RESUMEN
BACKGROUND: Nasopharyngeal angiofibroma (NA) is a vascular tumor of the nasopharynx of young males which presents rarely. Our aim was to analyse outcome and prognostic factors of a case series of NA. MATERIALS AND METHODS: We conducted a retrospective study of patients with diagnosis of NA treated at a single institution from 1981 to 2003. We evaluated clinical, radiological and therapeutic data for recurrence- and disease-free survival-associated prognostic factors. Bi- and multivariate analyses were performed. RESULTS: Fifty-four males with NA constitute our study group. Age varied from 12 to 35 years (mean, 18.5 years; standard deviation [SD], 4.9). There were 18 recurrences; localization in nasopharynx, nasal fossae or maxillary antrum was not associated with recurrences. Invasion to pterygomaxillary fossae, to infratemporal fossae or to skull base and/or intracranial extension were associated with recurrences in two of 14, in five of 12, and in 11 of 18 cases, respectively. Tumors < or >or=6 cm were associated with zero and with 18 recurrences, respectively (p<0.01). Multivariate analyses conferred statistical significance (p<0.01) to a model including patterns of extension, tumor size in pterygomaxillary or anterior infratemporal fossa invasion, and surgical margins. CONCLUSION: Recurrence factors for NA are defined and consequently treatment design is suggested. Endoscopic approaches could be considered in patients with minor lateral extensions, while wide surgical approaches are indicated in invasive cases. Radiotherapy could be applied alone or combined with surgery for extensive intracranial involvement.
Asunto(s)
Angiofibroma/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Angiofibroma/terapia , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Nasofaríngeas/terapia , Recurrencia Local de Neoplasia , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: A pretherapeutic staging system to design nonoperative or neoadjuvant treatments in gastric cancer is required. In this study, a simple staging system based on laparoscopic findings to define a treatment algorithm was developed. METHODS: A retrospective cohort study was conducted of 151 patients allocated into four stages based on laparoscopic findings. The depth of tumor invasion and the presence of metastasis based on laparoscopic findings were used to construct these stages. Laparoscopic findings were compared with histopathology. RESULTS: An excellent agreement of the laparoscopy-defined depth of invasion and the surgical pathology standard was found (weighted kappa 0.85). The likelihood ratios for a positive and negative laparoscopic diagnosis of metastasis were 40.4 and 0.015, respectively (98.5% sensitivity, 97.6% specificity). Those for positive and negative diagnosis of resectability were 2.6 and 0.03, respectively (98.4% sensitivity, 62% specificity). The laparoscopic stages presented significant prognostic value. Two-year survival was 93%, 69%, 60%, and 17%, respectively. Surgical resection was possible in 100%, 100%, 49%, and 12%, respectively. CONCLUSIONS: The proposed laparoscopic staging system is a simple and reproducibLe way for selection of a suitable therapy. It allows for adequate stratification of the main risk factors in the setting of clinical trials evaluating preoperative treatments.
