial cancer has a poor prognosis when diagnosed at advance stage. Patients with intraperitoneal metastases from endometrial cancer may benefit from CRS plus HIPEC with improvement in the recurrence-free survival results.

fifty to 70 percent of pancreatic neuroendocrine tumors are diagnosed incidentally. The objective of this study was to compare the phenotype and oncological outcomes of incidental versus symptomatic pancreatic neuroendocrine tumors.a retrospective study was performed, identifying all incidental and symptomatic tumors resected between 2000 and 2019. Baseline characteristics, symptoms, operative variables and pathological stage were all recorded. Patterns of recurrence and overall and disease-free survival were analyzed in both groups.fifty-one incidental and 45 symptomatic pancreatic tumor resections were performed. Symptomatic tumors were more frequent in females (29 vs 17; p = 0.005) and younger patients (median years; 50 vs 58; p = 0.012) and were detected at a more advanced stage (p = 0.027). There were no differences in location and most resections (n = 49; 51 %) were performed laparoscopically. There were no operative mortalities and 17 (17.7 %) severe complications (≥ IIIb on the Clavien-Dindo classification) were recorded with no differences between the two groups. With a median follow-up of 64.4 months (range 13.5-90), overall survival at five and ten years was 89.7 % and 72.8 % for the non-incidental tumors and 80.9 % and 54.6 % for the incidental tumors (p = ns), respectively. Disease-free survival in both groups (excluding M1a) was 71.2 % and 47.5 %, and 93.7 % and 78.1 %, respectively (p = ns).symptomatic tumors are more frequent in females and present at more advanced pathological stages. There were no significant differences in overall and disease-free survival between the two groups. Resection of incidental tumors ≥ 1.5-2 cm seems advisable, although each case should be assessed on an individual basis.

Gastric cancer (GC) with peritoneal carcinomatosis (PC) is traditionally considered a terminal stage of the disease. The use of a multimodal treatment, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), can benefit these patients. Our goal was to evaluate the morbidity and survival outcomes of these patients. This is a retrospective, multicenter study from a prospective national database of patients diagnosed with PC secondary to GC treated with CRS and HIPEC from June 2006 to October 2017. Eighty-eight patients from seven specialized Spanish institutions were treated with CRS and HIPEC, with median age of 53 years; 51% were women. Median Peritoneal Cancer Index (PCI) was 6, and complete cytoreduction was achieved in 80 patients (90.9%). HIPEC was administered in 85 cases with 4 different regimens (Cisplatin + Doxorubicin, Mitomycin-C + Cisplatin, Mitomycin-C and Oxaliplatin). Twenty-seven cases (31%) had severe morbidity (grade III–IV) and 3 patients died in the postoperative period (3.4%). Median follow-up was 32 months. Median overall survival (OS) was 21.2 months, with 1-year OS of 79.9% and 3-year OS of 30.9%. Median disease-free survival (DFS) was 11.6 months, with 1-year DFS of 46.1% and 3-year DFS of 21.7%. After multivariate analysis, the extent of peritoneal disease (PCI ≥ 7) was identified as the only independent factor that influenced OS (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.26–4.46, p = 0.007). The multimodal treatment, including CRS and HIPEC, for GC with PC can improve the survival results in selected patients (PCI

Resumen El linfoma anaplasico de celulas grandes asociado a implantes mamarios (BIA-ALCL segun sus siglas en ingles) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugia reconstructiva y estetica de mama mediante implantes. Este segundo articulo presenta la parte del consenso de la Sociedad Espanola de Senologia y Patologia Mamaria (SESPM) sobre el tratamiento quirurgico, medico, radioterapico, pronostico y seguimiento.

Resumen El linfoma anaplasico de celulas grandes asociado a implantes mamarios (BIA-ALCL segun sus siglas en ingles) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugia reconstructiva y estetica de mama mediante implantes. Estos articulos presentan un consenso de la Sociedad Espanola de Senologia y Patologia Mamaria (SESPM) con la idea de unificar, en esta primera parte, los criterios de diagnostico de esta enfermedad describiendo asimismo la epidemiologia y la etiopatogenia.

The use of preoperative breast MRI remains controversial despite being the most sensitive technique for the detection of breast malignancies.To evaluate the benefit of preoperative breast MRI after performing the three conventional techniques (DM, US, DBT). To analyze the influence of breast density in the sensitivity of the different imaging techniques.Retrospective review of 280 histologically confirmed breast cancers in 192 women. We reviewed the medical records and evaluated the change of treatment induced by MRI. Also, we assessed the reports of DM and the combination of the different imaging techniques, and categorized them according to ACR density (a-d) and as negative (BI-RADS 1-3) or positive (BIRADS 4 or 5). The gold standard was the pathologic assessment of the surgical specimen. The sensitivity of the different techniques was compared using McNemar test.Among these 192 women the use of MRI did not significantly increase the mastectomy rate (from 16.6% to 17.6%; p = 0.5). The addition of any technique demonstrated a higher sensitivity than DM alone. The sensitivity of DM alone was 52.5% while using all the techniques, including MRI, was 94.3% (p 0.001). Regardless of breast density pattern, the addition of any technique significantly increased the sensitivity of DM (p 0.001).The addition of MRI to the three conventional techniques increased the sensitivity but did not significantly modify the rate of mastectomies. Additional techniques increased the sensitivity of DM in both dense and non-dense breasts.

