ABSTRACT
Purpose: Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) has poor survival. Multi-modal treatment including systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) can be used in selected patients with curative intent. The majority published works consider PC of CRC origin as a homogenous disease. Aim of this study is to stress the different biological behaviors and survival of PC according to colonic or rectal origin. Methods: Data of CRS and HIPEC procedures for PC of CRC origin performed at MD Anderson Cancer Center-Madrid (Spain) have been collected, dividing patients into two groups according to colonic or rectal PC. Clinical, operatory, and postoperatory variables of the two groups have been analyzed to compare survival-related rates and PC origin. Results: In the years 2004-2015, 114 procedures of CRS followed by HIPEC for peritoneal metastasis of different origin have been performed; of these, 36 procedures were for colorectal PC (31 patients in colonic and 5 in rectal group). Two groups are homogenous after analysis of clinical, operatory, and follow-up data. Median survival (OS) is significantly higher in colonic compared to rectal group (47.83 vs. 22.0 months, p 0.008). 3- and 5-year survival rate is 74 and 50% in colonic group vs. 20 and 0% in rectal group. Conclusion: Rectal origin PC has a more aggressive behavior compared to colonic origin, reflecting in a worst prognosis of patients affected by rectal origin PC. According to our data and literature, indications of multi-modal treatment including CRS and HIPEC should be more restrictive for rectal cancer PC. Authors should differentiate colonic and rectal origin of PC when reporting cases in the literature
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Subject(s)
Humans , Rectal Neoplasms/therapy , Colonic Neoplasms/therapy , Peritoneal Neoplasms/therapy , Rectal Neoplasms/pathology , Colonic Neoplasms/pathology , Carcinoma/pathology , Peritoneal Neoplasms/pathology , Neoplasm Metastasis/pathology , Cytoreduction Surgical Procedures , Hyperthermia, InducedABSTRACT
PURPOSE: Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) has poor survival. Multi-modal treatment including systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) can be used in selected patients with curative intent. The majority published works consider PC of CRC origin as a homogenous disease. Aim of this study is to stress the different biological behaviors and survival of PC according to colonic or rectal origin. METHODS: Data of CRS and HIPEC procedures for PC of CRC origin performed at MD Anderson Cancer Center-Madrid (Spain) have been collected, dividing patients into two groups according to colonic or rectal PC. Clinical, operatory, and postoperatory variables of the two groups have been analyzed to compare survival-related rates and PC origin. RESULTS: In the years 2004-2015, 114 procedures of CRS followed by HIPEC for peritoneal metastasis of different origin have been performed; of these, 36 procedures were for colorectal PC (31 patients in colonic and 5 in rectal group). Two groups are homogenous after analysis of clinical, operatory, and follow-up data. Median survival (OS) is significantly higher in colonic compared to rectal group (47.83 vs. 22.0 months, p 0.008). 3- and 5-year survival rate is 74 and 50% in colonic group vs. 20 and 0% in rectal group. CONCLUSION: Rectal origin PC has a more aggressive behavior compared to colonic origin, reflecting in a worst prognosis of patients affected by rectal origin PC. According to our data and literature, indications of multi-modal treatment including CRS and HIPEC should be more restrictive for rectal cancer PC. Authors should differentiate colonic and rectal origin of PC when reporting cases in the literature.
Subject(s)
Adenocarcinoma/secondary , Colonic Neoplasms/pathology , Peritoneal Neoplasms/etiology , Peritoneal Neoplasms/therapy , Rectal Neoplasms/pathology , Adenocarcinoma/mortality , Adult , Aged , Chemotherapy, Cancer, Regional Perfusion/methods , Chemotherapy, Cancer, Regional Perfusion/mortality , Colonic Neoplasms/mortality , Cytoreduction Surgical Procedures/methods , Cytoreduction Surgical Procedures/mortality , Disease-Free Survival , Female , Humans , Hyperthermia, Induced/methods , Hyperthermia, Induced/mortality , Male , Middle Aged , Peritoneal Neoplasms/mortality , Rectal Neoplasms/mortalityABSTRACT
Se examinan 764 casos de querellas instauradas contra médicos de todas las especialidades y de todo el país presentadas al Servicio Médico Legal de Chile entre 1991 y 1998. De ellas se estudian 155 casos correspondientes a la especialidad de gineco-obstetricia, con el fin de comprobar el estado actual del problema. Se observa un aumento progresivo de las querellas, correspondiendo la mayor proporción de ellas a obstetricia. Se estudian los diagnósticos, intervenciones médicas, complicaciones y tipo de querella. Se revisan conceptos médico-legales, señalando posibles causas del problema y se sugieren modos de superarlo
Subject(s)
Humans , Female , Liability, Legal , Malpractice/legislation & jurisprudence , Obstetrics and Gynecology Department, Hospital/legislation & jurisprudence , JurisprudenceABSTRACT
Se presentan 641 casos de heridas cortopunzantes penetrantes abdominales en revisión retrospectiva desde 1985 a 1992, excluyendo las heridas toracoabdominales. La etiología más frecuente fue el arma blanca en el 99 por ciento. El 38,8 por ciento fue operado y hubo un 9,3 por ciento de laparotomías en blanco. En el grupo operado los órganos más lesionados fueron intestino delgado, 33,4 por ciento, y colon, 14,7 por ciento. Morbilidad 21,5 por ciento, la más frecuente infección de herida operatoria 9,4 por ciento. Al aplicar el Penetrating Abdominal Trauma Index, PATI, el 97,7 por ciento tenía valores bajo 25 y el promedio fue de 9,8 puntos. Mortalidad 4,1 por ciento, 10/246. En éste, el 57 por ciento tenía PATI mayor de 25 y el promedio fue de 26,8 puntos. El PATI es un índice útil en este tipo de lesiones con alta mortalidad en el grupo sobre 25 puntos
Subject(s)
Male , Female , Adolescent , Adult , Middle Aged , Abdominal Injuries/surgery , Wounds, Penetrating/surgery , Indicators of Morbidity and Mortality , Postoperative Complications/classification , Surgical Procedures, Operative , Trauma Severity Indices , Wounds, Penetrating/etiologyABSTRACT
Se presenta el estudio prospectivo en el manejo, tratamiento y seguimiento de una familia portadora de poliposis adenomatosa múltiple, PAM. Caso índice, paciente de sexo femenino de 19 años que consultó en junio de 1992 por anemia crónica en estudio. A partir de ella se logró controlar a 18 familiares con rectosigmoidoscopia y enema baritado. El grupo operado lo conforman cinco pacientes, un hombre y cuatro mujeres con edades entre los 16 y 23 años, además en dos de éstos se encontró hipertrofia congénita epitelial pigmentaria retiniana e hiperplasia linfoide reticular del antro. La preparación preoperatoria y el manejo del postoperatorio fue similar en todo el grupo. La técnica quirúrgica en todos fue la colectomía total con ileorrectoanastomosis. Sólo hubo una complicación postoperatoria, una infección urinaria. No hubo mortalidad en el grupo. En todos los casos el informe anatomopatológico fue adenomatosis tubular con displasia leve a moderada. Todos están en tratamiento con sulindaco. Los controles para todo el grupo continúan en la actualidad. Creemos que la colectomía total con ileorrectoanastomosis es una alternativa en pacientes jóvenes
