Publications (17)10.15 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Background: Surgical resection is the treatment of choice for most of the primary and secondary liver tumors, unfortunately, many patients are not suitable for resection. Several ablative alternatives have been employed for treatment; the most commonly used has been radiofrequency ablation. Objective: To establish the safety and results of treatment with radiofrequency ablation (RF) of malignant liver tumors. Material and methods: A retrospective review of clinical files of patients with malignant hepatic tumors treated with RF was performed. Epidemiological variables, selection criteria pre- treatment and morbidity and mortality related to the procedure were analyzed. Descriptive statistics were used. Results: From September 2002 to August 2006, 30 patients were treated: eighteen females and 12 males with a median age of 62 years (range 41-83 years). Histologic type was as follows: 18 hepatocellular carcinomas; 10 metastatic tumors (four breast, four colorectal and two neuro- endocrine); one gallbladder carcinoma and one peripheral cholangiocarcinoma. Indications for ablative procedure were the presence of cirrhosis, poor functional reserve, bilobar disease, proximity to major vascular structures and patients with increased operative risk. The size of the lesion range from 2 to 20 cm (mean 5.6 cm) and the median time of ablation was 30.2 min (range 5-50 min). Two minor complications (6.6%) and no operative mortality were recorded. At 18 months of follow-up, 23 patients (76.6%) are still alive and seven patients have died for tumor progression. Conclusion: Radiofrequency ablation is a safe procedure that allows local control of the disease with satisfactory results, when the surgical resection is not feasible.
- [Show abstract] [Hide abstract] ABSTRACT: Neuroendocrine tumors are rare neoplasms which have a slow growth pattern. When liver metastases are diagnosed, treatment is controversial and it is focused in symptomatic control. To present a patient with a neuroendocrine tumor that arised from the ileocecal valve and it was diagnosed with carcinoid syndrome and treated with radical liver and colonic resection. A discussion of the different forms of treatment is presented. A 41 year-old woman was sent to our hospital with liver metastases and carcinoid syndrome from a neuroendocrine tumor of the ileocecal valve for treatment. Right colectomy, right hepatic trisectionectomy and radiofrequency ablation of two left sided lesions was performed as a first procedure. A second procedure was performed two months afterwards when resection of residual left sided lesions was done. After a two year follow up a 2 cm residual liver lesion was diagnosed and percutaneous radiofre-quency ablation was done. After four years of follow up the patient has been asymptomatic without tumor recurrence Radical surgical treatment of neu-roendocrine tumors controls symptomatology, improving quality of life and survival. However, this treatment should only be performed in a well selected group of patients.
- [Show abstract] [Hide abstract] ABSTRACT: Percutaneous ethanol injection has been successfully used for hepatocellular carcinomas (HCC) smaller than 5 cm in size. For larger lesions large volume ethanol injection has not been well explored. Evaluate the results of intraoperative Ultrasonographic-guided large volume ethanol injection for HCC larger than 4 cm in size. Ten patients were candidates for this treatment between June 1999 and July 2003. A retrospective review of the clinical files was performed. Absolute ethanol, average of 100 mL (range 80-120 mL) was administered intraoperatively. Follow-up evaluation included alpha-fetoprotein (AFP) and ultrasound or computed tomography. There were six women and four men, the median age was 62 years (range 56-80). The median lesion size was 8 cm (range 4-15 cm). Hepatitis C liver cirrhosis was the most common associated chronic liver disease (70%). A significant reduction of AFP levels after treatment was observed (Initial 966 ng/dL, post treatment levels: 42 ng/dL) US and CT scan showed tumor necrosis. Morbidity was 40%. No operative mortality was recorded. The one and four year survival rate was 60% and 20%. Intraoperative US-guided large volume ethanol injection is a safe palliative therapy for cirrhotic patients with HCC lesions greater than 5 cm in size. The impact on survival should be compared in a controlled double blind study.
- [Show abstract] [Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) has increased in many countries as a result of an increased frequency of hepatitis C virus (HCV) infection. In Mexico, the association of HCC to HCV infection has not been evaluated. This study aims to evaluate the epidemiological factors related to HCC in Mexican patients as well as the results of treatment. A retrospective review of clinical files of patients with HCC diagnosed between May 1992 to July 2002 was performed. There were 63 males and 64 females with a median age of 57 years (range 17-82). Seventy-one patients were evaluated for hepatitis status. In 43 (60%) HCV was the etiological factor. Isolated HCV infection was present in 32 (45%), HCV infection and ethanol abuse was observed in 11 (15.5%). In six (8.4%) patients hepatitis B was the etiological factor. HCV and HBV infection were found in 9 (12.6%). HCV and HBV infection associated to ethanol abuse was present in one patient. Ethanol abuse alone was observed in six (8.4%) patients. The median size of the lesion was 8cm (range 3-20cm). Alpha-fetoprotein was measured in 113 patients and was higher than 500ng/dL in 60 (53%). Sixty-five patients received supportive measures. Sixty-two were treated. Eighteen were resected. Thirteen were treated with intraoperative large volume ethanol injection (ILVEI), 12 with chemotherapy and 19 with tamoxifen-talidomide. Patients without treatment had a median survival time of 11 months and patients who received treatment had a median survival time of 25.3 months. The median survival time in patients who received surgery was 26 months, the ILVEI group survival time was 18 months, the chemotherapy survival was 8.8 months, and the tamoxifen-talidomide survival time was 7 months. HCC is a rare neoplasm in Mexico and HCV infection is the main etiological factor. Surgical resection is the best form of treatment of HCC in our country. However, only 14% of the patients were candidates. For non-resectable lesions, ILVEI offers the best palliative results in our center.
- [Show abstract] [Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) is a very rare disease among young individuals. Epidemiological, clinical and histopathological features of this malignancy in the youth have not been thoroughly studied. A review of the clinical files of patients with HCC younger than 40 years of age, who were treated between May 1990 and July 2002, was performed. Seventeen patients were included for analysis; nine were female and eight male. The mean age at diagnosis was 24 years (range 12-39 years). Abdominal pain was the main symptom, followed by vomiting and nausea. Enlargement of the liver was observed in 11 patients (65%). In seven patients (41%), an etiological factor was not found. Five of these cases were of the fibrolamellar variant (29%). Only four patients were resected (23%) two of which belonged to the fibrolamellar type. Three patients (18%) are still alive after 64.9 months of follow-up. HCC is a very uncommon disease in the youth and affects similarly both genders. It is discovered at an advanced stage. Hepatitis B and C are uncommon etiological factors. The frequency of fibrolamellar carcinoma is higher in this age group. Though resection is more feasible, the overall survival rates remain low.
Article: [Laparoscopic liver surgery][Show abstract] [Hide abstract] ABSTRACT: Laparoscopic surgery has been widely used for digestive tract diseases, specially for gallbladder pathology. Laparoscopic liver surgery pretends to accomplish the same objectives of open surgery but with the advantages of minimally invasive surgery. To evaluate the indications and recent results of laparoscopic liver surgery, as well as the technique. A review of the world literature was performed on the roll of laparoscopic surgery for hepatic diseases. The results of the authors are also reported. Nowadays hepatic laparoscopic surgery is reserved for anterior non-parasitic liver cysts and type I polycystic liver disease. The treatment of choice is wide deroofing. For hydatic liver disease pericystectomy or wide deroofing plus omentoplasty are also described. For benign solid liver disease, hepatic resection can be performed with the same outcome that the one observed with open surgery when the lesions are symptomatic, small, anterior or peripherally located. Laparoscopic liver surgery is recommended for the treatment of malignant hepatic lesions only in very specific cases. Nonetheless there are no prospective randomized studies that show benefits of laparoscopic over open surgery. Several local ablative therapies like radiofrequency, ethanol injection, cryotherapy or laser can be also performed through the laparoscope. The results reported so far have been encouraging. Intra-arterial chemotherapy is an option for the treatment of liver malignancies via laparoscopy, considering that the arterial catheter can be placed under this approach. For years, the liver has been considered a challenging organ for its approach, even with open surgery. Laparoscopic liver surgery should be performed by an experienced surgeon with the adequate technology. To our knowledge there are no reported results that decisively point toward the benefits of laparoscopic surgery over open surgery for the management of liver disease. Nonetheless more experience in laparoscopic liver surgery is needed.
