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1.
Acta cir. bras ; 35(3): e202000308, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130622

ABSTRACT

Abstract Purpose: The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM. Methods: Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches. Results: Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time. Conclusions: Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.


Subject(s)
Humans , Colorectal Neoplasms/surgery , Colorectal Neoplasms/pathology , Laparoscopy/methods , Liver Neoplasms/secondary , Risk , Treatment Outcome , Patient Selection , Decision Making , Liver Neoplasms/surgery , Neoplasm Staging
2.
Rev. cir. (Impr.) ; 71(6): 571-577, dic. 2019.
Article in Spanish | LILACS | ID: biblio-1058321

ABSTRACT

Resumen El cáncer colorrectal es de las principales causas de muerte por cáncer a nivel mundial. Una proporción importante de los casos desarrolla metástasis hepáticas. Gracias a los avances diagnósticos y tratamientos oncológicos, la sobrevida ha ido en aumento, sin embargo, para ello es fundamental lograr la resección quirúrgica completa de las lesiones primarias y metastásicas con márgenes microscópicos negativos (R0). Existen numerosos procedimientos y técnicas diseñadas para este objetivo como la quimioterapia neoadyuvante, embolización portal, cirugía en etapas, etc. A pesar de ello, hay casos no resecables por compromiso hepático bilobar, multisegmentario y/o compromiso de vasos arteriales, portales o venosos que en caso de resección, no permiten mantener hígado remanente funcional compatible con la vida del paciente. El trasplante hepático surge como alternativa radical para el tratamiento de casos no resecables. Dado la escasez de donantes y mortalidad en la lista de espera nacional, no es aceptable ocupar hígados del pool de donantes para patologías con criterios expandidos como metástasis colorrectales. Sin embargo, con el recurso del donante vivo de adulto a adulto, hoy en día es posible indicar trasplante en casos seleccionados, que cumplan con todos los criterios establecidos.


Colorectal cancer is one of the leading causes of cancer death worldwide. A significant proportion of cases develop liver metastases. Thanks to diagnostic advances and oncologic treatments, survival has been increasing, however, it is essential to achieve complete surgical resection of primary and metastatic lesions with negative microscopic margins (R0). There are many procedures and techniques designed for this purpose such as neoadjuvant chemotherapy, portal embolization, stage surgery, etc. Despite this, there are non-resectable cases due to bilobar, multisegmental and/or hepatic involvement of arterial, portal or venous vessels that, in case of resection, do not allow the maintenance of functional remnant liver compatible with the patient's life. Liver transplantation emerges as a radical alternative for the treatment of unresectable cases. Given the shortage of donors and mortality on the national waiting list, it is not acceptable to occupy donor pool livers for pathologies with expanded criteria such as colorectal metastases. However, with the resource of the living donor from adult to adult, today it is possible to indicate transplantation in selected cases, which meet all established criteria.


Subject(s)
Humans , Colorectal Neoplasms/surgery , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Transplantation , Hepatectomy , Liver/pathology , Neoplasm Metastasis
3.
J. coloproctol. (Rio J., Impr.) ; 39(4): 365-372, Oct.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056638

ABSTRACT

Abstract Introduction Colorectal cancer is amongst the most prevailing malignancies in the world and it is associated with a relatively high mortality rate. Rectal cancer occurs in 20-30% of all colorectal cancer cases, and 25% of this present synchronous metastatic disease. This study aims to review the current treatment approaches for rectal cancer patients with synchronous liver metastases, as there are no specific guidelines for the management of this group of patients. Methods A systematic literature search was performed on Pubmed database with a 10 year timeline limitation from 2008 to 2018. Results Currently, the only potentially curative approach remains to be the surgical resection. Conventionally, the classical strategy of these patients involves resection of rectal tumor, followed by liver resection, with chemotherapy sessions between the two procedures. However, recent studies have reported no inferiority, in safety and survival outcomes, when compared with other approaches (liver-first resection or simultaneous resection), except when symptoms of primary tumor are present. Hence, treatment strategy should be individualized based on the assessment of metastatic extent, primary tumor symptoms and the patient's overall clinical status. Chemotherapy and targeted agents have substantially contributed to overall survival improvements, allowing enhanced tumor down staging. Conclusion Complete resection of liver metastases is considered the major condition for a potential survival outcome in these patients. Management of these patients should include a multidisciplinary team with consideration of each individual specificities. Prospective randomized trials are needed to elucidate the optimal treatment strategy.


