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Silva F, Bustamante M, Latorre G, Flandez J, Montero I, Dukes E, Gandara V, Robles C, Uribe J, Iglesias A, Bellolio F, Molina ME, Migueles R, Urrejola G, Larach T, Besser N, Sharp A, Agüero C, Riquelme A, Vargas JI, Candia R, Monrroy H, De Simone F, Espino A. Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile. Gastroenterol Hepatol 2024; 47:491-499. [PMID: 38331316 DOI: 10.1016/j.gastrohep.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AIM To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. METHODS Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. RESULTS A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. CONCLUSIONS Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.
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Affiliation(s)
- Felipe Silva
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel Bustamante
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Latorre
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - Jorge Flandez
- Institute of Medicine, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Isabella Montero
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eitan Dukes
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente Gandara
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Robles
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Uribe
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Iglesias
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Molina
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Migueles
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Urrejola
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Larach
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Besser
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allan Sharp
- Universidad Católica-Christus Health, Santiago, Chile; Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Agüero
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - José Ignacio Vargas
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - Roberto Candia
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - Hugo Monrroy
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile
| | - Federico De Simone
- Department of Digestive Endoscopy, Médica Uruguaya, Clínica CEVEN, Montevideo, Uruguay
| | - Alberto Espino
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Universidad Católica-Christus Health, Santiago, Chile.
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Gaete MI, Moreno D, Iglesias A, Navarro F, Dreyse J, Cerda J, Durán V, Molina ME, Miguieles R, Urrejola G, Larach JT, Bellolio F. Consistency between POLARS and LARS scores regarding the incidence of low anterior resection syndrome in a Chilean population undergoing rectal surgery secondary to cancer in a high-volume hospital. Colorectal Dis 2024; 26:317-325. [PMID: 38182552 DOI: 10.1111/codi.16852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/19/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024]
Abstract
AIM The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high-volume hospital. METHOD The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland-Altman plot with Lin's concordance correlation coefficient. RESULTS A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor. CONCLUSION In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales.
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Affiliation(s)
- M I Gaete
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Moreno
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Iglesias
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Navarro
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Dreyse
- Department of Internal Medicine and Critical Patient Center, Clínica Las Condes, Santiago, Chile
| | - J Cerda
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Durán
- Department of Digestive Surgery, Experimental Surgery and Simulation Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M E Molina
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Miguieles
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - G Urrejola
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J T Larach
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Bellolio
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Besser N, Chacón E, Iglesias A, Álvarez-Lobos M, Pavez C, Villalón C, Urrejola G, Zúñiga Á, Molina ME, Miguieles R, Bellolio F. [Has colectomy for moderate-severe active ulcerative colitis decreased?]. Rev Med Chil 2023; 151:313-320. [PMID: 38293876 DOI: 10.4067/s0034-98872023000300313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/04/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Nicolás Besser
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erika Chacón
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Iglesias
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Álvarez-Lobos
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Pavez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Villalón
- Clínica Alemana de Santiago, Facultad Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gonzalo Urrejola
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Zúñiga
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Molina
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Miguieles
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Cárcamo L, Peñailillo E, Bellolio F, Miguieles R, Urrejola G, Zúñiga A, Molina ME, Larach JT. Computed tomography-measured body composition parameters do not influence survival in non-metastatic colorectal cancer. ANZ J Surg 2021; 91:E298-E306. [PMID: 33682291 DOI: 10.1111/ans.16708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is an increasing interest in studying the impact of altered body composition parameters and colorectal cancer (CRC) treatment outcomes. The aim of this study is to explore the impact of computed tomography (CT)-measured visceral obesity, sarcopenia and myosteatosis on survival of non-metastatic CRC. METHODS Consecutive patients with stage I-III CRC who underwent curative-intent treatment between January 2010 and December 2015 were included. By measuring the visceral fat area, and the skeletal muscle index and radiodensity in the pre-operative staging CT, patients were classified as visceral obese, sarcopenic or myosteatotic. The associations between CT-based body composition parameters and survival were assessed using log-rank tests and a Cox regression analysis. RESULTS Of 359 patients, 263 (73.3%) were visceral obese, 85 (23.7%) sarcopenic and 80 (22.3%) myosteatotic. Overall (OS), cancer-specific (CSS) and disease-free survivals (DFS) at 5 years were 78.8%, 84.7% and 75%, respectively. Myosteatosis and the combination of myosteatosis and visceral obesity were associated with a reduced DFS (hazard ratio 1.67; 95% confidence interval 1.06-2.61 and hazard ratio 1.85; 95% confidence interval 1.15-2.96, respectively). However, after performing a multivariate analysis including other relevant clinicopathological factors, none of the body composition parameters were associated with any long-term outcome measures, even after stratifying by cancer stage. CONCLUSIONS CT-measured body composition parameters do not independently influence survival in non-metastatic CRC. There is a need for larger cohort studies with standardized patient selection and methodology to confirm these findings.
