RESUMEN
Hepatic resection for benign pathology is rare. We report our experience in two patients with hepaticolithiasis. One patient underwent left hemihepatectomy with removal of segments II, III and IV for localized Caroli's disease with multiple intrahepatic calculi. The second patient underwent resection of segment II and III with Roux-en-Y hepaticojejunostomy for right and left intrahepatic calculi with an abscess in the left lobe of the liver and a choledochal cyst.
Asunto(s)
Colelitiasis/cirugía , Hepatectomía , Hepatopatías/cirugía , Adulto , Enfermedad de Caroli/complicaciones , Colelitiasis/complicaciones , Femenino , Conducto Hepático Común , Humanos , Hepatopatías/complicaciones , Persona de Mediana EdadRESUMEN
OBJECTIVES: To assess the morbidity, mortality and 1- and 2-year survival rates, and safety of pancreaticoduodenectomy for periampullary (including pancreatic head) carcinomas in a non-oncology surgical set-up. METHODS: Records of 45 patients undergoing pancreaticoduodenectomies for periampullary cancers between July 1996 and April 2000 were reviewed. These included ampullary (n=23), pancreatic (14) and duodenal (2) adenocarcinomas, lower-end cholangiocarcinoma (5), and ampullary carcinoid (1). Thirty-seven patients underwent the Whipple procedure and 8 underwent the pylorus-preserving modification. RESULTS: The overall mortality rate was 11% and morbidity rate was 46%. Wound infection was the most common postoperative complication. The 1- and 2-year survival rates for periampullary cancers were 61% and 39% and those for pancreatic cancers were 57% and 36%, respectively. CONCLUSION: Pancreaticoduodenectomy for periampullary tumors remains a formidable procedure in our set-up. However, it can be performed safely with low mortality and morbidity rates.
Asunto(s)
Adenocarcinoma/cirugía , Ampolla Hepatopancreática/cirugía , Tumor Carcinoide/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Adenocarcinoma/mortalidad , Adulto , Anciano , Ampolla Hepatopancreática/patología , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos , Tumor Carcinoide/mortalidad , Colangiocarcinoma/mortalidad , Colangiocarcinoma/cirugía , Neoplasias Duodenales/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Benefit of resection of metastatic lesions to the liver and lung from colonic cancer is well established. Resection of solitary metastasis or of locally recurrent malignancies in the periampullary region has now become the norm, as it increases survival. We present our experience with two patients with metastases in the periampullary region from previously treated colonic carcinoma who were treated with pancreaticoduodenectomy.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias del Colon/patología , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Adenocarcinoma/secundario , Neoplasias Duodenales/secundario , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/secundarioRESUMEN
A prospective analysis of 50 patients undergoing palliative bypass surgery for incurable malignant obstructive jaundice was carried out in an attempt to identify factors predicting post-operative mortality. Five clinical and nine laboratory parameters were studied. Fourteen patients died within 30 days of surgery. It was seen that levels of haemoglobin, hematocrit and serum albumin levels were significantly lower while serum bilirubin was significantly higher in patients who died compared with the survivors. Patients having Hb < 10 Gm/dL, serum bilirubin > 350 micromol/dL, serum albumin < 2.5 g/dL and prothrombin index < 60% exhibited a higher percentage of mortality. On multivariate analysis, levels of haemoglobin, serum albumin and serum bilirubin could be used to independently predict the outcome with an accuracy of 86%. This was validated by prospectively applying the regression equation derived from the first 30 patients to the next 20 patients. It was seen that the predicted outcome correlated with the actual outcome with a correlation coefficient of 0.5098 (P = 0.01). It is concluded that in patients with high bilirubin, low haemoglobin and low albumin levels palliative surgical procedures carry a high risk of post-operative mortality and non-surgical methods may be more suitable.