- [Show abstract] [Hide abstract] ABSTRACT: El histiocitoma fibroso maligno (HFM) del hígado es un tumor infrecuente que ocurre predominantemente en hombres durante su vida adulta de media y tercera edad. No se asocia a enfermedad hepática crónica y estos pacientes habitualmente vienen a tratamiento con una enfermedad avanzada. Dolor abdominal es el síntoma principal. Las exploraciones radiológicas no podrían diferenciar HFM de otras lesiones hepáticas. La resección del hígado ha sido la forma más común de tratamiento. Se han usado quimioterapia y radioterapia sin éxito. Presentamos el caso de un histiocitoma fibroso maligno primario del hígado (HFMG) en una paciente de 62 años de edad que fue ingresada después de una biopsia laparoscópica complicada. Se hizo una segmentectomía lateral izquierda. El estudio immunocitoquímico fue positivo para alfa 1-antiquimiotripsina, vimentina, desmina y actina y confirmó el diagnóstico. La paciente presentó sarcomatosis peritoneal y murió 12 meses después de la operación.
- [Show abstract] [Hide abstract] ABSTRACT: Introduction. The aim is to evaluate the indications for and results of surgery in patients with benign solid and cystic liver lesions. Resection is the best method of management of symptomatic benign solid liver lesions. For cystic lesions fenestration or resection have been the most-used treatments. Recently, laparoscopy has changed the way we treat these lesions. Material and methods. We reviewed the clinical files of all patients with benign solid and cystic liver lesions operated-upon between May 1995 and May 2003. Results. There were 64 patients included in the present analysis (57 female; 7 male); median age was 48 years (range 21-74 years); 32 (50%) with benign solid liver lesions of which 22 were cavernous haemangiomas; 23 (35.9%) with non-parasitic liver disease (NPLD) and 9 (14%) had polycystic liver disease (PLD). There were 54 patients (84.3%) who had symptoms. Thirty-nine patients had liver resections performed (16 major and 23 minor), 15 patients were treated by open fenestration and 10 were treated by laparoscopic fenestration. There were 10 patients (15.6%) who presented complications; operative mortality was zero. Conclusions. The presence of symptoms is the most common indication for treatment. Laparoscopic fenestration has become the first-line treatment tor symptomatic NPLD and selected patients with benign solid liver lesions and PLD. However, in our centre, a considerable proportion of patients is still operated-upon via the open approach. A careful selection of cases is necessary to ensure good outcomes.