Introdução: O câncer colorretal está entre as neoplasias mais prevalentes no mundo, apresentando a uma taxa de mortalidade relativamente alta. Ele corresponde a 20% a 30% de todos os casos de câncer colorretal; 25% dos casos apresentam doença metastática síncrona. Este estudo teve como objetivo revisar as abordagens atuais de tratamento para pacientes com câncer retal com metástases hepáticas síncronas, uma vez que não existem diretrizes específicas para o manejo deste grupo de pacientes. Métodos: Uma busca sistemática da literatura foi realizada no banco de dados PubMed com uma limitação temporal de 10 anos (2008 a 2018). Resultados: Atualmente, a ressecção cirúrgica ainda é a única abordagem potencialmente curativa. Tradicionalmente, a estratégia clássica para o tratamento desses pacientes envolve a ressecção do tumor retal, seguida de ressecção hepática, com sessões de quimioterapia entre os dois procedimentos. No entanto, ao comparar a abordagem tradicional com outras técnicas (ressecção em primeiro plano do fígado ou ressecção simultânea), estudos recentes não relataram inferioridade nos desfechos de segurança e sobrevida, exceto quando sintomas de tumor primário estão presentes. Portanto, a estratégia de tratamento deve ser individualizada com base na avaliação da extensão metastática, nos sintomas primários do tumor e no estado clínico geral do paciente. A quimioterapia e os agentes dirigidos contribuíram substancialmente para as melhorias gerais na sobrevida, permitindo uma maior redução do estadiamento tumoral. Conclusão: A ressecção completa de metástases hepáticas é considerado o principal requisito para um possível resultado de sobrevida nesses pacientes. O manejo desses pacientes deve incluir uma equipe multidisciplinar e considerar as características específicas de cada paciente. Estudos prospectivos randomizados são necessários para elucidar a estratégia de tratamento ideal.


Subject(s)
Humans , Rectal Neoplasms/surgery , Liver Neoplasms/surgery , Neoplasms, Multiple Primary/surgery , Rectal Neoplasms/pathology , Rectal Neoplasms/drug therapy , Neoadjuvant Therapy , Proctectomy , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Neoplasms, Multiple Primary/drug therapy
4.
Rev. cuba. cir ; 58(3): e756, jul.-set. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1098981

ABSTRACT

RESUMEN La presencia de metástasis hepática es frecuente en el momento del diagnóstico del tumor primario, o bien puede aparecer tiempo después de haber resecado el cáncer. La enfermedad metastásica anteriormente era considerada como inoperable, sin embargo, los adelantos en la cirugía, terapias adyuvantes y medicamentos quimioterapéuticos, han ofrecido nuevas esperanzas a estos pacientes. El diseño de protocolos, guías de atención y esquemas de seguimiento en estos enfermos ha sido un tema importante en los centros especializados, por lo que se propone plantear las principales pautas de actuación diagnóstica y terapéutica frente a enfermos portadores de un hígado metastásico, que de forma simplificada y orientativa pueda interpretarse y adecuarse a los pacientes afectos por esta dolencia, además, de ser factibles de interpretar y aplicar por profesionales de la salud pertenecientes a varias especialidades(AU)


ABSTRACT The presence of liver metastases is frequent at the time of diagnosis of the primary tumor, or it may appear sometime after the cancer has been resected. Metastatic disease was previously considered inoperable, however, advances in surgery, adjuvant therapies, and chemotherapeutic drugs have offered new hope for these patients. The design of protocols, care guides and monitoring schemes in these patients has been an important topic in specialized centers, so it is proposed to propose the main guidelines for diagnostic and therapeutic action against patients with metastatic liver, which in In a simplified and guiding way, it can be interpreted and adapted to the patients affected by this ailment, as well as being feasible to interpret and apply by health professionals belonging to various specialtiesAU)


