HPV-negative Penile Intraepithelial Neoplasia (PeIN) With Basaloid Features.

Most human papillomavirus (HPV)-independent penile squamous cell carcinomas (PSCCs) originate from an intraepithelial precursor called differentiated penile intraepithelial neoplasia, characterized by atypia limited to the basal layer with marked superficial maturation. Previous studies in vulvar cancer, which has a similar dual etiopathogenesis, have shown that about one fifth of HPV-independent precursors are morphologically indistinguishable from high-grade squamous intraepithelial lesions (HSILs), the precursor of HPV-asssociated carcinomas. However, such lesions have not been described in PSCC. From 2000 to 2021, 55 surgical specimens of PSCC were identified. In all cases, thorough morphologic evaluation, HPV DNA detection, and p16, p53, and Ki-67 immunohistochemical (IHC) staining was performed. HPV-independent status was assigned based on both negative results for p16 IHC and HPV DNA. Thirty-six of the 55 PSCC (65%) were HPV-independent. An intraepithelial precursor was identified in 26/36 cases (72%). Five of them (19%) had basaloid features, morphologically indistinguishable from HPV-associated HSIL. The median age of the 5 patients was 74 years (range: 67 to 83 y). All 5 cases were p16 and DNA HPV-negative. Immunohistochemically, 3 cases showed an abnormal p53 pattern, and 2 showed wild-type p53 staining. The associated invasive carcinoma was basaloid in 4 cases and the usual (keratinizing) type in 1. In conclusion, a small proportion of HPV-independent PSCC may arise on adjacent intraepithelial lesions morphologically identical to HPV-associated HSIL. This unusual histologic pattern has not been previously characterized in detail in PSCC. p16 IHC is a valuable tool to identify these lesions and differentiate them from HPV-associated HSIL.

Simultaneous presentation of granulomatosis with polyangiitis (GPA) and immunoglobulin G4-related disease (IgG4-RD). Leaving an open question: widening the spectrum of a single disease or real overlap?

Because of a similar organ involvement and histopathological features, IgG4-related disease (IgG4-RD) may mimic some forms of granulomatosis with polyangiitis (GPA). However, several cases of clear coexistence or overlap of both diseases have been reported. We describe a case of a 47-year-old man presenting with a renal mass and a nasal crusting showing histopathological features of IgG4-RD in both territories. Cytoplasmic/proteinase 3 (PR3) antineutrophil cytoplasmic antibodies (ANCA) were positive and the patient subsequently developed kidney failure and nephritic syndrome that led to a renal biopsy re-evaluation revealing changes compatible with segmental necrotising glomerulonephritis and GPA. Remission induction therapy with prednisone and rituximab was started and clinical and laboratory parameters returned to normal. After administering a maintenance regimen based in rituximab 500 mg every six month the patient remained asymptomatic during 4 years of follow-up and free of prednisone the last 18 months. Although coexistence or overlap of GPA and IgG4-RD may be established in some clinical scenarios, the possibility of widening the spectrum of a single disease is also postulated.

Role of NADPH oxidases in inducing a selective increase of oxidant stress and cyclin D1 and checkpoint 1 over-expression during progression to human gastric adenocarcinoma.

BACKGROUND: Gastric cancer is one of the main causes of global mortality. Here, reactive oxygen species (ROS) could largely contribute to gastric carcinogenesis. Hence, the present work was aimed to assess the role of ROS, oxidant status, NADPH oxidases (NOXs) expression, during human gastric adenocarcinoma. METHODS: We obtained subcellular fraction from samples of gastric mucosa taken from control subjects (n = 20), and from 40 patients with gastric adenocarcinoma, as well as samples of distant areas (tumour-free gastric mucosa). RESULTS: Parameters indicative of lipid peroxidation and cell proliferation were selectively increased in both tumour-free and in cancerous gastric mucosa, despite of glutathione (GSH) content, glutathione reductase (GR) and superoxide dismutase (SOD) activities were increased in the adenocarcinoma. These high levels of antioxidant defences inversely correlated with down-regulated expression for NOX2 and 4; however, over-expression of NOX1 occurred with increased caspase-3 activity and overexpressed checkpoint 1 (MDC1) and cyclin D1 proteins. In the tumour-free mucosa an oxidant stress took place, without changing total GSH but with decreased activities for GR and mitochondrial SOD; moreover, over-expression of checkpoint 1 (MDC1) correlated with lower NOX2 and 4 expression in this mucosa. CONCLUSIONS: Chronically injured gastric mucosa increases lipoperoxidative events and cell proliferation. In the adenocarcinoma, cell proliferation was further enhanced, oxidant stress decreased which seemed to be linked to NOX1, MDC1 and cyclin D1 over-expression, but with a lower NOXs activity leading a 'low tone' of ROS formation. Therefore, our results could be useful for early detection and treatment of gastric adenocarcinoma.

