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319 Background: Gallbladder cancer (GBC) is the leading cause of cancer death in women in Chile. Even after curative surgery, prognosis is grim. To evaluate acute and late toxicity and efficacy in terms of overall survival of adjuvant chemoradiation (CR) after curative resection of GBC. Methods: We retrospectively analyzed the cohort of patients with curatively resected GBC diagnosed between January 1999 and April 2009, treated with adjuvant CR at the Instituto Nacional del Cáncer, Santiago de Chile. Treatment protocol considered external beam radiation therapy (RT) (45–54 Gy) to tumor bed and regional lymphnodes with concurrent 5-fluorouracil (5-FU) (500 mg/m2/day by 120-h continuous infusion on days 1-5 and 29-33). Data was obtained from medical records, mortality from death certificates. NCI CTC v 3.0 was used for toxicity grading, and 6th Edition of AJCC Cancer Staging Manual for staging. Survival was estimated by Kaplan- Meier curves. Results: 45 patients with curatively resected GBC received adjuvant CR. Mean age was 56 years (range 33-75), 38 patients were female. All patients had PS 0 or 1 at baseline. After diagnosis a second surgery was performed in 41 patients. Cholecystectomy with hepatic segmentectomy and lymphadenectomy was the curative surgery in 40 patients. For tumor and staging details see the Table. All patients received RT with a planned dose of 45 Gy in 25 fractions. 9 patients received a boost to the tumor bed up to 54 Gy. Three patients stopped RT early. 33 patients had concurrent 5-FU, 31 completed treatment as planned. Therapy was well tolerated, only 4 grade 3 toxicities were observed (1 neutropenia, 1 thrombocytopenia, 2 elevated alkaline phosphatase). No grade 4 or 5 toxicity was observed. No grade >2 late toxicity was observed. Twenty two patients have died. Median survival was 26 months, with 3- and 5-year overall survival of 64% and 46% respectively. Conclusions: Adjuvant chemoradiation with 5-FU is well tolerated and might impact favorably on survival in patients with curatively resected GBC. [Table: see text] No significant financial relationships to disclose.

Adjuvant chemoradiation is well tolerated and might impact favorably on survival in patients with curatively resected GBC.

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Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje mas larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Material y método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semi-estructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce  sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento.