RESUMO
Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor's infiltrating growth pattern or primary vascular origin. Surgery is still the mainstay for curing this disease, and resection of RPSs may include major vascular resections to secure adequate oncologic results. Our improved knowledge in the tumor biology of RPSs, in conjunction with the growing surgical expertise in both sarcoma and vascular surgical techniques, has allowed for major vascular reconstructions within multi-visceral resections for RPSs with good perioperative results. This complex surgical approach may include the combined work of various surgical subspecialties.
Assuntos
Neoplasias Retroperitoneais , Sarcoma , Humanos , Resultado do Tratamento , Sarcoma/cirurgia , Sarcoma/patologia , Neoplasias Retroperitoneais/cirurgia , Neoplasias Retroperitoneais/patologia , Veia Cava Inferior/cirurgia , Veia Cava Inferior/patologiaRESUMO
The optimal management of Siewert Type II or Junction AEG II adenocarcinoma remains a point of debate. Surgical options include an extended total gastrectomy or esophagectomy. Accurately identifying the location of the esophagogastric junction (GEJ) is important as the epicenter of the lesion is defined in reference to the GEJ. Type II tumors, in the most recent iteration of the AJCC, describe these lesions as being within 1 cm cephalad and 2 cm caudal to GEJ. Accurate staging of the location and identification of nodal metastasis is vital to guide the optimal surgical approach. Endoscopy, endosonography, CT, and PET help guide decision-making as to what junctional subtype is present. The extent of resection and lymphadenectomy remains contestable. Both surgical approaches remain viable, as each has its own advantages and issues. The key to the management of these cancers is that the surgeon has the capability to operate on both sides of the diaphragm to manage these oftentimes challenging malignancies.
Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Neoplasias Gástricas , Humanos , Esofagectomia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Gastrectomia , Junção Esofagogástrica/cirurgia , Junção Esofagogástrica/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Excisão de Linfonodo , Estudos RetrospectivosRESUMO
Leiomyosarcomas are soft tissue tumors that are derived from smooth muscle mainly in the pelvis and retroperitoneum. Percutaneous biopsy is paramount to confirm diagnosis. Imaging is necessary to complete clinical staging. Multimodal treatment should be directed by expert sarcoma multidisciplinary teams that see a critical volume of these rare tumors. Surgery is the mainstay of curative intent treatment; however due to its high metastatic progression, there may be a benefit for neoadjuvant systemic treatment. Adjuvant systemic treatment has no proven disease-free survival, and its main role is in the palliative setting to potentially prolong overall survival.
Assuntos
Leiomiossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Terapia Combinada , Intervalo Livre de Doença , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Leiomiossarcoma/terapia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologiaRESUMO
BACKGROUND: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has become a valuable treatment strategy for selected patients with peritoneal carcinomatosis (PC). In Chile, it is an emerging technique. The aim of this study is to describe our protocol and report our perioperative results. METHODS: A prospectively maintained database for patients undergoing exploratory surgery for PC was reviewed. Eligible patients were selected using the peritoneal cancer index in correlation with the primary tumor. Patients underwent HIPEC using mitomycin C. Clinical data and postoperative results were analyzed. RESULTS: Seventy-six patients underwent exploratory surgery. Most patients were female (55%) with a median age of 62 years (range, 25-83). Complete CRS and HIPEC were achieved in 53 patients. The most frequent primary tumor site was colon-rectum (49%). The median number of resected organs was 4 (range, 1-13). Overall 90-day incidence of major complications was 26%. After a median follow-up of 26 months, 44 patients (83%) in the resected group were alive with no evidence of disease. CONCLUSIONS: The PC treatment program at our institution has been established in a safe manner, with acceptable morbidity comparable to high-volume centers. A comprehensive preoperative evaluation, careful patient selection, and a cohesive team are necessary for successful results.
