Eliana Carolina Pabon Meza

Introducción: El rabdomiosarcoma resulta la principal causa de malignidad de piel y tejidos blandos en pediátricos, pero rara en adultos. Los avances en inmunohistoquímica y biología molecular han permitido clasificarlo en varios tipos, siendo el embrionario el más común en niños, con predilección por cabeza, cuello y tracto genitourinario. En adultos, si bien suele presentarse en las mismas localizaciones, el pronóstico suele ser más desfavorable. Caso: Paciente masculino de 19 años quien consulta por masa submandibular derecha asociada a dolor y epistaxis. Se documenta un rabdomiosarcoma embrionario y tras 4 ciclos de quimioterapia de primera línea (Vincristina, ciclofosfamida y dactinomicina), ocurre falla intratratamiento, estableciendo mal pronóstico y planteando dudas acerca del diagnóstico histopatológico. Conclusión: Este reporte busca destacar la necesidad de un enfoque multidisciplinario en el abordaje de estos tumores, enfatizar que la evaluación mediante pruebas moleculares emerge como una herramienta indispensable para clasificar el subtipo específico de rabdomiosarcoma y así establecer tanto respuesta a tratamiento como pronóstico y por último, resaltar la escasez de información sobre los rabdomiosarcomas en adultos, la cual se limita principalmente a reportes aislados y sin consenso terapéutico claro, en contraste con la abundante evidencia en población pediátrica.

Metabolic optimization before surgery has become an essential component of contemporary perioperative medicine due to the increasing prevalence of obesity, diabetes mellitus, hypertension, metabolic syndrome, dyslipidemia, and cardiovascular disease among adult surgical populations worldwide. The present review aimed to analyze the endocrine and cardiovascular factors influencing perioperative surgical risk and to evaluate the impact of preoperative metabolic optimization on postoperative outcomes and surgical safety. A comprehensive narrative review methodology based on the Scientific Method and a Process-Based Methodology was employed using scientific literature indexed in PubMed, Scopus, Cochrane Library, and international clinical guidelines. The review analyzed evidence related to perioperative glycemic control, cardiovascular assessment, obesity-associated surgical complications, endocrine dysfunction, inflammatory mechanisms, pharmacological management, and multidisciplinary perioperative care models. The findings demonstrated that poor metabolic control is strongly associated with increased postoperative infection, cardiovascular instability, delayed wound healing, prolonged hospitalization, thromboembolic events, and intensive care admission. Hyperglycemia, insulin resistance, endothelial dysfunction, oxidative stress, systemic inflammation, and neurohormonal activation were identified as major mechanisms contributing to perioperative morbidity. Multidisciplinary optimization strategies integrating surgery, endocrinology, cardiology, anesthesiology, nutrition, and internal medicine consistently improved perioperative outcomes and reduced preventable complications. Additionally, the review highlighted the growing perioperative relevance of modern cardiometabolic therapies such as GLP-1 receptor agonists and SGLT2 inhibitors. The evidence supports the conclusion that structured preoperative metabolic and cardiovascular optimization significantly improves surgical safety and postoperative recovery in adult patients with cardiometabolic disease, particularly within healthcare systems experiencing increasing burdens of obesity and diabetes mellitus, including Mexico, Colombia, and Ecuador.