BACKGROUND Laparoscopic resection is the treatment of choice for colorectal cancer. Rates of conversion to open surgery range between 7% and 30% and controversy exists as to the effect of this on oncologic outcomes. The objective of this study was to analyze what factors are predictive of conversion and what effect they have on oncologic outcomes. METHODS From a prospective database of patients undergoing laparoscopic surgery between 2000 and 2018 a univariate and multivariate analyses were made of demographic, pathologic, and surgical variables together with complementary treatments comparing purely laparoscopic resection with conversions to open surgery. Overall and disease-free survival were compared using the Kaplan-Meier method. RESULTS Of a total of 829 patients, 43 (5.18%) converted to open surgery. In the univariate analysis, 12 variables were significantly associated with conversion, of which left-sided resection [odds ratio (OR): 2.908; P=0.02], resection of the rectum (OR: 4.749, P=0.014), and local invasion of the tumor (OR: 6.905, P

COVID-19 is associated with severe coagulopathy. We present three cases of colonic ischemia that can be attributed to the hypercoagulable state related with SARS-CoV2 and disseminated intravascular coagulation. Three males aged 76, 68 and 56 with respiratory distress presented episodes of rectal bleeding, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia. One patient (case 2) in which a computed tomography (CT) scan showed perforation of the gangrenous cecum underwent surgery. D-dimer levels were markedly increased (2,170, 2,100 and 7,360 ng/ml) in all three patients. All three patients died shortly after diagnosis.

Severe disease caused by the SARS-CoV coronavirus is characterized by patients presenting with respiratory distress associated with a systemic inflammatory response syndrome (cytokine storm). Sixteen to thirty percent of COVID-19 patients also have gastrointestinal symptoms. Here we present three cases of COVID-19 who developed colonic ischemia. Three males aged 76, 68 and 56 with respiratory distress and receiving mechanical ventilation presented episodes of rectal bleeding, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia and pneumoperitoneum.One patient (case 2) underwent surgery in which perforation of the gangrenous cecum and colonic ischemia was confirmed.In all three patients D-dimer levels were markedly increased (2170, 2100 and 7360 ng/mL). All three patients died shortly after diagnosis.In severe COVID-19 disease, the pathogenic cause has increasingly become attributed to the development of disseminated intravascular coagulation secondary to the systemic inflammatory response.

Purpose: the aim of this study was to compare overall and disease-free survival among patients with colorectal cancer detected via a screening program as compared to those with symptomatic cancer. Material and methods: patients diagnosed via colonoscopy (screening group) and those with clinical symptoms (non-screening) were identified from 1995 to 2014. Demographic, clinical, surgical and pathologic variables were recorded. Stage I, II and III cancers were included. Overall and disease-free survival were calculated at five and ten years after tumor resection and survival was calculated by matching both groups for cancers at stage I, II and III. Results: two hundred and fifty patients were identified as a result of screening procedures and 1,330 patients presented with symptomatic cancers. There were no significant differences in the baseline characteristics between the two groups. Pathologic stage, degree of differentiation, perineural invasion and lymphovascular invasion were lower in the screening group (p < 0.01). Overall and disease-free survival at five and ten years were higher in the screening group (p < 0.01). However, when the subjects were matched for pathologic stage, significant differences were found between the two groups with regard to stage I and III tumors. Disease-free survival in stage III at five years (79.1 vs 61.7%; p < 0.001) and ten years (79.1% vs 58.5%; p < 0.001) were significantly higher in the screening group. Conclusions: patients with stage I and III tumors that were diagnosed via a screening program have a higher overall and disease-free survival at five and ten years.

Objective: the objective of the present study was to analyze the characteristics of resected incidental lesions of the pancreas. Material and methods: a retrospective study was performed of pancreatectomies due to incidentalomas between 1995 and 2018. Results: one hundred pancreatectomies were performed due to incidental lesions; 64 (64%) were solid and 36 (36%) were cystic lesions. The cytological analysis agreed with the diagnosis in 67/71 (88.7%) cases. Thirty-six tumors were cystic, 48 were neuroendocrine and 16 were adenocarcinomas. Disease-free survival for patients with cystic, neuroendocrine tumors and adenocarcinomas was 100%, 79% and 57.7% (p < 0.04). Conclusion: pancreatic incidentalomas have a heterogeneous phenotype and should be treated in experienced centers

Introduction Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. Aim of the study To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC. Patients and methods All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC. Results Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers. Conclusions Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.

Our aim was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in primary tumour staging of patients with breast cancer.This retrospective study evaluated 45 women with 49 pathologically proven breast carcinomas. MRI and prone PET-CT scans with time-of-flight and point-spread-function reconstruction were performed with the same dedicated breast coil. The studies were assessed by a radiologist and a nuclear medicine physician, and evaluation of fused images was made by consensus. The final diagnosis was based on pathology (90 lesions) or follow-up ≥ 24 months (17 lesions).The study assessed 72 malignant and 35 benign lesions with a median size of 1.8 cm (range 0.3-8.4 cm): 31 focal, nine multifocal and nine multicentric cases. In lesion-by-lesion analysis, sensitivity, specificity, positive and negative predictive values were 97%, 80%, 91% and 93% for MRI, 96%, 71%, 87%, and 89% for prone PET, and 97%. 94%, 97% and 94% for MRI fused with PET. Areas under the curve (AUC) were 0.953, 0.850, and 0.983, respectively (p 0.01).MRI fused with FDG-PET is more accurate than FDG-PET in primary tumour staging of breast cancer patients and increases the specificity of MRI.• FDG PET-CT may improve the specificity of MRI in breast cancer staging. • MRI fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose PET-CT has better overall diagnostic performance than MRI. • The clinical role of fused PET-MRI has not yet been established.

