Supervivencia del paciente trasplantado de hígado por hepatocarcinoma y riesgo de recurrencia tumoral / Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence

Objetivo: el objetivo de este estudio ha sido evaluar la supervivencia a corto y largo plazo del paciente trasplantado de hígado por hepatocarcinoma (CHC), el riesgo de recidiva tumoral postrasplante y los factores asociados a esta complicación. Diseño: estudio restrospectivo de una serie consecutiva de pacientes trasplantados de hígado por hepatocarcinoma. Pacientes y métodos: enfermos trasplantados por hepatocarcinoma desde el año 1989 hasta noviembre de 2003. Los pacientes fueron seleccionados con unos límites generales de tamaño y número de nódulos que fueron posteriormente publicados como criterios de Milán. En su diagnóstico pretrasplante se siguieron asimismo criterios consensuados en la Conferencia de Barcelona. Resultados: la supervivencia de este grupo de 81 pacientes trasplantados por hepatocarcinoma fue del 80, 61 y 52%, a los 1, 5 y 10 años respectivamente. En el 32% de los casos el CHC fue un hallazgo incidental en el explante. En el 12,3% se constató recidiva tumoral. El estudio multivariante identificó como factores de riesgo de recidiva el tamaño del nódulo (OR = 1,7944) (IC 95% = 1,1332-2,8413) y la invasión vascular (OR = 6,6346) (IC 95% = 1,4624-30,1003). Conclusiones: el trasplante de hígado en pacientes seleccionados con CHC obtiene buenos resultados a medio y largo plazo. El riesgo de recidiva tumoral postrasplante se ha reducido notablemente y está asociado con el tamaño del nódulo y con la invasión vascular microscópica

Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of posttransplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion

Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence.

OBJECTIVE: The goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of post-transplant tumor relapse and factors related to this complication. DESIGN: Retrospective study of a consecutive series of patients having had liver transplant for HCC. PATIENTS AND METHODOLOGY: Transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. RESULTS: The survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR=1,7944) (IC 95%=1,1332-2,8413) and the vascular invasion (OR=6,6346) (IC 95%=1,4624-30,1003) as risk factors of relapse. CONCLUSIONS: The liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion.

Biliopancreatic tumors: patient survival and quality of life after palliative treatment.

OBJECTIVES: to analyse survival and quality of life of patients with malignant obstructive jaundice after palliative treatment, comparing endoscopic stent insertion and palliative surgical (palliative resection and bypass surgical). PATIENTS AND METHOD: eighty and seven patients were included in a trial. They were distributed to endoscopic stent (50) and palliative surgical (37). It analysed survival, quality of life and comfort index of jaundiced patients. The good quality of life was defined by absence of jaundice, pruritus and cholangitis after the initial treatment. RESULTS: the median survival of the patients treated to endoscopic stent was 9,6 months whereas the patients to surgical treatment survived a median of 17 months. The time free of disease was 4 months in stented patients and 10,5 months in surgical patients. There was no significant difference in comfort index between the two groups (stented 34%, surgical 42,5%) Neither was there significant difference in survival and quality of life between palliative resection and bypass surgery. CONCLUSIONS: despite the survival and time free of disease being better in surgical patients, there was no significant difference in overall quality of life between the two groups. The survival and quality of life are the same after palliative resection as after bypass surgery, for this should not be performed routinely or to justify resection as a debulking procedure.

[Prospective and randomized study on the usefulness of octreotide in the prevention of complications after cephalic duodeno-pancreatectomy]. / Estudio prospectivo y randomizado sobre la utilidad del Octreótido en la prevención de complicaciones tras duodeno-pancreatectomía cefálica.

OBJECTIVE: This study seeks to evaluate the role of the somatostatin analogue Octreotide as postoperative prophylaxis in the prevention of pancreatic fistula following Pancreaticoduodenectomy (PD). METHODS: A prospective and randomized study has been completed in 34 patients undergoing PD. Sixteen patients were randomly assigned to receive Octreotide 0.1 cc (100 mcg) three times daily subcutaneously during the first seven days of the post-operative period and the remaining 18 constituted the control group. All patients were fed parenterally until normal oral feeding was restored (mean 8 days). Fisher's exact test was used to compare complications in both groups. Pancreatic fistula was defined as the persistence of an amylase-rich discharge at least 50 ml daily during a minimum period of two weeks. RESULTS: The mortality rate was 3% and the morbidity 26%. No significant differences were observed regarding the total number of complications. The appearance of pancreatic fistula was considerably smaller (p = 0.03) in the Octreotide group than in control group. Postoperative hospital stay and the number of subsequent surgical interventions were significantly higher (p < 0.05) in the control group. CONCLUSION: Octreotide prevents the occurrence of pancreatic fistula after PD when it is administered prophylactically during the immediate postoperative period.

[Complications of TPN in gastrointestinal surgery patients]. / Complicaciones de la NPT en pacientes sometidos a cirugía gastrointestinal.

Retrospective study of a group of 77 patients subjected to gastrointestinal surgery, who received total parenteral nutrition (TPN) during the postoperative period, During the evolution of the nutrition, 76 cases with technical complications arose, one case of sepsis, 10 cases of metabolic complications and one patient with haematological complications (acute medular failure). Although a higher percentage of metabolic and haematological alterations not requiring medical or surgical treatment for correction was observed, these were indicative of the tendencies of the metabolic and haematological states of the patients. An analysis was also made of the variance, observing a direct relationship between the components of TPN and the variations of the metabolic and haematological values studied, However, these values did not correlate with the number of days during which the patients was on nutrition, and thus the technique and guidelines for administration are the most important factors which determine the presence or absence of complications during TPN.

[Mirizzi syndrome: apropos of 13 cases]. / Síndrome de Mirizzi: a propósito de 13 casos.

The authors present 13 new cases of Mirizzi's syndrome seen over a 10-year period. An analysis is made of the scant frequency of this syndrome as a cause of extrahepatic obstructive jaundice, the diagnostic difficulties, and the results of surgical treatment.