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1.
Rev. chil. cir ; 71(1): 29-34, feb. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-985375

ABSTRACT

Resumen Introducción: La gastrectomía vertical (GV) y el by-pass gástrico (BPG) son los procedimientos más utilizados en el tratamiento de la obesidad. El objetivo de este trabajo es comparar ambas técnicas tanto en pérdida ponderal como en mejoría de las comorbilidades asociadas. Materiales y Método: Estudio observacional ambispectivo de los pacientes sometidos a BPG y GV desde enero de 2011 hasta diciembre de 2013. Se ha analizado la pérdida de peso y de IMC, la tasa de éxito, la reganancia de peso, el impacto en las comorbilidades asociadas y la morbimortalidad de ambas técnicas. Resultados: 172 pacientes fueron intervenidos (92 BPG y 80 GV). El BPG presenta mejores resultados en cuanto a pérdida de peso y mejoría de las comorbilidades. El grupo GV presenta mayor reganancia de peso. Ambos procedimientos presentan resultados similares en cuanto a morbimortalidad.


Introduction: Sleeve gastrectomy (SG) and gastric bypass (GBP) are the most commonly used procedures in the treatment of obesity. The objective of this paper is to compare these two techniques in regard to weight loss and improvement of the associated comorbidities. Material and Method: An ambispective observational study of patients undergoing GBP and SG from January 2011 to December 2013. Weight loss, BMI, success rate, weight regain, impact on associated comorbidities and morbimortality of both techniques were analysed. Results: 172 patients underwent operations (92 GBP and 80 SG). GBP had better results in regard to weight loss and improvement of comorbidities. The SG group had greater weight regain. The two procedures had similar results in regard to morbimortality.


Subject(s)
Humans , Male , Female , Gastric Bypass/adverse effects , Gastric Bypass/methods , Gastric Bypass/mortality , Gastrectomy/adverse effects , Gastrectomy/methods , Gastrectomy/mortality , Obesity, Morbid/surgery , Anastomosis, Roux-en-Y/methods , Weight Loss , Treatment Outcome , Perioperative Care
2.
ABCD arq. bras. cir. dig ; 32(1): e1413, 2019. tab, graf
Article in English | LILACS | ID: biblio-973378

ABSTRACT

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.


RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Laparoscopy/methods , Laparoscopy/mortality , Gastrectomy/methods , Gastrectomy/mortality , Postoperative Complications , Stomach Neoplasms/pathology , Time Factors , Chile , Survival Rate , Retrospective Studies , Treatment Outcome , Laparoscopy/adverse effects , Statistics, Nonparametric , Kaplan-Meier Estimate , Early Detection of Cancer , Perioperative Period , Gastrectomy/adverse effects , Lymph Node Excision/mortality , Neoplasm Staging
3.
Acta cir. bras ; 33(1): 95-101, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-886247

ABSTRACT

Abstract Purpose: To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique. Methods: IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA™ system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. Results: All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. Conclusion: Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.


Subject(s)
Animals , Laparoscopy/methods , Gastrectomy/methods , Swine , Time Factors , Obesity, Morbid/surgery , Feasibility Studies , Reproducibility of Results , Surgical Stapling/methods , Models, Animal , Operative Time , Gastrectomy/mortality , Medical Illustration
4.
Rev. chil. cir ; 70(2): 147-159, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959363

ABSTRACT

Resumen Introducción: La identificación de factores pronósticos del cáncer gástrico, ha permitido predecir la evolución de los pacientes y así tomar decisiones terapéuticas. En Chile existe un déficit en el análisis de factores pronósticos de sobrevida alejada. Objetivos: Los objetivos de este estudio fueron: evaluar distintos factores pronósticos de sobrevida alejada en cáncer gástrico, determinar la tasa de sobrevida global mayor a 5 y 10 años posoperatoria tanto en cánceres incipientes como avanzados y evaluar el valor de un nuevo factor pronóstico de sobrevida alejada denominado N+/T. Material y Método: Estudio prospectivo de la base de datos oncológica del Hospital Clínico de la Universidad de Chile entre mayo de 2004 y mayo de 2012. Resultados: Se incluyeron un total de 284 pacientes, 65,4% fueron hombres, la edad media fue 64,5 años. 75% de la muestra fueron cánceres avanzados, 72,5% de los pacientes requirieron una gastrectomía total. La linfadenectomía practicada fue D2 en un 85,2%. La cosecha linfononodal global media fueron 30 linfonodos. La morbilidad y mortalidad quirúrgica posoperatoria fue de 17,2% y 1,7% respectivamente. La sobrevida global media fue de 69,9 meses, la sobrevida a 5 años fue de 56,9% y la sobrevida a 10 años fue de 53,4%. Al analizar el índice N+/T, se identifica una diferencia estadísticamente significativa en la sobrevida global alejada de todos los subgrupos (p < 0,0001). El análisis multivariado de los factores pronósticos objetiva que las variables significativas son: índice N+/T (p = 0,0001, OR: 1,1 [1,05-1,12]), LNR (p = 0,0001, OR: 5,8 [1,04-15,6]), edad (p = 0,008, OR: 1,03 [1,00-1,06]), permeación linfovascular (p = 0,0001, OR: 2,19 [1,49-3.23]), clasificación T (p = 0,03, OR: 3,4 [1,10-8,93]), clasificación N (p = 0,001, OR: 1,06 [1,02-1,10]) y estadio TNM (p = 0,004, OR: 1,03 [1,01-1,06]). Las curvas ROC del índice N+/T, LNR y clasificación T poseen áreas bajo la curva de 0,789, 0,786 y 0,790 respectivamente, sin diferencia estadística significativa (p = 0,96). Conclusión: Los factores pronósticos independientes de sobrevida mayor a 5 años son: índice N+/T, LNR, edad, permeación linfovascular, clasificación T, clasificación N y estadio TNM. Concomitantemente se ha logrado aportar un nuevo cuociente pronóstico en la evaluación de pacientes con adenocarcinoma gástrico resecados con intención curativa, el índice N+/T.


