ABSTRACT
INTRODUCCIÓN: La esplenectomía laparoscópica (EL) es el tratamiento de elección de la púrpura trombocitopénica idiopática (PTI) cuando fracasa el tratamiento médico. El objetivo de este estudio ha sido evaluar la factibilidad y seguridad de la EL según el recuento preoperatorio de plaquetas. MÉTODOS: Análisis retrospectivo de una serie de 199 pacientes a los que se les realizó una EL por PTI durante el periodo 1993-2015. Los pacientes se dividieron en 3 grupos según las cifras de plaquetas: grupo I (< 10 × 109 /L), grupo II (10-50 × 109/L) y grupo III(>50 × 109/L). RESULTADOS: El tiempo operatorio fue significativamente menor en el grupo III respecto a los grupos I y II(100 ± 53 y 105 ± 61min; p < 0,025). La pérdida hemática intraoperatoria fue estadísticamente superior en el grupo I (263 ± 551 ml) respecto a los otros 2: grupo II (128 ± 352ml) y grupo III (24 ± 62 ml) (p < 0,003). La estancia hospitalaria de 6,4±5,8 días en el grupo I fue significativamente superior a la de los grupos II y III (3,8±2,3 y 3,2±1,8 días, respectivamente; p < 0,003). CONCLUSIONES: La realización de una EL en pacientes con PTI con recuentos bajos es efectiva y segura
INTRODUCTION: Laparoscopic splenectomy (LS) is the preferred treatment of idiopathic thrombocytopenic purpura (ITP) when medical treatment fails. The objective was to evaluate the feasibility and safety of LS according to the preoperative platelet count. METHODS: This study is a retrospective analysis of a series of 199 patients who underwent LS for ITP from 1993 to 2015. The patients were divided into 3 groups according to platelet count: group I(< 10 × 109/L), group II (10-50 × 109/L) and group III (> 50 × 109/L). RESULTS: Operative time was significantly lower in Group III compared to Group I and II (100 ± 53 and 105 ± 61min, P < .025)). Intraoperative blood loss was statistically higher in group I (263 ± 551ml) with respect to the other 2: group II (128 ± 352 ml) and group III (24 ± 62 ml) (P < .003). Hospital stay was 6.4 ± 5.8 days in group I, significantly higher compared to groups II and III(3.8 ± 2.3 and 3.2 ± 1.8 days, respectively (P < .003)). CONCLUSION: Conducting a LS in ITP patients with low platelet counts is effective and safe
Subject(s)
Humans , Male , Female , Adult , Platelet Count/methods , Platelet Count/standards , Preoperative Period , Splenectomy/methods , Splenectomy , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/surgery , Retrospective Studies , Length of Stay/trends , Analysis of Variance , 28599ABSTRACT
INTRODUCTION: Laparoscopic splenectomy (LS) is the preferred treatment of idiopathic thrombocytopenic purpura (ITP) when medical treatment fails. The objective was to evaluate the feasibility and safety of LS according to the preoperative platelet count. METHODS: This study is a retrospective analysis of a series of 199 patients who underwent LS for ITP from 1993 to 2015. The patients were divided into 3 groups according to platelet count: group i (<10×10(9)/L), group ii (10-50×10(9)/L) and group iii (> 50×10(9)/L). RESULTS: Operative time was significantly lower in Group III compared to Group I and II (100±53 and 105±61min, P<.025)). Intraoperative blood loss was statistically higher in group i (263±551ml) with respect to the other 2: group ii (128±352ml) and group iii (24±62ml) (P<.003). Hospital stay was 6.4±5.8 days in group i, significantly higher compared to groups ii and iii (3.8±2.3 and 3.2±1.8 days, respectively (P<.003)). CONCLUSION: Conducting a LS in ITP patients with low platelet counts is effective and safe.
