Primary hepatic pleomorphic liposarcoma: Case report and literature review / Liposarcoma pleomorfo hepático primario: presentación de un caso y revisión bibliográfica

Primary hepatic liposarcoma is an extremely rare malignant tumour derived from adipocytes and is part of the group of mesenchymal tumours. We present the case of a 43-year-old Hispanic male patient with a pleomorphic hepatic liposarcoma and absence of MDM2 gene amplification. Two years and six months after surgery, the patient is asymptomatic. The present case is the first report of this entity with positive immunohistochemical testing for p16, p53, S100, vimentin and absence of MDM2 gene amplification. (AU)

El liposarcoma hepático primario es un tumor maligno extremadamente raro, derivado de adipocitos, y forma parte del grupo de tumores mesenquimales. Presentamos el caso de un paciente masculino de 43 años con diagnóstico de liposarcoma hepático pleomorfo con ausencia de amplificación del gen MDM2. Dos años y 6 meses después de la cirugía el paciente se encuentra asintomático. El presente caso es el primer informe de esta entidad con estudio inmunohistoquímico positivo para p16, p53, S100, vimentina y ausencia de amplificación del gen MDM2. (AU)

Primary hepatic pleomorphic liposarcoma: Case report and literature review.

Primary hepatic liposarcoma is an extremely rare malignant tumour derived from adipocytes and is part of the group of mesenchymal tumours. We present the case of a 43-year-old Hispanic male patient with a pleomorphic hepatic liposarcoma and absence of MDM2 gene amplification. Two years and six months after surgery, the patient is asymptomatic. The present case is the first report of this entity with positive immunohistochemical testing for p16, p53, S100, vimentin and absence of MDM2 gene amplification.

Adjunctive low-voltage area ablation for patients with atrial fibrillation: An updated meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy and safety of adjunctive low-voltage area (LVA) ablation on outcomes of catheter ablation (CA) for atrial fibrillation (AF) remains uncertain. METHODS: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing CA with versus without LVA ablation for patients with AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. Our primary endpoint was recurrence of atrial tachyarrhythmia (ATA), including AF, atrial flutter, or atrial tachycardia. We used R version 4.3.1 for all statistical analyses. RESULTS: Our meta-analysis included 10 RCTs encompassing 1780 patients, of whom 890 (50%) were randomized to LVA ablation. Adjunctive LVA ablation significantly reduced recurrence of ATA (RR 0.76; 95% CI 0.67-0.88; p < .01) and reduced the number of redo ablation procedures (RR 0.54; 95% CI 0.35-0.85; p < .01), as compared with conventional ablation. Among 691 (43%) patients with documented LVAs on baseline substrate mapping, adjunctive LVA ablation substantially reduced ATA recurrences (RR 0.57; 95% CI 0.38-0.86; p < .01). There was no significant difference between groups in terms of periprocedural adverse events (RR 0.78; 95% CI 0.39-1.56; p = .49). CONCLUSIONS: Adjunctive LVA ablation is an effective and safe strategy for reducing recurrences of ATA among patients who undergo CA for AF.

Tumor hepático de presentación atípica en imágenes / Liver tumor of atypical presentation in images

RESUMEN El presente manuscrito desea recalcar la importancia de los diferentes métodos de diagnóstico. En este caso el paciente presentó clíni-ca de dolor abdominal y el estudio de ecografía indicó la presencia de una masa; sin embargo, se puede apreciar la disyuntiva que se presenta entre los resultados histopatológicos de la biopsia core, los marcadores serológicos, los estudios de imagen y el diagnóstico definitivo posterior a la resección quirúrgica total de la lesión. El hepatocarcinoma tiene un aspecto tomográfico diferente y presenta elevación de marcadores oncológicos en pacientes con antecedentes previos de hepatopatía, por lo que la presentación de esta forma resulta atípica. Palabras claves: Hepatocarcinoma, cirrosis, metástasis

