RESUMEN

UNLABELLED: The incidence of periampullary neoplasms substantially increases with age. If we take into account that this incidence is higher in the elder patient and that life expectancy is nowadays longer, questioning surgical approach in this group of patients turns out to be controversial. OBJECTIVE: [corrected] Asses if in the elder patients the duodenopancreatectomy has a higher mortality and complications. MATERIALS AND METHODS: A retrospective study including patients who underwent duodenopancreatectomy between October 2002 and June 2012 was undertaken to assess whether the elder ones had a higher morbidity and mortality after surgery. Patients were distributed in two groups according to age. The first group included 240 patients younger than 75 years, and the second one included 74 patients older than 75 years. There wasn't NO significant difference in morbidity between the two groups. RESULTS: General mortality for the whole series was 4%. The first group had a 2.9% mortality whereas in the second one mortality reached 4.9%, a significant difference. However, when we changed the reference age from 75 years to 65 or 70 years the difference was not significant any more. CONCLUSION: From this study we can ascertain that an age more than 75 years significantly increases the mortality risk in duodenopancreatectomy patients. This age, however, doesn't proscribe surgical approach, since surgery is the only choice for curative treatment in patients with this type of cancer.

Asunto(s)

RESUMEN

La incidencia de las neoplasias peri ampulares se incrementa sustancialmente con la edad, teniendo en cuenta que la incidencia de estas neoplasias se presenta mucho más en pacientes mayores y que la expectativa de vida cada vez es más alta es muy difícil cuestionar la cirugía en este grupo de pacientes. Objetivo: Evaluar la conveniencia de realizar una duodenopancreatectomía en los pacientes adultos mayores y si ésta presenta mayores complicaciones y mortalidad en este grupo de pacientes. Materiales y métodos: Durante el periodo comprendido entre octubre del 2002 hasta junio del 2012 se realizó un estudio retrospectivo en 314 pacientes sometidos a una duodenopancreatectomía para evaluar si los pacientes ancianos presentaban una mayor morbilidad y mortalidad luego de esta cirugía. Se distribuyó a los pacientes en dos grupos de acuerdo a la edad. En el primero se incluyeron a 240 pacientes que eran menores de 75 años y en el segundo se incluyeron a 74 pacientes mayores de 75 años. No existió diferencia significativa en la morbilidad de los dos grupos. Resultados: La mortalidad general en toda la serie fue de 4%. En el primer grupo la mortalidad fue de 2,9% mientras que en el segundo grupo subió a 9,4% ,siendo esta diferencia significativa. Sin embargo, cuando redujimos la edad de comparación a 65 años y a 70 años pudimos comprobar que la diferencia ya no fue significativa. Conclusion: Luego de este estudio podemos afirmar que la edad mayor de 75 años aumenta el riesgo de mortalidad de manera significativa en los pacientes sometidos a una duodenopancreatectomía, pero no contraindica la cirugía ya que es la única opción para tratar de curar a una paciente con este tipo de cáncer.

The incidence of periampullary neoplasms substantially increases with age. If we take into account that this incidence is higher in the elder patient and that life expectancy is nowadays longer, questioning surgical approach in this group of patients turns out to be controversial. Objetive: Asses if in the elder patients the duodenopancreatectomy has a higher mortality and complications. Materials and methods: A retrospective study including patients who underwent duodenopancreatectomy between October 2002 and June 2012 was undertaken to assess whether the elder ones had a higher morbidity and mortality after surgery. Patients were distributed in two groups according to age. The first group included 240 patients younger than 75 years, and the second one included 74 patients older than 75 years. There wasn't NO significant difference in morbidity between the two groups. Results: General mortality for the whole series was 4%. The first group had a 2.9% mortality whereas in the second one mortality reached 4.9%, a significant difference. However, when we changed the reference age from 75 years to 65 or 70 years the difference was not significant any more. Conclusion: From this study we can ascertain that an age more than 75 years significantly increases the mortality risk in duodenopancreatectomy patients. This age, however, doesn't proscribe surgical approach, since surgery is the only choice for curative treatment in patients with this type of cancer.