Subject(s)
Laparoscopy , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/surgery , Splenectomy/methods , Adult , Feasibility Studies , Female , Humans , Male , Middle Aged , Platelet Count , Preoperative Period , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCCIÓN: El objetivo de este estudio es llevar a cabo la evaluación de la técnica de detección del ganglio centinela (GC) con tinción de azul de metileno «ex vivo» en el cáncer de colon, así como calcular la supraestadificación y su correlación con la evolución de la enfermedad. MÉTODOS: Entre 2008 y 2011, 101 pacientes fueron operados de cáncer de colon con la detección del GC, estudiándose las micrometástasis. El seguimiento de los pacientes N0 fue mayor a un año en búsqueda de recidivas y si tenían relación con la aparición de dichas micrometástasis. RESULTADOS: El índice de detección del GC fue de 92 casos (91%). Fue positivo para micrometástasis en 9 casos, con una supraestadificación del 14%. La incidencia de falsos negativos fue de 9 pacientes (10%). El seguimiento medio de los 74 pacientes N0 fue de 38 meses. Se observó recurrencia en 4 pacientes (7%) del grupo de pacientes con GC− (65 pacientes) y en 2 pacientes (22%) en el grupo con GC+ (9 pacientes, sin diferencias estadísticas significativas. Tampoco se observaron diferencias en términos de supervivencia entre los 2 grupos. CONCLUSIONES: El estudio del GC es una práctica reproducible sin aumento significativo del tiempo y de costes. Puede llegar a supraestadificar el 14% de pacientes que habían sido clasificados como N0 con técnica convencional. En el seguimiento de los pacientes N0 con GC+ parece haber una tendencia a un porcentaje mayor de recidivas, lo que podría llevar a cambios en las pautas de tratamiento adyuvante, aunque debemos tomarlo con cautela ya que la muestra es escasa
INTRODUCTION: The aim of this study is to evaluate the sentinel lymph node mapping (SLNM) with methylene blue staining "ex vivo" in colon cancer, as well as calculate the upstaging obtained by the determination of micrometastases and its correlation with the evolution of the disease. METHODS: Between 2008 and 2011, 101 patients with colon cancer undergoing resection were studied prospectively with SLNM and detection of micrometastases. The correlation of SLN micrometastases with the disease evolution was evaluated in patients with a follow-up of more than one year. RESULTS: The SLNM rate was 92 cases (91%). Only SLN was positive for micrometastases in 9 cases, with a 14% upstaging. The incidence of false negatives was 9 patients (10%). Mean follow of N0 patients (n = 74) was 38 months. The SLN- (negative) group (65 patients) had a recurrence rate of 4 patients (7%), whereas this rate was 2 patients (22%) in the group of SLN + (positive) (9 patients), but without significant differences. No differences in survival were observed. CONCLUSIONS: SLNM is a reproducible technique without significant increase in time and costs. Upstaging was obtained in 14% of patients staged as N0 by conventional technique. At follow-up of N0 patients with SLN + there seems to be a higher rate of recurrence, which could change the guidelines of adjuvant treatment, but we must interpret the results it with caution because the sample is small
Subject(s)
Humans , Male , Female , Sentinel Lymph Node Biopsy/adverse effects , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/trends , Colonic Neoplasms/complications , Colonic Neoplasms/diagnosis , Colonic Neoplasms/therapy , Chemotherapy, Adjuvant , Chemoradiotherapy, Adjuvant , Sentinel Lymph Node Biopsy/standards , Sentinel Lymph Node Biopsy , Lymphatic Metastasis , Neoplasm Metastasis/therapy , Neoplasm Metastasis , Prospective StudiesABSTRACT
INTRODUCTION: The aim of this study is to evaluate the sentinel lymph node mapping (SLNM) with methylene blue staining "ex vivo" in colon cancer, as well as calculate the upstaging obtained by the determination of micrometastases and its correlation with the evolution of the disease. METHODS: Between 2008 and 2011, 101 patients with colon cancer undergoing resection were studied prospectively with SLNM and detection of micrometastases. The correlation of SLN micrometastases with the disease evolution was evaluated in patients with a follow-up of more than one year. RESULTS: The SLNM rate was 92 cases (91%). Only SLN was positive for micrometastases in 9 cases, with a 14% upstaging. The incidence of false negatives was 9 patients (10%). Mean follow of N0 patients (n=74) was 38 months. The SLN- (negative) group (65 patients) had a recurrence rate of 4 patients (7%), whereas this rate was 2 patients (22%) in the group of SLN+(positive) (9 patients), but without significant differences. No differences in survival were observed. CONCLUSIONS: SLNM is a reproducible technique without significant increase in time and costs. Upstaging was obtained in 14% of patients staged as N0 by conventional technique. At follow-up of N0 patients with SLN+there seems to be a higher rate of recurrence, which could change the guidelines of adjuvant treatment, but we must interpret the results it with caution because the sample is small.
Subject(s)
Colonic Neoplasms/pathology , Sentinel Lymph Node Biopsy , Aged , Colonic Neoplasms/surgery , Female , Humans , Male , Neoplasm Micrometastasis , Neoplasm Staging , Prospective StudiesSubject(s)
Humans , Male , Young Adult , Pancreatitis/complications , Jaundice, Obstructive/etiology , Pancreatitis/surgery , Laparotomy , BiopsyABSTRACT
BACKGROUND: Splenic metastases are extremely unusual. The aim of this paper is to review the world experience to date concerning to laparoscopic approach for splenic metastasis, and to report ours at the Hospital de Sant Pau. METHODS: Literature review was carried out and relevant reports on laparoscopic approach to splenic metastasis were obtained. In addition, we reviewed our patient's database and retrieved the data of those who underwent laparoscopic splenectomy due to splenic involvement. RESULTS: Electronic search yielded 8 relevant articles on open splenectomy and 7 articles on laparoscopic splenectomy for splenic metastasis. During the study period, 6 patients were operated on laparoscopically. Primary neoplasms were 3 melanomas, 2 colon carcinomas, and 1 malignant fibrous histiocytoma. None of the patients had surgical complications. Outcome ranged from 2-month to 11-year survival. CONCLUSIONS: The laparoscopic approach for splenic metastasis is feasible. Of course, it must be individualized in each case.