ABSTRACT This manuscript highlights the importance of the different diagnostic methods. In this case, the patient presented clinical symptoms of abdominal pain and the ultrasound showed the presence of a mass in the liver; however, the diagnosis was not easily achieved because there was a disjunctive between the histopathological result of the core biopsy, the serological markers, and the imaging studies. Definitive diagnosis was only possible after total surgical resection of the lesion. Hepatocellular carcinoma has a different tomographic appearance and presents elevated oncological markers in patients with a previous history of liver disease, so the presentation of this form is atypical.Keywords: Hepatocarcinoma, cirrhosis, metastasis.Correspondencia: Elizabeth ZamoraTeléfonos: 0982546676 e-mail: ezamora@hmetro.med.ecElizabeth Zamora: https://orcid.org/0000-0003-1807-625XFrans Serpa:https://orcid.org/0000-0001-6437-1140Fernanda Avalos:https://orcid.org/0000-0003-1917-3780IDs Orcid

Resultados de la resección hepática laparoscópica en el Hospital Metropolitano / Results of laparoscopic liver resection in the Metropolitan Hospital

Objetivo: evaluar los resultados perioperatorios de las resecciones hepáticas por abordaje laparoscópico, su seguridad y eficacia. Materiales y métodos: estudio epidemiológico descriptivo retrospectivo de serie de casos en el Hospital Metropolitano, en el cual se incluyó a todos los pacientes a quienes se realizó resecciones hepáticas laparoscópicas, durante un período de 10 años. Las variables recogidas se agruparon de la siguiente manera: I. Variables de los datos generales (edad, sexo, comorbilidades), II. Variables de diagnóstico prequirúrgico y cirugía, III. Variables de resultados intraoperatorios y posquirúrgico (pérdida de sangre, complicaciones, tiempo quirúrgico, etcétera). Resultados: de 10 pacientes identificados, 8 fueron de sexo femenino y 2 de sexo masculino, edad promedio: 46,8 años, 60% no presentó comorbilidades, estancia hospitalaria promedio: 5,3 días, tiempo quirúrgico promedio: 211 minutos, diagnóstico prequirúrgico más frecuente: hemangioma; sin embargo, en el histopatológico predominó la hiperplasia nodular focal en un 30%, y la patología maligna se observó en el 50% de los casos, de los cuales no hubo márgenes comprometidos; se presentó aproximadamente 20% de complicaciones posquirúrgicas de las cuales las más frecuentes fueron el sangrado y las trasfusiones. Conclusiones: la hepatectomía laparoscópica es una técnica segura y efectiva con baja morbilidad, además de las ventajas de la cirugía laparoscópica.

Objective: To evaluate the perioperative results of liver resections by laparoscopic approach, their safety and efficacy. Methods: A retrospective descriptive epidemiological study of a series of cases at the Hospital Metropolitano, including all patients who undergo laparoscopic liver resections. The variables collected are grouped as follows: I. Variables of the general data (age, sex, comorbidities), II. Pre-surgical diagnosis and surgery variables, III. Variables of intraoperative and postoperative results (blood loss, complications, surgical time, etc). Results: Of 10 identified patients, 8 were women and 2 were male, with an average age of 46.8 years, 60% without comorbidities, hospital stay with an average of 5.3 days, average surgical time of 211 minutes, the most frequent presurgical diagnosis was hemangioma however, in the histopathology, focal nodular hyperplasia predominated in 30%, and malignant pathology was detected in 50% of cases, of which there were no compromised margins, and 20% of complications were found among them more frequent bleeding and transfusions. Conclusions: Laparoscopic hepatectomy is a safe and effective technique with low morbidity in addition to having the advantages of laparoscopic surgery.