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Carcinoma/patología , Laparoscopía/métodos , Estadificación de Neoplasias/métodos , Neoplasias Gástricas/patología , Adulto , Anciano , Carcinoma/diagnóstico , Carcinoma/cirugía , Estudios de Cohortes , Intervalos de Confianza , Femenino , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND: Early gastric carcinoma (EGC) is defined as a neoplasm confined to the mucosa and submucosa regardless of the presence of metastasis. This lesion is found in approximately 3% of cases in Mexico. The aim of this study is to describe our experience with EGC, emphasizing early detection as the most useful method to decrease mortality. METHODS: Retrospective review of records of patients with EGC treated at an oncologic referral center over a 12-years period. RESULTS: Twenty-one cases of EGC were retrieved. Mean age was 58.1 years (range, 33 to 84). Twelve were women and nine, men. Lymph node or distant metastasis were not found. Overall 5-year survival was 66.4%. Twenty patients underwent radical gastrectomy and only one underwent wedge resection of the gastric wall. Two patients (9.5%) presented recurrence and cancer-related death. Mean follow-up was 8.3 years. CONCLUSION: The prognosis of EGC in our hospital is lower than in countries other than Mexico and this lesion is found with low frequency. Increasing the detection EGC is the best method to reduce GC-related mortality.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Gástricas/patología , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: A definite resolution to the controversy on the optimal extension of lymph node dissection (LND) in gastric cancer has not been achieved. Surgical morbidity and survival of D1 and D2 LND are compared by multivariate analysis. METHODS: A retrospective cohort study of 219 patients with gastric cancer and curative resection performed according to Japanese rules. D1 dissection was performed in 106 cases and D2 in 113. The logistic regression model was used to define risk factors for surgical morbidity and the Cox model to determine prognostic factors. RESULTS: Surgical morbidity occurs in 16.9% and 19.5% in D1 and D2 LND, respectively (P = .7). The morbidity determinants were operation blood loss, splenectomy, pancreaticosplenectomy, antrum location, low serum albumin, total gastrectomy, and metastatic nodal ratio (P < .0001), but not D2 LND. Five-year survival was 35.1% for D1 and 64% for D2 LND (P < .039). The prognostic factors were T stage, N stage, serum albumin level, total gastrectomy, D2 LND, and comorbidity (P < .0001). CONCLUSIONS: The increment of surgical morbidity and mortality rates attributed to D2 LND is largely caused by the effect of splenectomy and pancreaticosplenectomy. A significant survival benefit because of D2 LND was found. The results support the value of extended LND in the surgical treatment of gastric cancer.
Asunto(s)
Adenocarcinoma/patología , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Neoplasias Gástricas/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Interpretación Estadística de Datos , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Gastrectomy remains the only curative treatment for gastric cancer. However, surgical morbidity and mortality remains high. Our aim was to identify the risk factors that determine operative morbidity and mortality and to describe a simple method for preoperative stratification of morbidity outcome. METHODS: Retrospective review of patients who underwent gastrectomy for gastric cancer. Multivariate analysis was used to define risk factors for surgical morbidity and mortality. RESULTS: A total of 208 cases were included. Fifty-one episodes of operative morbidity and 19 surgery-related deaths were found. Operative blood loss (risk ratio [RR], 1.0012), serum albumin (RR, 0.42), extent of gastrectomy (RR, 2.8), lymphocyte count (RR, 0.999), and splenectomy (RR, 1.51) were the most important risk factors for morbidity. However, location of the tumor, serum albumin level, and lymphocyte count were the most important preoperative risk factors that determine the appearance of surgical complications. Receiver operating characteristic analysis of this model allowed definition of three risk groups in terms of surgical morbidity (11.8%, 28.5%, and 52.4%, respectively). CONCLUSIONS: A new method for preoperative calculation of the probability of surgical complications was developed. It must be validated prospectively and in different settings to be used in preoperative interventions designed to reduce that risk.
Asunto(s)
