RESUMO
OBJECTIVES: To determine the prognostic significance of size tumor in the survival of patients with advanced gastric carcinoma. MATERIAL AND METHODS: This retrospective study evaluated 95 patients with advanced gastric adenocarcinoma with a diameter smaller than 7 centimeters (Group I) and 85 cases with lesions equal or greater than 7 centimeters (Group II) whom underwent radical gastrectomy with lymphadenectomy D0-D1 (n=148) or D2-D3-D4 (n=32) at Belen Hospital, Trujillo, Peru, between 1966 and 1998. RESULTS: The median age of the Group I and II was of 58.1 12.9 and 58.5 15.3 years, respectively. The patients of the group II had a lower level of seric hemoglobin (p=0.007) and more frequency of lesions Borrmann type II and IV (p= 0.003). Using the log-rank test, there was no statistically significant difference with relation to five-year survival between both groups using the multivariate analysis of Cox regression. There was not statistically significance difference between the size tumoral and the survival but there were independent factors statistically related with the survival: depth of invasion (p=0.017) and lymph nodes compromised (p=0.014). CONCLUSIONS: Clinically the size of the tumor was not a factor to take as parameter in the prediction of the actuarial survival in patients with advanced gastric cancer.
Assuntos
Adenocarcinoma/patologia , Neoplasias Gástricas/patologia , Análise Atuarial , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Feminino , Gastrectomia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Cuidados Paliativos , Peru/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Análise de SobrevidaRESUMO
We present a case of a 78 year-old man with the pathological antecedent of chronic constipation that comes to our emergency room at the Victor Lazarte Echegaray Hospital. He presented abdominal pain and progressive abdominal distension, nausea and bilious vomits of two days of evolution. The clinical examination showed an evident abdominal distension, and some metallic intestinal noises. A frontal and lateral simple abdominal x- ray showed a considerable distension of the gastric camera and intestinal loops and free fluid all over the abdominal cavity, all of which was compatible with the diagnosis of intestinal obstruction. At the operating room we proceeded with a exploration and we founded an intestinal obstruction at the ascending colon (Ladd's Bands) of high location with bloody fluid in the abdominal cavity, multiple fecalomas in the descending colon, and intestinal ischemia in the distal small bowel, the color, tone and coiling of the intestine recovered after section of the Ladd's bands. The patient evolved favorably.
Assuntos
Colo/anormalidades , Doenças do Colo/etiologia , Obstrução Intestinal/etiologia , Peritônio/anormalidades , Dor Abdominal/etiologia , Doença Aguda , Idoso , Colo/embriologia , Doenças do Colo/cirurgia , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/cirurgia , Masculino , Peritônio/embriologia , Peritônio/cirurgia , Anormalidade Torcional/etiologia , Anormalidade Torcional/cirurgiaRESUMO
The intestinal obstruction by Meckel s diverticulum is caused by an adherence, volvulus or invagination affecting this diverticulum. This is not a very frequent event and our purpose is to describe a case of intestinal obstruction by a bridle formed by Meckel s diverticulum. Clinically, the patient experienced pain in the periumbilical region, abdominal distension and bilious vomits. The exploratory laparotomy evidenced the existence of Meckel s diverticulum without signs of inflammation.
Assuntos
Obstrução Intestinal/etiologia , Divertículo Ileal/complicações , Criança , Diagnóstico Diferencial , Seguimentos , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Radiografia Abdominal , Fatores de TempoRESUMO
The case of a 51 year-old female patient, who underwent a cholecystectomy four years ago is presented. She approached the surgical department at the Hospital Belén of Trujillo, Peru, suffering of abdominal pain for the past four months and with the presence of a mass located in the epigastrium occupying part of the right hypochondrium. A thoracic x-ray showed an encysted left pleural effusion, and an abdominal echography was compatible with a pancreatic pseudo-cyst. An exploratory laparectomy was performed and a 15x9 cm mass was found in the sub-hepatic area. This mass had a semisolid consistency with a rounded shape and multiple adherences to the upper omentum and the liver. In the macroscopic exam, after the dissection of the cyst, a 25x42 cm gauze was found inside the mass which was full of biliary fluid. Due to the unspecific clinical and image diagnosis it was decided to carry out a review of this topic, which is suspected of being under-recorded in this country.