Assuntos
Quimioterapia do Câncer por Perfusão Regional , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Neoplasias Peritoneais/terapia , Avaliação de Programas e Projetos de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/administração & dosagem , Chile , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Neoplasias Peritoneais/mortalidade , Estudos ProspectivosRESUMO
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective surgical therapy for morbid obesity. It is an advanced laparoscopic surgical procedure and has a protracted learning curve. Therefore, it is important to develop innovative ways of training and assessing surgeons. The aim of this study is to determine if a cadaveric porcine jejuno-jejunostomy model is an accurate way of assessing a surgeon's technical skills by determining if a correlation exists with how he performs in the operating room. METHODS: Eight surgeons of varying experience performed a side-to-side stapled jejuno-jejunostomy on a cadaveric bench model before proceeding to perform the procedure on a real patient scheduled for LRYGBP. Performance was assessed using a motion tracking device, the Imperial College Surgical Assessment Device. Each procedure was recorded in video and scored by two blinded expert surgeons using procedure-specific rating scales. RESULTS: The cadaveric bench model demonstrated concurrent validity with significant correlations between performance on the cadaveric model and patient for dexterity measures. Left-hand path length, r = 0.857 (median, 27, 41.3; P = 0.007), right-hand path length, r = 0.810 (median, 31.5, 60; P = 0.015) and total number of movements, r = 0.743 (median, 422, 637; P = 0.035). This correlation in performance was also demonstrated in the video rating scales, r = 0.727 (median, 13.2, 14.8; P = 0.041). No correlation was found in operative time (median, 541, 742; P = 0.071). CONCLUSIONS: This study demonstrates the concurrent validity of the cadaveric porcine model, showing similar performances in surgeons completing a jejuno-jejunostomy on the cadaveric model and the patient.
Assuntos
Derivação Gástrica/educação , Jejunostomia/educação , Laparoscopia/educação , Animais , Competência Clínica , Bolsas de Estudo , Derivação Gástrica/métodos , Cirurgia Geral/educação , Internato e Residência , Jejunostomia/métodos , Laparoscopia/métodos , Modelos Animais , Suínos , Análise e Desempenho de TarefasRESUMO
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the most common surgical treatment for morbid obesity. Intestinal obstruction and internal hernias are complications more commonly observed after LRYGB than after open RYGB. The aim of this study was to evaluate the incidence of these complications in patients who had undergone LRYGB using an antecolic versus a retrocolic technique. METHODS: From August 2001 to August 2005, LRYGB was performed in 754 patients. The retrocolic and antecolic technique was used in 300 and 454 consecutive patients, respectively. The mean patient age was 37 +/- 10 years, and 552 of the patients (73%) were women. The mean preoperative body mass index was 41.3 +/- 5 kg/m2. The median follow-up was 16 months. RESULTS: During follow-up, 36 patients (4.7%) underwent surgical exploration secondary to intestinal obstruction. This complication was observed in 28 (9.3%) and 8 (1.8%) patients in the retrocolic and antecolic technique groups, respectively (P <.001). In the retrocolic technique group, an internal hernia developed in 24 patients compared with 3 patients in the antecolic technique group. On multivariate analysis, the retrocolic technique was identified as a risk factor (P <.001). CONCLUSION: A greater incidence of intestinal obstruction and internal hernia was observed in the retrocolic technique group than in the antecolic technique group undergoing LRYGB. The results of our study have shown that the use of the retrocolic technique is a risk factor for intestinal obstruction after LRYGB.
Assuntos
Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Adulto , Anastomose em-Y de Roux , Distribuição de Qui-Quadrado , Feminino , Gastroscopia , Humanos , Incidência , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco , Técnicas de Sutura , Resultado do TratamentoRESUMO
BACKGROUND: The development of the laparoscopic surgery has allowed its incorporation to the surgical treatment of gastric cancer. AIM: To evaluate the feasibility and safety of laparoscopic gastrectomy in gastric cancer in our institution. PATIENTS AND METHODS: Prospective data in four patients who underwent laparoscopic gastrectomy for gastric cancer from May to August of 2005 was reviewed. Demographic data, clinical characteristics and postoperative results were registered. Patients were staged according to TNM-AJJC staging system. RESULTS: Four patients aged 48 to 80 years (three males), underwent a completely laparoscopic R0 gastrectomy with lymph node dissection. Two patients underwent total gastrectomy. A subtotal Billroth II gastrectomy was performed in the other two patients. The mean operative time was 260 minutes (Range 180-330). There were no conversions to open surgery. The mean postoperative hospital stay was 6.5 days (Range 6-7 days). There were no complications. According to pathology, one patient presented carcinoma in stage IA, two patients in stage IB and one patient in stage IIIB. The mean number of lymph nodes dissected was 40 (Range 35-54). CONCLUSIONS: Laparoscopic gastrectomy is a feasible procedure with good postoperative results in this preliminary experience.