Comparison of plasma exchange procedures using three apheresis systems.

BACKGROUND: A new protocol for the Amicus separator (Fresenius Kabi) enables the device to perform plasma exchange (PE). The aim of the study was to compare retrospectively the plasma removal efficiency (PRE) of the Amicus, the Optia (TerumoBCT), and the Spectra (TerumoBCT) when performing PEs. STUDY DESIGN AND METHODS: We retrospectively reviewed patients who received at least one PE with the Amicus and at least one PE with the Optia, the Spectra, or both. We collected data regarding PRE, volume of anticoagulant and calcium-magnesium (Ca-Mg) solution infused, and changes in laboratory data from patients' blood sampled immediately before starting and immediately after finishing each PE procedure: complete blood count, coagulation, acid-base equilibrium, and biochemistry variables. We also collected severe adverse events (AEs). RESULTS: We performed 18, 44, and 14 PEs with the Amicus, Optia, and Spectra, respectively. We observed significant differences among the Amicus, Optia, and Spectra regarding PRE (79.8 ± 8.2, 82.9 ± 5.8, and 70.4 ± 8.2%; p < 0.001), volume of anticoagulant infused (542 ± 196, 687 ± 120, and 647 ± 111 mL; p = 0.002), volume of Ca-Mg solution infused (81 ± 28, 56 ± 16, and 63 ± 15 mL; p < 0.001), absolute change of ionic Ca (-0.04 ± 0.13, -0.05 ± 0.12, and -0.19 ± 0.16 mmol/L; p = 0.002), and absolute change of Na (1.18 ± 1.97, 1.02 ± 1.93, and 3.71 ± 1.98 mEq/L; p < 0.001). We observed no significant differences in other analytic variables and we observed no severe AEs. CONCLUSION: The Amicus device could effectively perform PE procedures. In terms of PRE, the Amicus and Optia were similar, but both devices were superior to the Spectra. The Amicus used a lower volume of anticoagulant when compared with the Optia.

Intensive care unit admission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Is it necessary?

Introduction. Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m(2)/L and mitomycin C 3.3 mg/m(2)/L for 90-minutes at 40.5°C. Results. 26 (67%) of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%). The mean time on surgical procedures was 7.06 hours (range 5-9 hours). The mean blood loss was 939 ml (range 100-3700 ml). The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.

Comparative physiology and relative swimming performance of three redhorse (Moxostoma spp.) species: associations with fishway passage success.

Our understanding of biological criteria to inform fish passage design is limited, partially due to the lack of understanding of biological motivators, cues, and constraints, as well as a lack of biological performance evaluations of structures once they are built. The Vianney-Legendre vertical slot fishway on the Richelieu River, Quebec, Canada, passes large numbers of migrating redhorse (Moxostoma spp.) upriver to spawning grounds each year. We evaluated the physiological capacity and relative swimming ability of three redhorse species (Moxostoma anisurum, Moxostoma carinatum, Moxostoma macrolepidotum; silver, river, and shorthead redhorse, respectively) to determine how these biotic factors relate to variation in fishway passage success and duration. Shorthead redhorse had higher maximum metabolic rates and were faster swimmers than silver and river redhorse at their species-specific peak migration temperatures. Blood lactate and glucose concentrations recovered more quickly for river redhorse than for silver and shorthead redhorse, and river redhorse placed second in terms of metabolic recovery and swim speed. Interestingly, fish sampled from the top of the fishway had nearly identical lactate, glucose, and pH values compared to control fish. Using passive integrated transponders in 2010 and 2012, we observed that passage success and duration were highly variable among redhorse species and were not consistent among years, suggesting that other factors such as water temperature and river flows may modulate passage success. Clearly, additional research is needed to understand how organismal performance, environmental conditions, and other factors (including abundance of conspecifics and other comigrants) interact with fishway features to dictate which fish will be successful and to inform research of future fishways. Our research suggests that there may be an opportunity for a rapid assessment approach where fish chased to exhaustion to determine maximal values of physiological disturbance are compared to fish sampled from the top of the fishway, which could reveal which species (or sizes of fish) are approaching or exceeding their physiological capacity during passage.

Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution.

BACKGROUND: Pelvic exenteration (PE) continues to be the only curative option in selected patients with advanced or recurrent pelvic neoplasms. A current debate exists concerning the appropriate selection of patients for PE, with the most important factor being the absence of extrapelvic disease. AIM: To evaluate the outcome of patients submitted to exenterative surgery. PATIENTS AND METHODS: A review of the clinical charts of patients with colorectal cancer who underwent PE between January 1994 and June 2010 at the Institute National of Cancerología in Mexico City was performed. RESULTS: We selected 59 patients, 53 of whom were females (90%), and six of whom were males (10%). Mean age at the time of diagnosis was 50 years (range, 21-77 years). A total of 51 patients underwent posterior PE (86%), and eight patients underwent total PE (14%). Operative mortality occurred in two cases (3%), and 29 patients developed complications (49%). Overall, 11 patients (19%) experienced local failure with mean disease-free survival time of 10.2 months. After a mean follow-up of 28.3 months, nine patients are still alive without evidence of the disease (15%). CONCLUSIONS: PE should be considered in advanced colorectal cancer without extrapelvic metastatic disease. PE is accompanied by considerable morbidity (49%) and mortality (3%), but local control is desirable. Overall survival justifies the use of this procedure in patients with primary or recurrent locally advanced rectal cancer.

Antifungal activity of posaconazole against Candida spp. and non-Candida clinical yeasts isolates

Se ha determinado la actividad antifúngica in vitro de posaconazol frente a 315 aislamientos clínicos de levaduras y 11 cepas ATCC por medio de un método de difusión en agar (Neosensitabs, Rosco, Dinamarca) basado en el documento CLSI M44-A2. Posaconazol presentó una excelente actividad frente a las especies de Cryptococcus y Rhodotorula, como así también, frente a la mayoría de los aislamientos de Candida estudiados. Un total de 13 aislamientos (4,1%) resultaron resistentes: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) y Geotrichum capitatum (n=1). Nuestros resultados sugieren que posaconazol es un efectivo agente antifúngico frente a las especies de levaduras de mayor relevancia clínica (92,7% de sensibilidad). La técnica de difusión en agar aporta buenas condiciones para la realización de estudios de sensibilidad al posaconazol en la rutina del laboratorio(AU)

The in vitro antifungal activity of posaconazole was tested against 315 yeast clinical isolates and 11 ATCC reference strains by means an agar diffusion method (Neosensitabs, Rosco, Denmark) based in CLSI M44-A2 document. Posaconazole activity was excellent against Cryptococcus and Rhodotorula species studied and showed very good activity against most species of Candida tested. A total of 13 clinical isolates (4.1%) were resistant: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) and Geotrichum capitatum (n=1). Our results suggest posaconazole is an effective antifungal agent against the most clinically important yeasts species (92.7% of susceptibility). Agar diffusion method provides good conditions for the posaconazole susceptibility study in the routine laboratory(AU)

[Potential benefits of living donor kidney transplantation]. / Potenciales beneficios del trasplante renal de donante vivo.

Living donor kidney transplantation is the best therapeutic option for endstage renal failure. In spite of being an underused option in our country, it acquires an important role reducing the waiting lists for transplantation because cadaver donation is not enough. Living donor kidney transplantation offers multiple advantages when compared with cadaver donor transplantation: longer graft and patient survival on the short, mid and long-term; the fact that a scheduled procedure allows us to optimize donor and receptor's conditions; and ischemia time between nephrectomy and transplantation can be shortened to a minimum. A good initial function without need of dialysis (up to 90%) and lower incidence of rejection, which diminishes the need of antirejection drugs, should also be emphasized.

[Surgical evaluation of candidates for donation. Selection of the kidney]. / Estudio del donante desde el punto de vista quirúrgico. Elección del riñón.

