ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Pancreatic Neoplasms/surgery , Perivascular Epithelioid Cell Neoplasms/surgery , Pancreatic Neoplasms/pathology , Perivascular Epithelioid Cell Neoplasms/etiology , Immunohistochemistry , Diagnosis, Differential , Pancreatectomy/methods , SplenectomyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Liver Failure, Acute/complications , Liver Failure/complications , Liver Failure/surgery , Biliary Fistula/surgery , Biliary Fistula , Cholangiocarcinoma/complications , Cholangiocarcinoma/surgery , Cholangiocarcinoma , Ascites/complications , AscitesABSTRACT
The main cause of morbimor-mortality after major liver surgery is the development of liver failure posthepatectomy(LFPH). Treatment must involve multiple options and will be aggressive from the beginning. We report a case of a patient with cholangiocarcinoma perihilar treated with surgery: right hepatectomy extended to sI + IVb with develop of LFPH and biliary fistula and being management successfully in a multidisciplinary way.
Subject(s)
Biliary Fistula/surgery , Hepatectomy/adverse effects , Liver Failure/etiology , Liver Failure/therapy , Postoperative Complications/therapy , Bile Duct Neoplasms/surgery , Cholangiocarcinoma/surgery , Humans , Liver Neoplasms/surgery , Liver Regeneration , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided. Kaplan-Meier curves were constructed and compared by the log-rank test to identify factors associated with poor survival. Independent factors predictive of survival were evaluated by multivariate Cox regression analysis. RESULTS: The mean age was 65.6 +/- 11.9 years and 84% of the patients were men. Forty-eight percent of the patients had hepatitis C infection and 58% were Child-Pugh grade A. HCC was multinodular in 54% and the total tumor size was more than 5 cm in 90% of patients. Thirty-four percent of the patients had malignant portal thrombosis and four patients had metastases. Thirty-eight percent of the patients had received previous treatment. The median follow-up was 9.2 months and 1- and 2-year survival was 46% and 17.5%, respectively. Poor survival was associated with male sex, alpha-fetoprotein values of > 400 ng/ml, albumin levels of < 3 g/dl, and metastases. Independent predictors identified by multivariate Cox regression analysis were male sex, albumin levels of < 3 g/dl, and alpha-fetoprotein values of > 400 ng/ml. The median survival in patients with two or more independent factors was significantly lower than that in patients with none or only one factor (14.2 vs. 4.1 months). CONCLUSION: Survival in patients with non-active treatment of hepatocellular carcinoma can be estimated and the factors involved allow separate groups of patients with different short- to medium-term prognoses to be identified.
Subject(s)
Carcinoma, Hepatocellular/mortality , Liver Neoplasms/mortality , Aged , Carcinoma, Hepatocellular/pathology , Female , Humans , Liver Neoplasms/pathology , Male , Middle Aged , Prognosis , Risk Factors , Survival AnalysisABSTRACT
Objetivo: Evaluar los factores pronósticos relacionados con la supervivencia de los pacientes con carcinoma hepatocelular (CHC) desestimados para el tratamiento activo. Material y métodos: Entre mayo de 2003 y junio de 2005 se desestimaron 50 pacientes para el tratamiento curativo o paliativo del CHC, según los criterios de la Clasificación de Barcelona, y desde ese momento se realizó un soporte sintomático. Se valoraron los factores pronósticos independientes de la mortalidad mediante curvas de Kaplan-Meier, comparadas a través del test de rangos logarítmicos, y posteriormente mediante análisis de regresión de Cox. Resultados: La edad media fue de 65,9 ± 11,9 años y el 84% eran varones. El 48% de los pacientes tenían hepatitis C, y el 58% tenían un grado A de Child-Pugh. El CHC era multinodular en el 54% de los pacientes, y en el 90% el tamaño tumoral total fue mayor de 5 cm. El 34% presentaba una trombosis portal maligna y 4 pacientes, metástasis. El 38% había sido tratado previamente a su desestimación. La mediana de seguimiento fue de 9,2 meses, y la supervivencia a 1 y 2 años fue del 46 y del 17,5%, respectivamente. Los factores asociados a una mayor mortalidad fueron los siguientes: sexo masculino, alfafetoproteína > 400 ng/ml, albúmina sérica < 3 g/dl y presencia de metástasis. Se identificaron los siguientes factores pronósticos independientes de la mortalidad: sexo masculino, albúmina < 3 g/dl y alfafetoproteína > 400 ng/ml. La mediana de supervivencia de los pacientes sin ninguno o un factor de mortalidad fue claramente superior respecto a los pacientes con 2 o más factores (14,2 frente a 4,1 meses). Conclusión: La supervivencia de los pacientes desestimados para el tratamiento activo del CHC puede ser estimada, y los factores implicados permiten separar grupos de pacientes con diferente pronóstico a corto-medio plazo
Objective: To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC). Material and Methods: Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided. Kaplan-Meier curves were constructed and compared by the log-rank test to identify factors associated with poor survival. Independent factors predictive of survival were evaluated by multivariate Cox regression analysis. Results: The mean age was 65.6 ± 11.9 years and 84% of the patients were men. Forty-eight percent of the patients had hepatitis C infection and 58% were Child-Pugh grade A. HCC was multinodular in 54% and the total tumor size was more than 5 cm in 90% of patients. Thirty-four percent of the patients had malignant portal thrombosis and four patients had metastases. Thirty-eight percent of the patients had received previous treatment. The median follow-up was 9.2 months and 1- and 2-year survival was 46% and 17.5%, respectively. Poor survival was associated with male sex, alpha-fetoprotein values of > 400 ng/ml, albumin levels of < 3 g/dl, and metastases. Independent predictors identified by multivariate Cox regression analysis were male sex, albumin levels of < 3 g/dl, and alpha-fetoprotein values of > 400 ng/ml. The median survival in patients with two or more independent factors was significantly lower than that in patients with none or only one factor (14.2 vs. 4.1 months). Conclusion: Survival in patients with non-active treatment of hepatocellular carcinoma can be estimated and the factors involved allow separate groups of patients with different short- to medium-term prognoses to be identified