Background: The degree of histopathological response after neoadjuvant therapy in locally advanced gastric cancer (GC) is a key determinant of patients' long-term outcome. We aimed to assess the pattern of histopathological regression after two neoadjuvant approaches and its impact on survival times. Methods: Regression grade of the primary tumour (Becker criteria) and the degree of nodal response by a 4-point scale (grades A–D) were assessed. Grade A—true negative lymph nodes (LNs); grade B and C—infiltrated LNs with any or little evidence of nodal response; and grade D—complete pathological response in a previously infiltrated LN. A favourable pathological response was defined as Becker Ia–b and grade D. Results: From 2004 to 2014, 80 patients with GC (cT3–4/N+ by CT-scan/EUS) were treated with either preoperative chemotherapy (ChT, n=34) or chemoradiation (CRT, n=46). Patients in the CRT group had a higher likelihood of achieving a Becker Ia–b response (58 vs 32%, P=0.001), a grade D nodal regression (30 vs 6%, P=0.009) and a favourable pathological response (23 vs 3% P=0.019). Patients with a grade D nodal response had a longer 5-year PFS and OS compared with those with a grade B or C response. Patients with a baseline negative LN status had similar outcomes irrespective of the preoperative therapy received (5-year OS; ChT vs CRT, 58 vs 51%, P=0.92). Conclusions: Preoperative chemoradiation increases the likelihood of achieving favourable histopathological features that correlate with a 5-year OS>70% in GC patients.

Purpose To assess the safety, feasibility, and efficacy of free-hand intraoperative multicatheter breast implant (FHIOMBI) and perioperative high-dose-rate brachytherapy (PHDRBT) in early breast cancer. Methods and Materials Patients with early breast cancer candidates for breast conservative surgery (BCS) were prospectively enrolled. Patients suitable for accelerated partial breast irradiation (APBI) (low or intermediate risk according GEC-ESTRO criteria) received PHDRBT (3.4 Gy BID × 10 in 5 days). Patients not suitable for APBI (high risk patients according GEC-ESTRO criteria) received PHDRBT boost (3.4 Gy BID × 4 in 2 days) followed by whole breast irradiation. Results From June 2007 to November 2014, 119 patients were treated and 122 FHIOMBI procedures were performed. Median duration of FHIOMBI was 25 minutes. A median of eight catheters (range, 4–14) were used. No severe intraoperative complications were observed. Severe early postoperative complications (bleeding) were documented in 2 patients (1.6%), wound healing complications in 3 (2.4%), and infection (mastitis or abscess) in 2 (1.6%). PHDRBT was delivered as APBI in 88 cases (72.1%) and as a boost in 34 (27.8%). The median clinical target volume T was 40.8 cc (range, 12.3–160.5); median D90 was 3.32 Gy (range, 3.11–3.85); median dose homogeneity index was 0.72 (range, 0.48–0.82). With a median followup of 38.4 months (range, 8.7–98.7) no local, elsewhere, or regional relapses were observed; there was only one distant failure in PHDRBT boost. No major (acute or late) RTOG grade 3 or higher were documented in any of the 119 patients treated with PHDRBT. Cosmetic outcome in APBI patients was excellent or good in (87.0%) and fair or poor in (11.9%) while in boost patients was excellent or good in (76.4%) and fair in (23.5%). Conclusion The FHIOMBI-PHDRBT program does not add complications to conservative surgery. It allows precise selection of APBI patients and offers excellent results in disease control and cosmetics. It also offers logistic advantages because it dramatically shortens the time of local treatment and avoids further invasive procedures.

CASE A 62-YEAR-OLD WOMAN presented with slight hypophosphatemia (2.4 mg/dL; normal range, 2.5– 4.7) and mild hypercalcemia (10.5 mg/dL; normal range, 8.1–10.4) in the preoperative assessment of surgery for morbid obesity (body mass index of 44 kg/m). Bone densitometry showed severe lumbar osteoporosis, and parathyroid hormone (PTH) levels were 188 pg/mL (reference range, 12–72). Within this frame work, the most probable diagnosis was primary hyperparathyroidism caused by a solitary adenoma. However, neither cervical ultrasonography or scintigraphy with mTc-MIBI showed a parathyroid adenoma. C-11 methionine positron emission tomography/computed tomography (Met-PET/CT) showed 1 focal high uptake (SUVmax = 5.5) located in contact with the left posterior wall of cervical esophagus (Fig 1). Endoscopic ultrasonography confirmed the presence of a 3.5-cm, oval-shaped nodule in contact with the posterior surface of the esophagus but not infiltrating esophageal wall. Operative resection of the nodule was indicated by the probable diagnosis of primary hyperparathyroidism caused by an ectopic retroesophageal parathyroid adenoma. A lateral neck incision was made along the anterior border of the left sternocleidomastoid muscle (Fig 2). The omohyoid muscle was displaced and the cervical visceral fascia was

Resumen Introduccion La irradiacion parcial acelerada de la mama (IPAM) con multicateteres tras cirugia conservadora del cancer de mama (CM) puede ser una alternativa a la radioterapia externa adyuvante convencional para un grupo seleccionado de pacientes. El objetivo es describir nuestra experiencia en los ultimos 5 anos. Metodos Entre junio de 2007 y junio de 2012 fueron evaluados 87 pacientes con CM para IPAM. Los criterios de inclusion fueron: edad mayor de 40 anos, tumor unifocal, histologia de carcinoma ductal infiltrante o intraductal, tamano menor de 3 cm y ausencia de afectacion ganglionar. Se valoraron las complicaciones, el resultado cosmetico y la recidiva local y a distancia. Resultados La IPAM se completo en 48 pacientes y se contraindico en 39. La edad media de las pacientes tratadas fue de 59 anos. La mediana del tiempo quirurgico fue de 123 min (rango 72-234), con una media de 9 cateteres implantados por paciente. No se registraron complicaciones durante la intervencion ni en la radioterapia. La mediana de la estancia hospitalaria fue de 4 dias (rango 2-14). El tamano tumoral medio fue de 11 mm. En 35 casos se trataba de carcinomas ductales infiltrantes y en 13 de carcinomas intraductales. Cuarenta y cuatro pacientes recibieron tratamiento adyuvante. Con una mediana de seguimiento de 22 meses (rango 5-64), no se ha observado recidiva local ni a distancia. El resultado estetico fue bueno o excelente en el 66% de casos. Conclusiones La IPAM con multicateteres colocados en el mismo acto operatorio de la cirugia conservadora del CM es una tecnica segura y fiable pero exige una meticulosa seleccion de pacientes.

