Factores que afectan a la recurrencia postoperatoria de la enfermedad de Crohn. Nuevas controversias a través de la experiencia de un centro / No disponible

Introducción Muchos pacientes con enfermedad de Crohn presentan recurrencias frecuentes mientras otros mantienen periodos prolongados de remisión después de la cirugía. Determinar los factores de riesgo de recidiva puede ser útil para identificar pacientes de alto riesgo y poder adoptar estrategias adecuadas durante el acto quirúrgico y en la elección del tratamiento médico postoperatorio. Material y métodos Estudio retrospectivo de 78 pacientes con enfermedad de Crohn ileocólica sometidos a una primera cirugía resectiva durante el periodo de enero de 2000 a diciembre de 2005; posteriormente se han estudiado los factores de riesgo de recurrencia endoscópica, radiológica y quirúrgica hasta mayo de 2009. Resultados 41 pacientes (52,6%) tuvieron recurrencia; siendo en 17 pacientes (21,8%) endoscópica, en 12 (15,4%) radiológica y en 12 (15,4%) quirúrgica. El tiempo medio de la primera recurrencia es de 70,24 meses. El no realizar anastomosis durante la cirugía resectiva parece tener más relación con la existencia de recidiva (77,7% vs 48,2%). Aunque solo la existencia de complicaciones postoperatorias (p=0,018) tiene relación significativa con la existencia de recurrencia (68,4% vs 47,4%) así como la necesidad de transfusión en el periodo postoperatorio inmediato (67,8% vs 42,8%). Conclusiones La transfusión de hemoderivados es un factor de riesgo para la recurrencia postoperatoria de la enfermedad de Crohn. Pero solo las complicaciones postoperatorias se muestran como factor de riesgo independiente en el análisis multivariable. Una técnica quirúrgica adecuada y segura es un factor perioperatorio muy importante en el que podemos influir para disminuir esta recidiva (AU)

Introduction: Many patients with Crohn’s disease have frequent recurrences, while others have long periods of remission after surgery. Determination of the risk factors of recurrence would be useful in identifying these high risk patients and to adopt suitable strategies during the surgical act and in the choice of post-surgical medical treatment. Material and methods: A retrospective study was conducted on 78 patients with ileocolic Crohn’s disease subjected to a first surgical resection, during the period from January 2000 to December 2005. The risk factors for endoscopic, radiological and surgical were subsequently analysed up to May 2009.Results: A total of 41 patients (52.6%) had recurrences, being endoscopic in 17 (21.8%) of patients, radiological in 12 (15.4%) and surgical in 12 (15.4%). The mean time to first recurrence was 70.24 months. Recurrence was associated more to not performing anastomosis(77.7% vs. 48.2%) during surgical resection. Although only the existence of postoperative complications (P = .018) was significantly associated with (68.4% vs. 47.4%), as well as with the need for transfusion in the immediate post-operative period (67.8% vs. 42.8%). Conclusions: Transfusion of blood products is a risk factor for postoperative recurrence of Crohn’s disease. But only postoperative complications are shown as an independent risk factor in the multivariate analysis. An adequate and safe surgical technique is a very important perioperative factor over which we have the influence to decrease these recurrences (AU)

Tratamiento quirúrgico del hepatocarcinoma: experiencia del CHU A Coruña / Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)

Introducción El hepatocarcinoma (HCC) es uno de los tumores más frecuentes, y su tratamiento potencialmente curativo es la cirugía: resección quirúrgica parcial o trasplante hepático. Objetivos Determinar la morbimortalidad, la supervivencia y sus factores asociados en pacientes con HCC según tipo de tratamiento quirúrgico: trasplante hepático o resección quirúrgica parcial. Material y métodos Estudio observacional de seguimiento retrospectivo de HCC diagnosticados y tratados de junio de 1994 a diciembre de 2007. Se realiza un análisis descriptivo de las variables, análisis de supervivencia Kaplan-Meier y regresión de Cox. Resultados En los 150 pacientes trasplantados, la incidencia de recidiva tumoral es del 13,3%, con supervivencias a 1, 3 y 5 años del 89,3, el 73,1 y el 61,4% respectivamente; el análisis multivariable demuestra que sólo el grado de diferenciación histológica es factor de riesgo independiente. En los 33 pacientes con resección quirúrgica parcial, la incidencia de recidiva tumoral fue del 51,5%, con supervivencias a 1, 3 y 5 años del 90,9, el 60,2 y el 38,6%. Se evidencia una mortalidad significativamente mayor en pacientes con estadio tumoral y TNM superiores. Conclusiones La supervivencia en el seguimiento es mayor con trasplante hepático y la recidiva tumoral es más frecuente en pacientes con resección quirúrgica parcial. Los resultados de supervivencia en pacientes trasplantados coinciden con el Registro Español y Europeo de Trasplante Hepático y el registro de la United Network for Organ Sharing (AU)

Introduction: Liver cancer (LC) is one of the most frequent tumours, in which the potentiallycurative treatment is surgery: partial surgical resection or liver transplant. Objectives: To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection orliver transplant. Material and methods: A retrospective, observational follow-up study of LC patients diagnosedand treated from June 1994 to December 2007. A descriptive analysis of the variableswas performed, as well as a Kaplan- Meier survival analysis and Cox regression. Results: The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with asurvival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. Inthe 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with asurvival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly highermortality was observed in patients with higher tumour and TNM staging. Conclusions: The survival throughout follow-up was higher in liver transplant, and tumourrecurrence was more frequent in patients with partial surgical resection. The survivalresults in transplanted patients are consistent with the Spanish and European LiverTransplant Register and with the United Network for Organ Sharing register (AU)

[Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)]. / Tratamiento quirúrgico del hepatocarcinoma: experiencia del CHU A Coruña.

INTRODUCTION: Liver cancer (LC) is one of the most frequent tumours, in which the potentially curative treatment is surgery: partial surgical resection or liver transplant. OBJECTIVES: To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection or liver transplant. MATERIAL AND METHODS: A retrospective, observational follow-up study of LC patients diagnosed and treated from June 1994 to December 2007. A descriptive analysis of the variables was performed, as well as a Kaplan- Meier survival analysis and Cox regression. RESULTS: The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with a survival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. In the 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with a survival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly higher mortality was observed in patients with higher tumour and TNM staging. CONCLUSIONS: The survival throughout follow-up was higher in liver transplant, and tumour recurrence was more frequent in patients with partial surgical resection. The survival results in transplanted patients are consistent with the Spanish and European Liver Transplant Register and with the United Network for Organ Sharing register.