Introduction Cervical drainage has been used to facilitate the diagnosis of anastomotic dehiscence (AD) and its local control. The aim of this study has been to analyse the association between the initial mode of presentation of cervical AD after McKeown esophagectomy (ME) and its overall clinical severity. Materials and methods This retrospective study included patients with oesophageal neoplasia who underwent ME between 2010 and 2024, developed cervical AD, and had a cervical drain in place. The mode of diagnosis (clinical presentation vs drainage output), treatment, and severity of AD were analysed using the Comprehensive Complication Index (CCI). A temporal analysis comparing the periods before and after 2020 was performed following the introduction of new endoscopic therapies. Multivariable linear regression was used to identify factors associated with CCI. Results A total of 31 patients with cervical AL were included. Diagnosis was established through the cervical drain in 14 patients (45.2%) and through clinical manifestations in 17 (54.8%). No significant differences were observed in time to diagnosis between the groups (p = 0.49). Temporal analysis showed a reduction in surgical treatment of AD after 2020 (p = 0.039). In the multivariable analysis, the independent factors associated with CCI were the mode of diagnosis (p = 0.043) and diagnostic delay (p = 0.041). Conclusion Diagnosis through cervical drainage was not associated with earlier detection of AD. Severity was mainly related to diagnostic delay and the mode of clinical presentation. The introduction of endoscopic therapies has reduced the need for surgery.
Objective To analyse morbidity, mortality, and outcomes of inguinal hernia surgery in patients aged 80 years or older. Methods A retrospective descriptive study was conducted including patients aged ≥80 years who underwent inguinal hernia repair at a tertiary referral centre between April 2021 and April 2024. Demographic, clinical, and surgical variables were analysed, as well as intraoperative and postoperative complications, mortality, follow-up, and hernia recurrence. Results A total of 104 patients were included, accounting for 113 inguinal hernias. Mean age was 84 ± 3.2 years, and 76% of patients were male. Most procedures were performed electively (80.8%). Open mesh hernioplasty was the most frequently used technique (95.6%). Intraoperative complications occurred in 3.8% of cases, and mild postoperative complications were observed in 13.5%, with haematoma being the most common. No reoperations or postoperative mortality were recorded. Mean hospital stay was 1.55 days. During follow-up, two hernia recurrences and four de novo contralateral inguinal hernias were identified. Conclusion Inguinal hernia surgery in patients aged 80 years or older is associated with low morbidity and mortality when performed electively. Advanced age alone should not be considered a contraindication for surgical treatment.
BACKGROUND:Oesophageal cancer is a rare type of neoplasm in Western countries, yet it ranks as the seventh leading cause of death. Due to its anatomical location, oesophageal surgery is a highly complex procedure. The morbidity and mortality associated with oesophagectomy are significant, highlighting the need for a multidisciplinary approach to minimise complications. The measure of failure to rescue (FTR) reflects surgical outcomes and indicates the capacity to prevent death after a major complication (MC). It serves as a valuable metric for comparing results among different medical centers. OBJECTIVE:To evaluate the failure to rescue rate following esophagectomy at a high-volume tertiary oesophageal surgery center. METHODS:This retrospective study analysed FTR, mortality, and morbidity rates following oesophageal surgery from 2003 to 2024. Preoperative, intraoperative, and postoperative variables were assessed across patient groups. Comorbidities were evaluated using the ASA score, and complications were classified according to the Clavien-Dindo classification. RESULTS:268 patients underwent oesophagectomy during the period of study. 129 (48%) experienced MC. Among these, 25 patients died within the first 90 days after surgery: FTR rate of 19.3%. Univariate and multivariate logistic regression analyses identified respiratory complications, including pneumonia and adult respiratory distress syndrome, as independent factors associated with FTR. CONCLUSION:Respiratory complications are identified as the most significant risk factor for FTR following oesophagectomy.