Fundamento. La mastectomia de limpieza esta indicada con caracter paliativo en el cancer de mama localmente avanzado. Para cerrar el defecto cutaneo puede ser necesario el empleo de un injerto. Mostramos nuestra experiencia con el uso de un colgajo DIEP ( Deep Inferior Epigastric artery Perforators ) de cobertura tras la realizacion de una mastectomia de gran extension. Material y metodos. Se muestra el caso de una paciente con un tumor de mama muy avanzado localmente, que era subsidiaria de un tratamiento quirurgico agresivo tras la administracion de quimioterapia. Resultados. Se considero que el cierre que puede ofrecer un colgajo realizado con el musculo dorsal ancho esta insuficiente, por lo que se realizo un DIEP. La paciente presento una evolucion postoperatoria satisfactoria. Conclusiones. El colgajo DIEP de cobertura ofrece una gran extension cutanea. Puede ser un recurso en casos muy seleccionados de tumores de mama localmente avanzados, en los que la cirugia se convierte en la principal arma terapeutica.

Objective To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. Material and methods We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. Results The mean age of patients in the two series were similar (51.5 and 51.8 years, p = 0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (p Conclusion When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend toward significance.

Resumen Objetivo Comparar 2 series de pacientes con cancer de mama, una estadificadas mediante resonancia magnetica (RM) preoperatoria y la otra con tecnicas convencionales, y estudiar los cambios de tratamiento y el numero de mastectomias y de reintervenciones por afectacion de los bordes. Material y metodos Se revisaron 600 pacientes divididas en 300 con RM preoperatoria (serie 1) y 300 sin RM (serie 2). Se valoraron: la edad, el estado menopausico, el tamano tumoral anatomopatologico, la multiplicidad y bilateralidad, el tratamiento quirurgico y tipo de tratamiento, la administracion de quimioterapia neoadyuvante y las reintervenciones por margenes afectos. Las variables fueron comparadas con las pruebas t de Student y la Chi-cuadrado. Resultados La edad media fue similar (51,5 y 51,8 anos, p = 0,71). El tamano tumoral medio fue menor (p Conclusion Las mastectomias disminuyen al emplear la RM, con disponibilidad de tecnicas de cirugia oncoplastica y quimioterapia neoadyuvante. Pese al aumento de cirugias conservadoras en la serie con RM, no observamos un aumento significativo del numero de reintervenciones por margenes afectos, aunque existe una tendencia.

Resumen Objetivos Entre los factores moduladores de prevalencia de carcinoma diferenciado de tiroides (CDT) destacan la concentracion plasmatica de TSH, la nodularidad tiroidea y la asociacion con la autoinmunidad. La TSH estimula la proliferacion de celulas foliculares normales y neoplasicas. Los anticuerpos contra el receptor de TSH (TSI), por su accion TSH-like , deberian estimular el crecimiento del CDT. El objetivo fue comparar la prevalencia de CDT incidental en pacientes tiroidectomizados por enfermedad benigna. Pacientes y metodos Se estudio la anatomia patologica de 372 pacientes con diagnosticos prequirurgicos de bocio multinodular normofuncionante (BMN) o hipertiroidismo. La gammagrafia, y/o presencia de TSI diferencio entre bocio multinodular hiperfuncionante (BMH) y enfermedad de Graves (EG). Se comparo la prevalencia de CDT en cada categoria (χ 2 ). Resultados Se encontraron 221 sujetos con BMN, 125 con EG y 26 con BMH. Se hallaron 58 CDT con la siguiente distribucion: BMN, 49 (22,2%); EG, 8 (6,4%) y BMH, 1 (3,8%). La diferencia de prevalencia de CDT entre los grupos fue estadisticamente significativa (p Conclusiones La prevalencia de CDT incidental es menor en EG que en BMN, siendo el resultado independiente de la edad. Este hallazgo puede indicar una predisposicion hacia el desarrollo de CDT en pacientes con enfermedad nodular tiroidea y/o que la reaccion autoinmunitaria puede resultar un factor protector contra el desarrollo de enfermedad neoplasica.

To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution.From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment.Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%.The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