Assuntos
Carcinoma/cirurgia , Gastrectomia/métodos , Laparoscopia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Estudos de Viabilidade , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias Gástricas/patologiaRESUMO
Background: The development of the laparoscopic surgery has allowed its incorporation to the surgical treatment of gastric cancer. Aim: To evaluate the feasibility and safety of laparoscopic gastrectomy in gastric cancer in our institution. Patients and methods: Prospective data in four patients who underwent laparoscopic gastrectomy for gastric cancer from May to August of 2005 was reviewed. Demographic data, clinical characteristics and postoperative results were registered. Patients were staged according to TNM-AJJC staging system. Results: Four patients aged 48 to 80 years (three males), underwent a completely laparoscopic R0 gastrectomy with lymph node dissection. Two patients underwent total gastrectomy. A subtotal Billroth II gastrectomy was performed in the other two patients. The mean operative time was 260 minutes (Range 180-330). There were no conversions to open surgery. The mean postoperative hospital stay was 6.5 days (Range 6-7 days). There were no complications. According to pathology, one patient presented carcinoma in stage IA, two patients in stage IB and one patient in stage IIIB. The mean number of lymph nodes dissected was 40 (Range 35-54). Conclusions: Laparoscopic gastrectomy is a feasible procedure with good postoperative results in this preliminary experience.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma/cirurgia , Gastrectomia/métodos , Laparoscopia , Neoplasias Gástricas/cirurgia , Carcinoma/patologia , Estudos de Viabilidade , Excisão de Linfonodo , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias Gástricas/patologiaRESUMO
Obesity is highly prevalent in both liver transplant candidates and recipients, and can have a significant impact on perioperative morbidity and mortality and the overall cost of transplantation. Herein, we describe an obese patient who was managed sequentially with an intragastric balloon in the pre-transplant setting and a gastric sleeve following transplantation, with good long-term results. Sleeve gastrectomy is a non-malabsorptive bariatric procedure with potential benefit for liver transplant patients due to its lack of influence on the absorption of immunosuppressive agents.
Assuntos
Gastrectomia/métodos , Falência Hepática/complicações , Falência Hepática/cirurgia , Transplante de Fígado , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Balão Gástrico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Epidemiological studies have proven that obesity is a significant risk factor for type 2 diabetes. Long-term progression of diabetes leads to various microvascular complications, of which diabetic nephropathy has become of increasing importance, and is the main cause of end-stage renal failure in occidental countries. Microalbuminuria is the first marker of incipient diabetic nephropathy, an early stage glomerulopathy which can progress to renal failure and which historically has been treated with angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists. We report a severely obese diabetic patient on treatment for diabetic nephropathy with ACE-inhibitors and poor results, which resolved after Roux-en-Y gastric bypass.
Assuntos
Nefropatias Diabéticas/epidemiologia , Obesidade/epidemiologia , Obesidade/cirurgia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Índice de Massa Corporal , Comorbidade , Nefropatias Diabéticas/tratamento farmacológico , Enalapril/uso terapêutico , Feminino , Derivação Gástrica , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Falha de TratamentoRESUMO
Introducción: El tratamiento actual de la úlcera péptica en su etapa aguda es la erradicación del Helicobacter pylori (HP) junto con tratamiento de la úlcera con inhibidores de la bomba de protones (IBP). Objetivos Determinar el costo del tratamiento de erradicación con 2 antibióticos por 7 ó 14 días y el costo de diferentes inhibidores de la bomba de protones por 42 días. material y Método: Se revisó un documento farmacológico que contenía los precios de todos los medicamentos con un valor promedio de dólares de 670 pesos. Se analizó presentaciones, dosis y costo del tratamiento. Resultados: Hubo una importante variación de precios de los 2 antibióticos evaluados: Claritromicina y Amoxicilina, con costos que variaban entre 11.000 y 26.000 por 7 días. En cuanto a IBP hay 19 Omeprazoles en el merfcado nacional, con costos de tratamiento por 42 días que varían entre 2.922 pesos y 33800 pesos. Hay 5 Lanzoprazoles y 3 Pantoprazoles. El costo final de todo el tratamiento completo puede variar entre 14.229 pesos y 116.936 pesos. Conclusiones: Los costos de este tratamiento son muy variables y afectan fuertemente el presupuesto de los pacientes. por lo tanto, los médicos que prescriben estos tratamientos deben estar informados claramente de los costos.