Background: The identification of survival prognostic factors for gastric cancer, allows us to create clinical guidelines. Chile has a deficit in the analysis of long-term survival prognostic factors. Aim: To assess different prognostic factors of long-term survival in gastric cancer. Determine the survival rate at 5 and 10-years post gastrectomy, and the value of a new prognostic factor of long-term survival called N+/T. Material and Method: Prospective study of the oncological database of the Clinical Hospital of the University of Chile between May 2004 and May 2012. Results: A total of 284 patients were included, 65.4% were men and the mean age was 64.5 years. Seventy-five percent were advanced gastric cancer, 72.5% of the patients required a total gastrectomy. The lymphadenectomy practiced was D2 in 85.2%, and average lymph node harvest was 30 lymph nodes. The postoperative morbidity and mortality was 17.2% and 1.7% respectively. The average global survival was 69.9 months, the 5-year survival was 56.9% and the 10-year survival was 53.4%. The N+/T index presented a statistically significant difference in the global survival of all the subgroups (p < 0.0001). The multivariate analysis showed that the significant variables were: N+/T index (p = 0.0001, OR: 1.1 [1.05-1.12]), LNR (p = 0.0001, OR: 5.8 [1.04-15.6]), age (p = 0.008, OR: 1.03 [1.00-1.06]), lymphovascular permeation (p = 0.0001, OR: 2.19 [1.49-3.23]), T classification (p = 0.03, OR: 3.4 [1.10-8.93]), N classification(p = 0.001, OR: 1.06 [1.02-1.10]), and TNM stage (p = 0.004, OR: 1.03 [1.01-1.06]). The areas under the ROC curves of the N+/T, LNR and T classification, were 0.789, 0.786 and 0.790 respectively (p = 0.96). Conclusion: The independent prognostic factors of long-term survival were N+/T index, LNR, age, lymphovascular permeation, T classification, N classification and TNM stage. Concomitantly, a new prognostic factor has been created to assess survival in gastric cancer, the N+/T index.


Subject(s)
Humans , Male , Female , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Gastrectomy/methods , Prognosis , Survival Analysis , Multivariate Analysis , Prospective Studies , ROC Curve , Gastrectomy/mortality , Lymph Node Excision , Lymphatic Metastasis , Neoplasm Staging
5.
Clinics ; 73(supl.1): e543s, 2018. tab, graf
Article in English | LILACS | ID: biblio-974960

ABSTRACT

OBJECTIVES: Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS: We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS: From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS: TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Adenocarcinoma/surgery , Adenocarcinoma/mortality , Time Factors , Brazil , Adenocarcinoma/pathology , Multivariate Analysis , Treatment Outcome , Age Distribution , Disease-Free Survival , Kaplan-Meier Estimate , Gastrectomy/methods , Gastrectomy/mortality , Hospitals, University/statistics & numerical data , Lymph Node Excision/methods , Lymph Node Excision/mortality , Lymphoma/surgery , Lymphoma/mortality , Lymphoma/pathology
6.
Rev. chil. cir ; 69(4): 320-324, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899609