Subject(s)
Humans , Practice Guidelines as Topic , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Liver Neoplasms/surgery
5.
Rev. chil. cir ; 71(1): 55-60, feb. 2019. tab
Article in Spanish | LILACS | ID: biblio-985379

ABSTRACT

Resumen Introducción: El cáncer colorrectal se ha convertido en el tercer cáncer a nivel mundial en cuanto a incidencia y cuarto en mortalidad. Al diagnóstico, aproximadamente el 25% de los pacientes tendrán metástasis hepáticas. Con tratamiento adecuado el pronóstico de los pacientes etapa IV alcanza una sobrevida de 40% a 5 años. Con nuestro trabajo queremos evaluar la respuesta del tumor primario de colon desde el punto de vista imagenológico y anatomopatológico en pacientes con cáncer colorrectal con metástasis hepáticas tratados con quimioterapia y que luego fueron a resección del colon. Materiales y Método: Se trata un estudio retrospectivo y descriptivo, de pacientes con cáncer colorrectal con metástasis hepáticas. Los criterios de inclusión fueron que presentaran cáncer de colon o recto superior, con metástasis hepáticas sincrónicas, recibieran al menos 4 ciclos de quimioterapia neoadyuvante y que posteriormente fueran a resección del tumor primario. Resultados: Se reclutaron 9 pacientes, 4 hombres y 5 mujeres. Todos recibieron 4 o más ciclos de quimioterapia previo a la cirugía del tumor primario. De ellos, 8 tuvieron control imagenológico posquimioterapia. Según criterios RECIST, 3 pacientes presentaron respuesta completa, 1 paciente respuesta parcial y 4 enfermedad estable. El estudio anatomopatológico del colon resecado mostró desaparición tumoral macroscópica en 2 pacientes y microscópica en 1 paciente. Conclusiones: La regresión patológica completa en nuestros casos tratados con quimioterapia neoadyuvante es un hecho poco frecuente. Esto nos permite indicar la resección del sitio del tumor colorrectal en todos estos casos.


Introduction: Colorectal cancer has become the third cancer worldwide in terms of incidence and fourth in mortality. At diagnosis approximately 25% of patients will have liver metastases. With adequate treatment, the prognosis of stage IV patients reaches a survival of 40% at 5 years. We want to evaluate the response of the primary tumor of the colon from imaging and anatomopathological point of view in patients with colorectal cancer with liver metastases treated with chemotherapy and who then went to colon resection. Materials and Method: It is a retrospective and descriptive study of patients with stage IV colorectal cancer. The inclusion criteria were that they had cancer of the colon or upper rectum, with synchronous liver metastases, who have received at least 4 cycles of neoadjuvant chemotherapy and that subsequently went to resection of the primary tumor. Results: We recruited 9 patients, 4 men and 5 women. All received 4 or more cycles of chemotherapy prior to primary surgery. Of these, 8 had imaging control after chemotherapy. According to RECIST criteria, 3 patients presented complete response, 1 patient partial response and 4 stable disease. The anatomopathological study of the resected colon showed a macroscopic tumor disappearance in 2 patients, and microscopic in 1 patient. Conclusions: The complete pathological regression in our cases treated with neoadjuvant chemotherapy is a rare occurrence. This allows us to indicate the resection of the colorectal tumor site in all these cases.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/surgery , Colorectal Neoplasms/radiotherapy , Liver Neoplasms/secondary , Neoplasm Metastasis , Colorectal Neoplasms/mortality , Survival Rate , Disease-Free Survival , Neoplasm Staging
6.
Medicina (B.Aires) ; 79(1): 64-66, feb. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1002589

ABSTRACT

El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales. Puede sufrir transformación maligna y metastatizar a otros órganos distantes y, en otros casos, hacerlo como un tumor benigno. Se presenta el caso de un hombre de 82 años con lesión hepática detectada por ecografía en estudio urológico de rutina. La tomografía computarizada reveló una imagen sólida en los segmentos V-VI-VII del hígado. Se efectuó biopsia de la lesión de cuyo examen se informó metástasis de adenoma pleomorfo salival. Se realizó hepatectomía derecha y la anatomía patológica describió un tumor de 10 cm de diámetro, con margen libre, compatible con adenoma pleomorfo salival, 32 años después de la cirugía de su tumor primario. Luego de 8 años, en el seguimiento se hallaron cuatro nódulos hepáticos y una nueva imagen ósea en la vértebra L4 sugerente de recurrencia de la enfermedad. Se decidió administrar radioterapia corporal estereotáctica a la lesión ósea y evaluar la respuesta para decidir el futuro tratamiento de los nódulos hepáticos, debido a su lento crecimiento.


