Introduction: The objective of this study was to evaluate the need for cholecystectomy in patients who underwent surgery for gallstone ileus. Methods: This was a retrospective review of the clinical history of patients who underwent surgery for gallstone ileus between December 1992 and December 2018 and follow-up until October 2020. Data regarding the surgical intervention, location of the obstruction, and surgical procedure performed were collected, as well as complications in relation to biliary pathology in the postoperative period. Results: Twenty-five patients underwent surgery for gallstone ileus. In all patients, except one, the site of the obstruction was identified. The mean age of the patients was 72 (standard deviation [SD] 13.3) years, with a female predominance (18: 7). The patients presented symptoms, on average, 2.9 (1–7) days before going to the emergency room; the primary symptoms were vomiting associated with abdominal pain and constipation (56%). Fifty-six percent of patients were diagnosed preoperatively by imaging tests. In 72% of patients, an enterolithotomy was performed alone without any other intervention on the gallbladder or bile duct. Eighty-three percent of the patients did not present any cholecystobiliary complications during the entire follow-up period, and urgent or delayed cholecystectomy was not performed after the acute episode. Conclusions: Gallstone ileus is a rare entity, and there are no randomized studies that support a preferred treatment. If surgical intervention is required, enterotomy for stone extraction is a safe and effective technique, and in our experience, urgent or delayed cholecystectomy is not necessary.

Background At present, the term mucocele is outdated, and mucinous appendiceal neoplasm is preferred. Mucinous appendiceal neoplasm is an uncommon pathology that occurs predominantly in middle-aged women. Its classification and management have been the subject of debate in recent decades. The aim of this study was to analyse the incidence, clinical management and survival of these tumours diagnosed in our centre in the last 10 years. Methods This was a retrospective observational study of patients with a diagnosis of appendiceal neoplasms between 2009 and 2018 in our centre. Variables such as sex, age, tumour type, clinical status, diagnosis, treatment and survival were collected. All data were analysed using the statistical program IBM SPSS Statistic® version 25. Results Twenty-nine patients with a diagnosis of appendiceal neoplasm were identified, and 24 corresponded to neoplastic appendiceal mucinous lesions (85.7%). The average age was 59.7 ± 17.6 years. Most patients were women (15 cases; 62.5%). Most of them presented with chronic abdominal pain (37.5%), and the diagnosis was performed by computed tomography (CT) (50%). The treatment was surgical in all cases. The surgical technique depended on the findings and histology of the tumour. Conclusion Mucinous appendiceal neoplasms are an uncommon entity, and their pathological classification and management have recently changed.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Objective. The main objective of the study was to determine the effect of the presence of mutation in the KRAS gene on the survival in patients with colorectal cancer (CRC) and peritoneal metastases (PM). Materials and Methods. A retrospective cohort study was performed. Patients diagnosed with CRC with synchronous or metachronous PM between January 2006 and December 2019 were included. Data on the histopathological, clinical, and treatment factors were collected. The effect of each variable on survival was evaluated by Cox regression. Results. A total of 149 patients were included (64 women (43%) and 85 men (57%); mean age, 63 years). The long-term survival rate at 36 months was 24% (median, 21 months). KRAS mutation was detected in 75 patients (50.3%). Kaplan–Meier analysis estimated that likelihood of survival was higher in patients with wild-type KRAS tumours (35%) than in mutated-type KRAS (14%) (median: 28 vs. 15, respectively) ( P = 0.001 ). Within the categories into which the peritoneal cancer index (PCI) was classified, survival at 36 months depended on the KRAS status. Survival in wild-type KRAS tumours with PCI 1–10 was 71% and with PCI 11–20 was 26%, while in mutant-type KRAS tumours, survival was 41% and 4%, respectively ( P = 0.025 ). In the multiple regression analysis, the KRAS mutation was revealed to have an independent prognostic value (HR: 2.144; 95% CI: 1.342–3.424). Conclusion. The mutational status of the KRAS gene has demonstrated a strong association with survival and prognostic utility in patients with CRC with PM.