ABSTRACT

Introducción: La población chilena, al igual que la mundial, ha presentado un importante envejecimiento en los últimos 25 años. El cáncer gástrico ocupa la primera causa de mortalidad por tumores malignos en Chile. Objetivo: Determinar la mortalidad operatoria de la gastrectomía total o subtotal en pacientes con cáncer gástrico de 80 o más años y la sobrevida a 5 años. Material y método: Estudio retrospectivo y prospectivo de todos los pacientes sometidos a resección gástrica por cáncer gástrico entre 1988 y 2016, con 80 o más años. Se excluyeron los pacientes sometidos a técnicas quirúrgicas no resectivas. Se analizaron las siguientes variables: síntomas y signos, comorbilidades, características anatomopatológicas, mortalidad según el tipo de gastrectomía y sobrevida global a 5 años. Resultados: En el periodo de tiempo analizado hubo 70 pacientes con cáncer gástrico y edad igual o mayor de 80 años, que representan al 7,4% del total de pacientes con resección gástrica. Los síntomas más frecuentes fueron dolor, baja de peso y anemia crónica microcítica. Hubo un 66% de pacientes con comorbilidades. El cáncer se ubicó preferentemente en el tercio superior, siendo un adenocarcinoma en 66 pacientes. En 4 pacientes hubo 2 linfomas, un GIST maligno y un carcinoide maligno. El carcinoma incipiente correspondió al 12% de los adenocarcinomas. La mortalidad global de la gastrectomía fue del 17%, siendo el 5% para la subtotal y el 22% para la total. La sobrevida promedio a 5 años fue del 26%. Conclusiones: La gastrectomía subtotal o total en pacientes con cáncer gástrico sobre 80 años es factible de realizar en pacientes seleccionados, pero el riesgo de mortalidad operatoria es de 7 a 10 veces mayor que en pacientes bajo los 75 años.


Introduction: The longevity of Chilean population has increased greatly in the last 25 years, similar to world population. Gastric cancer in Chile is the first cause of death due to malignant tumors. Purpose: To determine operative mortality of subtotal or total gastrectomy in patients with gastric cancer older than 80 years, and the rate 5 year-survival. Material and method: This is an retrospective-prospective study of all patients with 80 years of age or more submitted to gastric resection due to gastric cancer between 1988 and 2016. Patients submitted to non-resective procedures were excluded. The following parameters were analized: symptoms and signs, comorbidities, pathologic features of the gastric cancer, operative mortality according to the gastrectomy and 5-year survival rate. Results: There were 70 patients with gastric cancer older than 80 years of age, which represented 7.4% of all patients with gastric cancer submitted to gastric resection in the same period of time. Most frequent symptoms were epigastric pain, loss of weight and chronic microcitic anemia. There were 66% of the patients with comorbidities. The tumor was located mainly in the upper third of the stomach, being an adenocarcinoma in 66 patients (94%). There were also 2 linfomas, one GIST and one patient with a malignant carcinoid. Early cancer was observed in 12% of the adenocarcinomas. Global operative mortality was 17% being 5% for subtotal and 22% for total gastrectomy. Mean 5-year survival rate was 26%. Conclusions: Subtotal or total gastrectomy in patients with gastric cancer with 80 years of age or more is possible to perform in selected patients, but the risk of operative mortality is 7 to 10 times greater than below 75 years of age.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Gastrectomy/mortality , Stomach Neoplasms/mortality , Survival Analysis , Prospective Studies , Retrospective Studies , Follow-Up Studies , Age Factors , Gastrectomy/methods
7.
Rev. chil. cir ; 63(6): 585-590, dic. 2011. tab
Article in Spanish | LILACS | ID: lil-608751

ABSTRACT

Background: Surgery for gastric cancer may have high rates of complications and mortality. Aim: To analyze operative mortality of total and subtotal gastrectomy in the period 2004-2010. Material and Methods: Prospective study 345 patients with gastric cancer, mean age 62 years, 64 percent males, subjected to a total or subtotal R0, R1 or R2 gastrectomy. All patients were assessed in the postoperative period and all complications were recorded. Results: Total and subtotal gastrectomies were performed in 224 and 69 patients respectively. Postoperative complications consisted in anastomotic leaks, duodenal stump leaks, hemoperitoneum, pulmonary infections and intestinal obstruction. Mortality of total gastrectomy R1 or R2 was 2.1 percent whereas palliative gastrectomy, to improve quality of life, had 15 percent mortality. Subtotal gastrectomy had 1.4 percent mortality. Conclusions: There has been a reduction in operative mortality of gastrectomy for gastric cancer, however the rate of complications has not changed.


