Pancreaticoduodenectomy due to cancer in the elderly.

The elderly have traditionally been excluded from pancreaticoduodenectomy due to the high morbimortality of this procedure. Six cases of pancreaticoduodenectomy) 5 cephalic and 1 total) for periampullary tumors in patients over 70 are reported. There was no mortality. We conclude that, in selected cases, pancreaticoduodenectomy can be performed safely in the elderly.

Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection.

BACKGROUND: Gastric cancer has a poor prognosis. The aim of this study was to determine the influence of several clinicopathological variables on outcome in a series of 297 Western patients undergoing surgical resection for gastric adenocarcinoma. METHODS: The results were analysed retrospectively and prognostic factors were identified in a univariate and Cox proportional hazards regression model. Mean patient age at the time of operation was 61.9 years; 65.7 per cent were men. Mean follow-up was 7.8 (range 1-15) years. Of the 297 patients undergoing surgery, 70 per cent had subtotal gastrectomy, 26.3 per cent underwent total gastrectomy and 3.7 per cent had proximal gastrectomy. RESULTS: The overall survival rate was 38.9 per cent at 5 years. In th univariate analysis, survival-related factors were weight loss (P < 0.05), abdominal mass (P < 0.01), dysphagia (P < 0.001), type of gastrectomy (subtotal gastrectomy versus total gastrectomy, P < 0.001), intention of resection (curative versus palliative resection, P < 0.001), tumour site (P < 0.001), histopathological grade (low versus high grade, P < 0.05), tumour diameter less than 3 cm (P < 0.001), degree of gastric wall invasion (P < 0.001), degree of lymph node invasion (P < 0.001) and stage of the neoplasia (P < 0.001). Other variables had no significant influence. In the multivariate analysis, degree of gastric wall invasion, lymph node invasion, tumour size and dysphagia at presentation were the only independent prognostic variables. CONCLUSION: From these data it was possible to derive a prognostic index with which patients could be classified as at low, intermediate or high risk.

Does perioperative blood transfusion influence long-term prognosis of gastric cancer?

We analyzed the influence of packed red blood cell (PRBC) transfusions on the prognosis of 163 patients with gastric adenocarcinoma undergoing subtotal gastrectomy with a curative intention. Over a period of 15 years, our department admitted 505 patients with gastric adenocarcinoma, with curative subtotal gastrectomy being performed in 167 cases. Mean age was 62.2 years (range: 30-87); there was a predominance of males (104 cases; 63.8%). Excluding the four patients who died in the immediate postoperative period (first 30 days), the remaining 163 were reviewed twice yearly in our department until either they died or the study ended. Follow-up averaged 49.5 months, with a median of 36 months. Sixty-nine (42.3%) of the 163 patients received transfusions of PRBC. On correlating the variables with the transfusion, we found a statistical significance only between the rate of transfusion and patient age over 63 years (P < 0.01), with an evolution time of less than three months (P < 0.05) and in tumors of >4 cm (P < 0.05). The five-year survival rate of the nontransfusion patients was 56.9% and of the transfusion patients 40%, with statistically significant differences (P = 0.0132). On studying patients according to tumor stage, we found that blood transfusion had a statistically significant influence on prognosis only in patients with tumor stage III (P = 0.0051). In the univariate analysis of the remaining variables collected, the existence of abdominal tumor (P = 0.0307), tumor size (P = 0.00001), degree of involvement of the gastric wall (P = 0.00001), lymph node involvement (P = 0.00001) and tumor stage (P = 0.00001) revealed a statistically significant influence on prognosis. If we apply Cox's regression model to the variables that in the univariate analysis had a statistically significant influence on prognosis, we found that only tumor size and stage were independent predictors of survival. In our experience, PRBC transfusion does not influence the long-term survival of patients with resected gastric adenocarcinoma.

Life quality of patients undergoing liver transplantation.

The aim of this study was to assess the life quality of a group of patients who had undergone liver transplantation using (1) a psychological test to evaluate family relations, work activity, emotional state and social relationships; (2) the quantification of hospital dependence and degree of fitness for work. Included in the study were 32 patients using the following criteria: diagnosis of hepatic cirrhosis and minimum posttransplant follow-up of 6 months. The average age of the study population was 44.8 +/- 10.5 years; there were 23 males and 9 females, with an average follow-up of 15 months. The psychological test used was the Quality of Life Scale (QLS) which consists of 21 items each scoring from 1 to 6 points. The questionnaire was completed before transplantation by all the patients, and after transplantation by 32 patients at 6 months, 20 at 12 months and 12 at 24 months. Hospital dependence was evaluated by the number of admissions and number of days per admission. Lastly, we compared fitness for work before transplantation and at 1 and 2 years after transplantation. The QLS test showed a post-transplant improvement in the four aspects assessed, particularly in the personal aspects (emotions and family) (P < 0.001). Hospital dependence following liver transplantation decreased significantly compared with the pretransplant situation (P < 0.01). Finally, the post-transplant percentage of unfitness for work decreased with time, reaching a significant differences 2 years after transplantation (P < 0.05).

[Mallory-Weiss syndrome as etiologic factor of upper gastrointestinal hemorrhage. A review of 142 cases]. / El síndrome de Mallory-Weiss como factor etiológico en la hemorragia digestiva alta. Revisión de 142 casos.

The diagnosis of Mallory-Weiss syndrome was made in 142 patients with upper gastrointestinal haemorrhage by early endoscopy. These patients represent 5.16% of all patients with haemorrhage treated in our unit over a period of ten years. Emergency surgery was needed in 13 due to persistent haemorrhage. In the remaining 129, conservative management sufficed to stop the bleeding. All patients receiving medical therapy survived while one of the surgically treated patients died of pulmonary thromboembolism in the early postoperative period.

[Surgical treatment of gastric cancer. Evaluation of results in 313 consecutive cases]. / Tratamiento quirúrgico del cáncer gástrico. Valoración de resultados en 313 casos consecutivos.

The results of 313 gastric adenocarcinomas, treated by the same surgical team during 10 years have been evaluated retrospectively. The pathological characteristics, operability (88.8%) and resectability (69.8%) rates, surgical technique and morbility and mortality rates are analyzed. The causes of late mortality, total five-year survival, depending on the stage of the tumors, and survival in relation to treatment are reported.

[Colorectal carcinoma in young adults. Our experience]. / Carcinoma colorrectal en adultos jóvenes. Nuestra experiencia.

Colorectal cancer usually appears in patients over 60 years-old. However, all the series communicate a small percentage of cases in young patients, ranging from 2 to 10% of the total. We have found important discrepancies between authors who have worked on the possible distinctive characteristics of colorectal cancer of the young over the last decade. This motivated us to examine more closely the clinical, follow-up and prognostic features of colorectal cancerous disease in the young as compared to that occurring in the general population. We analyzed retrospectively the clinical histories of our patients with special reference to the following parameters: sex, diagnostic delay (time from the appearance of the first symptom to diagnosis), index symptom, site, Dukes' grade, type of surgical treatment, complications, recurrence and survival. We found that 4.9% of our patients with colorectal cancer were as old as 40 years. The clinical presentation, tumoral site and Dukes grade were similar in the young adult and in the general population. In spite of the fact that there were no differences in these parameters, in younger patients the surgeon was more aggressive, more often performing a radical operation. Perhaps for this reason, this age group had a higher percentage of complications and recurrences. We found no differences in the 4-year survival or in the time survived after surgery.