Asunto(s)

RESUMEN

Female of 64 years old, who two years ago was hospitalized in another institution for treatment of an abscess in the right liver lobe. During that hospitalization, it was found a duodenal tumor by tomography; however, no further studies or follow up on this finding was done. Prior to actual hospitalization, she was seen in a private clinic and treated with antibiotics for a suggestive"organized abscess" in the pancreatic head diagnosed by tomography. She presented with fever, abdominal pain and a palpable abdominal tumor in the right upper quadrant for a month. We realized a three-phase multislice spiral tomography with pancreatic curved reconstruction, which allowed to identified an ovoid tumor of 80 x 60 mm, with an area of central necrosis and intense contrast enhancement (arterial phase), located between the second and third duodenal portion, near the head of the pancreas. An upper endoscopy showed an extrinsic compression of the third duodenal portion. The patient underwent tumor resection without complication and the histologic diagnosis of the surgical specimen revealed a duodenal stromal tumor (GIST) with extraluminal transmural growth. We presented this case because of its unusual presentation of this tumor.

Asunto(s)

RESUMEN

Paciente mujer de 64 años de edad, quien hace dos años estuvo hospitalizada en otra institución para el tratamiento de un absceso en el lóbulo hepático derecho. Durante esa hospitalización se diagnosticó un tumor duodenal por tomografía; sin embargo, no se completó el estudio sobre este hallazgo. Previa a la actual hospitalización, la paciente estuvo internada en una clínica privada, donde fue tratada con antibióticos por una imagen sugestiva de "absceso organizado" en la cabeza del páncreas. Desde hace un mes presentaba fiebre, dolor abdominal y una masa palpable en el cuadrante superior derecho del abdomen. Se le realizó una tomografía espiral multicorte trifásica, con reconstrucción curvada de páncreas que permitió reconocer una tumoración ovoidea de 80 x 60 mm, con área de necrosis central e intenso realce del contraste (fase arterial), localizada entre la segunda y tercera porción duodenal, próxima a la cabeza de páncreas. La endoscopía alta demostró una compresión extrínseca en la tercera porción duodenal. La paciente fue sometida a una resección tumoral sin complicaciones y la histología del espécimen quirúrgico reveló un Tumor Estromal Gastrointestinal (GIST) Duodenal, de crecimiento transmural extraluminal. Presentamos el caso por ser una inusual presentación este tipo de tumores.

Female of 64 years old, who two years ago was hospitalized in another institution for treatment of an abscess in the right liver lobe. During that hospitalization, it was found a duodenal tumor by tomography; however, no further studies or follow up on this finding was done. Prior to actual hospitalization, she was seen in a private clinic and treated with antibiotics for a suggestive "organized abscess" in the pancreatic head diagnosed by tomography. She presented with fever, abdominal pain and a palpable abdominal tumor in the right upper quadrant for a month. We realized a three-phase multislice spiral tomography with pancreatic curved reconstruction, which allowed to identified an ovoid tumor of 80 x 60 mm, with an area of central necrosis and intense contrast enhancement (arterial phase), located between the second and third duodenal portion, near the head of the pancreas. An upper endoscopy showed an extrinsic compression of the third duodenal portion. The patient underwent tumor resection without complication and the histologic diagnosis of the surgical specimen revealed a duodenal stromal tumor (GIST) with extraluminal transmural growth. We presented this case because of its unusual presentation of this tumor.

Asunto(s)

RESUMEN

OBJECTIVE: The purpose of this study is to define the factors that condition complications and mortality in a group of 119 patients with periampullary neoplasms operated on at a general hospital. MATERIALS AND METHOD: Between October 2002 and December 2006, 119 patients who were diagnosed with periampullary neoplasms and underwent a pancreatoduodenectomy at Rebagliati Hospital were evaluated. RESULTS: Age and sex were not conditioning factors of complications. A significant difference in the type of pancreatic anastomosis used was noticed, whereby telescoping was a conditioning factor of complication (p<0.009) compared with mucous-mucous anastomosis.After analyzing the bleeding associated with each complication, a significant connection was established between the greatest bleeding volume obtained in the operating room with the development of pancreatic fistulas (p<0.03), re-operation (p<0.01), abscesses (p<0.006) and intestinal fistulas (p<0.001).The complications related to mortality in patients who underwent a pancreatoduodenectomy (PD) were evaluated. It was observed that pancreatic fistulas (p<0.003), intestinal fistulas (p<0.003) and gallbladder fistulas (p<0.03), intra-abdominal hemorrhaging and bleeding during a standard operating procedure (SOP), transfusions and re-operations were factors that increased mortality significantly. When the surgeon was evaluated as a factor of morbimortality, it was proven that there was a connection between the surgical volume and the incidence of complications and mortality.There was a shorter hospital stay, a lower incidence of intra-operative bleeding and lower morbimortality in the high surgical volume group. CONCLUSIONS: The most-feared complications, since they are directly related to mortality, are intestinal fistulas, intra-abdominal hemorrhaging, intra-abdominal abscesses, gallbladder fistulas and the need to undergo repeated operations. Both complications and mortality are directly related to the surgeon factor, which, according to our analysis is the most important factor in decreasing costs, morbidity and mortality in this type of surgery.

