RESUMEN
BACKGROUND/AIMS: Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse. METHODS: A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99. RESULTS: 11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5-66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus. CONCLUSION: Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy.
Asunto(s)
Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/cirugía , Píloro/cirugía , Adenocarcinoma/cirugía , Adenocarcinoma Mucinoso/cirugía , Anciano , Anciano de 80 o más Años , Peso Corporal , Carcinoma Ductal Pancreático/cirugía , Neoplasias del Conducto Colédoco/patología , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Pancreatectomía/efectos adversos , Pancreatectomía/mortalidad , Neoplasias Pancreáticas/patología , Estudios Prospectivos , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
The increasing knowledge of the anatomy and function of the liver made the surgical resection of liver metastases currently to the therapy of choice. Although liver metastasis is an advanced stage in tumor-progression, surgery achieves the best long-term results due to a better understanding of the carcinogenesis (i.e. micrometastases) and the prognostic risk factors. This study summarizes the results of 109 resections of colorectal and non-colorectal liver metastases during a period of 59 months at our department. Four different surgical techniques (extended hepatectomy vs. segmental resection vs. atypical resection vs. biopsy) were investigated. For resections a tumour-free resection margin of at least 10 mm was always attempted to achieve. The accumulated morbidity of all techniques together was 23%. Although the morbidity was higher for extended resections (Encephalopathy 16% vs. 2.3% for segmental resections, Liver insufficiency 23% vs. 4.7%), compared to the limited resection procedures, the long-term survival improved. The overall mortality was 2.7%. Survival was higher in patients with resection of colorectal than non colorectal metastases. Our results indicate that liver resection, under observance of the anatomical and functional margins (i.e. an adequate resection margin), is the only potentially curative therapy for liver metastases. An extensive formal resection, although inducing a higher perioperative morbidity, is superior to the limited resection techniques and results in an increased long-term survival. One reason is the increased probability of co-resection of preoperatively undetected local micrometastases.
Asunto(s)
Neoplasias Colorrectales/cirugía , Hepatectomía , Neoplasias Hepáticas/secundario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Connective tissue growth factor (CTGF) belongs to a family of factors that regulate fibrogenesis and wound healing. While the significance of transforming growth factor beta (TGF-beta) in liver fibrosis is well established, the role of CTGF in fibrosing hepatopathy is still unknown. METHODS: CTGF was analyzed in 10 normal and in 16 cirrhotic liver tissue samples. Northern blot analysis was used to examine the concomitant expression of CTGF and TGF-beta1 mRNAs, and the cellular localization of CTGF mRNA was studied by in situ hybridization. For identification of myofibroblasts and activated hepatic stellate cells, alpha-smooth muscle actin (alpha-SMA) immunohistochemistry was used. RESULTS: Northern blot analysis showed 6.5-fold enhanced expression of CTGF mRNA and 7.8-fold enhanced expression of TGF-beta1 mRNA in liver cirrhosis in comparison with normal controls (p<0.01). By in situ hybridization, CTGF mRNA was detectable in only a few spindle cells in the portal tracts in normal liver samples. In contrast, there was strong expression of CTGF mRNA in fibroblasts and myofibroblast-like cells present in fibrous septa surrounding the cirrhotic nodules, in stellate cells, in endothelial cells and in mesenchymal cells around ductular proliferations, and in ductular epithelial cells. There was a strong correlation between CTGF mRNA and TGF-beta1 mRNA as well as the degree of fibrosis (p<0.01). CONCLUSIONS: Overexpression of CTGF in liver cirrhosis, especially in fibroblasts/myofibroblasts and stellate cells, suggests that this novel factor may play an important role in hepatic fibrosis.
