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ABSTRACT: Duodenal cancer has a low prevalence in the general population. Metastases from this neoplasm usually affect the lymph nodes, liver or lung. Bone metastases from duodenal cancer are highly infrequent and xiphoid localization is exceptional. We present the case of a patient who, 5 years after undergoing surgery for duodenal adenocarcinoma, developed xiphoid metastasis. We discuss the utility of positron emission tomography in the diagnosis of this entity and the therapeutic options.
Cirugía Española 06/2007; 81(5):282-3. · 0.87 Impact Factor
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ABSTRACT: Mirizzi syndrome (MS) has a low incidence in patients with gallbladder disease. The coexistence of gallbladder cancer seems to be more frequent in patients with MS than in those with gallstones only. We present two patients with MS type II and gallbladder cancer (stages T4N1M0 and T3NxMx). The etiopathogenic mechanisms, diagnostic methods and therapeutic options are discussed.
Cirugía Española 03/2007; 81(2):105-6. · 0.87 Impact Factor
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Cirugía Española 01/2007; 80(6):411-2. · 0.87 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC) usually develops in patients with liver cirrhosis or chronic liver disease. These tumors are highly infrequent in patients without precipitating factors. We present a series of four patients with nonfibrolamellar HCC arising in healthy liver. None of the patients had viral infection, or showed alcohol abuse and/or hemochromatosis. Three patients underwent surgery. The clinical characteristics, therapeutic options, and survival and recurrence rates in this type of tumor are discussed.
Cirugía Española 09/2006; 80(2):111-3. · 0.87 Impact Factor
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ABSTRACT: A small number of patients with breast cancer develop liver metastases (LM) as the sole site of regional dissemination. In these patients, surgical resection seems to be the best therapeutic option. We present our experience of LM from breast cancer and discuss the indications for resection.
Between July 2003 and March 2005, we performed five hepatectomies for LM from breast cancer. The mean age was 51 years (range: 38-66). Patients received diverse combinations of chemotherapy, hormone therapy and radiotherapy after mastectomy. The disease-free interval between mastectomy and diagnosis of LM was 61 months (range: 36-80). The number of LM was 1.83 (range: 1-6) with a median of one LM. The mean size was 4.1 cm (range: 1.5-6).
Surgery consisted of segmentectomy (three patients), bisegmentectomy (one patient), right hepatectomy associated with isolated metasectomies of the left lobe and hilar lymphadenectomy (one patient). Operative mortality was 0%. Morbidity was 20% (one patient). The mean length of hospital stay was 8 days. The mean length of follow-up was 11.4 months (range: 3-21). The mean survival was 11.4 months (range: 3-21). Disease-free survival was 9.6 months (range: 3-21). Two patients have had recurrence (one local and one regional).
Given its characteristics, LM from breast cancer is an infrequent indication for liver resection and should be performed whenever technically feasible, whenever R0 resection can be achieved, and when there is low operative risk. Postoperative survival is better with resection than with any other therapeutic modality, even though the period of disease-free survival is short.
Cirugía Española 12/2005; 78(5):318-22. · 0.87 Impact Factor
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ABSTRACT: Benign solid liver tumors are a heterogeneous group of lesions (adenoma, focal nodular hyperplasia, hemangioma, etc.) with highly varied epidemiological characteristics. Advances in diagnostic methods have improved preoperative diagnosis. Magnetic resonance imaging has become the key test, but there is still a percentage of cases in which definitive preoperative diagnosis is not feasible. The most frequent symptom is abdominal pain, although patients are frequently asymptomatic. Surgery is indicated when diagnosis is uncertain or there are complications (rupture, hemorrhage, etc.). Because of the risk of malignant transformation, adenomas should always be resected. Morbidity and mortality after resection of these tumors is very low since excision is limited, performed in young people without concomitant disease, and in healthy liver.
Cirugía Española 06/2005; 77(5):247-53. · 0.87 Impact Factor
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ABSTRACT: Duodenal adenocarcinoma is an infrequent neoplasm. Consequently, there are no large series that would allow conclusions to be reached on its diagnosis and treatment.
A retrospective study (1999-2003) of five patients diagnosed with duodenal adenocarcinoma in our service was performed.
The mean age was 54 years. Eighty percent were male. All patients showed weight loss and abdominal pain. The tumors were localized in the second portion in three patients and in the third portion in two patients. All patients underwent gastrointestinal endoscopy with biopsy, which revealed adenocarcinoma. The most effective diagnostic test was computed tomography. In all patients, the preoperative diagnosis was correct. The technique performed was cephalic duodenopancreatectomy in three patients and duodenectomy with atypical pancreatic resection and right hemicolectomy in one patient. A decision not to perform surgery was made in one patient with liver metastases. Two patients who underwent surgery showed no complications. The remaining two patients showed slow gastric emptying in one patient and pancreatitis of the stump leading to fatal systemic inflammatory response syndrome in the other. Patient survival was 60, 13 and 1 month respectively. There were no recurrences. The patient who did not undergo surgery died at 4 months.