Living donation for kidney transplantation is being promoted due to the shortage of organs, the improved outcomes of living donor transplants and the evolution of immunosuppression regimens. The process of organ donation from a living donor affects not only medical-surgical features but also emotional, social and economic. Using kidneys from living donors involves a great responsibility in evaluation and selection. Candidates for donation undergo an extensive set of examinations in order to optimize selection and to plan surgery. Radiological evaluation is one of the most important features of the evaluation process and selection of the kidney; it shows precisely the renal vascular anatomy, which is decisive in the choice of the kidney and helps to optimize the process and diminish risks and complications during extraction and/or tronsplantation. The advantages on imaging tests allow to evaluate potential donors in a safely, fast and almost noninvasive matter. The aim of the process is to select the kidney with less likelihood of failure due to technical reasons, and always leave the best kidney for the donor.

Potenciales beneficios del trasplante renal de donante vivo / Potential benefits of living donor kidney transplantation

El trasplante renal de donante vivo es lamejor opción terapeútica en la insuficiencia renal terminal,y aunque en nuestro país ha sido una opcióninfrautilizada, adquiere un papel importante en lareducción de las listas de espera para trasplante, puestoque la donación de cadáver es insuficiente. El trasplanterenal de donante vivo ofrece múltiples ventajasrespecto al de cadáver: mayor supervivencia del injertoy receptor a corto, medio y largo plazo, el hecho deser un procedimiento programado permite optimizar lascondiciones del donante y receptor, así como disminuiral mínimo el tiempo de isquemia entre la nefrectomía yel implante. Además, destaca la buena función inicial (hasta un 90% ) sin necesidad de diálisis y la menorincidencia de rechazo, lo cual disminuye la necesidadde fármacos para prevenir el rechazo

Living donor kidney transplantation is the best therapeutic option for endstage renal failure. In spite of being an underused option in our country, it acquires an important role reducing the waiting lists for transplantation because cadaver donation is not enough. Living donor kidney transplantation offers multiple advantages when compared with cadaver donor transplantation: longer graft and patient survival on the short, mid and long-term; the fact that a scheduled procedure allows us to optimize donor and receptor´s conditions; and ischemia time between nephrectomy and transplantation can be shortened to a minimum. A good initial function without need of dialysis (up to 90%) and lower incidence of rejection, which diminishes the need of antirejection drugs, should also be emphasized

Estudio del donante desde el punto de vista quirúrgico. Elección del riñón / Surgical evaluation of candidates for donation. Selection of the kidney

Debido a la escasez de órganos paratrasplantar, el aumento del éxito en el resultado del trasplante(Tx) de donante vivo renal, junto a la evoluciónen las pautas de inmunosupresión, se intenta potenciarla obtención de riñones a partir de este tipo de donantesvivos. El proceso de obtención de un órgano a partirde un donante vivo repercute sobre múltiples aspectosno sólo médico-quirúrgicos, sino también emocionales,sociales y económicos. La utilización de riñonesprocedentes de donante vivo implica una gran responsabilidaden el evaluación y selección Los candidatospara la donación son sometidos a una extensa bateríade exploraciones de cara a optimizar la posible seleccióny planificación prequirúrgica. Uno de los aspectosmás importantes en la evaluación y elección del riñónreside en la realización de pruebas radiológicas, a suvez básicas para delimitar e informar, de la forma másprecisa y detallada posible, de la anatomía renovascular,determinante en la elección del riñón y así optimizary disminuir los riesgos y complicaciones que se puedanproducir en la extracción o en el implante. Losavances en la tecnología de la imagen permiten evaluarde forma segura, rápida y practicamente no invasivaal donante potencial. De esta forma se pretendeseleccionar el riñón con menor probabilidad de fallopor causas técnicas, y que siempre se conserve elmejor riñón en el donante

Living donation for kidney transplantation ;;is being promoted due to the shortage of organs, the ;;improved outcomes of living donor transplants and the ;;evolution of immunosuppression regimens. The process ;;of organ donation from a living donor affects not only ;;medical-surgical features but also emotional, social and ;;economic. Using kidneys from living donors involves a ;;great responsibility in evaluation and selection. ;;Candidates for donation undergo an extensive set of ;;examinations in order to optimize selection and to plan ;;surgery. Radiological evaluation is one of the most ;;important features of the evaluation process and selection ;;of the kidney; it shows precisely the renal vascular ;;anatomy, which is decisive in the choice of the kidney ;;and helps to optimize the process and diminish risks and ;;complications during extraction and/or transplantation. ;;The advantages on imaging tests allow to evaluate ;;potential donors in a safely, fast and almost noninvasive ;;matter. The aim of the process is to select the kidney ;;with less likelihood of failure due to technical reasons, ;;and always leave the best kidney for the donor