Assuntos
Abdome , Corpos Estranhos , Tampões de Gaze Cirúrgicos , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Pessoa de Meia-IdadeRESUMO
Retrospectively collected information on 77 patients who had undergone resection for colorectal cancer at Belén Hospital, Trujillo, Perú, from 1966 to 1993, was analyzed to establish their clinical features and the importance of both clinical and pathological factors affecting outcome. Common presenting features in right colon cancer were abdominal pain, pallor, and palpable mass; in left colon cancer were symptoms of obstruction, and in rectal carcinoma predominated bleeding. The diagnostic accuracy of barium enema (n = 25) and proctosigmoidoscopy (n = 18) was 72 and 100% respectively. In 54.5% (n = 42) curative resection and in 45.5% (n = 35) palliative resection was performed The surgical procedures performed were right hemicolectomy (n = 29), transverse colectomy (n = 6), left hemicolectomy (n = 11), sigmoid resection (n = 14), low anterior resection (n = 5), and abdominoperineal resection of the rectum (n = 12). The total perioperative mortality rate was 18%. The 5 year survival rate in this series was 28% (53% for curative resection and 0% for palliative resection). An univariate analysis of survival time using long-rank test revealed that presence of bowel obstruction or perforation, macroscopic appearance, tumor size, depth of invasion, lymph node status, number of lymph node metastasis, distant metastasis, and clinical stage had and individual prognostic significance. Age, sex, length of disease, serum hemoglobin level, blood transfusions, location of tumor, histologic type, and tumor grade did not affect the prognosis. Improvement in the survival probably depends on development of better adjuvant therapy in association with surgery.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Peru/epidemiologia , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
An analysis was made on 134 patients with gastric cancer underwent conventional gastrectomy consecutively at Belen Hospital, Trujillo, Peru from 1966 to 1990. The main objective was to determine the influence on prognosis of independent treatment variables and treatment-dependent variables. Gastric cancer patients (78M:56F) had a median age of 58 years (range, 23 to 82 years). The resectability rate was 48%. The operative mortality rate was of 14.2%. The 5-year actuarial survival rate of this series was 16% (33% for curative gastrectomy and 1% for palliative gastrectomy, p < 0.001). Using univariate analysis, the evolution of gastric cancer was related to palpable mass, macroscopic appearance, tumor size, depth of invasion, tumor stage, lymph node involvement, distant metastases, number of lymph node metastases and operative curability, parameters that affected the rate of survival. However the most important prognostic factor was curability, and almost all patients who survived more than five years were among those submitted to curative gastric resection. The clinical course was not related to age, gender, length of history, location of tumor, histologic type and operative procedure. We concluded that the feasibility of a curative resection would be increased and the prognosis probably improved if the carcinoma could be detected at an early stage.
Assuntos
Gastrectomia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Árvores de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Taxa de SobrevidaRESUMO
This retrospective analysis evaluated 25 patients with benign polypoid lesions and 2 cases with malignant polyps of the gallbladder who had undergone cholecystectomy at Belén Hospital, Trujillo, Perú, from January, 1966 through December, 1993 in a attempt to elucidate the clinicopathological aspects of these patients. Cholelithiasis and cholesterolosis were present as associated findings in about 68% and 12% of patients respectively. The median age was of 48.8 +/- 15 years, the male:female ratio was 1:4, a right upper quadrant pain was the most common symptom (100%) and nonvisualization of a diseased gallbladder was seen in about 44% of cholecystograms. Microscopically, the lesions were classified as follow: Hyperplasias (n = 11), adenomas (n = 10), cholesterol polyps (n = 2), inflammatory polyps (n = 2) and malignant polyps (n = 2). Seventy six percent of benign lesions measured less than 0.5 cm and 12% were multiple lesions. The average diameter of malignant polyps was larger than 3 cm. We concluded that the benign epithelial tumors of the gallbladder are extremely rare cases and the treatment of choice for adenomatous polyps should be surgical for the possibility of developing malignant transformation.
Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Pólipos/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Feminino , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Pólipos/patologia , Pólipos/cirurgia , Estudos Retrospectivos , Distribuição por SexoRESUMO
This retrospective analysis evaluated 50 patients with gangrenous colonic volvulus two cases with ileocecal volvulus, one case with volvulus of the colon transverse and 47 cases with sigmoid volvulus- who were managed by primary resection with anastomosis (n = 21) or resection plus colostomy (n = 29) at Belén Hospital, Trujillo, Perú, from January 1, 1967 to July 31, 1993. The principal aim of the study was to identify by univariate analysis the combination of predictive risk factors for postoperative mortality. The following factors were associated with increased mortality: mean arterial pressure lower than 70 mmHg (p = 0.004), presence of purulent or fecaloid peritoneal fluid (p = 0.013) or evidence of macroscopic bowel perforation (p < 0.001). A method of quantifying the risk of mortality following gangrene of the loop using these factors was described. Each factor was given a weight value ranging from 0 a 2 (0 = major, 1 = moderate, 2 = minor) according to the severity of injury estimate. The sum of the individual factor scores comprised the final score of the Severity of Gangrenous Colon by Volvulus (S.S.G.C.). In this series the 30-day mortality rate was of 30%. A S.S.G.C. resulted greater than 4 in 34 (68%) of the patients. This was associated with a 9% mortality rate and contrasted to a 75% when the S.S.G.C. was equal to or less than 4. Mortality developed in 33% of the patients operated on using an immediate anastomosis (S.S.G.C., 4.2 +/- 0.99) and it was of 28% in those whose operation was resection plus colostomy (S.S.G.C., 3 +/- 0.87).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doenças do Colo/classificação , Gangrena/classificação , Obstrução Intestinal/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Doenças do Colo/etiologia , Doenças do Colo/mortalidade , Doenças do Colo/cirurgia , Feminino , Gangrena/etiologia , Gangrena/mortalidade , Gangrena/cirurgia , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
El presente estudio retrospectivo evaluó 112 pacientes operados por perforació tífica en el Hospital Belén, Trujillo, Perú entre los años 1967 a 1990 con la finalidad de identificar por análisis univariado factores que inflyen en la morbimortalidad operatoria. Todos los pacientes tuvieron una o más de los siguientes criterios diagnósticos: bacteriológico, serológico, anatomopatológico y quirúrgicos. Los procedimientos quirúrgicos efectuados fueron: sutura simple ( n=70 ), resección intestinal con anastomosis primaria ( n=6 ), resección intestinal más ileostomía ( n=33 ) y drenaje peritoneal solamente ( n=3 ). Los siguientes parámetros fueron evaluados: edad, sexo, tiempo de enfermedad, tiempo de perforación, hemorragia digestiva baja, recuento leucocitario, tipo de secreción peritoneal y número de perforaciones. La morbimortalidad fue únicamente influenciada por el tiempo de perforación mayor de 48 horas ( p menor que 0.05). El análisis de la morbimortalidad post-operatoria mostró a los siguientes factores asociados con su incremento: tiempo de perforación mayor de 48 horas ( p menor que 0.001 ), presencia de enterorragia ( p menor que 0.01 ), leucopenia ( p menor que 0.05 ), secreción peritoneal fecaloidea ( p menor que 0.05 ) o la evidencia de 3 o más perforaciones intestinales ( p menor que 0.05 ); factores que deben considerarse para un tratamiento oportuno y adecuado
Assuntos
Humanos , Indicadores de Morbimortalidade , Febre Tifoide/enfermagemRESUMO
This retrospective study evaluated 112 patients who had undergone surgery by typhoid perforation at the Belen Hospital, Trujillo, Peru, from 1967 trough 1990 in order to identify by univariate analysis the combination of factors predictive of postoperative morbidity and mortality. All the patients had one or more of the following diagnostic criteria: bacteriologic, serologic, anatomopathologic and surgical. The surgical procedures performed were: simple closure (n = 70), intestinal resection in conjunction with primary anastomosis (n = 6), intestinal resection plus ileostomy (n = 33), whilst peritoneal drainage operations were used in 3 cases. The following parameters were evaluated: age, sex, length of history, length of perforation, low intestinal hemorrhage, leukocyte count, type of peritoneal fluid and number of perforations. The operative mortality rate for all patients was 21.4% and morbidity rate was 80.4%. Significant differences in morbidity were only found in patients with perforations over 48 hours (p < 0.05). Analysis of post-operative mortality: length of perforation over 48 hours (p < 0.001), presence of hematochezia (p < 0.01), leukopenia (p < 0.05), fecaloid peritoneal fluid (p < 0.05) or the evidence of 3 or more intestinal perforations (p < 0.05). We concluded that a surgeon must take into account all of these factors to lead to satisfactory results.
Assuntos
Perfuração Intestinal/mortalidade , Febre Tifoide/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Perfuração Intestinal/microbiologia , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos RetrospectivosRESUMO
This retrospective analysis evaluated 123 patients with sigmoid volvulus that underwent surgery at the Belen Hospital, Trujillo, Peru, from January 1, 1967 to December 31, 1992 in an attempt to identify by univariate analysis factors of prognostic value of operative mortality. The surgical procedures performed were destortion plus colopexia (n = 19), intestinal resection with primary anastomosis (n = 69) and resection plus colostomy (n = 35) with an operative death rate of 0%, 13% and 31.4% respectively (p = 0.005). The overall operative mortality rate was of 19.4%. The following parameters were evaluated: age, sex, duration of obstruction, mean arterial pressure, leukocyte count, type of peritoneal fluid, state of the bowel and surgical technique. Analysis of post-operative mortality disclosed the following factors associated with increased mortality: age older than 40 (p = 0.008), mean arterial pressure lower than 70 mmHg (p = 0.0001), presence of purulent or fecaloid peritoneal fluid (p = 0.001) and evidence of gangrenous colon with perforation (p = 0.0001). There were no statistically significant differences in mortality rate with regard to sex, length of history and leukocyte count. Therefore, we emphasize the need to take into account these risk factors to better clarify appropriate therapy options.
