Quality standards in 480 pancreatic resections: a prospective observational study.

Pancreatic resection is a standard procedure for the treatment of periampullary tumors. Morbidity and mortality are high, and quality standards are scarce in our setting. International classifications of complications (Clavien-Dindo) and those specific for pancreatectomies (ISGPS) allow adequate case comparisons. The goals of our work are to describe the morbidity and mortality of 480 pancreatectomies using the international classifications ISGPS and Clavien-Dindo to help establish a quality standard in our setting and to compare the results of CPD with reconstruction by pancreaticogastrostomy (1,55) versus 177 pancreaticojejunostomy). We report 480 resections including 337 duodenopancreatectomies, 116 distal pancreatectomies, 11 total pancreatectomies, 10 central pancreatectomies, and 6 enucleations. Results for duodenopancreatectomy include: 62 % morbidity (Clavien > or = III 25.9 %), 12.3 % reinterventions, and 3.3 % overall mortality. For reconstruction by pancreaticojejunostomy: 71.2 % morbidity (Clavien > or = III 34.4 %), 17.5 % reinterventions, and 3.3 % mortality. For reconstruction by pancreaticogastrostomy: 51 % morbidity (Clavien > or = III 15.4%), 6.4 % reinterventions, and 3.2 % mortality. Differences are significant except for mortality. We conclude that our series meets quality criteria as compared to other groups. Reconstruction with pancreaticogastrostomy significantly reduces complication number and severity, as well as pancreatic fistula and reintervention rates.

Estándares de calidad en 480 resecciones pancreáticas: estudio prospectivo observacional / Quality standards in 480 pancreatic resections: a prospective observational study

INTRODUCCIÓN: la resección pancreática es un procedimiento estándar para el tratamiento de los tumores periampulares. La morbimortalidad es elevada y los estándares de calidad en nuestro medio son escasos. Las clasificaciones internacionales de las complicaciones Clavien-Dindo y las específicas de las pancreatectomías (ISGPS) permiten una adecuada comparación de casuísticas. OBJETIVOS: los objetivos de nuestro trabajo son describir la morbimortalidad de 480 pancreatectomías utilizando las clasificaciones internacionales ISGPS y Clavien-Dindo para contribuir al establecimiento de un estándar de calidad en nuestro medio, y comparar los resultados de la DPC con reconstrucción mediante pancreaticogastrostomía (1.55) frente a la pancreaticoyeyunostomía (177). MÉTODOS: presentamos 480 resecciones que incluyen 337 duodenopancreatectomías, 116 pancreatectomías distales, 11 pancreatectomías totales, 10 pancreatectomías centrales y 6 enucleaciones. RESULTADOS: los resultados en la duodenopancreatectomía son: 62 % de morbilidad (Clavien ≥ III 25,9 %), 12,3 % de reintervenciones y 3,3 % de mortalidad global. En las reconstrucción con pancreaticoyeyunostomía: 71,2 % de morbilidad (Clavien ≥ III 34,4 %), 17,5 % de reintervenciones y 3,3 % de mortalidad. En la reconstrucción con pancreaticogastrostomía: 51 % de morbilidad (Clavien ≥ III 15,4 %), 6,4 % de reintervenciones y 3,2 % de mortalidad, las diferencias son significativas, excepto en la mortalidad. CONCLUSIONES: concluimos que nuestra serie cumple criterios de calidad en comparación con la experiencia de otros grupos. La reconstrucción con pancreaticogastrostomía disminuye significativamente el número de complicaciones, su gravedad, la tasa de fístula pancreática y las reintervenciones

BACKGROUND: Pancreatic resection is a standard procedure for the treatment of periampullary tumors. Morbidity and mortality are high, and quality standards are scarce in our setting. International classifications of complications (Clavien-Dindo) and those specific for pancreatectomies (ISGPS) allow adequate case comparisons. OBJECTIVES: The goals of our work are to describe the morbidity and mortality of 480 pancreatectomies using the international classifications ISGPS and Clavien-Dindo to help establish a quality standard in our setting and to compare the results of CPD with reconstruction by pancreaticogastrostomy (1,559 versus 177 pancreaticojejunostomy). METHODS: We report 480 resections including 337 duodenopancreatectomies, 116 distal pancreatectomies, 11 total pancreatectomies, 10 central pancreatectomies, and 6 enucleations. RESULTS: Results for duodenopancreatectomy include: 62 % morbidity (Clavien ≥ III 25.9 %), 12.3 % reinterventions, and 3.3 % overall mortality. For reconstruction by pancreaticojejunostomy: 71.2 % morbidity (Clavien ≥ III 34.4 %), 17.5 % reinterventions, and 3.3 % mortality. For reconstruction by pancreaticogastrostomy: 51 % morbidity (Clavien ≥ III 15.4%), 6.4 % reinterventions, and 3.2 % mortality. Differences are significant except for mortality. CONCLUSIONS: We conclude that our series meets quality criteria as compared to other groups. Reconstruction with pancreaticogastrostomy significantly reduces complication number and severity, as well as pancreatic fistula and reintervention rates