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Affiliation(s)
- Leonardo Cárcamo
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Peñailillo
- Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Miguieles
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Urrejola
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Zúñiga
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Molina
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Tomás Larach
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Irarrázaval MJ, Inzunza M, Muñoz R, Quezada N, Brañes A, Gabrielli M, Soto P, Dib M, Urrejola G, Varas J, Valderrama S, Crovari F, Achurra P. Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic. Surg Endosc 2020; 35:6300-6306. [PMID: 33140151 PMCID: PMC7605475 DOI: 10.1007/s00464-020-08130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
Summary and background data Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak. Methods Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed. Results Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department. Conclusions In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.
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Affiliation(s)
- María J Irarrázaval
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martin Inzunza
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Rodrigo Muñoz
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Nicolás Quezada
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Alejandro Brañes
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Mauricio Gabrielli
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pedro Soto
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martín Dib
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Gonzalo Urrejola
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Julian Varas
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Sebastián Valderrama
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Fernando Crovari
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pablo Achurra
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile.
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7
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Carcamo L, Miranda P, Zúñiga A, Alexander E, Molina ME, Urrejola G, Larach T, Miguieles R, Bellolio F. Ileal pouch-anal anastomosis in ulcerative colitis: outcomes, functional results, and quality of life in patients with more than 10-year follow-up. Int J Colorectal Dis 2020; 35:747-753. [PMID: 32067061 DOI: 10.1007/s00384-020-03529-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). IPAA was incorporated into our institution in 1984, and thereafter, more than 200 procedures have been performed. The functional results and morbidity of this surgery have been reported previously. However, long-term functional outcomes and quality of life have not been evaluated. METHODS As a cohort study, we identified all consecutive patients who underwent IPAA for UC between 1984 and 2017 and selected those with more than 10-year follow-up. Demographic data, morbidity, and pouch survival information were obtained. Long-term functional results and quality of life were evaluated through an e-mail survey using the Öresland score and the Cleveland Global Quality of Life scales, respectively. RESULTS Of 201 patients, 116 met the inclusion criteria. Median follow-up was 20 (10-34) years. Early post-operative complications (30 days) were observed in 19 (16.4%) patients and 66 (56.9%) presented adverse events. The IPAA preservation rate at 10 and 20 years was 96.5% and 93.1%, respectively. Long-term functional scores presented a median of 6 (1-15) points. IPAA function was satisfactory in 11 (20.0%) patients, acceptable in 18 (32.7%), and deficient in 26 (47.3%). The median score for global quality of life was 0.8 (0.23-1.0) points. CONCLUSION IPAA as treatment for UC meets the expectations of cure of the disease, maintaining adequate long-term intestinal functionality associated with a good quality of life in most patients.
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Affiliation(s)
- L Carcamo
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - P Miranda
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - A Zúñiga
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - E Alexander
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - M E Molina
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - G Urrejola
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - T Larach
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - R Miguieles
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile
| | - Felipe Bellolio
- Colorectal Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Región Metropolitana, Chile.
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8
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Quezada F, Castillo R, Villalón C, Zúñiga JM, Manterola C, Molina ME, Bellolio F, Urrejola G. [Treatment of a severe Clostridium difficile infection with colonic lavages. Report of one case]. Rev Med Chil 2015. [PMID: 26203580 DOI: 10.4067/s0034-98872015000500016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A loop ileostomy with intraoperative anterograde colonic lavage has been described as an alternative to colectomy in the management of cases of Clostridium difficile infection refractory to medical treatment. We report a 69 years old diabetic women admitted with a septic shock. An abdominal CAT scan showed a pan-colitis that seemed to be infectious. A polymerase chain reaction was positive for Clostridium Difficile. Due to the failure to improve after full medical treatment, a derivative loop ileostomy and intra-operatory colonic lavage were performed, leaving a Foley catheter in the proximal colon. In the postoperative period, anterograde colonic instillations of Vancomycin flushes through the catheter were performed every 6 hours. Forty eight hours after surgery, the patient improved. A colonoscopy prior to discharge showed resolution of the pseudomembranous colitis.