Pleomorphic adenoma is the most benign tumor of the salivary glands. It can undergo a malignant transformation to carcinoma and metastasize to distant organs, sometimes it can metastasize as a benign tumor. We present the case of an 82 years old male with hepatic lesion detected by ultrasound in routine urologic follow-up. CT scan revealed a solid image placed in segments V-VI-VII of the liver. A CT guided fine needle biopsy was made. Pathologic analysis reported a pleomorphic salivary adenoma metastasizing in the liver. Right hepatectomy was performed. Pathology study described a 10 cm diameter tumor with free margin, compatible with pleomorphic salivary adenoma, 32 years after surgery for the primary tumor. After 8 years of follow up, four hepatic nodules and a bone image in L4 vertebra that seemed to be a disease recurrence were found. It was decided to administer stereotactic body radiotherapy to the bone lesion and evaluate the response to decide the future treatment of the hepatic nodules, due to its slow growth.


Subject(s)
Humans , Male , Aged, 80 and over , Salivary Gland Neoplasms/pathology , Adenoma, Pleomorphic/pathology , Liver Neoplasms/secondary , Adenoma, Pleomorphic/surgery , Biopsy, Fine-Needle , Hepatectomy/methods , Liver Neoplasms/surgery
8.
Appl. cancer res ; 39: 1-7, 2019. ilustr.
Article in English | LILACS, Inca | ID: biblio-1023627

ABSTRACT

Background: Mutations in the RAS/RAF pathway predict resistance to anti-epidermal growth factor receptor antibodies in colorectal cancer (CRC), and may be targets for future therapies. This study investigates concordance of BRAF, HRAS, KRAS, NRAS and PIK3CA mutation status in primary CRC with matched liver (n = 274), lung (n = 114) or combined liver and lung metastases (n = 14). Methods: Next generation sequencing was performed on DNA from formalin-fixed paraffin embedded CRC and matched liver and/or lung metastases, for recurrent mutations in BRAF, HRAS, KRAS, NRAS and PIK3CA and using the single-molecule molecular inversion probe method. Results: Paired sequencing results on all five genes were reached in 249 of the 402 cases (62%). The obtained number of unique reads was not always sufficient to confidently call the absence or presence of mutations for all regions of interest. The mutational status of matched pairs was highly concordant; 91.1% concordance for all five genes, 95.5% for KRAS, 99.1% for NRAS. Lung metastases more often harboured RAS mutations compared to liver metastases (71% vs. 48%, p < 0.001). Conclusions: In this large series of CRC we show that both primary tumors and corresponding metastases can be used to determine the mutational status for targeted therapy, given the high concordance rates. Next generation sequencing including a single molecule tags is feasible, however in combination with archival formalin-fixed paraffin embedded material is limited by coverage depth.


Subject(s)
Humans , Colorectal Neoplasms/genetics , ras Proteins/genetics , Proto-Oncogene Proteins B-raf/genetics , Liver Neoplasms/genetics , Lung Neoplasms/genetics , Base Sequence , Colorectal Neoplasms/pathology , High-Throughput Nucleotide Sequencing , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Mutation/genetics
9.
Arq. gastroenterol ; 55(3): 258-263, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973888