Asunto(s)

RESUMEN

El propósito de este estudio, es definir cuales son los factores que condicionan las complicaciones y la mortalidad en un grupo de 119 pacientes con neoplasias peri ampulares operados en un hospital general. MATERIAL Y MÉTODO: Desde Octubre del 2002 hasta Diciembre del 2006 se analizaron 119 pacientes operados de duodenopancreatectomía en el hospital Rebagliati por el diagnostico de neoplasia peri ampular.RESULTADOS: La edad y el sexo no fueron factores condicionantes de complicaciones. Se observo una diferencia significativa en el tipo de anastomosis pancreática utilizadadonde el telescopaje fue un factor condicionante de complicación (p<0.009) Cuando se comparó con a la anastomosis mucosa-mucosa. Al analizar el sangrado con cada una de las complicaciones, se pudo ver que existía una relación significativa entre el mayor volumen de sangrado en sala de operaciones con el desarrollo de fístula pancreática (p<0.03), reoperación (p<0.01), absceso (p<0.006), y fístula intestinal (p<0.001). Se evaluó cuales fueron las complicaciones relacionados a la mortalidad en los pacientes sometidos a Pancreatoduodenectomía (PD), se pudo observar que la fístula pancreática (p<0.003), la fístula intestinal (p<0.003), la fístula biliar (p<0.03), la hemorragia intra abdominal, el sangrado en Sala de Operaciones (SOP), las transfusiones y las reoperaciones fueron factores que aumentaron la mortalidad, en forma significativa. Cuando se evaluó al cirujano como factor de morbi-mortalidad, se pudo comprobar queexistía una relación entre el volumen quirúrgico y la incidencia de complicaciones y mortalidad. Teniendo una menor estancia hospitalaria una menor incidencia en el sangradointra operatorio y una morbi-mortalidad menor en el grupo de alto volumen quirúrgico. CONCLUSIONES: Las complicaciones más temidas ya que se relacionan directamente con la mortalidad son: la fístula intestinal, hemorragia intra abdominal, absceso intraabdominal, fístula biliar y la necesidad de...

OBJECTIVE: The purpose of this study is to define the factors that condition complications and mortality in a group of 119 patients with periampullary neoplasms operated on at a general hospital. MATERIALS & METHOD: Between October 2002 and December 2006, 119 patients who were diagnosed with periampullary neoplasms and underwent a pancreatoduodenectomyat Rebagliati Hospital were evaluated. RESULTS: Age and sex were not conditioning factors of complications. A significant difference in the type of pancreatic anastomosis used was noticed, whereby telescopingwas a conditioning factor of complication (p<0.009) compared with mucous-mucous anastomosis. After analyzing the bleeding associated with each complication, a significant connection was established between the greatest bleeding volume obtained in the operating room with the development of pancreatic fistulas (p<0.03), re-operation (p<0.01), abscesses (p<0.006) and intestinal fistulas (p<0.001). The complications related to mortality in patients who underwent a pancreatoduodenectomy (PD) were evaluated. It was observed that pancreatic fistulas (p<0.003), intestinal fistulas (p<0.003) and gallbladder fistulas (p<0.03), intra-abdominal hemorrhaging and bleeding during a standard operating procedure (SOP), transfusions and re-operations were factors that increased mortality significantly. When the surgeon was evaluated as a factor of morbimortality, it was proven that there was a connection between the surgical volume and the incidence of complications andmortality. There was a shorter hospital stay, a lower incidence of intra-operative bleeding and lower morbimortality in the high surgical volume group.CONCLUSIONS: The most-feared complications, since they are directly related to mortality, are intestinal fistulas, intra-abdominal hemorrhaging, intra-abdominal abscesses,gallbladder fistulas and the need to undergo repeated operations. Both complications and mortality are directly related to the...