Seguridad del procedimiento de Whipple: experiencia de 10 años en un centro de tercer nivel / Whipple procedure safety: 10 year experience in a third level center / Whipple procedure safety: 10 year experience in a third level center

Resumen Antecedentes: el procedimiento de Whipple, apesar de los avances en cirugía, continúa siendo el procedimiento más complejo en cirugía general. Su principal indicación es la patología neoplásica de páncreas, duodeno y vías biliares que persiste como un desafío terapéutico debido a su alta morbilidad y mortalidad que en nuestro país alcanza 40% a 60% y de 15% a 30%, respectivamente. Objetivo: determinar la seguridad del procedimiento de Whipple en una institución privada de tercer nivel. Materiales y métodos: se realizó un estudio observacional retrospectivo, desde 2007 hasta 2017 en el Hospital Metropolitano. Datos recolectados: indicación quirúrgica, complicaciones, estancia hospitalaria, entre otros, que se analizaron con JASP 0.9.2.0. Resultados: universo 30 pacientes, edad promedio: 60,1 años IC (95%: 39 a 79 años); mujeres: 56%, hombres: 44%. Estancia hospitalaria promedio: 15 días con un DS:15 días. Principales indicaciones: adenocarcinoma de páncreas 33,3%, adenocarcinoma de ámpula de Vatter 16,7% colangiocarcinoma 16,7%. Según la escala Clavien Dindo, el 76,7% presentó complicaciones; sin embargo, de éstas el 59,9% fueron leves. Mortalidad intrahospitalaria: 6,7%. Conclusiones: atribuimos los resultados, entre otros motivos, a la disponibilidad de facilidades técnicas y a la experiencia del equipo quirúrgico que enfatiza en la prevención de las complicaciones o, si se presentare, al diagnóstico oportuno y tratamiento adecuado con todo el arsenal terapéutico requerido.

Abstract: Background: The Whipple procedure, despite advances in surgery, remains the most complex procedure in general surgery, its main indication is the neoplastic pathology of pancreas, duodenum and bile ducts. This persists as a therapeutic challenge due to its high morbidity and mortality that in our country reaches from 40% to 60% and from 15% to 30%, respectively. Objective: Determine the safety of performing the Whipple procedure in a third level private institution. Materials and methods: A retrospective observational study was conducted from 2007 to 2017 at the Hospital Metropolitano, the data collected included: surgical indication, complications, hospital stay, among others; these were analyzed with JASP 0.9.2.0. Results: We included 30 patients, their mean age was 60.1 years, 95% CI: 39 -79 years; 56% were women and 44% men. The average hospital stay was 15 days with a SD:15 days. The main indications were: adenocarcinoma of the pancreas 33.3%, adenocarcinoma of the Vatter ampulla 16.7% and cholangiocarcinoma 16.7%. According to the Clavien Dindo scale, 76.7% presented complications, however, 59.9% of these were mild. In-hospital mortality reached 6.7%. Conclusions: We attribute the results shown, among others, to the availability of technical facilities, as well as to the experience of the surgical team, emphasizing the prevention of complications or in the case of occurrence, provide a timely diagnosis and adequate treatment with allthe required therapeutic methods.

Tratamiento quirúrgico de la enfermedad poliquística hepática autosómica dominante, serie de casos / Surgical treatment of autosomic polycistic liver disease, case series

Nowadays liver and biliary tract surgery are the most commonly performed procedures worldwide; refinement in surgical techniques, anesthetic care and liver transplantation have revolutionized the treatment of liver diseases that were previously incurable. The autosomal dominant polycystic liver disease is a rare condition that may be associated with polycystic kidney disease or can present alone; the symptoms of this condition occur in the advanced stages of the disease. Despite the multiple modalities of treatment available, surgery with hepatectomy and fenestration has shown better results in patients with early satiety and massive hepatomegaly. A literature review was carried out and a number of cases dealt with this disease at the Metropolitan Hospital in Quito, Ecuador, are presented.

Nowadays liver and biliary tract surgery are the most commonly performed procedures worldwide; refinement in surgical techniques, anesthetic care and liver transplantation have revolutionized the treatment of liver diseases that were previously incurable. The autosomal dominant polycystic liver disease is a rare condition that may be associated with polycystic kidney disease or can present alone; the symptoms of this condition occur in the advanced stages of the disease. Despite the multiple modalities of treatment available, surgery with hepatectomy and fenestration has shown better results in patients with early satiety and massive hepatomegaly.