Asunto(s)
Sustancias de Crecimiento/metabolismo , Proteínas Inmediatas-Precoces/metabolismo , Péptidos y Proteínas de Señalización Intercelular , Cirrosis Hepática/metabolismo , Actinas/metabolismo , Adulto , Anciano , Northern Blotting , Factor de Crecimiento del Tejido Conjuntivo , Femenino , Fibroblastos/metabolismo , Fibroblastos/patología , Técnica del Anticuerpo Fluorescente Indirecta , Sustancias de Crecimiento/genética , Humanos , Proteínas Inmediatas-Precoces/genética , Hibridación in Situ , Macrófagos del Hígado/metabolismo , Macrófagos del Hígado/patología , Hígado/citología , Hígado/metabolismo , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , ARN Mensajero/metabolismo , Factor de Crecimiento Transformador beta/genética , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta1Asunto(s)
Neoplasias de los Conductos Biliares/diagnóstico , Colelitiasis/diagnóstico , Errores Diagnósticos , Anciano , Neoplasias de los Conductos Biliares/complicaciones , Preescolar , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Colelitiasis/complicaciones , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND/AIM: In an attempt to overcome some of the problems encountered with the materials available for liver embolisation, we investigated a novel radiopaque polymer of the polyurethane family (Degra-Bloc). METHODS: Hepatic artery embolisation of one liver lobe using polyurethane was performed in 19 healthy pigs. Microcirculatory changes were assessed by laser Doppler flowmetry. Radiological and pathological examinations of the livers, hearts and lungs removed provided information about the extent and effect of the embolisation. RESULTS: None of the pigs died due to hepatic failure or toxicity of polyurethane. Microcirculation of embolised liver lobes significantly decreased from 106 (+/-15) perfusion units (PU) to 45 (+/-6) PU immediately after embolisation and further to 28 (+/-7) PU before euthanasia. At this time conventional and angiographic X-ray controls demonstrated the radiopaque casts extending up to the peripheral arteries with signs of degradation over time but without formation of collateral vessels. The main pathological findings consisted of destruction of the portal tract structures and also of large areas of liver necrosis. Polyurethane was encountered in arterioles as small as 10-20 microm, but not in liver sinusoids, hearts or lungs. CONCLUSIONS: The novel polymer called DegraBloc is a biocompatible, slowly degradable, radiopaque embolic agent. The occlusion of the arterial tree up to the smallest arteriolar diameter combined with concomitant portal vein occlusion leads to sharp segmental necrosis in pig livers without formation of significant collaterals and without systemic embolism. In the treatment of liver tumours polyurethane might provide a promising alternative to conventional embolic materials, provided that it is used with care in patients with advanced liver cirrhosis.
Asunto(s)
Medios de Contraste/efectos adversos , Embolización Terapéutica/efectos adversos , Hígado/patología , Polímeros/efectos adversos , Poliuretanos/efectos adversos , Vena Porta/fisiopatología , Animales , Constricción Patológica/etiología , Embolización Terapéutica/mortalidad , Arteria Hepática , Flujometría por Láser-Doppler , Hígado/diagnóstico por imagen , Circulación Hepática , Necrosis , Complicaciones Posoperatorias/mortalidad , Radiografía , PorcinosRESUMEN
BACKGROUND: Peritonitis is, even today, a significant source of death and complications. The objective of this study was to determine the morbidity and mortality rates, the incidence of reoperations, and the need for additional treatment strategies (on demand) in patients with diffuse peritonitis. METHODS: Prospective analysis including all patients (n = 258) with diffuse peritonitis admitted to our surgical service between November 1993 and April 1998 who underwent a uniform surgical treatment concept of peritonitis including early intervention, source control, and extensive intraoperative lavage. RESULTS: The 258 patients with diffuse peritonitis averaged a mean Mannheim Peritonitis Index of 27.1 points (range, 11-43 points). Source control at the initial operation was possible in 230 of the patients (89%), of those, 21 patients (9%) needed reintervention. In 28 patients (11%), source control was not possible at the initial operation. Twenty of these patients (71%) had to undergo additional treatment strategies (on demand) such as continuous lavage and/or laparostomy. Overall 228 of the 258 patients (88%) needed just 1 initial surgical intervention. The overall morbidity rate was 41%; the rate of reoperation was 12%, and the hospital mortality rate was 14%. CONCLUSIONS: A conservative surgical treatment concept supplemented with "extensive" intraoperative lavage reduces the reoperation rate compared with other treatment standards of peritonitis and achieves a low mortality rate in patients with diffuse peritonitis.