Hepatocellular carcinoma and hepatitis C in Mexico.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) has increased in many countries as a result of an increased frequency of hepatitis C virus (HCV) infection. In Mexico, the association of HCC to HCV infection has not been evaluated. This study aims to evaluate the epidemiological factors related to HCC in Mexican patients as well as the results of treatment. METHODOLOGY: A retrospective review of clinical files of patients with HCC diagnosed between May 1992 to July 2002 was performed. RESULTS: There were 63 males and 64 females with a median age of 57 years (range 17-82). Seventy-one patients were evaluated for hepatitis status. In 43 (60%) HCV was the etiological factor. Isolated HCV infection was present in 32 (45%), HCV infection and ethanol abuse was observed in 11 (15.5%). In six (8.4%) patients hepatitis B was the etiological factor. HCV and HBV infection were found in 9 (12.6%). HCV and HBV infection associated to ethanol abuse was present in one patient. Ethanol abuse alone was observed in six (8.4%) patients. The median size of the lesion was 8cm (range 3-20cm). Alpha-fetoprotein was measured in 113 patients and was higher than 500ng/dL in 60 (53%). Sixty-five patients received supportive measures. Sixty-two were treated. Eighteen were resected. Thirteen were treated with intraoperative large volume ethanol injection (ILVEI), 12 with chemotherapy and 19 with tamoxifen-talidomide. Patients without treatment had a median survival time of 11 months and patients who received treatment had a median survival time of 25.3 months. The median survival time in patients who received surgery was 26 months, the ILVEI group survival time was 18 months, the chemotherapy survival was 8.8 months, and the tamoxifen-talidomide survival time was 7 months. CONCLUSIONS: HCC is a rare neoplasm in Mexico and HCV infection is the main etiological factor. Surgical resection is the best form of treatment of HCC in our country. However, only 14% of the patients were candidates. For non-resectable lesions, ILVEI offers the best palliative results in our center.

Hepatocellular carcinoma in the youth. A comparative analysis with hepatocellular carcinoma in adulthood.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a very rare disease among young individuals. Epidemiological, clinical and histopathological features of this malignancy in the youth have not been thoroughly studied. METHODOLOGY: A review of the clinical files of patients with HCC younger than 40 years of age, who were treated between May 1990 and July 2002, was performed. RESULTS: Seventeen patients were included for analysis; nine were female and eight male. The mean age at diagnosis was 24 years (range 12-39 years). Abdominal pain was the main symptom, followed by vomiting and nausea. Enlargement of the liver was observed in 11 patients (65%). In seven patients (41%), an etiological factor was not found. Five of these cases were of the fibrolamellar variant (29%). Only four patients were resected (23%) two of which belonged to the fibrolamellar type. Three patients (18%) are still alive after 64.9 months of follow-up. CONCLUSIONS: HCC is a very uncommon disease in the youth and affects similarly both genders. It is discovered at an advanced stage. Hepatitis B and C are uncommon etiological factors. The frequency of fibrolamellar carcinoma is higher in this age group. Though resection is more feasible, the overall survival rates remain low.

The beta form of the estrogen receptor is predominantly expressed in the papillary cystic neoplasm of the pancreas.

INTRODUCTION: Papillary cystic neoplasm (PCN) of the pancreas is a low-malignancy tumor affecting predominantly young females. Sex steroid hormones have been involved in its development and/or growth. Estrogen receptor (ER) has been scarcely found in this tumor, although there is some evidence suggesting expression of the beta-isoform. Unlike ER, progesterone receptor (PR) expression has been consistently observed. Immunohistochemical analysis of the two isoforms of ER has not been performed in this tumor. AIM: To characterize expression of ER isoforms with an immunohistochemical method. METHODOLOGY: Expression of ER-alpha, ER-beta, and PR was analyzed by immunohistochemistry using isoform-specific ER and PR antibodies in paraffin-embedded tissue blocks from seven cases of PCN of the pancreas. RESULTS: Most patients were young females. ER-alpha and ER-beta were present in two and six tumors, respectively. PR was identified in six tumors. CONCLUSIONS: ER-beta expression predominates over the alpha-isoform in PCN of the pancreas. This finding supports the idea that previous negative results on ER expression were a consequence of the use of antibodies with no anti-beta activity. The role of ER-beta in the milieu of factors promoting the development and aggressiveness of PCN needs to be elucidated to address novel diagnostic and therapeutic approaches.