Adenocarcinoma/cirugía , Gastrectomía , Complicaciones Posoperatorias , Neoplasias Gástricas/cirugía , Femenino , Gastrectomía/efectos adversos , Gastrectomía/mortalidad , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Morbilidad , Análisis Multivariante , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Probabilidad , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Colorectal cancer is the second among gastrointestinal malignancies in Mexico Locally advanced disease or metastatic lesions are frequently found. To resect or not such a tumor is a difficult decision. OBJECTIVE: To report a case of colon cancer with multivisceral invasion resected and to review the published information. CLINICAL MATERIAL: A 43 year-old Mexican male with rectal bleeding and weight loss with a tumor located in transverse colon with direct invasion to stomach. CT scan demonstrated invasion to spleen and pancreas. En-bloc radical-extended right colectomy, total gastrectomy, distal pancreatectomy, splenectomy and left adrenalectomy was performed. Adjuvant chemotherapy was used. At 12-month follow-up he is asymptomatic, without neoplasic activity and with good quality of life. CONCLUSION: An aggressive multiorganic resection in T4 colorectal tumors is justified in selected cases. The high morbidity and mortality of these procedures must be evaluated individually, and if permissive must be performed.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias del Colon/cirugía , Adenocarcinoma/patología , Adrenalectomía , Adulto , Antimetabolitos Antineoplásicos/uso terapéutico , Colectomía , Neoplasias del Colon/patología , Fluorouracilo/uso terapéutico , Gastrectomía , Humanos , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Escisión del Ganglio Linfático , Masculino , Invasividad Neoplásica , Estadificación de Neoplasias , Páncreas/patología , Páncreas/cirugía , Pancreatectomía , Inducción de Remisión , Bazo/patología , Bazo/cirugía , Esplenectomía , Estómago/patología , Estómago/cirugíaRESUMEN
OBJECTIVE: To describe the 12-year experience with Gastric Cancer (GC), with special emphasis in prognostic factors. BACKGROUND: GC is the most common gastrointestinal malignancy and is the second cause of cancer-related mortality in Mexico. Poor results have been reported, and new treatments have not improved the life expectancy. The available information regarding GC in our country is limited. METHODS: Retrospective cohort study of 793 patients with gastric adenocarcinoma treated in an oncologic referral center in Mexico City. Demographic and clinical data, and the results of surgical treatment are presented. Survival curves by TNM stage and other prognostic factors are described. RESULTS: Sixty two percent of the patients presented in stage IV, with a median survival of 8.6 months. Only 33% of the whole group underwent surgical resection. One hundred and sixty two subtotal, 86 total and 12 proximal gastrectomies were performed, 74% with curative intention and in 26% for palliation. Operative morbidity and mortality were 23.3% and 10.9%, respectively. The multivariate analysis showed that the independent prognostic factors were TNM stage (Risk ratio 1.49; 95% CI 1.26-1.76; p < 0.0001), operative morbidity (RR 6.05; 95% IC 3.74-9.7; p < 0.0001), seralbumin (RR 1.26; 95% CI 1.03-1.5; p < 0.03), age (RR 1.01; 95% CI 0.9-1.02; p < 0.057), type of lymphadenectomy (RR 1.59; 95% CI 0.97-2.59; p < 0.06) and gastrectomy performed (RR 1.9; IC 95% 0.9-4.2; p < 0.06). CONCLUSION: The TNM staging system was the most important prognostic factor. The high rate of GC in advanced stages affects directly the results. Better survival may be expected if the relative frequency of stages I and II increase. Endoscopy is warranted to patients with dispeptic symptoms who present no response to treatment or recurrence. Our experience reflects the importance of this health problem in México.
Asunto(s)
Neoplasias Gástricas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Pronóstico , Derivación y Consulta , Estudios Retrospectivos , Neoplasias Gástricas/terapiaRESUMEN
INTRODUCTION: Pseudocyst of the pancreas (PP) develops in 2 to 5% the cases of acute pancreatitis (AP). Most cases of PP regress spontaneously. PP has been misdiagnosed as a malignant pancreatic cyst neoplasm, reason why the patients are referred to specialized institutions. OBJECTIVE: To describe the cases of PP treated in a 15 year-period. MATERIAL AND METHODS: Review of clinical records of 14 cases treated from 1975 to 1989. RESULTS: There were 5 men (36%) and 9 women (64%) Mean age was 41 years (range 18 to 77). In 50% of the cases the patient had a history of severe alcoholic abuse, cholelithiasis in 28% and abdominal trauma in 15%. Five patients (35%) had AP. The period between AP symptoms and the diagnosis of PP was a mean of 5.7 months. Abdominal pain and abdominal mass were present in all of the cases, in all cases, ultrasonography and CT scan made the diagnosis of PP. Thirteen cases were treated by surgery, 12 with internal drainage, one by resection and one by external drainage. An enterocutaneous fistula (7%) was recorded in one case. There were no operative mortality. The mean follow-up time was of 10 years and 4 months. CONCLUSIONS: PP is a uncommon pathology in oncologic centers. Internal drainage was the most frequent treatment. The diagnosis of cystic neoplasms of the pancreas should be ruled out.