Asunto(s)
Peritonitis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Peritonitis/mortalidad , Peritonitis/patología , Complicaciones Posoperatorias , Estudios Prospectivos , ReoperaciónRESUMEN
BACKGROUND AND OBJECTIVE: The preoperative investigation for choledocholithiasis in patients undergoing elective laparoscopic cholecystectomy is still a matter of debate. PATIENTS AND METHODS: In a prospective clinical trial the accuracy of intravenous cholangiography (IVC), ultrasonography and liver function tests in the preoperative diagnosis of choledocholithiasis was assessed in 98 patients undergoing elective cholecystectomy. Only patients with uncomplicated cholecystolithiasis considered to be at low risk for having bile duct stones were investigated. A 2-year follow-up clinical survey (mean) was performed in 92 of the 98 patients to investigate the occurrence of postoperative choledocholithiasis (gold standard: clinically manifest choledocholithiasis). RESULTS: In this patient cohort the incidence of choledocholithiasis was found to be 5.1%. Among the three diagnostic tests IVC proved to be more accurate with higher sensitivity and a better positive predictive value than ultrasonography and liver function tests. The sensitivity for IVC was 100% compared to 20% for ultrasonography and 40% for liver function tests, respectively. The positive predictive value for IVC was 83.3% in comparison to 20% for ultrasonography and 25% for liver function tests. Mild side effects caused by intravenous contrast media were observed in 2.0%. During a mean postoperative follow-up of 2 years no clinically manifest and initially overlooked choledocholithiasis could be detected in the 92 investigated patients. CONCLUSION: IVC is a reliable method to detect unsuspected common bile duct stones and should be used in the preoperative diagnosis prior to elective laparoscopic cholecystectomy. IVC may play a role in decreasing the rate of preoperative ERCP or intraoperative cholangiography in these patients.
Asunto(s)
Colangiografía , Colecistectomía Laparoscópica , Cálculos Biliares/diagnóstico , Adolescente , Adulto , Anciano , Algoritmos , Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/cirugía , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Sensibilidad y Especificidad , Factores de Tiempo , UltrasonografíaRESUMEN
Hepatocellular carcinoma (HCC) is a highly malignant tumor with a poor prognosis. The success of its established treatment modalities is frequently limited by the advanced stage of the tumor at the time of diagnosis. Therefore, it is important to understand the mechanisms that control its growth behavior. In the present study, we review some aspects of molecular and cellular processes involved in growth control and metastatic potential of HCC. These include some growth factors and their receptors, oncogenes and tumor suppressor genes, and factors that control angiogenesis and extracellular matrix formation. These factors may be important targets for novel therapeutic approaches in the future.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Animales , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patología , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologíaRESUMEN
Giant liver hemangiomas are defined as hemangiomas with a diameter of more than 4 cm. They often require surgery due to bleeding tendencies or local compression. Between 1994 and 1998 we operated 11 patients with giant hemangiomas (median diameter 5.8 cm, range 4-12.5 cm). Average age was 50 years (range 23-85 years). 6 patients complained of pain, 1 patient sustained a bleeding. 7 hemangiomas were enucleated, 2 segmentally resected, 1 patient underwent a hemihepatectomy. 1 patient suffered from a bile leakage. Mortality was 0%. We conclude that clinically symptomatic liver hemangiomas can be safely resected. In a right sided localisation a enucleation has the best parenchyma sparing effect, in left sided locations a segmentectomy or bisegmentectomy can be performed with little blood loss.