Objetivos: Analizar la morbilidad y mortalidad operatoria de la gastrectomía total y subtotal en el período 2004-2010 y compararlo con las cifras publicadas en los últimos 40 años. Material y Método: El presente estudio prospectivo incluye a los pacientes sometidos a gastrectomía total o subtotal R0 R1 o R2 entre mayo de 2004 y diciembre de 2010. Se evaluaron la morbilidad y la mortalidad postoperatoria. Resultados: La gastrectomía total se realizó en 244 pacientes y la subtotal en 69 pacientes. La morbilidad postoperatoria correspondió a filtración de la anastomosis, filtración del muñón duodenal, hemoperitoneo, infecciones pulmonares y obstrucción intestinal. La mortalidad de la gastrectomía total R0 o R1 fue de 2,1 por ciento, mientras que la gastrectomía de aseo tuvo un 15 por ciento de mortalidad. La gastrectomía subtotal presentó una mortalidad de 1,4 por ciento. Conclusiones: Como consecuencia de todos los adelantos técnicos y materiales en la cirugía del cáncer gástrico, que significó una baja muy importante en la mortalidad operatoria, las complicaciones postoperatorias no han variado estos últimos 40 años.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Gastrectomy/methods , Gastrectomy/mortality , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Postoperative Complications/epidemiology , Length of Stay , Neoplasm Staging , Stomach Neoplasms/epidemiology , Prospective Studies , Reoperation
8.
Rev. méd. Chile ; 138(12): 1487-1494, dic. 2010. tab
Article in Spanish | LILACS | ID: lil-583044

ABSTRACT

Background: Extended gastrectomy allows a complete tumor excision in patients with advanced gastric cancer. Aim: To compare the surgical results of extended (ER) and non-extended gastrectomy (NER) among patients with gastric cancer, and determine factors associated with complications and mortality. Material and Methods: Review of medical records of patients with gastric cancer who underwent complete resection between 2002 and 2008 in an oncological hospital. Demographics, patient-related and therapeutic features were compared between groups, and independent factors were established with multivariate analysis. Results: Seventy four patients, (44 men, median age 62 years) underwent an ER and 103 patients, (56 men, median age 61 years) a NER. Specifically, ER included splenectomy alone in 27 patients, splenectomy associated with other procedure in 24, partial esophagectomy in 18, distal pancreatectomy in 13, hemicolectomy in 8, total esophagectomy in 7, partial hepatectomy in 4, and adrenalectomy in 1. Postoperative complications were observed in 19 patients treated with an ER (26 percent) and in 11 patients treated with a NER (11 percent), p < 0.05. Serious complications were higher in patients who underwent an ER compared with NER (6 patients (8 percent) vs. 4 (4 percent), respectively) p < 0.05. In the same way, mortality was higher in patients treated with ER when it was compared with NER (4 patients (5 percent) vs two (2 percent), respectively), p < 0.05. ER and serum albumin levels were independent factors associated to a higher risk of mortality and rate of complications. Conclusions: ER was associated with a higher rate of general and severe complications, and mortality.


Subject(s)
Female , Humans , Male , Middle Aged , Gastrectomy/adverse effects , Gastrectomy/mortality , Stomach Neoplasms/surgery , Epidemiologic Methods , Gastrectomy/methods , Postoperative Complications/classification , Postoperative Complications/epidemiology , Postoperative Complications/mortality
9.
Rev. méd. Chile ; 138(1): 53-60, ene. 2010. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-542047

ABSTRACT

Background: The long-term survival of adenocarcinoma of the esophago-gastric junction is poor and depends on the possibility of performing a complete surgical excision and the absence of lymph node involvement. Aim: To report surgical results and survival of patients with adenocarcinoma of the esophago-gastric junction. Material and Methods: Retrospective review of medical records of patients with adenocarcinoma of the esophago-gastric junction, subjected to a curative surgical procedure between 2000 and 2008. Deaths that occurred within 60 days of the operation were considered operative mortality. Tumor stage was determined using TNM and Siewert pathological classifications. Results: Thirty-nine patients aged 40 to 80years (27 men), were operated. According to Siewert classification, seven patients had type I, six type II and 26 type III tumors. Twenty-two patients were subjected to a total gastrectomy with partial excision of distal esophagus and mediastinal reconstruction, 10patients were subjected to a trans-hiatal esophagectomy and seven to a total esophagogastrectomy. According to postoperative staging, five patients were in stage I, 12 in stage II, nine in stage III and 13 in stage IV. Median, three and five year's survival figures were 21.4 months, 33 and 25 percent, respectively. Lymph node and perineural involvement was associated with a lower survival. Well differentiated and stage I tumors had a better survival. Multivariate analysis showed that the presence of a type III tumor, N3 lymph node involvement and vascular permeation were independent predictors' ofa lower survival. Conclusions: Among patients with adenocarcinoma of the esophago-gastric junction, type III tumors, lymph node involvement and vascular permeations are associated with a lower survival.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/surgery , Esophageal Neoplasms/surgery , Esophagectomy/mortality , Esophagogastric Junction/surgery , Gastrectomy/mortality , Stomach Neoplasms/surgery , Adenocarcinoma/pathology , Esophageal Neoplasms/pathology , Esophagectomy/adverse effects , Gastrectomy/adverse effects , Multivariate Analysis , Neoplasm Staging , Retrospective Studies , Stomach Neoplasms/pathology , Treatment Outcome
10.
Acta cir. bras ; 23(6): 520-530, Nov.-Dec. 2008. tab
Article in English | LILACS | ID: lil-496755