ABSTRACT

ABSTRACT BACKGROUND: Liver metastases from colorectal cancer are an important public health problem due to the increasing incidence of colorectal cancer worldwide. Synchronous colorectal liver metastasis has been associated with worse survival, but this prognosis is controversial. OBJECTIVE: The objective of this study was to evaluate the recurrence-free survival and overall survival between groups of patients with metachronous and synchronous colorectal hepatic metastasis. METHODS: This was a retrospective analysis of medical records of patients with colorectal liver metastases seen from 2013 to 2016, divided into a metachronous and a synchronous group. The Cox regression model and the Kaplan-Meier method with log-rank test were used to compare survival between groups. RESULTS: The mean recurrence-free survival was 9.75 months and 50% at 1 year in the metachronous group and 19.73 months and 63.3% at 1 year in the synchronous group. The mean overall survival was 20.00 months and 6.2% at 3 years in the metachronous group and 30.39 months and 31.6% at 3 years in the synchronous group. Patients with metachronous hepatic metastasis presented worse overall survival in multivariate analysis. The use of biological drugs combined with chemotherapy was related to the best overall survival prognosis. CONCLUSION: Metachronous colorectal hepatic metastasis was associated with a worse prognosis for overall survival. There was no difference in recurrence-free survival between metachronous and synchronous metastases.


RESUMO CONTEXTO: As metástases hepáticas de câncer colorretal representam um importante problema de saúde pública devido à incidência crescente de câncer colorretal pelo mundo. A metástase hepática colorretal sincrônica está associada a pior sobrevida, no entanto, o pior prognóstico é assunto controverso. OBJETIVO: O objetivo do estudo foi avaliar a sobrevida livre de recorrência e a sobrevida global entre os grupos de pacientes com metástase hepática colorretal metacrônica e sincrônica. MÉTODO: Análise retrospectiva através de revisão de prontuários de pacientes com metástase hepática colorretal atendidos no período de 2013 a 2016, divididos em grupos metacrônico e sincrônico. Foram utilizados o modelo de regressão de Cox e o método de Kaplan-Meier com teste de Log-rank para comparação de sobrevida entre os grupos. RESULTADOS: A média de sobrevida livre de recorrência no grupo metacrônico foi de 9,75 meses e 50% em 1 ano, e no grupo sincrônico 19,73 meses e 63,3% em 1 ano. A média de sobrevida global no grupo metacrônico foi de 20,00 meses e 6,2% em 3 anos, e no grupo sincrônico 30,39 meses e 31,6% em 3 anos. Os pacientes com metástase hepática metacrônica apresentaram pior sobrevida global em análise multivariada. O uso de drogas biológicas associadas ao tratamento quimioterápico foi relacionado ao melhor prognóstico em sobrevida global. CONCLUSÃO: A metástase hepática colorretal metacrônica foi associada a pior prognóstico na sobrevida global. Não houve diferença na sobrevida livre de recorrência entre as metástases metacrônica e sincrônica.


Subject(s)
Humans , Male , Female , Colorectal Neoplasms/pathology , Neoplasms, Second Primary/secondary , Liver Neoplasms/secondary , Neoplasms, Multiple Primary/secondary , Time Factors , Colorectal Neoplasms/surgery , Colorectal Neoplasms/mortality , Multivariate Analysis , Retrospective Studies , Neoplasms, Second Primary/surgery , Neoplasms, Second Primary/mortality , Disease-Free Survival , Kaplan-Meier Estimate , Liver Neoplasms/surgery , Liver Neoplasms/mortality , Middle Aged , Neoplasm Recurrence, Local , Neoplasms, Multiple Primary/surgery , Neoplasms, Multiple Primary/mortality
10.
Rev. chil. cir ; 70(2): 194-198, 2018. ilus
Article in Spanish | LILACS | ID: biblio-990836

ABSTRACT

Resumen: Introducción: Los tumores de glándulas salivales son neoplasias poco frecuentes y representan menos del 5% de todos los tumores de cabeza y cuello. El carcinoma mucoepidermoide representa un 10-15% de todas las neoplasias de las glándulas salivales y aproximadamente un 30% de los tumores malignos salivales. El comportamiento biológico y las manifestaciones clínicas de este tipo de tumores son variables y se correlacionan con el estadio y grado histológico, siendo la presencia de metástasis a distancia un hallazgo inhabitual (en especial, en tumores de grado bajo o intermedio). Caso clínico: Paciente de 65 anos de edad con antecedentes de tabaquismo, a quien se diag nostica carcinoma mucoepidermoide de grado intermedio de glándula submandibular izquierda tratado con cirugía más radioterapia adyuvante, y que presenta progresión metastásica hepática y carcinomatosis peritoneal a los 26 meses de seguimiento.