Asunto(s)
Hemangioma Cavernoso/cirugía , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemangioma Cavernoso/mortalidad , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana EdadRESUMEN
Congenital cystic liver disease represents a rare entity and only in 5%-20% the cysts cause symptoms or complications that demand therapy. In the past decades several therapeutic approaches have been developed with variable long-term outcome. We report herein our results and the postoperative outcome of 26 patients treated from 1987 to 1998 in our department because of symptomatic or complicated congenital cystic liver disease. In cases of symptom-producing solitary liver cysts our therapy of choice was laparoscopic fenestration. In cases of adult polycystic liver disease we mostly performed partial hepatic resection and fenestration. Both therapeutic approaches have proven a favorable long-term outcome. However, some types of adult polycystic liver disease possess a high risk of reappearance. Preoperative pathomorphological assessment of polycystic liver disease should be performed to choose the operative procedure in relation to the expected recurrence rate. Because of the progresses made in dialysis therapy and transplantation surgery in patients with adult polycystic kidney disease, an increase of patients with symptomatic polycystic liver disease has to be expected in the near future.
Asunto(s)
Quistes/congénito , Quistes/cirugía , Hepatopatías/congénito , Hepatopatías/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: We intend to analyze if additional treatment concepts are necessary in any case as a part of the standard therapy next to the well established principle of source control in the treatment of secondary peritonitis. DESIGN: A treatment concept with early intervention, source control and extensive intraoperative lavage (20-301) should be evaluated as a standard procedure in a prospective survey. Additional treatment concepts will be applied only for special reason (on demand). RESULTS: From 11/1993 to 9/1997 241 patients with diffuse peritonitis were treated with the concept mentioned above. Additional treatment concepts as continuous postoperative lavage (n = 20) and staged lavage (n = 4) were applied as primary treatment in 24 patients only (10%), mainly for impossibility of source control and evisceration. Source control at the initial operation was possible in 216 patients (90%). Due to secondary evisceration 3 patients had to undergo laparostomy for staged lavage later. Severity of peritonitis was determined according to the Mannheim Peritonitis Index (median 26, range 15-43). The primary causes of peritonitis were perforation, leakage and abscess after operation (n = 56), followed by diverticular (n = 42) and gastric or duodenal perforation (n = 39). The hospital mortality rate was 14% in the whole group, and the postoperative morbidity rate was 39%. CONCLUSIONS: Due to progress in intensive care and antibiotic treatment only a few patients (ca. 10%) need additional therapies such as postoperative or staged lavage. Surgical source control in combination with intraoperative lavage is sufficient in most of the patients with diffuse peritonitis.
Asunto(s)
Cuidados Intraoperatorios/tendencias , Peritonitis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lavado Peritoneal/métodos , Lavado Peritoneal/tendencias , Cuidados Posoperatorios/tendencias , Estudios ProspectivosRESUMEN
BACKGROUND: Tumors of the small bowel are rare, accounting for about 3-6% of all gastrointestinal neoplasms. However, diagnosis and treatment are difficult and an ongoing challenge. METHODS: We retrospectively reviewed the medical records of 54 patients with tumors of the small intestine over a period of 10 years to elucidate important factors for diagnosis, therapy and prognosis. RESULTS: 42 patients had malignant (36 primary, 6 secondary) and 12 had benign tumors. Histologically, adenocarcinoma (33%), leiomyosarcoma (17%) and carcinoid (17%) were the most frequent malignancies found. All 12 benign lesions were either leiomyomas or adenomas. Initial symptoms were nonspecific: abdominal pain in 67% and 50%, anemia in 38% and 58% and weight loss in 38% and 42% in patients with malignant and benign tumors, respectively. Upper gastrointestinal series, endoscopy, computed tomography scan and selective angiography were the most useful diagnostic tools. Resectability rate for malignant tumors was 98%; curative resection was achieved in 51%. Survival for malignant tumors has been poor: median postoperative survival was 26.9 months, the 1- and 5-year survival rates were 42.9% and 20.8%, respectively. CONCLUSIONS: These results document the need for an aggressive diagnostic work-up in these rare tumors with non-specific symptoms, as early diagnosis and radical operative therapy are important prognostic factors.