ABSTRACT

PURPOSE: To compare morbidity, mortality, recurrence and 5-year survival between D1 and D2 or D3 for treatment of gastric cancer. METHODS: Systematic review and meta-analysis of RCTs. Metaview in RevMan 4.2.8 for analysis; statistical heterogeneity by Cochran's Q test (P<0.1) and I² test (P>50 percent). Estimates of effect were calculated using random effects model. RESULTS: D2 or D3 was associated with higher in-hospital mortality, with RR = 2.13, p=0.0004, 95 percent CI, 1.40 to 3.25, I²=0 percent, P=0.63; overall morbidity showed higher incidence in D2 or D3, RR = 1.98, p<0.00001, 95 percent CI, 1.64 to 2.38, I² = 33.9 percent, P=0.20; operating time showed longer duration in D2 or D3, weighted mean difference of 1.05, p<0.00001, 95 percent CI, 0.71 to 1.38, I² = 78.7 percent, P=0.03, with significant statistical heterogeneity; reoperation showed higher rate in D2 or D3, with RR = 2.33, p<0.0001, 95 percent CI, 1.58 to 3.44, I² = 0 percent, P=0.99; hospital stay showed longer duration in the D2 or D3, with weighted mean difference of 4.72, p<0.00001, 95 percent CI, 3.80 to 5.65, I² = 89.9 percent, P<0.00001; recurrence was analyzed showed lower rate in D2 or D3, with RR = 0.89, p=0.02, 95 percent CI, 0.80 to 0.98, I² = 71.0 percent, P = 0.03, with significant statistical heterogeneity; mortality with recurrent disease showed higher incidence in D1, with RR = 0.88, p=0.04, 95 percent CI, 0.78 to 0.99, I² =51.8 percent, P=0.10; 5-year survival showed no significant difference, with RR = 1.05, p=0.40, 95 percent CI, 0.93 to 1.19, I² = 49.1 percent and P=0.12. CONCLUSIONS: D2 or D3 lymphadenectomy procedure is followed by higher overall morbidity and higher in-hospital mortality; D2 or D3 lymphadenectomy shows lower incidence of recurrence and lower mortality with recurrent disease, when analysed altogether with statistical heterogeneity; D2 or D3 lymphadenectomy has no significant impact on 5-year survival.


OBJETIVO: Comparar a morbidade, mortalidade, recidiva e sobrevida de cinco anos entre linfadenectomia D1 e D2 ou D3 no tratamento do câncer gástrico. MÉTODOS: Revisão sistemática metanálise de ensaios clínicos randomizados, programa Metaview, Revman 4.2.8. Heterogeneidade estatística pelo teste Q de Cochrane (P<0,1) e teste I² (P>50 por cento). Estimativas dos efeitos pelo modelo randômico. RESULTADOS: Maior mortalidade hospitalar em D2 ou D3, RR = 2.13, p=0.0004, 95 por cento IC, 1.40 a 3.25, I²=0 por cento, P=0.63; maior morbidade geral em D2 ou D3, RR = 1.98, p<0.00001, 95 por cento IC, 1.64 a 2.38, I² = 33.9 por cento, P=0.20; maior tempo operatório em D2 e D3, diferença de média ponderal de 1.05, p<0.00001, 95 por cento IC, 0.71 a 1.38, I² = 78.7 por cento, P=0.03; número de reoperações maior em D2 e D3, RR = 2.33, p<0.0001, 95 por cento IC, 1.58 a 3.44, I² = 0 por cento, P=0.99; maior tempo de permanência hospitalar em D2 e D3, diferença de média ponderal de 4.72, p<0.00001, 95 por cento IC, 3.80 a 5.65, I² = 89.9 por cento, P<0.00001; recidiva maior nos grupos D2 e D3, RR = 0.89, p=0.02, 95 por cento IC, 0.80 a 0.98, I² = 71.0 por cento, P = 0.03; mortalidade com doença recidivada maior em D1, RR = 0.88, p=0.04, 95 por cento IC, 0.78 a 0.99, I² =51.8 por cento, P=0.10; 5 anos de sobrevida mostrou diferença estatística não significante, RR = 1.05, p=0.40, 95 por cento IC, 0.93 a 1.19, I² = 49.1 por cento e P=0.12. CONCLUSÕES: Linfadenectomia D2 ou D3 está associada a maior morbidade e maior mortalidade intra-hospitalar; D2 ou D3 apresenta menor incidência de recidiva e menor mortalidade com recidiva, analisadas em conjunto, com heterogeneidade estatística; D2 ou D3 não tem impacto na sobrevida de 5 anos.