Abstract: Introduction: Tumors of salivary glands are uncommon and comprise of about 5% of all head and neck tumors. Although constituting less than 15% of all salivary gland tumors, mucoepidermoid carcinoma account for approximately 30% of all malignant salivary gland neoplasms. Commonly these tumours are metastatic to local lymph nodes and distant metastases are rare (especially, in low and intermediate grade tumors). Case report: We report a case of 65 years old man who developed peritoneal carcinomatosis secondary to metastatic dissemination of mucoepidermoid carcinoma of the major salivary glands, which is an uncommon occurrence with intermediate grade tumors.


Subject(s)
Humans , Male , Aged , Peritoneal Neoplasms/secondary , Salivary Gland Neoplasms/pathology , Carcinoma, Mucoepidermoid/secondary , Liver Neoplasms/secondary
11.
Clinics ; 72(10): 645-648, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-1039533

ABSTRACT

OBJECTIVES: Disruption of the intestinal barrier and bacterial translocation commonly occur when intestinal blood flow is compromised. The aim of this study was to determine whether liver resection induces intestinal damage. METHODS: We investigated intestinal fatty-acid binding protein and insulin-like growth factor binding protein levels in the plasma of patients who underwent liver resection. RESULTS: We show that liver resection is associated with significant intestinal barrier injury, even if the Pringle maneuver is not performed. CONCLUSION: We propose the use of insulin-like growth factor binding protein-1 as a novel biomarker of intestinal damage in such situations.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Venous Pressure/physiology , Insulin-Like Growth Factor Binding Protein 1/blood , Hepatectomy/adverse effects , Intestinal Mucosa/blood supply , Intestinal Mucosa/injuries , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Postoperative Complications , Biomarkers/blood , Treatment Outcome , Colonic Neoplasms/pathology , Bacterial Translocation , Fatty Acid-Binding Proteins/blood
12.
Int. j. morphol ; 35(3): 1083-1090, Sept. 2017. ilus
Article in Spanish | LILACS | ID: biblio-893097

ABSTRACT

La disfunción hepática postoperatoria del remanente hepático que ocurre en pacientes sometidos a grandes resecciones hepáticas, es un problema complejo y temido, dado su pronóstico incierto. La asociación de partición hepática y ligadura portal para hepatectomía por etapas (ALPPS), es un enfoque novedoso para pacientes portadores de enfermedad hepática oncológica que anteriormente eran considerados "no resecables". El procedimiento se realiza en dos etapas. La primera, comprende la ligadura de la rama derecha de la vena porta. Luego, se realiza la transección del parénquima hepático; incluyendo o no, la sección y ligadura de la vena hepática media. A continuación se empaqueta el hígado tumoral en una bolsa de polietileno y el abdomen es cerrado. La segunda etapa, se realiza 7 a 15 días después. Una vez abierto el abdomen, se retira la bolsa de polietileno; se ligan y seccionan la arteria, el conducto biliar y la vena hepática derechos; y se elimina el hígado tumoral. Pueden instalarse drenes y se procede al cierre de la laparotomía. La técnica ALPPS puede permitir entonces, la resección curativa de hígados tumorales en pacientes con lesiones considerados previamente como no resecables. El objetivo de este artículo fue describir las indicaciones y aspectos técnicos del ALPPS a propósito del primer caso realizado en nuestra ciudad, en una paciente de 47 años con un cáncer de vesícula biliar avanzado y metástasis bilobares.