Linfoma de tejido linfoide asociado a mucosas primario de mama con infiltración de la piel / Primary mucosa-associated lymphoid tissue lymphoma of the breast with cutaneous involvement

El linfoma de células B extranodal de la zona marginal del tejido asociado a mucosas es de bajo grado de malignidad y representa el 0,04-0,53% de todos los tumores malignos de la mama y el 2,2% de los linfomas malignos extranodales. Se asocia a enfermedades autoinmunes. En la mama se presenta habitualmente como un tumor único, indoloro y de rápido crecimiento. En algunos casos existe compromiso de la piel y adenopatías axilares. Presentamos el caso de una mujer de 39 años con artritis reumatoide de 20 años de evolución, que presenta desde hace 5 meses una tumoración palpable en la mama izquierda de 4 cm y lesiones eritematosas cambiantes en la piel de ambas mamas. Los hallazgos radiológicos fueron similares a los del resto de las tumoraciones malignas, por lo que para su diagnóstico fue necesario un estudio anatomopatológico, inmunohistoquímico y molecular (AU)

Mucosa-associated lymphoid tissue lymphoma is a low-grade malignant tumor representing 0.04 to 0.53% of all malignant breast tumors and 2.2% of extranodal malignant lymphomas. This entity is associated with autoimmune diseases. In the breast, mucosa-associated lymphoid tissue lymphomas usually appear as a single, painless, and fast growing tumor. Some patients also have cutaneous involvement and axillary lymphadenopathy. We present a case of a 39-year-old woman with a 20-year history of rheumatoid arthritis and a 5-month history of a palpable 4 cm lump in the left breast and erythematous skin lesions on both breasts. Radiological findings were similar to those of other malignant tumors. Consequently, histopathological, immunohistochemical and molecular studies were required for diagnosis (AU)

[Training periods with experts improve results in colorectal laparoscopic surgery]. / Las estancias de formación con expertos mejoran los resultados en cirugía laparoscópica colorrectal.

OBJECTIVE: To analyse the effects of training in elective colorectal laparoscopic surgery with a minimum 6 months follow up to assess early and delayed complications, and comparing the first 40 cases in the 1st Period (P-1: 1996-2002) with the 100 cases in the 2nd Period (P-2: 2003-2008). One of the surgeons had two training courses between P-1 and P-2. MATERIAL AND METHODS: A total of 66 colorectal resections due to cancer were performed and 74 operations for benign disease. The cases of malignant diseases increased between P-1 and P-2 (P<0.001). (Odds-Ratio=0.16). RESULTS: There number of complex cases increased between P-1 and P-2 (Anterior resection-amputation, left hemicolectomy, total colectomy, rectopexy) vs. Others (Sigmoidectomy, right resections) (P<0.05), but the mean duration of the operations was reduced by 29 minutes P<0.01). There were 24% conversions, with no change in P-2 (P=0.85). Surgical mortality at 3 months (1.4%) showed no differences (P=0.49). The total complications rate (31%) was significantly lower in P-2 (P=0.001), because medical complications (P=0.05), the more serious surgical complications (with reintervention) (P=0.05) and wound infections (P=0.0001) were lower. There was no change in the other surgical complications (P=0.61). The overall mean stay was 7.8 days (3-36) (median=6 days), with no differences between P-1 and P-2 (P=0.165). Conversion significantly lengthened the mean hospital stay (P=0.015) (from 7.2+/-5 days to 10.1+/-7 days), but there was no increase in complications (P=0.31). CONCLUSION: Training in colorectal laparoscopy and training periods with experts improve results (duration, complications, more complex surgery). Conversions did not decrease with experience and the hospital stays lengthened, but they were not associated with more complications.