- [Show abstract] [Hide abstract] ABSTRACT: Cavernous hemangioma is the most frequent focal liver lesion. It affects mainly women and may cause symptoms such as abdominal pain, mass, and early satiety, or complications such as heart failure or coagulopathy. There are several options for treatment in symptomatic patients. However, it seems that surgical resection is the only curative treatment. Evaluate indications and results of liver resection in patients with cavernous hemangiomas and hepatic hemangiomatosis. We conducted a retrospective analysis of clinical files of patients treated at the Instituto Nacional de Cancerología (INCan) and the Centro Médico ISSEMYM during a 8-year period. Epidemiological data as well as diagnostic work-up and treatment were analyzed. From August 1995 to May 2003, 24 patients with liver hemangiomas were resected at both institutions. Twenty three were female (95.8%) and one, male (4.1%). Indications for surgery were presence of symptoms in 20 patients (83.3%), undefined diagnosis in three (12.5%), and rapid growth in one (4.1%). Most frequent symptoms were abdominal pain in 20 (83.3%) patients, followed by abdominal mass in five (20.8%), and early gastric satiety in four (16.6%). Abdominal computed tomography (CT) scan was the most frequent imaging study used in 22 patients (91.6%), followed by ultrasound in 20 (83.3%). Size of lesion ranged from 4-30 cm (X: 8.7 cm), 16 patients were submitted to formal liver resection (66.6%), and eight to enucleation (33.3%). Four patients presented operative complications (16.6%) that included postoperative bleeding in two (8.3%), fever in one (4.1%) and abdominal haematoma in one (4.1%). There was no operative mortality. Twenty two patients were asymptomatic at time of evaluation (91%). This lesion affects mainly women, and presence of symptoms is the most common indication for treatment. Choice of surgical procedure to be carried out depends on location and morphology of the lesion. Liver resection or enucleation are safe forms of treatment that properly controlled symptomatology.
- [Show abstract] [Hide abstract] ABSTRACT: Introduction Intraoperative ultrasound (IOUS) is a safe and reproducible tool and it is considered an essential component of major hepatobiliary procedures. The aim of this study was to define the place of IOUS as an adjuvant for ethanol tumor ablation and liver resection. Material and methods A review of clinical files of patients operated with liver tumors between August 1998 and January 2001 was performed. Results Fifty-two patients (30 men, 22 women) age ranging from 17 and 86 years (mean=45) were included for analysis and 26 had primary liver carcinomas (24 HCC and 2 CCC), 16 were considered resectable by preoperative imaging studies. However, IOUS avoid resection in 6 patients (37.5%). in 2 patients (20%) a change in the plane of resection was made. Eight patients with large single HCC lesions were managed with a single session of large volume intraoperative ethanol injection. IOUS detected the distribution of ethanol within the lesion and helped determine the dosage. This technique detected spillage of ethanol into a hepatic vein and helped to avoid a major complication in one patient (12.5 %). Twenty patients presented liver metastases of which, 16 were resected. IOUS avoid resection in 4 patients (20%); a change in the plane of resection was made in 5 (31%). Of 6 benign liver tumors that were operated with an unconfirmed diagnosis, IOUS made the diagnosis in 4. In all, IOUS influenced in the final decision in 70% of patients. Conclusion IOUS has become in creasingly important in hepatic resection in our center and is an essential tool for intraoperative elthanol tumor ablation.
- [Show abstract] [Hide abstract] ABSTRACT: El leiomiosarcoma de la vena cava es un tumor vascular maligno de presentación rara que tiene mal pronóstico. Habitualmente se presenta en mujeres entre la quinta y sexta décadas de la vida. Es una lesión de bajo grado de malignidad pero habitualmente fatal. En este artículo se revisan dos casos clínicos de leiomiosarcomas de la vena cava inferior de localización pararrenal. Ambos ocurrieron en mujeres y la resección radical fue la forma de manejo. En un paciente se utilizó pericardio bovino y en el otro un injerto de politetra-fluoroetileno como reemplazo de la vena cava. Ambos pacientes presentaron recurrencias locales y sistémicas. Una falleció 5 años después del diagnóstico con recurrencia local y sistémica, la otra se encuentra viva pero con recurrencia local y hepática.