Subject(s)
Humans , Gastrectomy/mortality , Lymph Node Excision/mortality , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Gastrectomy/methods , Gastrectomy/standards , Hospital Mortality , Quality Control , Randomized Controlled Trials as Topic , Treatment Outcome
11.
Rev. méd. Chile ; 134(4): 426-432, abr. 2006. tab
Article in Spanish | LILACS | ID: lil-428541

ABSTRACT

Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.


Subject(s)
Humans , Adenocarcinoma/mortality , Gastrectomy/mortality , Stomach Neoplasms/mortality , Adenocarcinoma/surgery , Chile/epidemiology , Retrospective Studies , Stomach Neoplasms/surgery , Treatment Outcome
12.
Bol. Hosp. Viña del Mar ; 61(1/2): 2-10, ene. 2005. tab
Article in Spanish | LILACS | ID: lil-420766

ABSTRACT

La cirugía del cáncer gástrico es un procedimiento complejo que no está libre de complicaciones graves y letales. El objetivo del presente estudio es describir la morbimortalidad asociada a gastrectomía por cáncer en los últimos años. Se revisan las historias de los pacientes operados de gastrectomía en un período de 5 años. Se encuentran 107 casos, de los cuales, se realiza cirugía con intención curativa en 90 (84,1 por ciento). La cifra global de morbilidad es 25,2 por ciento y la mortalidad 7,5 por ciento. La principal complicación post operatoria es la fístula esófago-yeyunal post gastrectomía total, con una incidencia de 17,6 por ciento y una letalidad de 44 por ciento. Otras complicaciones incluyen la peritonitis post operatoria, absceso intraabdominal, infección de herida operatoria y retardo del vaciamiento gástrico, entre otros. Destaca una baja incidencia de neumonía. Se encontró una tendencia favorable en gastrectomías con intención curativa vs. paliativa y en el uso de suturas mecánicas vs. manuales. La morbimortalidad se compara favorablemente a lo encontrado en la literatura y se mantiene una tendencia a la reducción al compararla con la experiencia ya publicada por el mismo grupo quirúrgico.


Subject(s)
Male , Humans , Female , Esophageal Fistula/surgery , Gastrectomy/mortality , Stomach Neoplasms , Abdominal Abscess/complications , Chile , General Surgery , Gastric Emptying , Surgical Wound Infection/complications , Peritonitis/complications
13.
Rev. chil. cir ; 56(5): 443-448, oct. 2004. tab, graf
Article in Spanish | LILACS | ID: lil-394628

ABSTRACT

Introducción: En los últimos años se han producido un aumento de la población anciana que debe ser sometida a gastrectomía pos cáncer gástrico. Algunos autores consideran a la edad como un factor de riesgo importante de morbimortalidad en cirugía. Otros consideran que son las patología concomitantes y no la edad las que aumentan el riesgo. Material y Métodos: Estudio retrospectivos de los pacientes portadores de cáncer gástrico sometidos a gastrectomía total en el Hospital Clínico Regional de Concepción entre los años 1985 y 1999. Se dividen en grupo I, menores de 65 años. Resultados: Se estudian 263 pacientes, 162 menores de 65 años. La distribución por sexo fue similar (73,3 por ciento en grupo II). Los pacientes ancianos presentaron un 36,9 por ciento de patología concominate y los jóvenes un 14,8 por ciento (p< 0,000086). Las características de los tumores (localización, grado de diferenciación y profundidad de invasión) fueron similares en los grupos. En los ancianos predominó el tipo intestinal de Lauren (58,6 por ciento) y en los jóvenes el tipo difuso (56,1 por ciento) (p< 0,03). Los jóvenes fueron etapificados principalmente en el grupo III (67,3 por ciento), los ancianos se distribuyeron en las etapas II (22,8 por ciento), IIIA (28,7 por ciento) y IV (23,7 por ciento) (p<0,0005). La mortalidad fue de 24,1 por ciento en el grupo I y 37,6 por ciento en el grupo II (ns), y predominaron las complicaciones respiratorias. La mortalidad fue de 2,5 por ciento en el grupo I y 6,9 por ciento en el grupo II (ns). La estadía hospitalaria fue similar en ambos grupos. Conclusiones: Un 38,2 por ciento de los pacientes con cáncer gástrico sometidos a gastrectomía total son mayores de 65 años. Los ancianos presentan un mayor número de patologías asociadas que los jóvenes. Las características de los tumores son similares en ancianos y jóvenes. No existe relación entre la edad y la etapa del tumor. La morbilidad, mortalidad operatoria y estadía hospitalaria no mostraron diferencias significativas.