Asunto(s)
Neoplasias Intestinales/diagnóstico , Intestino Delgado/patología , Dolor Abdominal/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Adenoma/diagnóstico , Adenoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anemia/diagnóstico , Angiografía , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Endoscopía Gastrointestinal , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Intestinales/cirugía , Intestino Delgado/cirugía , Leiomioma/diagnóstico , Leiomioma/cirugía , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Pérdida de PesoRESUMEN
Acute hemorrhage in the course of chronic pancreatitis is the most serious and challenging complication, and its treatment has been the subject of controversy for years. We relate our experience in the management of this complication by superselective microcoil embolization. Five patients with acute hemorrhage resulting from chronic pancreatitis between 1994 and 1997 were included in this study. All patients were men with a median age of 44 years (range, 29-59 years). The bleeding occurred into a pseudocyst in all patients, with the splenic artery as feeding vessel. In all instances, the bleeding was successfully controlled by superselective microcoil embolization. Two patients underwent subsequent uneventful elective pseudocystojejunostomy. There was no mortality or morbidity, and no rebleeding occurred during a median follow-up of 22 months (range, 8-36 months). In appropriate patients, diagnostic angiography and superselective microcoil embolization may obviate the need for emergency surgery and should be considered as treatment alternative.
Asunto(s)
Embolización Terapéutica , Hemorragia/diagnóstico , Hemorragia/terapia , Pancreatitis Alcohólica/complicaciones , Arteria Esplénica , Enfermedad Aguda , Adulto , Angiografía , Enfermedad Crónica , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Arteria Esplénica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
CONCLUSION: The clinical significance of intrapancreatic accessory spleens resides in the mimicry of pancreatic cancer. Radionuclide tests (Octreotide scan and Tc99m sulfur colloid scan) should be undertaken to distinguish these lesions from neuroendocrine tumors, hypervascular metastases and pancreatic carcinoma. If the tests are equivocal, diagnostic laparotomy or laparoscopy is recommended. BACKGROUND: Despite its relatively common occurrence, intrapancreatic ectopic splenic tissue is rarely detected owing to its asymptomatic nature. METHODS: We report a case of a clinically asymptomatic patient in which abdominal computed tomography (CT) scans revealed a mass of 1.5 cm in diameter in the distal pancreas. The tumor markers CA 19-9 and carcinoembryonic antigen (CEA) were slightly elevated, and pancreatic neoplasm was suspected. RESULTS: Left pancreatic resection and splenectomy were performed. The removed specimen disclosed the presence of an accessory spleen within the pancreatic tail.