- [Show abstract] [Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) is a very rare disease among young individuals. Epidemiological, clinical, and histopathological features of this malignancy in youth have not been thoroughly studied. A review of clinical files of patients with HCC < 40 years of age treated between May 1990 and July 2002 was performed. Seventeen patients were included for analysis, nine were female and eight, male. Mean age at diagnosis was 24 years (range 12-39 years). Abdominal pain was the main symptom, followed by vomiting and nausea. Enlargement of liver was observed in 11 patients (65%). In seven patients (41%), etiologic factor was not found. Five of these cases were of fibrolamellar variant (29%). Only four patients were resected (23%) two of whom belonged to fibrolamellar type. Three patients (18%) are still alive after 64.9 months of follow-up. HCC is a very uncommon disease in youth and affects similarly both genders. It is discovered at advanced stage. Hepatitis B and C are uncommon etiologic factors. Frequency of fibrolamellar carcinoma is higher in this age group. Although resection is more feasible, overall survival rates remain low.
- [Show abstract] [Hide abstract] ABSTRACT: Neuroendocrine or carcinoid tumors of the gastrointestinal tract considered previously extremely rare, are diagnosed at present with increased frequency due to the better capacity to identify neuroendocrine system cells in normal and pathologic conditions. Occasionally, these tumors secrete a great variety of vasoactive substances, producing the carcinoid syndrome. Gastric carcinoids are classified, according to their degree of differentiation into well differentiated and poorly differentiated tumors, also called neuroendocrine carcinomas. Neuroendocrine gastric carcinomas or poorly differentiated gastric carcinoids are seen in 5-15% of all gastric carcinoids, mainly in older male patients. Generally they are large, very aggressive tumors with extensive local infiltration. Due to poor differentiation, they are not frequently associated with an endocrine syndrome. They can be located in any part of the stomach but are mainly seen in antrum. These tumors have an aggressive behavior and must be treated in a radical manner; recurrences are not uncommon. We report the case of a patient with a neuroendocrine gastric carcinoma treated with an en bloc subtotal gastrectomy and colectomy.
- [Show abstract] [Hide abstract] ABSTRACT: We present the case of a 32-year-old female patient referred to the Instituto Nacional de Cancerología (INCan) with a history of several months of systemic hypertension and epigastric pain associated to early postprandial satiety, fatigue, and dyspnea. At physical examination, a smooth, non-tender, palpable mass was found in right upper quadrant 7 cm below costal margin. Computed tomography (CT) scan showed right-sided non-parasitic liver cyst. The patient was taken to the operating room, where she presented hypertensive crisis of 180/125 mm Hg, which did not respond to midazolam therapy. The procedure was suspended and deferred. After blood pressure control with angiotensin II-antagonist and calcium-antagonist, the patient was submitted to laparotomy, where a wide deroofing of the lesion was performed. The postoperative evolution was uneventful and the patient has remained normotense without anti-hypertensive medication after 6 months of follow-up.
- [Show abstract] [Hide abstract] ABSTRACT: Cholangiocarcinoma is a rare malignant tumor that may occur anywhere along intra or extrahepatic biliary tree. Prognosis remains poor with overall 5-year survival rate of 5%. Experience in management of this lesion in Mexico is scarce. Our objective was to report on our experience at the Instituto Nacional de Cancerología in Mexico City with the management of this lesion. A retrospective review of clinical files of patients diagnosed and treated in a period of 10 years was performed. Epidemiologic data, forms of diagnosis, results of management, and survival were analyzed. From June 1992 to June 2002, 36 patients were diagnosed and treated; 25 patients had perihilar tumor (Klatskin tumor) and 11 had peripheral cholangiocarcinoma. Twenty seven were females (75%) and nine males (25%). Abdominal pain was the main symptom (72%) followed by jaundice (65%) and weight lost (59%). Computed tomography was the most used imaging study (86%); surgery was main form of management (72%). No survivors were observed in patients nor receiving treatment after a follow-up of 3 years. For those resected, an 18%, 5-year survival was observed. This lesion was more frequent in females between fifth and seventh decades of life and no relation with ulcerative colitis or primary sclerosing cholangitis was observed in our study. Surgery is still the best form of management but prognosis remains poor.
Instituto Nacional de Cancerología - MexicoCiudad de México, The Federal District, Mexico