Asunto(s)
Seudoquiste Pancreático , Traumatismos Abdominales/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Alcoholismo/complicaciones , Colelitiasis/complicaciones , Diagnóstico Diferencial , Drenaje , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Seudoquiste Pancreático/diagnóstico , Seudoquiste Pancreático/cirugía , Pancreatitis/complicaciones , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Carcinoid tumors are rare, most of the publications are case reports and the clinical series are uncommon. The quality of life and survival time of these patients depend on the adequate control of tumor growth and good palliation of their symptoms. AIMS: The purpose of this study is to inform epidemiological data and forms of management for these tumors and the Carcinoid Syndrome at the National Institute of Cancerology (INCan) at Mexico City in the last 15 years. METHODS: A retrospective review of the clinical records of patients diagnosed and treated at the INCan with carcinoid tumors from 1982 to 1997 was performed. RESULTS: The most common origin place was the gastrointestinal tract (GI), and the majority involved the right colon and the appendix. The longest survivors were patients with tumors originated in the appendix, tumors smaller than 2 cm or localized. At the time of diagnosis 47% of patients had metastatic disease that was also a poor prognostic factor. The experience in our hospital seem to support the use of interferon alone or in combination with octreotide or debulking surgery for the palliation of carcinoid syndrome. CONCLUSIONS: Carcinoid tumors are rare, and have a slow growth and less aggressive biological nature than noncarcinoid tumors. Treatment should be focused on trying to cure the small or localized lesions or to find the best palliative method for those symptomatic advanced lesions.
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Tumor Carcinoide/terapia , Neoplasias del Sistema Digestivo/terapia , Síndrome Carcinoide Maligno/terapia , Adulto , Anciano , Antineoplásicos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/mortalidad , Neoplasias del Sistema Digestivo/diagnóstico , Neoplasias del Sistema Digestivo/mortalidad , Femenino , Humanos , Interferones/uso terapéutico , Masculino , Síndrome Carcinoide Maligno/diagnóstico , Síndrome Carcinoide Maligno/mortalidad , Persona de Mediana Edad , Metástasis de la Neoplasia , Octreótido/uso terapéutico , Cuidados Paliativos , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Gastric cancer (GC) is a frequent neoplasm with high mortality. Most patients in occidental countries show advanced stages of the disease, and low resectability rates. In this paper, some epidemiological items are detailed. The morphologic classifications, TNM stages and risk factors for GC are defined. Clinical manifestations are described, focused in the necessity of early diagnosis as it is the only way to reduce mortality. The usefulness of diagnostic methods in preoperative staging are discussed in relation to the role of these methods in the prediction of resectability and the evaluation of new therapeutic regimens. The role of radical surgery and extended lymphadenectomy as definitive treatment is analyzed as well the role of adjuvant and palliative interventions. The experience in Instituto Nacional de Cancerología is briefly described.
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Neoplasias Gástricas , Adulto , Anciano , Quimioterapia Adyuvante , Terapia Combinada , Endoscopía , Femenino , Gastrectomía , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Pronóstico , Radioterapia Adyuvante , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Tomografía Computarizada por Rayos XRESUMEN
Small bowel tumors (SBT) are rare neoplasms and represent less than 10% of all gastrointestinal tumors. The majority of them are benign and discovered at the time of autopsy. However of those who present symptoms the majority belong to the group of malignant tumors and require of treatment. The most common histological variety are the adenocarcinoma and the carcinoid tumors. Abdominal pain, intestinal obstruction or gastrointestinal bleeding are the most common clinical complaints. Endoscopy or contrast X-ray examination are the most common forms of diagnosis and surgery remain the best way of treatment chemotherapy or radiotherapy are used in combination with surgery according to the histological diagnosis, the survival depends to the final histological report. A review of the experience at the National Institute of Cancer in Mexico city was performed and 34 patients were found with the diagnosis of SBT of which the majority presented with abdominal pain, nausea, vomiting and abdominal distension. The most common histological diagnosis were the adenocarcinoma (52%) and the leiomyosarcoma (32%). Surgery was the most common form of treatment (73%) of which in 20% distant metastasis was diagnosed. Only nine are alive at the time of the report without recurrent disease with a mean follow up of 7 months. Our experience shows that SBT are rare neoplasms, the majority are diagnosed late but surgery remain the best way of treatment because it can offer the possibility of cure or adequate palliation with derivative procedures.