Duodenal adenocarcinoma is an infrequent tumor that is associated with various diseases. Surgical treatment is usually cephalic duodenopancreatectomy. Survival in resected patients is better than that obtained in primary pancreatic tumors.
Cirugía Española 05/2005; 77(4):208-12. · 0.87 Impact Factor
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ABSTRACT: We evaluated the clinical results of different techniques of resection for malignant left-sided colonic obstruction.
The subjects of this prospective nonrandomized study were 63 consecutive patients who underwent surgery between 1995 and 2000 at a single institution. Patients with nonprimary colonic tumors, lesions located proximally to splenic flexure, peritonitis, perforation, or cecal necrosis were excluded.
Segmental colectomy with primary anastomosis (CPA) was performed in 35 patients; with intraoperative colonic irrigation (ICI) in 19, and without ICI in 16. Total or subtotal colectomy (TSC) was performed in 8, and Hartmann's procedure (HP) was performed in 20. There were no differences in age, sex, comorbidity, time of symptoms, preoperative hospital stay, or tumor staging among the groups of patients defined by the different surgical techniques. The overall incidence of postoperative complications was 43%; postoperative mortality, 5%; anastomotic dehiscence, 12%; urgent reoperations, 12%; and readmissions, 5%, without significant differences among the treatment groups. However, the postoperative and total hospital stay were significantly shorter after ICI (P = 0.016 and P = 0.012, respectively). The overall 5-year survival was 42.7%.
We think that segmental colectomy with anastomosis after intraoperative colonic irrigation is the most effective operative treatment for neoplastic left-sided colonic obstructions, considering its safety and cost-effectiveness.
Surgery Today 02/2005; 35(4):275-81. · 1.22 Impact Factor
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ABSTRACT: Distal pancreatectomy (DP) is performed for various pancreatic processes. This procedure has become less frequent since it ceased to be systematically used in oncologic gastric surgery and it is now performed mainly in patients with chronic pancreatitis. We present a series of patients who underwent DP and discuss technical features and surgical indications.
We performed a retrospective study of patients who underwent classical DP with associated splenectomy (CIE: 52.52) in our service from 1998-2003. Fourteen DP were performed during the study period.
The mean age was 52.6 years. Thirty-six percent of the patients were male (5/14). Diagnosis was mucinous cystic tumor of the pancreas (5), neuroendocrine tumor (3), focal chronic pancreatitis (2), pancreatic cancer (2), pancreatic injury due to a sharp instrument wound (1), and pancreatic metastases from renal cancer (1). The most frequently used diagnostic procedure was abdominal computerized axial tomography (13/14). Surgery was elective in 86%. The technique used to close the distal stump was manual suture (29%), mechanical stapling (64%) and suture plus stapling (7%). No statistically significant relationship was observed between closure of the stump and the development of pancreatic fistula. Morbidity was 35% and mortality was 0%. The mean length of hospital stay was 18 days.
DP can be performed without mortality but morbidity is not inconsiderable and is usually associated with the development of pancreatic fistulas. The indications for DP have changed and currently this procedure is performed for several pancreatic processes that are becoming increasingly frequent.
Cirugía Española 02/2005; 77(1):22-6. · 0.87 Impact Factor
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Cirugía Española 02/2005; 77(1):54. · 0.87 Impact Factor
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ABSTRACT: Most tumors affecting Vater's Ampulla are adenocarcinomas and other histological variants are less frequent. A review of the literature revealed only seven previously reported cases of signet ring cell carcinoma of the ampulla of Vater. The presence of this kind of tumor has no clear histological explanation. Two possible theories have been proposed: the presence of gastric heterotopia in the ampulla of Vater or the existence of a perivaterian duodenal heterotopia of ulcerous etiology as the origin of a signet ring cell tumor which secondarily invades the ampulla of Vater.
We performed a pancreatoduodenectomy in a 67-year-old woman with a T2N0M0 ampulla tumor. A histologic study revealed a signet ring cell neoplasm.
Etiology and survival of signet ring cell carcinoma of Vater's ampulla is not well-defined in the literature due to the extreme rarity of this disease. Duodenopancreatectomy with pylorus preservation is the treatment of choice.
JOP: Journal of the pancreas 11/2004; 5(6):495-7.
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The American Journal of Surgery 05/2004; 187(4):519-20. · 2.78 Impact Factor
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Journal of the American College of Surgeons 02/2002; 194(1):86. · 4.55 Impact Factor
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