Publications by authors named "Carlos Cerdan Santacruz"

Background/objectives: Colon cancer presents as an obstruction in almost 30% of patients. Self-expandable metallic stents emerged as an alternative to emergency surgery, despite early controversies around their use. Improved techniques led to stent incorporation in clinical guidelines.

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  • Organ preservation through the Watch and Wait (WW) approach in rectal cancer patients shows promise but poses a risk of local regrowth (LR), leading to higher rates of distant metastases (DM) compared to traditional surgery (TME).
  • A study comparing 508 LR patients managed by WW and 893 near-complete pathologic response (nPCR) patients after TME found a significantly higher DM rate in the LR group (22.8% vs. 10.2%).
  • The research concluded that patients with LR have poorer 3-year DM-free survival (75% vs. 87%) and highlight that leaving a primary undetectable tumor can result in worse overall outcomes.
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  • Specific training in colorectal surgery is crucial but currently faces challenges in evaluating its effectiveness and potential benefits.
  • An online survey conducted by the "Grupo Joven de la Asociación Española de Coloproctología" revealed that 84% of 128 participating surgeons reported moderate to high satisfaction with their training, highlighting the need for improvement in advanced surgical techniques and academic knowledge.
  • While trainees successfully performed common procedures, there was a noticeable lack of exposure to pelvic floor surgeries and diagnostic techniques, suggesting a need for further development in these areas to enhance overall training in minimal invasive methods.
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As watch and wait has become an attractive management alternative among patients with rectal cancer who achieve a clinical complete response to neoadjuvant chemoradiation, the focus of organ preservation has now shifted toward the use of this approach in patients with early rectal cancer. These patients would otherwise be treated without the use of neoadjuvant therapy for oncological reasons. The sole purpose of any neoadjuvant treatment here would be the achievement of a complete clinical response in an attempt to avoid total mesorectal excision.

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There is no international consensus on the definition of the type of oncological resection that corresponds to each of the colectomies existing in the current literature. The objective is to define for each colectomy described in the literature: embryological dissection plane, vascular pedicles in which to perform central ligation, the extent of the colectomy, and the need for resection of the greater momentum. A consensus of experts is carried out through the Delphi methodology through two rounds from the Coloproctology Section of the Spanish Association of Surgeons.

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  • The study evaluates the safety and effectiveness of a new treatment protocol for acute uncomplicated diverticulitis (AUD) that does not utilize antibiotic therapy at a hospital from January 2021 to September 2023.
  • Out of 199 patients diagnosed with AUD, 75 were treated as outpatients without antibiotics, and only 7 needed antibiotics later due to complications, but none required surgery.
  • The findings support the idea that non-antibiotic treatment can be safe for selected patients, with the presence of bacteriuria identified as a key risk factor for treatment failure.
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Introduction: Local resection (LR) is an alternative to total mesorectal excision (TME) that avoids its associated morbidity to the detriment of oncological radicality in early stages of rectal cancer. There are several conditioning factors for the success of this strategy, such as poor prognosis histological factors (PPHF), involvement of resection margins, clinical under staging, or complications that may lead to the indication for radical surgery with TME.

Patients And Method: An international multicenter prospective observational open-label study has been designed.

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  • Recent guidelines suggest outpatient management for acute uncomplicated diverticulitis without antibiotics in selected patients, but adherence to these recommendations varies significantly across national hospitals.
  • A survey involving 104 surgeons from 69 hospitals showed that 82.6% of centers offer outpatient management, but only 23.2% have protocols for antibiotic-free treatment, often citing logistical challenges and a lack of evidence.
  • There are notable differences between accredited hospitals and others, with accredited centers more likely to implement outpatient care and antibiotic-free protocols, highlighting the need for standardized treatment practices across the board.
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Introduction: Performing the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an anal fistula (AF).

Material And Methods: A retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals.

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  • * A study involving 393 patients showed that those using the app experienced a significantly lower incidence of PPCs (12.2% compared to 24% in the control group) and had a shorter hospital stay (median of 3 days vs. 4 days).
  • * The app demonstrated a 63.5% reduction in the risk of developing PPCs, suggesting it effectively improves clinical outcomes after surgery.
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  • Various neoadjuvant treatments for advanced colon cancer are becoming available, and effective preoperative staging is essential for choosing the right approach.
  • A study involving 50 centers and 1,950 patients focused on the diagnostic accuracy of CT scans for T4 colon tumors, revealing significant limitations in terms of sensitivity and specificity for staging.
  • The findings indicated that while CT had high accuracy for detecting peritoneal metastases, its overall performance for T4 staging and lymph node classification was inadequate, highlighting the need for improved diagnostic methods.
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  • The study aimed to identify the ideal patient profiles and outcomes for the fistula laser closure (FiLaC®) technique in treating anal fistulas, focusing on its safety and effectiveness.
  • Conducted between October 2015 and December 2021, the study included 36 patients, revealing primary and secondary healing rates of 55.6% and 91.7%, respectively, with no cases of fecal incontinence reported.
  • FiLaC® is shown to be a safe and effective option, especially for patients with Crohn's disease, as they had a significantly higher primary healing rate compared to others.
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Background: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce.

Methods: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database.

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The administration of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorrectal excision (TME) and selective use of adjuvant chemotherapy can still be considered the standard of care in locally advanced rectal cancer (LARC). However, avoiding sequelae of TME and entering a narrow follow-up program of watch and wait (W&W), in select cases that achieve a comparable clinical complete response (cCR) to nCRT, is now very attractive to both patients and clinicians. Many advances based on well-designed studies and long-term data coming from big multicenter cohorts have drawn some important conclusions and warnings regarding this strategy.

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Background: Use of antibiotics in selected cases of acute uncomplicated diverticulitis (AUD) has recently been questioned.

Objective: The aim of this study is to examine the safety and efficacy of treatment regimens without antibiotics compared with that of traditional treatments with antibiotics in selected patients with AUD.

Data Sources: PubMed, Medline, Embase, Web of Science, and the Cochrane Library.

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