Introducción El impacto del tratamiento neoadyuvante sobre las complicaciones postoperatorias en el cáncer de estómago es motivo de controversia. El objetivo de este trabajo es analizar la morbilidad y la mortalidad postoperatoria en un grupo de pacientes a los que se les había aplicado un protocolo de quimiorradioterapia preoperatoria, así como identificar posibles factores de riesgo que se asocian al desarrollo de complicaciones. Material y métodos Entre junio de 2005 y junio de 2008, pacientes diagnosticados de adenocarcinoma gástrico localmente avanzado se intervinieron en nuestro Centro tras haber seguido un protocolo de quimiorradioterapia preoperatoria. Se recogieron prospectivamente los datos sobre morbilidad y mortalidad postoperatoria y se analizaron las variables dependientes relacionadas con los pacientes, con el tipo de intervención y las características tumorales. Resultados Se evaluaron 40 pacientes. La morbilidad y la mortalidad global fue del 32,5% (13 pacientes) y del 2,5% (un paciente), respectivamente. Las complicaciones más frecuentes fueron la neumonía en el 12,9% y la sepsis por catéter en el 9,7% de los pacientes. Los factores de riesgo para el desarrollo de complicaciones fueron el índice de masa corporal (>25 kg/m2) y la inclusión en la resección del páncreas o del bazo. Conclusiones El tratamiento preoperatorio con quimiorradioterapia en pacientes con cáncer de estómago localmente avanzado no incrementa la incidencia de complicaciones postoperatorias. La condición preoperatoria del paciente (índice de masa corporal) y la extensión de la cirugía del bazo y del páncreas son factores pronósticos de complicaciones postoperatorias precoces. Abstract Introduction The impact of neoadjuvant treatment on the postoperative complications in stomach cancer is a subject of controversy. The aim of this study is to analyse the post-surgical morbidity and mortality in a group of patients who were treated using a chemoradiotherapy protocol before surgery, as well as to identify the possible risk factors that may be associated with the development of complications. Material and methods Patients diagnosed with locally advanced gastric adenocarcinoma between June 2005 and June 2008 were operated on in our Centre after having followed a preoperative chemoradiotherapy protocol. Data on postoperative morbidity and mortality were collected retrospectively and the dependent variables associated with the patients, the type of intervention and the tumour characteristics were analysed. Results A total of 40 patients were evaluated. The overall morbidity and mortality was 32.5% (13 patients) and 2.5% (1 patient), respectively. The most frequent complications were pneumonia in 12.9% and sepsis due to the catheter in 9.7% of the patients. The risk factors for the development of complications were the body mass index (BMI 25 kg/m2) and the inclusion of the pancreas and/or spleen in the resection. Conclusions Preoperative treatment with chemoradiotherapy in patients with locally advanced stomach cancer does not increase the incidence of post-surgical complication. The preoperative condition of the patient (BMI) and extending the surgery to the spleen and pancreas are prognostic factors of early postoperative complications.

Introduction The impact of neoadjuvant treatment on the postoperative complications in stomach cancer is a subject of controversy. The aim of this study is to analyse the post-surgical morbidity and mortality in a group of patients who were treated using a chemoradiotherapy protocol before surgery, as well as to identify the possible risk factors that may be associated with the development of complications. Material and methods Patients diagnosed with locally advanced gastric adenocarcinoma between June 2005 and June 2008 were operated on in our Centre after having followed a preoperative chemoradiotherapy protocol. Data on postoperative morbidity and mortality were collected retrospectively and the dependent variables associated with the patients, the type of intervention and the tumour characteristics were analysed. Results A total of 40 patients were evaluated. The overall morbidity and mortality was 32.5% (13 patients) and 2.5% (1 patient), respectively. The most frequent complications were pneumonia in 12.9% and sepsis due to the catheter in 9.7% of the patients. The risk factors for the development of complications were the body mass index (BMI, 25 kg/m2) and the inclusion of the pancreas and/or spleen in the resection. Conclusions Preoperative treatment with chemoradiotherapy in patients with locally advanced stomach cancer does not increase the incidence of post-surgical complication. The preoperative condition of the patient (BMI) and extending the surgery to the spleen and pancreas are prognostic factors of early postoperative complications.

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM) have been used to predict morbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations need some adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group of patients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables. METHODS: between January 1995 and December 2004, 273 consecutive patients underwent surgery for rectal cancer. Information was gathered about the patients, tumour and therapy. To assess the prediction capacity of POSSUM, subgroups for analysis were created according to variables related to operative morbidity and mortality. RESULTS: The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7% (6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUM predictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for those receiving neoadjuvant therapy. CONCLUSION: POSSUM is a good instrument to make results between different institutions and publication comparable. We found prediction errors for some variables related to morbidity. Modifications of surgical variables and specifications for neoadjuvant therapy as well as physiological variables including life style may improve future prediction of surgical risk. More research is needed to identify further potential risk factors for surgical complications.

Resumen Objetivo Analizar las caracteristicas de una serie, con especial referencia a su histogenesis y las posibilidades de la cirugia conservadora. Material y metodos Se reviso a 27 pacientes portadoras con cancer de mama (CM) y afectacion del pezon con caracteristicas de enfermedad de Paget (EP). Resultados Las pacientes tenian una media de 56,5 anos, los motivos de consulta fueron: eccema de pezon (48,1%), presencia de tumor mamario (26%) y secrecion por el pezon (18,5%). El examen fisico advirtio la lesion eccematosa en 26/27 casos. En 11 casos la imagen mamografica se localizo a nivel retroareolar, en 13 casos distal al pezon y en 3 casos la mamografia fue normal. En 15 casos correspondio a un carcinoma intraductal, y en los 12 restantes a carcinoma ductal infiltrante. En uno la EP fue hallazgo del estudio seriado de la pieza de mastectomia. Se practico una cirugia conservadora en 5 casos y mastectomia en 22 (6 con reconstruccion inmediata). Tras 6,5 anos de seguimiento medio, 2 pacientes presentaron diseminacion a distancia y una de las pacientes sometida a cirugia conservadora presento recidiva local. Conclusiones La EP representa el 1,4 % de los CM en nuestra serie y el signo diagnostico caracteristico es el eccema de pezon-areola. La mamografia muestra una baja sensibilidad diagnostica; se puede recurrir a la resonancia magnetica en los casos de EP sin patologia mamografica y se debe realizar biopsia de la lesion ante la menor duda diagnostica. El tratamiento mas utilizado fue la mastectomia, y se recurrio a la cirugia conservadora en casos seleccionados de EP limitada al pezon, o con lesion subareolar circunscrita, conociendo los riesgos de un tumor subyacente inadvertido.