Asunto(s)

RESUMEN

INTRODUCTION: The cystic tumors of the pancreas represent an uncommon entity and the less frequent type among them is the solid pseudopapillary tumor of the pancreas. Its main difference lies in the fact that this type of tumor is more frequent in young patients. Solid pseudopapillary tumors are generally tumors of large size and the majority of them have a benign behavior. MATERIAL AND METHOD: During a period of three years, seven patients with this neoplasia underwent surgery. Six patients (86%) were females and just one was a male, all of them between the ages of 11 and 37. None of these cases showed metastasis and there were no signs of malignancy reported in the pathological anatomy. The average tumor size was 8 cm and the head of the pancreas was the most frequent location (57%). Of the resections performed in these patients, three were middle pancreatectomies, two were distal pancreatectomies one was a duodenopancreatectomy and one was duodenum preserving head resection of the pancreas. DISCUSSION: The solid pseudopapillary tumors are uncommon tumors which are generally benign or premalignant neoplasias. Nevertheless, 9% of them can behave like carcinomas; therefore, these tumors should not be ignored.

Asunto(s)

RESUMEN

Introducción: Los tumores quísticos del páncreas representan una entidad poco común, la variedad menos frecuente dentro de estos tumores es el tumor sólido pseudopapilar del páncreas. Su diferencia principal radica en que se presenta más frecuente en pacientes jóvenes. Son tumores generalmente de gran tamaño siendo la mayoría de ellos de comportamiento benigno. Material y método: Durante un periodo de tres años se han operado a 7 pacientes con esta neoplasia. Seis pacientes (86) fueron de sexo femenino y uno solo fue de sexo masculino, las edades fluctuaron desde los 11 a los 37 años, en ningún caso se encontraron metástasis o en la anatomía patológica se reportaron signos de malignidad. El promedio del tamaño tumoral fue de 8 cm y la localización más frecuente fue la cabeza de páncreas (57), realizándose tres pancreatectomias medias, dos pancreatectomias distales una duodenopancreatectomia, y una resección de cabeza de páncreas con preservación de duodeno. Discusión: Los tumores sólidos pseudopapilares son poco frecuentes generalmente se tratan de neoplasias benignas o pre malignas pero en un 9 pueden comportarse como carcinoma por lo cual estos tumores no pueden ser ignorados.

Introduction: The cystic tumors of the pancreas represent an uncommon entity and the less frequent type among them is the solid pseudopapillary tumor of the pancreas. Its main difference lies in the fact that this type of tumor is more frequent in young patients. Solidpseudopapillary tumors are generally tumors of large size and the majority of them have a benign behavior. MATERIAL AND METHOD: During a period of three years, seven patients with this neoplasia underwent surgery. Six patients (86 per cent) were females and just one was a male, all of them between the ages of 11 and 37. None of these cases showed metastasis and there were no signs of malignancy reported in the pathological anatomy. The average tumor size was 8 cm and the head of the pancreas was the most frequent location (57 per cent). Of the resections performed in these patients, three were middlepancreatectomies, two were distal pancreatectomies one was a duodenopancreatectomy and one was duodenum preserving head resection of the pancreas. DISCUSSION: The solid pseudopapillary tumors are uncommon tumors which are generally benign orpremalignant neoplasias. Nevertheless, 9% of them can behave like carcinomas; therefore, these tumors should not be ignored.

Asunto(s)

RESUMEN

INTRODUCTION: The cystic tumor of the pancreas is a relatively uncommon entity. There are different types of pancreatic cystic tumors and they all exhibit different degrees of malignancy. These tumors represent 1% of all primary pancreatic tumors and only 15% of the cystic lesions. The serous cystadenomas (SCA) are mostly benign lesions with an average size of 4 cm; nevertheless, in some rare cases these are giant lesions, generally larger than 15 cm. Sometimes these tumors produce a symptomatology caused by the compression of neighboring structures, therefore they are generally operable. MATERIAL AND METHOD: During the period from June 2004 to June 2005, the 3A II unit of the Edgardo Rebagliati Martins Hospital operated on two cases of giant serous cystadenomas of the pancreas, one located in the tail of the pancreas and the other in the head of the pancreas, with an average size of 16 cm. DISCUSSION: The giant SCAs of the pancreas are rarely seen lesions that, according to different authors, are usually larger than 10 to 15 cm. in diameter. These lesions do not represent a diagnosis problem and are generally operable since they produce a symptomatology by compression. The surgical resection can be complicated due to their large size and to the considerable neovascularization.