Postoperative hepatic malfunction subsequent to insufficiency of hepatic remnant is a complex and dire problem in patients subjected to large hepatic resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), is a novel approach for oncology patients whose hepatic tumors were previously considered non-resectable. The technique is performed in two phases. The first one comprises the ligation of the right portal vein branch. Subsequently, a parenchymal transection is performed, including or not, the middle hepatic vein. A plastic bag is employed to cover the tumoral liver, and the abdomen is closed. The second one is performed at 7 to 15 days interval. After laparotomy, the plastic bag is removed. The right artery, bile duct and hepatic vein are sectioned and the tumoral liver is removed. Drain was placed at the resection surface, and the abdomen is closed. ALPPS can enable curative resection of hepatic metastasis in patients with tumors previously considered non-resectable. The aim of this manuscript was to describe the indications and technical aspects of ALPPS in relation to the first case carried out in our city, in a 47-year-old woman with advanced gallbladder cancer with bilobar metastases.


Subject(s)
Humans , Female , Middle Aged , Hepatectomy/methods , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Portal Vein/surgery , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/pathology , Ligation/methods
16.
ABCD arq. bras. cir. dig ; 29(3): 173-179, July-Sept. 2016. tab
Article in English | LILACS | ID: lil-796946

ABSTRACT

ABSTRACT In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.


RESUMO Neste último módulo do consenso, abordou-se alguns temas controversos. O primeiro tópico discutido foi o manejo da doença após progressão na primeira linha de quimioterapia, com foco em se ainda haveria indicação cirúrgica neste cenário. A seguir, o painel debruçou-se sobre as situações de ressecção da doença hepática na presença de doença extra-hepática, assim como, qual a melhor sequência de tratamento. O tratamento de conversão para doença inicialmente irressecável também foi abordado neste módulo, incluindo as importantes definições de quando se pode esperar que a doença se torne ressecável e quais esquemas terapêuticos seriam mais efetivos à luz dos conhecimentos atuais sobre a biologia tumoral e taxas de resposta objetiva. Por último, o tratamento da doença não passível de ressecção foi discutida, focando-se nos melhores esquemas a serem empregados e seu sequenciamento, bem como o papel da quimioembolização no manejo destes pacientes.


Subject(s)
Humans , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Brazil , Combined Modality Therapy , Embolization, Therapeutic , Antineoplastic Agents/therapeutic use
17.
ABCD arq. bras. cir. dig ; 29(1): 9-13, Jan.-Mar. 2016.
Article in English | LILACS | ID: lil-780014

ABSTRACT

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients. Aim : In the second module of this consensus, management of resectable liver metastases was discussed. Method : Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities. Results : Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions. Conclusion : Were presented validated ressectional strategies, to be taken into account in clinical practice.


Racional: As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução dos pacientes. Objetivo : No segundo módulo desse consenso, foi discutido o manejo de metástases hepáticas ressecáveis. Método : Foi definido o conceito de metástases síncrônicas e metacrônicas, e ambos os cenários foram discutidos separadamente de acordo com as suas peculiaridades prognósticas e terapêuticas. Resultados : Foi dada especial atenção às missing metástases em resposta ao tratamento pré-operatório sistêmico, com ênfase em estratégias para evitar sua recorrência e como gerenciar as lesões desaparecidas. Conclusão : Foram apresentadas e validadas estratégias de ressecção em várias circunstâncias, para serem aplicadas na prática clínica.


Subject(s)
Humans , Colorectal Neoplasms/pathology , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Brazil , Combined Modality Therapy
18.
Biol. Res ; 49: 1-7, 2016. ilus, graf
Article in English | LILACS | ID: biblio-950862

ABSTRACT

BACKGROUND AND OBJECTIVE: Long non-coding RNAs can regulate tumorigenesis of various cancers. Dys-regulation of lncRNA-AFAP1-AS1 has not been studied in colorectal carcinoma (CRC). This study was to examine the function involvement of AFAP1-AS1 in tumor growth and metastasis of CRC. METHODS: Relative expression of AFAP1-AS1 in CRC tissues and CRC cells lines was determined using quantitative real-time PCR (qRT-PCR). Functional involvement of AFAP1-AS1 in tumor proliferation and metastasis was evaluated in AFAP1-AS1-specific siRNA-treated CRC cells and in CRC cell xenograft. Expression of epithelial-mesenchymal transition (EMT)-related gene expression was determined using western blot. RESULTS: Relative expression of AFAP1-AS1 was significantly elevated in CRC tissues and CRC HCT116 and SW480 cell lines. AFAP1-AS1 knock-down suppressed SW480 cell proliferation, colony formation, migration and invasion. Also AFAP1-AS1 knock-down inhibited tumor metastasis-associated genes expression in terms of EMT. This carcinostatic action by AFAP1-AS1 knock-down was further confirmed by suppression of tumor formation and hepatic metastasis of CRC cells in nude mice. CONCLUSION: lncRNA-AFAP1-AS1 knock-down exhibits antitumor effect on colorectal carcinoma in respects of suppression of cell proliferation and metastasis of cancer cells.