Subject(s)
Humans , Male , Female , Aged , Gastrectomy/mortality , Stomach Neoplasms , Chile , Risk Factors
14.
Rev. chil. cir ; 56(3): 226-231, jun. 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-394593

ABSTRACT

Introducción: Las complicaciones postoperatorias habituales de la gastrectomía total son la dehiscencia de la anastomosis esófago-yeyunal y los abscesos subfrénicos. Estas complicaciones son causa de morbimortalidad, reintervenciones y de períodos postoperatorios prolongados. Los drenes abdominales serían útiles en el diagnóstico precoz de la fístula de la anastomosis y el tratamiento. Objetivo: Analizar nuestra experiencia en gastrectomía total por cáncer gástrico en pacientes con y sin drenes abdominales y evaluar los resultados en la morbilidad operatoria, período de hospitalización postoperatoria, tiempo de realimentación oral, número de reintervenciones y morbilidad operatoria. Material y Método: Se realiza un estudio prospectivo y randomizado en 60 pacientes (43 hombres y 17 mujeres) sometidos a una gastrectomía total por cáncer gástrico en el Hospital Clínico Regional de Concepción en el período 2000-2003. Los pacientes se dividieron en 2 grupos: Grupo I (sin drenes) y Grupo II (2 drenes). Resultados: El Grupo I fue de 31 pacientes y el Grupo II de 29 pacientes. El período de hospitalización postoperatoria fue de un promedio de 12,9 días en el Grupo I y de 18,8 días en el Grupo II (p= 0,0242, s.). La morbilidad fue de 97 por ciento en el Grupo I y de 37,9 por ciento en el Grupo II (0,0242, s.). Las reintervenciones fueron más frecuentes en el Grupo II (24,1 por ciento) que en el Grupo I (9,7 por ciento)(p= 0,1239), n.s.). La realimentación oral se inició a los 9,4 días promedio en el Grupo I y a los 12,8 días en el Grupo II (p= 0,0514, n.s.). La mortalidad operatoria fue de 0 por ciento en el Grupo I y de 3,4 por ciento en el Grupo II (p= 0,4833, n.s.). Conclusión: En nuestra experiencia la morbilidad operatoria y el tiempo de hospitalización postoperatoria son significativamente mayores en el grupo de pacientes con drenes abdominales.


Subject(s)
Humans , Male , Female , Postoperative Complications/epidemiology , Postoperative Complications/mortality , Drainage/adverse effects , Gastric Fistula , Gastrectomy/mortality , Stomach Neoplasms , Anastomosis, Surgical , Morbidity , Prospective Studies
15.
Rev. gastroenterol. Perú ; 15(3): 265-72, sept.-dic. 1995. ilus
Article in Spanish | LILACS | ID: lil-161894

ABSTRACT

El presente estudio retrospectivo evaluó a 134 pacientes con cáncer gástrico sometidos a gastrectomía radical convencional en el Hospital de Belén, Trujillo, Perú, desde 1966 a 1990. El objetivo principal fue determinar la influencia en el pronóstico de variables independientes y dependientes del tratamiento. Los pacientes con cáncer gástrico (78M: 56F) tuvieron una edad media de 58 años (rango, 23 a 82 años). La tasa de resecabilidad fue 48 por ciento. La tasa de mortalidad operatoria fue de 14.2 por ciento. En la presente serie la sobrevida actuarial a 5 años fue 16 por ciento (33 por ciento para la gastrectomía curativa y 1 por ciento para la gastrectomía paliativa, p<0.001). Usando el análisis univariante, la evolución del cáncer gástrico estuvo relacionada con los siguientes factores: masa palpable, apariencia macroscópica, tamaño tumoral, profundidad de invasión, criterios de etapificación (UICC), número de ganglios linfáticos positivos y curabilidad operatoria; sin embargo el factor pronóstico más importante fue la curabilidad, ya que casi todos los pacientes que sobrevivieron más de 5 años fueron aquellos a quienes se le realizó resección gástrica curativa. El curso clínico no se relacionó con la edad, sexo, tiempo de enfermedad,localización del tumor, tipo histológico y procedimiento operatorio. Nosotros concluimos que la disponibilidad de una resección curativa se incrementaría y el pronostico probablemente mejoraría si el cáncer pudiera ser detectado en un estadio precoz


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Prognosis , Stomach Neoplasms/surgery , Stomach Neoplasms/therapy , Gastrectomy/mortality , Gastrectomy/statistics & numerical data , Neoplasms by Histologic Type , Survivors/statistics & numerical data
17.
An. Acad. Nac. Med ; 152(3): 85-8, jul.-set. 1992. tab
Article in Portuguese | LILACS | ID: lil-141748