Asunto(s)

RESUMEN

Introducción: Los tumores quísticos del páncreas son una entidad poco común que reúnen a distintas variedades. Las cuales presentan diferentes grados de malignidad. Estos representan el 1 por ciento de todos los tumores primarios del páncreas y solo el 15 por ciento de las lesiones quísticas. Los cistoadenomas serosos (SCA) son lesiones casi siempre benignas con un tamaño promedio de 4 cm sin embargo en muy raros casos existen lesiones gigantes generalmente mayores de 15 cm, estos tumores algunas veces producen una sintomatología causada por la comprensión de estructuras vecinas por lo que generalmente son quirúrgicos. Material y método: Durante el periodo comprendido entre Junio del 2004 a Junio del 2005 se operaron en el servicio 3A II del Hospital Edgardo Rebagliati Martins dos casos de cistoadenomas serosos gigantes del páncreas uno localizado en la cola del páncreas y otro en la cabeza con un tamaño promedio de 16 cm. Discusión: Los SCA gigantes del páncreas son lesiones muy poco frecuentes generalmente mayores de 10 a 15 cm. de diámetro de acuerdo a los diferentes autores, estas lesiones no presentan un problema diagnóstico, siendo generalmente quirúrgicas ya que producen sintomatología por comprensión. La resección quirúrgica puede ser complicada debido al gran tamaño y a la neovascularización importante que presentan.

Introduction: The cystic tumor of the pancreas is a relatively uncommon entity. There are different types of pancreatic cystic tumors and they all exhibit different degrees of malignancy.These tumors represent 1 per cent of all primary pancreatic tumors and only 15 per cent of the cystic lesions. The serous cystadenomas (SCA) are mostly benign lesions with an average size of 4 cm; nevertheless, in some rare cases these are giant lesions, generally larger than 15 cm. Sometimes these tumors produce a symptomatology caused by the compression of neighboring structures, therefore they are generally operable.MATERIAL AND METHOD: During the period from June 2004 to June 2005, the 3A II unit of the Edgardo RebagliatiMartins Hospital operated on two cases of giant serous cystadenomas of the pancreas, one located in the tail of the pancreas and the other in the head of the pancreas, with an average size of 16 cm. DISCUSSION: The giant SCAs of the pancreas are rarely seen lesions that, according to different authors, are usually larger than 10 to 15 cm. in diameter. These lesions do not representa diagnosis problem and are generally operable since they produce a symptomatology by compression. The surgical resection can be complicated due to their large size and to the considerable neovascularization.

Asunto(s)

RESUMEN

The Vater's ampulla neoplasias are not very frequent lesions. The ampullectomy consists on the total resection of the Vater's ampulla and part of the duodenal wall with the later reconstruction and anastomosis of the common bile duct and the Wirsung's duct to the duodenum. The local resection of the ampulla is an alternative to the duodenopancreatectomy that has to be taken into account, especially in benign lesions as in the case of adenomas of the Vater's ampulla. Here we describe two cases one with adenoma of the Vater's ampulla, with a high degree dysplasia, who first underwent an ampullectomy and finally ended up in a duodenopancreatectomy due to the infiltration of the adenoma into the edge of section and other case of Lymphangioma of Vater's ampulla with no infiltration in the edge of section.

Asunto(s)

RESUMEN

Las neoplasias de ampolla de Vater son lesiones poco frecuentes, la ampulectomía consiste en la resección total de la ampolla de Vater y parte de la pared duodenal con la posterior reconstrucción y anastomosis de los conductos colédoco y Wirsung al duodeno. La resección local de la ampolla es una alternativa a la duodenopancreatectomía, que tiene que ser tomada en cuenta, sobre todo en lesiones benignas como son los casos de adenomas de la ampolla de Vater. Aquí se describen dos casos. El primero se trata de un adenoma de ampolla de Vater que luego de la ampulectomía presentó bordes comprometidos en la biopsia de congelación y terminó en una duodenopancreatectomía y el segundo caso se trata de un lifangioma de ampolla que no presento compromiso del borde de sección y luego de la ampulectomía no requirió mayor tratamiento.

Asunto(s)