Subject(s)
Humans , Animals , Male , Carcinoma/secondary , Colorectal Neoplasms/pathology , RNA, Long Noncoding/metabolism , Liver Neoplasms/secondary , Tumor Cells, Cultured , Carcinoma/genetics , Carcinoma/metabolism , Carcinoma/pathology , Colorectal Neoplasms/genetics , Colorectal Neoplasms/metabolism , Gene Expression Regulation, Neoplastic , Cell Movement , Blotting, Western , HCT116 Cells , Cell Proliferation , Gene Knockdown Techniques , Epithelial-Mesenchymal Transition , Real-Time Polymerase Chain Reaction , RNA, Long Noncoding/analysis , Liver Neoplasms/genetics , Mice, Inbred C57BL , Mice, Nude
19.
Clinics ; 70(12): 775-780, Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-769705

ABSTRACT

OBJECTIVE: The role of chemotherapy in treating advanced thymic carcinoma is unclear. The purpose of the current study was to investigate the efficacy of chemotherapy and the prognostic factors for patients with advanced thymic carcinoma. METHODS: A retrospective review of the medical records of 86 patients treated with chemotherapy for advanced thymic carcinoma was conducted between 2000 and 2012 at our institution. The clinical characteristics, chemotherapy regimens and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method and the Cox proportional hazard model was used for multivariate analysis. RESULTS: Of the 86 patients, 56 were male and 30 were female. The median survival time was 24.5 months. For the first-line chemotherapy treatment, the objective response rate was 47.7% and the disease control rate was 80.2%. The median progression-free survival for all patients was 6.5 months for first-line chemotherapy. No significant differences in progression-free survival were observed among the different chemotherapy regimens. Multivariate analyses revealed that the prognostic factors for overall survival included performance status (p=0.043), histology grade (p=0.048), and liver metastasis (p=0.047). CONCLUSION: Our results suggest that there is no difference in efficacy between multiagent and doublet regimens. The prognosis of patients with advanced thymic carcinoma can be predicted based on histological grade, liver metastasis and performance status.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents/therapeutic use , Thymoma/drug therapy , Thymus Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Kaplan-Meier Estimate , Liver Neoplasms/secondary , Prognosis , Retrospective Studies , Time Factors , Treatment Outcome , Thymoma/mortality , Thymoma/pathology , Thymus Neoplasms/mortality , Thymus Neoplasms/pathology
20.
ABCD arq. bras. cir. dig ; 28(4): 222-230, Nov.-Dec. 2015.
Article in Portuguese | LILACS | ID: lil-770256

ABSTRACT

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.


Racional : As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução de pacientes com estas neoplasias. Objetivo : Neste módulo procurou-se contextualizar esta situação clínica, bem como parametrizar dados epidemiológicos e de resultados das diversas modalidades de tratamento estabelecidas. Método : Foi realizada discussão sobre como detectar e estadiar o câncer colorretal metastático, bem como o emprego dos métodos de imagem na avaliação de resposta ao tratamento sistêmico instituído. Resultado : Fundamentou na definição de quais pacientes teriam suas metástases consideradas ressecáveis e de como se poderia ampliar a gama de pacientes submetidos às modalidades de tratamento ditas de intuito curativo. Conclusão : Foram apresentados os fatores prognósticos clínicos, patológicos e moleculares com validação para serem levados em consideração na prática clínica.


Subject(s)
Humans , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Brazil , Combined Modality Therapy , Practice Guidelines as Topic
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