Asunto(s)
Coristoma/patología , Enfermedades Pancreáticas/patología , Bazo , Anciano , Coristoma/diagnóstico por imagen , Humanos , Masculino , Enfermedades Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Transforming growth factor betas (TGF-betas) are multifunctional polypeptides that have been suggested to influence tumor growth. They mediate their functions via specific cell surface receptors (type I ALK5 and type II TGF-beta receptors). The aim of this study was to analyze the roles of the three TGF-betas and their signaling receptors in human hepatocellular carcinoma (HCC). METHODS: HCC tissue samples were obtained from 18 patients undergoing partial liver resection. Normal liver tissues from 7 females and 3 males served as controls. The tissues for histological analysis were fixed in Bouin's solution and paraffin embedded. For RNA analysis, freshly obtained tissue samples were snap frozen in liquid nitrogen and stored at -80 degrees C until used. Northern blot analysis was used in normal liver and HCC to examine the expression of TGF-beta1, -beta2, -beta3 and their receptors: type I ALK5 (TbetaR-I ALK5), type II (TbetaR-II), and type III (TbetaR-III). Immunohistochemistry was performed to localize the corresponding proteins. RESULTS: All three TGF-betas demonstrated a marked mRNA overexpression in HCC in comparison with normal controls, whereas the levels of all three TGF-beta receptors showed no significant changes. Intense TGF-beta1, TGF-beta2, and TGF-beta3 immunostaining was found in hepatocellular carcinoma cells and in the perineoplastic stroma with immunohistochemistry, whereas no or mild immunostaining was present in the normal liver. For TbetaR-I ALK5 and TbetaR-II, the immunostaining in both HCC and normal liver was mild to moderate, with a slightly higher intensity in the normal tissues. CONCLUSION: The upregulation of TGF-betas in HCC suggests an important role for these isoforms in hepatic carcinogenesis and tumor progression. Moreover, the localization of the immunoreactivity in both malignant hepatocytes and stromal cells suggests that TGF-betas act via autocrine and paracrine pathways in this neoplasm.
Asunto(s)
Receptores de Activinas Tipo I , Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , ARN Neoplásico/biosíntesis , Receptores de Factores de Crecimiento Transformadores beta/metabolismo , Transducción de Señal/fisiología , Factor de Crecimiento Transformador beta/metabolismo , Adulto , Anciano , Northern Blotting , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patología , División Celular , Sondas de ADN/química , Femenino , Humanos , Técnicas para Inmunoenzimas , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Proteínas Serina-Treonina Quinasas/genética , Proteínas Serina-Treonina Quinasas/inmunología , ARN Mensajero/biosíntesis , Receptor Cross-Talk/fisiología , Receptor Tipo I de Factor de Crecimiento Transformador beta , Receptor Tipo II de Factor de Crecimiento Transformador beta , Receptores de Factores de Crecimiento Transformadores beta/genética , Receptores de Factores de Crecimiento Transformadores beta/inmunología , Factor de Crecimiento Transformador beta/genética , Factor de Crecimiento Transformador beta/inmunologíaRESUMEN
DEFINITION: Periampullary carcinomas are rare and constitute a special entity, as diagnosed earlier and having a better prognosis than other duodenal tumors. METHODS: In the present study, we retrospectively reviewed the medical records of 16 patients with periampullary carcinomas over 10 years. RESULTS: 16 patients, 10 men and 6 women (median age 66.7 years, range 42-80) had a malignant periampullary tumor. Initial symptoms were jaundice (88%), weight loss (69%), nausea and vomiting (50%) and abdominal pain (38%). Gastro-duodenoscopy, ERCP, ultrasound and CT scan were the most useful diagnostic tools. Histologically all the tumors were adenocarcinomas and solitary tumors. 91% were stage pT1 or pT2 tumors, localized in the duodenal wall without any infiltration of the pancreas. 36% of the tumors had metastasized either in lymph nodes or distant organs at diagnosis (18% pN1, 18% pM1). Resectability rate was 81%, curative resection was achieved in 62%. The operations performed were pancreatico-duodenectomy (n = 8), local tumor resection (n = 5) and palliative bypass (n = 3). Morbidity and reoperation rate were 37.5% and 18.8%, respectively; 30-day mortality was 0%. The 1- and 5-year survival rates were 58.3% and 33.3%, respectively. CONCLUSIONS: Compared to carcinomas of the small bowel or the exocrine pancreas periampullary carcinomas have a far better 5-year survival rate of more than 30%. Aggressive diagnostic workup in case of the leading symptom jaundice and radical operative therapy are key factors to achieve this goal.
Asunto(s)
Carcinoma/patología , Neoplasias Duodenales/patología , Neoplasias Pancreáticas/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico , Carcinoma/terapia , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/terapia , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). METHODS: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.