The aim of the study was to show the clinical and radiological manifestations of metastases to the breast (MB). From 1987 to 2006, 33 patients with MB were diagnosed at our institution. Their clinical and radiological features were retrospectively evaluated. Of the 33 cases, 31 presented as a palpable breast lump. On mammography, their findings were classified as follows: well-circumscribed masses (11 cases), ill-circumscribed masses (five), focal asymmetric densities (one) and inflammatory skin changes (six). Mammograms were normal in six cases (all of them showed dense breast tissue). Four CT scans showed two well-circumscribed masses and two ill-circumscribed masses. Ultrasonography was available in 18 cases: hypoechoic lesions (15 cases) were more frequent than hyperechoic (one) or isoechoic lesions (two). The appearance on magnetic resonance was similar to primary breast cancer (one case). The most common primary tumours causing MB were haematological malignancies (nine cases) and melanomas (seven). Metastases to the breast showed a wide range of mammographic and ultrasonographic appearances, resembling both benign and malignant lesions. Any patient who presents with a breast lump with a history of cancer should undergo a core-needle biopsy in order to determine the histology of the lump.

Objetivo Revisar los hallazgos radiologicos del carcinoma adenoide quistico (CAQ), asi como su presentacion clinica. Material y metodo Realizamos un estudio retrospectivo desde enero de 1990 hasta julio de 2004, en el que se encontraron 5 casos de CAQ de mama, todos ellos en mujeres, entre 4.036 lesiones malignas diagnosticadas (0,12%). Se revisaron los estudios mamograficos disponibles (5 casos), ecograficos (4 casos) y de resonancia magnetica (un caso). Asimismo se reviso la presentacion clinica de los casos y la evolucion de las pacientes. Resultados Tres casos fueron palpables. Los hallazgos mamograficos consistieron en tres nodulos irregulares y mal delimitados, un nodulo redondeado bien delimitado y una densidad asimetrica. En ningun caso se apreciaron microcalcificaciones. En tres casos la ecografia mostro la presencia de nodulos polilobulados y mal delimitados, mientras que otra de las lesiones aparecio como un nodulo redondeado y bien delimitado con pequenos quistes en su interior. Esta lesion presento una intensa vascularizacion en el estudio doppler. El unico caso en que se realizo resonancia magnetica mostro un nodulo redondeado con captacion heterogenea de contraste, margenes bien definidos y curva de captacion altamente sospechosa de malignidad. El tratamiento aplicado en todos los casos fue la tumorectomia asociada a radioterapia. Cuatro de las pacientes se encuentran asintomaticas hasta el momento (seguimiento medio de 64 meses) y una de ellas presento metastasis pulmonares y hepaticas 12 anos despues del diagnostico de CAQ. Conclusion El CAQ es una tumoracion infrecuente de mama cuya apariencia radiologica es variada, aunque predominan lesiones de moderada o alta sospecha. Destacamos la ausencia de microcalcificaciones en estos tumores. Generalmente su pronostico es bueno, aunque existe la posibilidad de desarrollar metastasis a distancia.

Introduction Major abdominal surgery can be contraindicated in some cirrhotic patients because of severe portal hypertension. The present study reports our experience of three patients with abdominal tumours prepared for surgery by transjugular intrahepatic portosystemic shunts (TIPS) in order to reduce portal hypertension and the risk of intraoperative bleeding. Patients and methods Three patients with cirrhosis and portal hypertension diagnosed with a right colon carcinoma, an adenocarcinoma of pancreas and a gastric and sigmoid synchronic tumours in the same patient. Because portal hypertension was the leading cause of surgical contraindication, neoadjuvant TIPS placement was proposed before surgery. Results TIPS placement was performed without intra-procedure complications. An average reduction of 18 mmHg was achieved in portosystemic gradients. The planned operations were performed with a delay of 14-45 days after TIPS without intraoperative bleeding. Complications occurred in one patient without operative mortality. Conclusion TIPS placement allows a pre-operative portal decompression in cirrhotic patients with portal hypertension and abdominal tumours that require surgical treatment. This procedure reduces the risk of bleeding by reducing the portosystemic gradient and the varices around the tumoral area. This procedure is less invasive than conventional shunt surgery, but it is not free of complications and should be performed by experienced interventional radiologists on selected patients. This is still an experimental indication of TIPS which efficacy must be confirmed in larger series.

Background: Although curative resection is the treatment of choice for gastric cancer, controversy exists about the adequate extent of lymph node dissection when resection is performed. Methods: We retrospectively assessed 85 patients who underwent a limited lymphadenectomy (D1) and 71 who had an extended lymph node dissection (D2) in a single institution between 1990 and 1998 (median follow-up, 37.3 months). Prognostic factors were assessed by Cox proportional hazard models adjusted for potential confounders. Results: We found no significant difference in the length of hospital stay (median, 12.1 and 13.1 days), overall morbidity (48.2% and 53.5%), or operative mortality (2.3% and 0%) between D1 and D2, respectively. Five-year survival in the D2 group was longer (50.6%) than in the D1 group (41.4%) for tumor stages (tumor-node-metastasis) >I. In multivariate analysis, tumor-node-metastasis stage (hazard ratio for stages >I vs. 0–I, 11.6), the ratio between invaded and removed lymph nodes, the presence of distant metastases, Lauren classification, and the extent of lymphadenectomy (hazard ratio for D1 vs. D2, 2.3; 95% confidence interval, 1.25–4.30) were the only significant prognostic factors. Conclusions: Our experience shows that extended (D2) lymph node dissection improves survival in patients with resected gastric cancer.