Introduction: COVID-19 infection has spread throughout the world and is considered a pandemic. Since its appearance, the number of non-COVID-19 patients admitted to hospitals has decreased and patients differ care for emergency diseases. We analyze the impact of the SARS-CoV-2 coronavirus pandemic on the management of acute cholecystitis. Material and methods: Retrospective observational study that includes all patients diagnosed with acute cholecystitis during the SARS-CoV-2 coronavirus pandemic (period between March 11th and June 21st, 2020) and patients diagnosed with acute cholecystitis in the same period, the previous year in our center. Patient’s features, management, postoperative complications and mean hospital stay were compared. Results: In 2020, 19 patients with acute cholecystitis were diagnosed compared to 21 who were registered in the same period in 2019. The mean number of days from symptoms onset in 2020 was 2.42±1.8 days, while in 2019 it was 3.5±3.1 days (p=0.32). The percentage of cholecystectomies, percutaneous cholecystostomies and conservative management was similar in both periods. Among patients who underwent cholecystectomy in 2020, 37.5% had no complications, 62.5% had accidental opening of the gallbladder, and none had bleeding. Among patients who underwent cholecystectomy in 2019, 81.8% had no complications, 9.09% had accidental opening of the gallbladder, and 9.09% presented bleeding. The mean stay in 2020 was 4.21±3.2 days, compared to 8.57±7.4 days in 2019 (p=0.005). Two patients of 19 diagnosed with acute cholecystitis in 2020 had COVID-19 disease. Conclusion: The mean stay of the patients was shorter in 2020 period. These results can be explained by an early surgical management. So, early laparoscopic cholecystectomy should be considered as a treatment for acute cholecystitis in COVID-19 times if the clinical and hospital situation allows it. We found no differences in the number of patients diagnosed with acute cholecystitis between the two periods, nor in the mean number of days from the onset of symptoms.

Pancreatic necrosis infection (PNI) accounts for about 20–40 % of severe acute pancreatitis. PNI caused by anaerobic bacteria is unusual but when they present, Clostridium perfringens is the microorganism most commonly involved. We present a 60-year-old patient with a previous history of SARS-CoV-2, diagnosed with acute pancreatitis. During the hospitalisation he developed Clostridium perfringens bacteraemia. A CT-scan showed pancreatic gas gangrene and a surgical necrosectomy was performed. Clostridium perfringens was isolated in cultures of the pancreatic tissue and collections. The patient’s clinical status improved after surgery and the appropriate medical therapy. He was discharged 76 days after admission. Nowadays, the ‘step-up approach’ is an accepted therapeutic tool in treatment of pancreatic necrosis and peripancreatic fluid collections. However, most authors suggest that Clostridum perfringens infection requires a more aggressive approach due to the high mortality associated to clostridial infection.

OBJECTIVES. The achievement of a good health-related quality of life (HRQoL) has become one of the primary objectives of medical–surgical interventions. The objective of this study is to determine the HRQoL of patients who underwent abdominal aortic aneurysm (AAA) surgery and to analyse the influence of age on HRQoL. MATERIALS AND METHODS. This is an observational cross-sectional study with 151 male patients who underwent an operation for AAAs between January 2013 and December 2020 in two hospital centres. HRQoL was assessed with the Spanish version of the 36-Item Short Form Survey (SF-36), starting in the month following the surgical intervention. Statistical analyses were performed using hypothesis tests and multivariate linear regression. RESULTS: The mean age of the patients was 73 years (SD: 7), and the mean interval between surgery and the interview was 37 months (SD: 27). The scores of the Physical Function (p = 0.001), Vitality (p = 0.016), Social Function (p = 0.014), and Mental Health (p = 0.007) dimensions of the SF-36 were significantly lower in the older age groups. In addition, the scores on the Physical Summary Component (p = 0.003) and the Mental Summary Component (p = 0.026) were significantly lower among individuals older than 70 years of age. The HRQoL in patients who underwent operations for AAAs was similar to that reported in the general population of Spain. Patients with an aorto-aortic shunt had better scores on the Physical Function (Beta: 10; p = 0.014) and Mental Health (Beta: 8.12; p = 0.040) dimensions than those who had an aorto-bi-iliac or bifemoral shunt, regardless of the age of the patients at operation. CONCLUSION: Among patients who underwent an operation for an AAA, there was a negative association between the age at operation and scores on the Physical Function, Vitality, Social Function, and Mental Health dimensions of the SF-36. The type of surgical technique influences the evolution of Physical Function and Mental Health scores, regardless of age.

The aim of the present study was to identify predictive parameters of survival in patients affected by stage IV colorectal cancer with synchronous and bilateral liver metastases. A retrospective cohort study was performed. Patients diagnosed between January 2013 and December 2018 were included in the present study. Data on the histopathological, clinical and treatment factors (chemotherapy as the first measure or resection of the primary tumor) were collected. The effect of each variable on survival was evaluated using Cox regression analysis. A total of 104 patients were included [43 women (41.3%) and 61 men (58.7%); mean age, 63 years]. The long-term survival rate at 36 months was 29% (median, 25 months). Kaplan-Meier analysis was used to estimate that survival was higher in patients with wild-type KRAS tumors (42%) than in patients with mutated KRAS tumors (9%; P=0.001). In the multivariate analysis, KRAS mutation (HR, 2.484; 95% CI, 1.472-4.192), T4 tumors (HR, 1.795; 95% CI, 1.045-3.084), resection/local treatment of hepatic metastases (HR, 0.447; 95% CI, 0.222-0.901), Eastern Cooperative Oncology Group performance status (HR, 1.632; 95% CI, 1.182-2.254), were revealed to have independent predictive value. The type of treatment (chemotherapy or resection of the primary tumor) did not influence the survival. The results indicated that mutation of the KRAS gene was an important prognostic factor and associated with survival.