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Villalon C, Quezada F, Hartmann J, Roa JC, Urrejola G. Synchronous ileocecal and duodenal tuberculosis: case report and review of the literature. Int J Colorectal Dis 2014; 29:1027-8. [PMID: 24811119 DOI: 10.1007/s00384-014-1894-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Constanza Villalon
- Colorectal Surgery Unit, Digestive Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile
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10
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Urrejola G, Villalón R, Rodríguez N. [Perianal tuberculosis: report of two cases]. Rev Med Chil 2010; 138:220-222. [PMID: 20461312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Perianal tuberculosis is an uncommon variant of extra pulmonary tuberculosis and mimics other common perianal conditions. We report two patients with perianal tuberculosis. An 82-year-old male presenting with purulent perianal discharge and weight loss. A pelvic magnetic resonance imaging showed a low trans sphincteric anorectal fistula with abscess formation. A fistulectomy was performed and the pathological study showed a granulomatous-tuberculous chronic inflammation. Mycobacteria were recovered from gastric contents. A 48-year-old male with the same symptoms. An ulcerated lesion in the anal region was biopsied, disclosing a granulomatous inflammatory process with Ziehl-Nielsen stainable organisms.
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Affiliation(s)
- Gonzalo Urrejola
- Servicio de Cirugía, Hospital Barros Luco Trudeau, Santiago, Chile.
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11
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Puga B, Puga I, Cabrera ME, Undurraga MS, Guerra C, Urrejola G, Toro P. [High risk febrile neutropenia in acute leukemia. The experience of a public hospital. National Program of Antineoplastic Drugs in Adult, Hospital del Salvador, 1991-2001]. Rev Med Chil 2003; 131:1023-30. [PMID: 14635589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Febrile neutropenia is one of the most important problems to face during the treatment of acute leukemia. AIM To assess the results of a standardized protocol for the treatment of febrile neutropenia and compare it with a period in which treatment was not standardized. PATIENTS AND METHODS One hundred and eight episodes of febrile neutropenia in 69 patients, treated with a standardized antimicrobial protocol between 1996 and 2001, were analyzed. The protocol consisted in the use of a combination of antimicrobial whose spectrum was broadened progressively according to the isolated microorganisms and the involved foci. These were compared with 83 episodes in 54 patients, treated without standardized protocols between 1990 and 1995. RESULTS Both groups of patients were comparable. Their ages ranged from 15 to 65 years old. The male/female ratio was 1.3 and the lymphoblastic/myeloid leukemia ratio was 1.4. Sixty one percent of episodes occurred during induction chemotherapy and mean duration of neutropenia was 17 days. A clinically significant focus was identified in 72% of episodes and a microorganism was isolated blood culture in 35% of them. There was a predominance of gram negative organisms. The mortality decreased from 18 to 9% in the period 1996-2000 (p = 0.094). CONCLUSIONS The use of a standardized antimicrobial protocol reduced the mortality in febrile neutropenia, even when colony stimulating factors and filtered air rooms are unavailable.
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Affiliation(s)
- Bárbara Puga
- Sección de Hematología, Servicio de Medicina, Hospital del Salvador, SSMO, Santiago de Chile.
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Abstract
The aim of this study was to evaluate the place of pancreaticogastrostomy (PG) in reducing pancreatic
fistula after pancreatoduodenectomy. From January 1988 to June 1991, 32 consecutive patients (mean
age, 57 years) were operated on, 25 for malignant disease (78%). The pancreatic remnant was normal in
17 patients (53%) and sclerotic in the others. There was one operative death (3.1%) unrelated to PG.
Post-operative complications occurred in five patients (16%). Only two complications were related to
PG: 1 patient had anastomotic intra-gastric bleeding and was reoperated on, 1 patient with a normal
pancreatic remnant developed a pancreatic fistula (3.1%) treated conservatively. Reported series of PG, as well as our results, demonstrates that PG is associated with a dramatic
decrease of both pancreatic fistula and mortality rates. The risk of anastomotic haemorrhage can be
reduced by preventative ligation of submucosal gastric vessels. In conclusion, PG appears as a simple and reliable method of management of the pancreatic remnant
after pancreatoduodenectomy.
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Affiliation(s)
- A Sauvanet
- Service de Chirurgie Digestive, Université Paris VII, Hôpital Beaujon, Clichy, France
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