We describe a novel technique for marking non-palpable breast lesions with the aim of selecting the best approach prior to performing a biopsy. The technique employs a new coil, specifically designed for breast localization, guided by stereotaxy. This technique is reserved for selected cases in which the lesion is seen peripherally in only one mammographic view with negative or non-conclusive ultrasonographic results, and deeply seated after a stereotactic study. Once the coil is released beside the lesion, the shortest approach from the skin may be employed to perform the biopsy. To our knowledge, this is the first report of this technique.

Background Operations for large and recurrent abdominal hernias have a high associated recurrence rate, although it is lower when prosthetic material is used. Expanded polytetrafluoroethylene (ePTFE) seems to be the best tolerated prosthetic material in surgery. Methods A series of 45 ventral hernias repaired using ePTFE for closure or reinforcement of the herniorrhaphy has been evaluated prospectively. Thirty-six were midline incisional hernias and nine were transverse or pararectal ventral hernias. There were 13 recurrent ventral hernias and three defects were operated as an emergency procedure. The patch was sutured to the anterior aponeurosis with a running non-absorbable suture. Some other kind of intra-abdominal procedure was undertaken in 12 cases. Results ePTFE was well tolerated. Complications occurred in five patients. Major complications were found in three patients: cutaneous necrosis requiring a myocutaneous flap; and infection of the prosthesis (primary, and secondary to enterocutaneous fistula due to diverticulitis, both requiring removal of the patch). Mean follow-up was 39 months and hernia recurrence occurred in only one patient. Conclusion This clinical experience shows that ePTFE is a very reliable prosthetic material for the repair of abdominal wall hernias.

The use of liquid silicone for breast augmentation was widespread in the 1960s but was abandoned at the end of the decade due to numerous studies describing the development of a large number of local complications, as well as remote migration of small amounts of silicone. The use of liquid silicone also leads to enormous difficulty in the early diagnosis of breast cancer; these patients are precluded from routine screening programs and must undergo exhaustive periodic examinations. Magnetic resonance imaging has become the most effective test for the early detection of breast cancer in these patients. Indications for subcutaneous mastectomy are the presence of local complications, suspicion of a malignant lesion, or the patient’s desire to prevent both these potential problems.

La presencia de atipia o carcinoma en un fibroadenoma es un hallazgo infrecuente. Se ha realizado un estudio retrospectivo de los archivos de nuestro centro desde enero de 1995 hasta junio de 2003. Se encontraron un total de 881 fibroadenomas con confirmacion histologica, y siete de ellos con atipia o carcinoma asociados (dos carcinomas ductales in situ , dos carcinomas lobulillares in situ , y tres hiperplasias ductales con atipia). La edad media fue de 44 anos (rango: 36-67). Cuatro de los siete fibroadenomas se presentaron como lesiones palpables que habian experimentado crecimiento, que correspondieron a los cuatro casos de carcinoma. Hallazgos mamograficos (tres casos): dos agrupaciones de microcalcificaciones y un nodulo bien delimitado. Hallazgos ecograficos (seis casos): cuatro nodulos ovoideos bien definidos, un nodulo con calcificaciones y un nodulo ovoideo bien definido de ecoestructura heterogenea. El diagnostico inicial se realizo mediante biopsia escisional en 5 casos y mediante biopsia con aguja gruesa en otros dos casos. Los dos casos de biopsia con aguja gruesa tuvieron un primer resultado de fibroadenoma, pero la cirugia posterior demostro la presencia de carcinoma ductal in situ y un carcinoma lobulillar in situ . En conclusion se puede decir que los fibroadenomas con atipia o carcinoma pueden ser similares a los fibroadenomas habituales en mamografia y ecografia. Sin embargo, el crecimiento de un nodulo palpable, la presentacion mamografica como microcalcificaciones sospechosas o el hallazgo ecografico de un nodulo heterogeneo, obligan a la realizacion de una biopsia escisional para un diagnostico fiable.

Objetivo Los tumores mucocele-like (TML) de mama son lesiones infrecuentes que se definen anatomopatologicamente como quistes o conductos dilatados que contienen mucina. Nuestro objetivo es describir los hallazgos clinicos, mamograficos y ecograficos de los TML de mama. Material y metodos Estudio retrospectivo. En los archivos de nuestro centro se encontraron cuatro casos de TML, todos ellos confirmados mediante biopsia escisional. Se reviso la presentacion clinica (edad y palpacion), asi como los hallazgos mamograficos y ecograficos. Resultados La edad media de las pacientes fue de 42 anos (rango: 35-48). Uno de los casos resulto palpable, se trataba de un nodulo blando de baja sospecha. Los hallazgos mamograficos consistieron en dos casos en una agrupacion de microcalcificaciones polimorficas sospechosas, mientras que en los otros dos las mamografias fueron normales. La ecografia mostro la presencia de quistes con ecos internos difusos en los dos casos con mamografias normales. Conclusiones Los TML son lesiones mamarias que pueden manifestarse como un nodulo palpable de baja sospecha en la exploracion fisica, como microcalcificaciones sospechosas en mamografia o como quistes con ecos internos difusos en ecografia.

Resumen Los paragangliomas son tumores derivados del sistema neuroendocrino, muy poco frecuentes, cuya incidencia estimada es de alrededor de unos 0,2-0,5 casos por 100.000 habitantes/ano. El 60-70% de los paragangliomas son funcionantes, localizandose en su mayoria en el espacio retroperitoneal, sobre todo en las glandulas suprarrenales, constituyendo los feocromocitomas. Un porcentaje muy escaso tienen una localizacion extraadrenal. La mayoria son tumores unicos. El tratamiento de estos tumores consiste en la extirpacion quirurgica debido a la clinica, sobre todo de hipertension arterial (HTA), que producen y a la posibilidad de malignizacion. Presentamos el caso de un paciente diagnosticado por tomografia de emision de positrones (PET) de paraganglioma extraadrenal localizado en la confluencia de las venas cava y renal derecha, al que se realizo extirpacion del mismo mediante abordaje laparoscopico transabdominal.