Introduction The objective was to analyse the functioning and short and long-term outcomes of an Integrated Care Area for frail patients requiring surgery. Methods Observational, descriptive study with prospective data collection. From December 2016 to January 2025, 413 frail patients were included in an Integrated Care Area for the Complex Surgical Patient (AAPQC for its initials in Spanish). Age, sex, referring service, ASA, frailty index (VGI-Frail and Clinical Frailty scale), Barthel, Pfeiffer, Complex Chronic Patient (PCC), and Advanced Chronic care Model (MACA) were analysed. Operated and non-operated patients were compared. Complications (Clavien-Dindo), mean length of stay, 30-day mortality, readmissions, and quality of life at 3 months and one year were evaluated. Results 413 patients, mean age 80 years, 251 men (60.8%). 91.8% were ASA III-IV, 259 (53%) PCC and 61 (14.7%) MACA. 298 (77.6%) came from general surgery. 7,3% lived in care facilities. 125 (30.3%) were recommended not to undergo surgery. Age, ASA, PCC, MACA, VGI-frail, Clinical Frailty Score, Barthel and Pfeiffer were significantly (P < 0.0001) better in those operated. Postoperative complications (Clavien-Dindo III-IV-V), readmissions and mortality were 9.7%, 13.2% and 3.1% respectively. 10% required convalescence resources at discharge. 82.5% of operated patients were better or the same as before surgery at three months and one year. Of those not operated (n = 125), 48.3% died during the first year. Conclusions The establishment of an Integrated Care Area for frail patients requiring surgery facilitates decision-making and reduces postoperative morbidity with acceptable quality of life.
Introduction Resective surgery is the cornerstone of gastric cancer treatment, but it carries considerable morbidity and mortality, with anastomotic leak (AL) being the most feared complication. This study aims to describe the prevalence and diagnostic management of AL after oncological gastrectomy, analyzing clinical and laboratory parameters that may facilitate its early diagnosis. Methods A prospective, multicentre, national study was conducted between 2023 and 2024. 435 patients who underwent surgery for gastric cancer at 43 centres were included. Sociodemographic variables and diagnostic and therapeutic management data were described, comparing the postoperative evolution of clinical and laboratory variables in patients with and without anastomotic leak. Results The overall prevalence of AL was 10.5%, with patients exhibiting a significantly higher heart rate from the second postoperative day. In the group of patients with AL, C-reactive protein, procalcitonin, and interleukin-6 showed higher levels from the first postoperative day. Other markers, such as leukocytes and the neutrophil-to-lymphocyte ratio, were also significantly higher in the AL group. The diagnosis of AL was established at a median of 6 days post-surgery, with a resolution rate of 80% using endoscopic therapies, interventional radiology and surgery. Discussion Although the diagnosis of AL is often delayed until the sixth postoperative day, the differences in the values of variables such as C-reactive protein, procalcitonin, and interleukin-6 between patients with and without AL become noticeable earlier. These findings support the creation of predictive models based on the variables studied to diagnose this complication early.
Introduction The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption.This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. Methods A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall’s W coefficient was used to assess concordance. Results High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. Conclusions This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre’s context, case volume, and available resources.
Introduction The liver is one of the most frequent sites of metastatic spread in gastric cancer (GC). Although systemic chemotherapy remains the standard of care, surgical resection of liver metastases has demonstrated promising outcomes in carefully selected patients. Methods A retrospective, observational, multicentre study including all adult patients who underwent surgical treatment for GC liver metastases between January 2010 and December 2022 in Hepatobiliopancreatic Surgery units across Spain. Results A total of 37 patients were analysed, predominantly male (73%), with a mean age of 64.1 years (SD: 13.2). Metachronous metastases were present in 73% of cases. Most procedures consisted of non-anatomical liver resections, performed via an open approach in 75.7% of patients. Negative surgical margins were achieved in 91.9% of resections. The rate of major postoperative complications was 29.6%, with an operative mortality of 2.7% and a mean postoperative hospital stay of 7.5 days. During follow-up, 64.9% of patients developed disease recurrence, predominantly within the liver. Median disease-free survival (DFS) was 14 months, and median overall survival (OS) was 40 months. The 1-, 3-, and 5-year DFS rates were 54.1%, 29.7%, and 24.3%, respectively, while the corresponding OS rates were 89.2%, 54.1%, and 37.8%. On multivariable Cox proportional hazards analysis, age, lymph node involvement, and metachronous resection were independently associated with an increased risk of death. Conclusions Hepatectomy in selected patients with liver metastases from GC may be associated with favourable long-term survival. These findings support a potential role for surgical resection within a multidisciplinary treatment strategy; however, well-defined selection criteria are essential to optimize patient outcomes.