[Arterial hypertension as clinical manifestation of non-parasitic hepatic cyst. A case report]. / Hipertensión arterial como manifestación clínica de quiste no parasitario de hígado. Reporte de un caso.

We present the case of a 32-year-old female patient referred to the Instituto Nacional de Cancerología (INCan) with a history of several months of systemic hypertension and epigastric pain associated to early postprandial satiety, fatigue, and dyspnea. At physical examination, a smooth, non-tender, palpable mass was found in right upper quadrant 7 cm below costal margin. Computed tomography (CT) scan showed right-sided non-parasitic liver cyst. The patient was taken to the operating room, where she presented hypertensive crisis of 180/125 mm Hg, which did not respond to midazolam therapy. The procedure was suspended and deferred. After blood pressure control with angiotensin II-antagonist and calcium-antagonist, the patient was submitted to laparotomy, where a wide deroofing of the lesion was performed. The postoperative evolution was uneventful and the patient has remained normotense without anti-hypertensive medication after 6 months of follow-up.

[Hepatocellular carcinoma in youth: a comparative analysis with hepatocarcinoma in adults]. / Carcinoma hepatocelular en jóvenes: un análisis comparativo con hepatocarcinoma en adultos.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a very rare disease among young individuals. Epidemiological, clinical, and histopathological features of this malignancy in youth have not been thoroughly studied. PATIENTS AND METHODS: A review of clinical files of patients with HCC < 40 years of age treated between May 1990 and July 2002 was performed. RESULTS: Seventeen patients were included for analysis, nine were female and eight, male. Mean age at diagnosis was 24 years (range 12-39 years). Abdominal pain was the main symptom, followed by vomiting and nausea. Enlargement of liver was observed in 11 patients (65%). In seven patients (41%), etiologic factor was not found. Five of these cases were of fibrolamellar variant (29%). Only four patients were resected (23%) two of whom belonged to fibrolamellar type. Three patients (18%) are still alive after 64.9 months of follow-up. CONCLUSION: HCC is a very uncommon disease in youth and affects similarly both genders. It is discovered at advanced stage. Hepatitis B and C are uncommon etiologic factors. Frequency of fibrolamellar carcinoma is higher in this age group. Although resection is more feasible, overall survival rates remain low.

La colecistectomía por laparoscopia en un centro oncológico: un análisis comparativo / Laparoscopic cholecystectomy in an oncologic center; a comparative study

Objetivo: Analizar comparativamente los resultados de la colecistectomía abierta (CA) y la colecistectomía laparoscópica (CL) en pacientes con cáncer. Diseño: Estudio de casos y controles. Lugar: Un centro oncológico de referencia en México D.F. Pacientes: Sujetos tratados por cáncer y con indicación para colecistectomía en un periodo de 60 meses. Para efectos de comparación se dividieron en dos grupos. El grupo CA con pacientes sometidos a CA durante los primeros 30 meses del estudio y el grupo CL con pacientes sometidos a CL los últimos 30 meses. Resultados: El grupo CL de 55 pacientes presentó significativamante menos complicaciones, mortalidad y estancia hospitalaria en comparación al grupo CA de 50 pacientes. La frecuencia de conversiones en el grupo CL fue de 14 por ciento. Esta frecuencia de conversiones fue mayor en el subgrupo de pacientes con antecedente de cirugía previa en el abdomen superior. No hubo diferencia en morbimortalidad en pacientes con antecedentes de cirugía previa en abdomen superior o de diabetes mellitus (DM). El antecedente de cirrosis hepática (CH) condicionó mayor morbimortalidad en el grupo CA. Conclusiones: En nuestro medio la CL puede realizarse con seguridad en pacientes con historia de cáncer, laparotomía o radioterapia (RT) abdominal y debe considerarse el tratamiento de elección para litiasis vesical sintomática. Debe considerarse también como tratamiento de elección en pacientes con DM o con CH. Cuando se presenta antecedente de cirugía en abdomen superior se recomienda la inserción del primer trocar bajo visión directa de la cavidad peritoneal. En este subgrupo la frecuencia de conversiones es alta