Purpose Accelerated partial breast irradiation (APBI) with multicatheters after lumpectomy for breast cancer (BC) may be an alternative to whole breast irradiation in selected patients. The aim is to show our 5 year experience. Method Between June 2007 and June 2012, 87 BC patients have been evaluated for APBI. Inclusion criteria were: age over 40 years, unifocal tumor, infiltrating ductal or intraductal carcinoma, tumor size smaller than 3 cm and no lymph node involvement. Results Treatment was completed in 48 patients and contraindicated in 39. The average age of treated patients was 59 years. Operating time was 126 min with 9 implanted catheters in each patient. No complications were observed during surgery or radiotherapy. Patients were discharged from hospital after 4–6 days. Tumor size was 11 mm. Of these, 35 were infiltrating ductal and 13 intraductal carcinomas. 44 patients received adjuvant treatment. Mean follow-up was 20 months with no evidence of local or distant recurrence. The cosmetic outcome was good or excellent in 63% of cases. Conclusions APBI with multicatheter placed after lumpectomy for BC is feasible and safe but requires a strict selection of patients. Moreover, it may have certain advantages over other APBI techniques and over standard radiation therapy.

OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges reported in the literature for teams with high prevalence of the disease.

Risk factors for differentiated thyroid carcinoma (DTC) are poorly understood, but serum TSH levels, thyroid nodularity, and presence of autoimmunity are well-recognized factors that modulate DTC prevalence. TSH stimulates proliferation of both normal and neoplastic follicular cells. Consequently, thyroid-stimulating immunoglobulins (TSI), because of its TSH-like action, should induce DTC progression in patients with Graves' disease (GD). The study objective was to compare the prevalence of incidental DTC in patients undergoing thyroidectomy for benign thyroid disease.The pathology reports of 372 patients with preoperative diagnosis of euthyroid multinodular goiter (EMG) or hyperthyroidism were reviewed. Scintigraphy results and serum TSI levels were used to diagnosed either GD or hyperactive MG (HMG) to hyperthyroid subjects. Prevalence of DTC in each category was calculated using a Chi-square test.EMG, GD, and HMG were diagnosed in 221, 125, and 26 patients. There were 58 DTCs, distributed as follows [n (%)]: EMG, 49 (22.2%); GD, 8 (6.4%), and HMG, 1 (3.8%). Difference in prevalence of incidental DTC between the groups was statistically significant (p0.001). After adjustment for age, patients with EMG had a greater DTC prevalence than GD patients, with an OR of 4.17 (p0.001). Tumor size (mm, mean ± SD) was 6.92 ± 11.26, 1.97 ± 1.85, and 9.0 for EMG, GD and HMG respectively (p=0.017).Incidental DTC was less prevalent in GD as compared to EMG irrespective of age. This finding may suggest a predisposition to develop DTC in patients with thyroid nodular disease and/or a potential effect of autoimmunity to protect against development of neoplastic disease.

Background Significant tumor downstaging has been achieved in patients with localized gastric adenocarcinoma by preoperative chemoradiotherapy (ChRT) or induction chemotherapy (Ch). However the influence of ChRT and Ch on postoperative outcomes has not yet been clarified, with very few studies examining this issue. We retrospectively analyzed the efficacy in terms of pathological response and early postoperative complications of two protocols of preoperative ChRT and Ch for locally advanced gastric cancer. Methods Between 2000 and 2008, 72 patients with operable locally advanced gastric cancer (cT3-4/N+) were treated with preoperative treatment: 1—patients receiving induction Ch or 2—neoadjuvant Ch followed by concurrent ChRT. Postoperative histopathological regression and surgical complications were investigated including variables related to patients, surgical variables, preoperative treatment, and tumor. Results There were no differences in the incidence of complications between the ChRT and Ch groups (30.9% vs. 33.3%). The most frequent complications were nonspecific surgical complications (pneumonia [12.5%] and infection from intravenous catheters [9.7%]). Risk factors for complications were high-body mass index (BMI > 25 kg/m2) and extension of surgery to the pancreas and spleen. A major pathological response was observed in 33.3% of patients, being more frequent in the ChRT group (47.6% vs. 13.3%; χ2, P = 0.0024). Conclusions Preoperative treatment with Ch or ChRT for locally advanced gastric cancer can be performed safely with an acceptable operative morbidity and low operative mortality rate with careful consideration of the added risk associated with BMI and surgical resection of the pancreas and spleen. Ch and ChRT is feasible and effective in terms of pathological response and R0 resection. J. Surg. Oncol. 2011;104:124–129. © 2011 Wiley-Liss, Inc.

The Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous poliposis describred in 1921. Hemminki in 1997 described the presence of LKB-1 mutation tumor-suppressor gen. The patients with PJS develop a higher cumulative incidence of gastrointestinal, pancreas and extraintestinal tumors, being oc casion of a renew interest on hamartomatous polyposis syndro mes regarding the clinical care, cancer surveillance treatment and long term follow-up. We report the case of a 38 years old male, diagnosed of PJS who developed a multiple adenocarcinoma in duodenum and ye yunum. Surgically treated and with a long-term free disease survival of 11 years represents the sixth case reported in the spanish literature of PJS associated with a gastrointestinal tumor. A critical review, molecular alterations and the established criteria of tumor screening and surveillance are reviewed.