ABSTRACT

Trinta e uma gastrectomias totais foram efetuadas pelo Curso de Mestrado de Cirurgia Gastroenterológica da Universidade Federal Fluminense, quando sob a direçäo do autor. O modelo operatório adotado combinou, ecleticamente, reconstruçäo esofagojejunal à Roscoe-Graham - de notória eficácia na proteçäo da anastomose - à bolsa Lima Bastom, capaz de assegurar ao neo-estômago a indispensável funçäo reservatório. A mortalidade operatória de 3,2 por cento figura entre as mais baixas consignadas nas literaturas nacional e estrangeira, precisamente porque, protegida a anastomose näo houve a lamentar caso algum de deiscência - sem dúvida a causa prevalente de mortalidade em todas casuísticas consultadas. Analisando as razöes desta fragilidade anastomótica em outros modelos, destaca o autor, como causa maior, a forte tensäo retrátil do esôfago ao sofrer secçäo transversa, agindo sobre a linha de sutura a nu, com tendência a desuni-la. A este potencial disruptivo a técnica Roscoe-Graham, opöe-se energicamente; antes do mais, imobilizando esôfago e jejuno, solidarizados por duas linhas simétricas, verticais, de sutura seromuscular; e ademais, pelo envolvimento da anastomose término-lateral bordo-face, por manguito jejunal à sua volta, com sua coberta serosa a oferecer "adesivo biológico" em toda circunferência. Reduzir a mortalidade operatória da gastrectomia total, ainda elevada em muitas casuísticas, sobre justificar-se em si mesmo, reveste-se de especial atualidade: näo só porque a demanda por esta técnica de vulto mantém-se inalterada, a despeito do minimalismos em voga na cirurgia do abdome, e ainda tende a aumentar, em funçäo da incidência crescente dos neoplasmas gástricos de sede proximal, que parece marcar novo perfil epidemiológico da doença


Subject(s)
Adult , Middle Aged , Humans , Male , Female , Gastrectomy , Aged, 80 and over , Gastrectomy/mortality , Incidence
18.
Rev. argent. cir ; 63(1/2): 1-5, jul.-ago. 1992. ilus, tab
Article in Spanish | LILACS | ID: lil-125158

ABSTRACT

Se presenta el resultado del tratamiento quirúrgico de pacientes portadores de la enfermedad, en quienes se determinaron las características clínicos patológicas, la mortalidad postoperatoria y realizado el seguimiento alejado. Fueron 169 pacientes considerados inoperables y 155 tratados con cirugía. De éstos últimos, 17 pacientes padecieron cáncer temprano (10%) y los 138 restantes cáncer avanzado. Al comparar entre estos grupos la sintomatología previa, se observó que predominaban los primeros, síntomas de padecimientos ulceroso. Realizada la estadificación T.N.M. en 132 enfermos se comprobó que la suma de los pacientes T3 y T4, representaron el 75%. El índice de resecabilidad de la serie alcanzó el 77%y la mortalidad postoperatoria del total fue de un 8,4%. La evolución alejada de 5 años demostró una supervivencia del 81,3%en el cáncer temprano y del 13,7%en los avanzados. Debido al gran número de pacientes con diagnóstico de cáncer gástrico avanzado cuyo pronóstico es desalentador, es necesario que para mejorar los resultados se recurra más frecuentemente a la aplicación de procedimientos endoscópicos en los pacientes con riesgo de padecimiento. Ello permitirá un diagnóstico más oportuno y un tratamiento más efectivo


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenocarcinoma , Neoplasm Staging , Stomach Neoplasms/surgery , Gastrectomy , Gastrectomy/mortality , Gastrectomy/statistics & numerical data , Stomach Neoplasms/diagnosis , Stomach Neoplasms/mortality , Survival Analysis
19.
Rev. argent. cir ; 60(5): 155-65, mar.1991. ilus
Article in Spanish | LILACS | ID: lil-105772

ABSTRACT

La gastrectomía total amplió sus indicaciones como consecuencia de la mayor incidencia de tumores gástricos del tercio superior del estómago. Un análisis de 116 casos consecutivos operados entre 1980 y 1990 demuestra que esta operación puede practicarse como cifras de morbilidad (11%) y mortalidad (1,7%) muy bajas. Ciertos recursos técnicos (uso de valvas especiales, apertura del diafragma, evolución intraoperatoria de las anastomosis) nos permitieron lograr estos resultados. Destacamos las ventajas del montaje en Y de Roux y del papel de la yeyunostomía profiláctica en el manejo de las fístulas anastomóticas


Subject(s)
Anastomosis, Surgical/methods , Gastrectomy , Stomach Neoplasms/surgery , Esophageal Fistula/etiology , Pancreatic Fistula/etiology , Gastrectomy/mortality , Gastrectomy/statistics & numerical data , Intraoperative Complications/epidemiology , Pancreatic Neoplasms/surgery , Postoperative Complications/epidemiology , Zollinger-Ellison Syndrome/surgery , Stomach Neoplasms/epidemiology , Duodenal Ulcer/surgery , Stomach Ulcer/surgery
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