Asunto(s)
Adenocarcinoma , Adenoma , Tumor Carcinoide , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias del Yeyuno , Linfoma , Sarcoma , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Adenoma/diagnóstico , Adenoma/cirugía , Adenoma Velloso/diagnóstico , Adenoma Velloso/cirugía , Adolescente , Adulto , Anciano , Angiografía , Antineoplásicos/uso terapéutico , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Quimioterapia Adyuvante , Niño , Terapia Combinada , Diagnóstico Diferencial , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/cirugía , Femenino , Humanos , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/cirugía , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/cirugía , Escisión del Ganglio Linfático , Metástasis Linfática , Linfoma/diagnóstico , Linfoma/cirugía , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Cuidados Paliativos , Radioterapia Adyuvante , Factores de Riesgo , Sarcoma/diagnóstico , Sarcoma/cirugíaRESUMEN
OBJECTIVE: Determine the general features of primary gallbladder carcinoma (GBC), the diagnostic procedure and the current management as well as to analyze the experience at the National Institute of Cancer in Mexico City (INCan). INTRODUCTION: GBC is a rare and frequently lethal disease. The majority of patients are diagnosed at late clinical stages when the prognosis is poor. However in recent years several investigators have shown that radical procedures increase survival. MATERIAL AND METHODS: A review of relevant articles regarding epidemiological features, laboratory and imaging studies together with the actual form of management according to the stage at diagnosis was made. A review of clinical records of patients with GBC at the INCan in the last 10 years was also made. RESULTS: The prognosis of GBC carcinoma depends of the stage at the time of diagnosis, tumors confined to the gallbladder (Nevin I-III) have better prognosis than those presented with lymphadenopathy or liver invasion. Actually the surgical procedure most accepted is wedge liver resection and lymphadenectomy, because it seems to improve survival. At the INCan one hundred patients were analyzed of which only six were diagnosed with lesion Nevin I all alive with a mean follow up of 33 months, with lesions Nevin II five out of 13 are alive and were treated with wedge liver resection or radiotherapy, lesion Nevin III only 4 alive and received radiotherapy. Patients with lesions Nevin IV and V have the poorest prognosis. CONCLUSION: GBC is a highly lethal disease. Early diagnosis make possible to perform radical resections and improve survival.
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Neoplasias de la Vesícula Biliar/cirugía , Adulto , Anciano , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colecistectomía Laparoscópica , Terapia Combinada , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/mortalidad , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Pronóstico , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Anal carcinoma is a rare malignant tumor, It occurs in only 0.02% of all malignant neoplasms. In Mexico, the incidence is of 1.5%, and only 0.18% belong to the anal canal. In recent years it has been reported an increased incidence of this tumor due to the association with the human papilloma virus in HIV positive patients. The most common histological forms are the epidermoid and the cloacogenic carcinomas. The most relevant prognostic factors are the size of the tumor and the presence of lymph node metastasis. Surgery has been the traditional form of treatment but the combined use of chemotherapy and radiotherapy seems to have the best results and surgery is reserved for local recurrences or palliation. A review of our experience at the National Institute of Cancer at Mexico city with the management of this tumor was performed. Thirty-four patients with the diagnosis of carcinoma of the anal canal were included of which none of them received previous treatment or have the diagnosis of AIDS. Patients were divided in four groups according to the form of treatment (surgery, radiation, and chemoradiation either with 5FU-MMC or 5FU and CDDP). The group that received chemotherapy with 5FU and CDDP combined with radiotherapy had the best results in terms of clinical response, survival and toxicity. The size of the tumor and the presence of lymph node metastasis are the prognostic factors that influence in survival: tumor smaller than 5 cm without lymph node metastasis have the best prognosis (p: 0.01 and p: 0.00004). Epidermoid carcinoma have a better prognosis than cloacogenic carcinoma (p: 0.07).