Assuntos
Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/mortalidade , Doenças do Colo Sigmoide/mortalidade , Doenças do Colo Sigmoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
From January 1, 1966 to December 31, 1991, 137 patients with carcinoma of the stomach underwent standard radical gastrectomy at Belen Hospital, Trujillo, Perú. The patients were classified into two groups--those with age < or = 40 years (n = 19) and those with age > 40 years (n = 118)--and we analyzed herein comparatively clinicopathologic features and five year survival rates using the Mantel Haenszel test. In patients aged 40 years and younger there was a significant increased in the number of patients with carcinomas present in the upper two-thirds of stomach (p < 0.01) and in undifferentiated type adenocarcinoma in histology (p < 0.01) compared with patients more than 40 years old. There were no statistically significant differences between these two groups of age with regard to sex, abdominal mass, size of tumor, type of cancer (early vs advanced carcinoma), Borrmann's criteria, depth of invasion (T), nodal involvement (N), clinical stage (UICC, 1987), type of operation, curability, operative death and five year actuarial survival (8.0 percent vs 6.0 percent, respectively) (p > 0.05). In this study, carcinomas in young people were found to have a higher incidence of undifferentiated forms pathologically and the majority occurred in the body and after gastric resection were similar in both groups of patients.
Assuntos
Gastrectomia , Neoplasias Gástricas/mortalidade , Análise Atuarial , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/cirurgia , Análise de SobrevidaRESUMO
Acute ileocecal volvulus is a condition of the abdomen which requires emergency treatment and is currently managed by several methods with a mortality rate of 25%. Surgical options include detorsion, cecostomy for nongangrenous volvulus or resection when gangrene is present. We studied the mortality and recurrence rate of ileocecal volvulus. This retrospective analysis evaluated 16 patients who underwent operation at Belen Hospital, Trujillo, Peru, between January 1966 and August 1992. As of August 1992, median follow-up was 160 months for 13 surviving patients (range, 6 to 307 months). Eleven men and 5 women with a median age of 52.3 + 21.1 years (range, 9 months to 83 years) formed the study population. Sixty eight percent of cases were 41 to 80 years of age and all women were than 40 years of age. Most of them were from the Peruvian Andes (81.3%), were from Indian and Spanish extraction (93.7%), and farmers (50%). Twelve patients (75%) developed a chronic ileocecal volvulus and 4 (25%) had an acute presentation. The clinical picture presented as large bowel obstruction in all patients. An ileocecal volvulus was accurately diagnosed by plain films of the abdomen in only 2 patients (16%) pre-operatively. A variety of procedures were used: cecopexy (9 cases), right hemicolectomy (3 cases) simple detorsion (2 cases), Mickulics exteriorization-resection (1 case) and cecostomy (1 case). The operative mortality rate was 18.7%. There were no recurrences after cecopexy. The most frequent post-operative complications were bronchopneumonia (18.7%), and wound infection (18.7%).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doenças do Ceco/cirurgia , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ceco/mortalidade , Criança , Pré-Escolar , Colectomia , Feminino , Seguimentos , Humanos , Doenças do Íleo/mortalidade , Lactente , Obstrução Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de TempoRESUMO
This retrospective study evaluated predisposing factors, clinical picture and the methods of treatment related to morbidity and mortality of 19 small bowel volvulus (SBV) who underwent operation at Belen Hospital (Trujillo-Peru) during the last 26 years (1966-1992). The SBV was 1.6% of all cases of intestinal obstruction in this period and 10.8% of all intestinal volvulus. The median age was of 43 +/- 20.5 years (range, 6 to 78 years) and the majority of them were between 41 and 60 years. Sixteen cases (84.2%) were men from Indian and Spanish extraction and most of them were farmers and came from the Sierra of the Department of La Libertad. Two cases (10.5%) had non-related antecedents previous surgery. In six patients (31.6%) the volvulus was less than seven day's duration and in thirty (68.4%) it was more eight day's duration with previous attacks of obstruction (median: 19.3 days, range: 17 hours to 94 days). Pain, vomiting and distention were present in almost all of these cases. The most frequent abdominal finding was distention. The location of the volvulus was: ileum, 12 cases (63.2%), root of mesentery, 4 cases (21%) and jejunum, 3 cases (15.8%). Gangrenous bowel was present in six patients (31.5) and gangrenous intestine with perforation in two cases (10.5%) who underwent resection of the involved segment with primary anastomosis. In this group one patient (5.2%) died of sepsis and the wound infection rate was of 37.5%. There was no statistically significant correlation with the duration of illness and the presence of gangrenous loops or the mortality rate (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)