Asunto(s)
Neoplasias del Ano/terapia , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Transicionales/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/administración & dosificación , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias del Ano/radioterapia , Neoplasias del Ano/cirugía , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Transicionales/radioterapia , Carcinoma de Células Transicionales/cirugía , Cisplatino/administración & dosificación , Ensayos Clínicos como Asunto , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Pronóstico , Dosificación RadioterapéuticaRESUMEN
This study was performed in order to define the histological patterns of gastric carcinoma according to Lauren's classification and the IT:DT ratio in a Mexican population. We analyzed the relative frequency of intestinal-type and diffuse-type carcinomas in a group of patients, diagnosed at the Instituto Nacional de Cancerologia in Mexico City between 1982 and 1992. Of the 460 cases of gastric cancer, 242 (52.7%) were of the intestinal-type, 206 (44.7%) of the diffuse type, and 12 (2.6%) others. A predominance of the diffuse type among the younger age groups (< 50 years) was observed-the transitional age for men and women occurred in the sixth decade. The global intestinal: diffuse ratio was 1.2 and increased with age. This ratio remained similar during the 11 years of the analysis. Men had a higher proportion of intestinal type carcinoma than women. These findings indicate that Mexico is not a low risk area for gastric cancer with a consistently low intestinal: diffuse type ratio. Despite differences in geographic and demographic patterns, the intestinal and diffuse types of gastric carcinoma have common etiological factors.
Asunto(s)
Neoplasias Intestinales/patología , Neoplasias Gástricas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/epidemiologíaRESUMEN
OBJECTIVE: To analyze and compare our results with open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cancer. DESIGN: Case-control study. SETTING: An oncologic referral center in Mexico City. PATIENTS: All patients with previous treatment for cancer and indication for cholecystectomy who where referred in a 60-month period. They were divided into two groups. Group OC with operation performed in the former 30 months and group LC with operation performed in the later 30 months. RESULTS: Lower morbidity and mortality rates and less hospital stay were found in group LC (55 cases) as compared with group OC (50 cases). Conversion rate in group LC was 14%. This rate is higher in patients with previous surgeries in upper abdomen. There were no differences in morbidity and mortality in patients with previous abdominal surgeries or with diabetes. Patients with liver cirrhosis in group OC had higher morbidity and mortality. CONCLUSIONS: LC can be performed safely in patients with history of cancer, laparotomy or abdominal radiation therapy and should be considered as first choice for symptomatic gallstones. LC should be considered also in diabetes and liver cirrhosis. When previous surgery in the upper abdomen is found we recommend to insert the first trocar under direct vision of peritoneal cavity. In this case conversion rate is high.
Asunto(s)
Colecistectomía , Enfermedades de la Vesícula Biliar/cirugía , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Enfermedades de la Vesícula Biliar/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is a rare tumor in Mexico. Stands in the 21st place, corresponding to 1.4% of all malignant tumors. However in Southeast Asia, Japan and Sub-Sahara Africa, its incidence is very high. Frequently this tumor is diagnosed in late clinical stages and curative surgery is difficult to perform. OBJECTIVES: To analyze the general features of patients with HCC, and its management in our hospital. METHODS: An observational, transversal retrospective study was performed with 63 patients with histological proved HCC. RESULTS: Thirty-two were male (50.7%) and 31 female, the mean age was 56 years, 18 had history of alcohol abuse. Liver enlargement, abdominal pain and weight loss were the most common clinical manifestations. The alpha-fetoprotein (AFP) was positive in 55% of the patients, ultrasonography and computed tomography were the most useful studies. Fifty-six percent had associated chronic liver pathology, of which 51% had alcoholic cirrhosis, 43% had cirrhosis of other undetermined origin, and 6% had chronic hepatitis. Seventy percent were diagnosed in clinical stage II, 17% in stage III. Only 31% were taken to surgery, of which laparotomy and liver biopsy was performed in 70%, liver resection in 15%, liver dearterialization in 15%. Fifty-four percent of all cases did not received any kind of treatment. Postoperative complications occurred in 25% and the operative mortality was 20%, with a mean survival time of 10 months. CONCLUSIONS: HCC is a rare tumor in our country. All cases were diagnosed in late clinical stages. The male-female ratio was 1:1. AFP was positive in only 55% of cases. Due to the late stages at presentation or poor clinical conditions, most tumors were considered irresectable, thereby other forms of management need to be evaluated in order to define its place. It is important to identify patients with higher risk of HCC for an early detection and management.