Subject(s)
Laparoscopy/methods , Splenectomy/methods , Splenic Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Colonic Neoplasms , Female , Histiocytoma, Malignant Fibrous/secondary , Humans , Male , Melanoma/secondary , Middle Aged , Splenic Neoplasms/secondaryABSTRACT
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Subject(s)
Humans , Male , Aged , Burkitt Lymphoma/diagnosis , Gallbladder Neoplasms/diagnosisSubject(s)
Burkitt Lymphoma , Aged , Burkitt Lymphoma/diagnosis , Gallbladder Neoplasms/diagnosis , Humans , MaleABSTRACT
In some patients with colorectal cancer and synchronous liver metastases, chemotherapy and current combinations of chemotherapy allow the size of these metastases to be reduced so that they can be surgically resected. However, in many patients, the initial systematic treatment of the primary tumor is associated with growth of the metastases (which predict the patient's life expectancy). This metastatic growth contraindicates surgical treatment that might otherwise be curative. We report the case of a patient with advanced recto-colonic cancer, which responded well to chemotherapy given as neoadjuvant treatment prior to surgery, in which the hepatic metastases were resected before excision of the primary tumor.
Subject(s)
Chemotherapy, Adjuvant/methods , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Neoplasms, Multiple Primary , Surgical Procedures, Operative/methods , Combined Modality Therapy , Humans , Liver Neoplasms/diagnostic imaging , Male , Middle Aged , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/surgery , Time Factors , Tomography, X-Ray ComputedABSTRACT
En algunos pacientes afectos de cáncer colorrectal con metástasis hepáticas sincrónicas, la quimioterapia y sus nuevas combinaciones permiten reducir el tamaño de las metástasis y rescatarlas para un tratamiento quirúgico. Sin embargo, en muchos pacientes, el tratamiento inicial sistemático del tumor primario se acompaña de un crecimiento de las metástasis (que marcan el pronóstico vital del paciente). Esta progresión de las metástasis impide cualquier opción de tratamiento con intención curativa. Presentamos el caso de un paciente con enfermedad colorrectal avanzada, con muy buena respuesta a la quimioterapia y candidato a una novedosa estrategia, que combina neoadyuvancia primero, con cirugía de las metástasis hepáticas que se adelanta a la cirugía colorrectal (AU)
In some patients with colorectal cancer and synchronous liver metastases, chemotherapy and current combinations of chemotherapy allow the size of these metastases to be reduced so that they can be surgically resected. However, in many patients, the initial systematic treatment of the primary tumor is associated with growth of the metastases (which predict the patient's life expectancy). This metastatic growth contraindicates surgical treatment that might otherwise be curative. We report the case of a patient with advanced recto-colonic cancer, which responded well to chemotherapy given as neoadjuvant treatment prior to surgery, in which the hepatic metastases were resected before excision of the primary tumor (AU)
Subject(s)
Male , Middle Aged , Humans , Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/pathology , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , Treatment Outcome , Chemotherapy, Adjuvant , Hepatectomy , Liver Neoplasms/secondaryABSTRACT
No disponible
Subject(s)
Humans , Specialties, Surgical/education , Digestive System Surgical Procedures/education , Professional Competence/standards , Training Support/trends , Curriculum , Internship and Residency/standards , Educational Measurement/methodsABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Tomography, Emission-Computed/methods , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/surgery , Abdomen/pathology , Abdomen , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms , Neoplasm Recurrence, Local/prevention & controlABSTRACT
Clásicamente, la existencia de un tumor colorrectal conlleva su exéresis quirúrgica, con independencia de que se asocie o no a metástasis hepáticas. El importante desarrollo de las técnicas de imagen por un lado, la aparición de nuevas formas de quimioterapia y sus combinaciones, con diferentes vías de administración y eficacia progresivamente creciente por otro, junto al abordaje multidisciplinario en la toma de decisiones terapéuticas y la disponibilidad de tratamientos paliativos satisfactorios, obligan a matizar el papel de la cirugía y, en cualquier caso, el orden en el que se integra en la estrategia de tratamiento del cáncer colorrectal avanzado. Presentamos el caso de una paciente con neoplasia de sigma y múltiples metástasis hepáticas sincrónicas, que recibió inicialmente una quimioterapia intensiva, tras la cual pudo ser tratada con intención curativa de todas sus lesiones (primaria y metástasis) (AU)
Subject(s)
Female , Middle Aged , Humans , Colorectal Neoplasms/complications , Liver Neoplasms/secondary , Sigmoid Neoplasms/complications , Disease-Free Survival , Chemotherapy, Adjuvant , Clinical Protocols , Colorectal Neoplasms/surgery , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/diagnosis , Liver Neoplasms/surgery , Liver Neoplasms/drug therapy , Neoplasm Metastasis/drug therapy , Sigmoid Neoplasms/surgery , Sigmoid Neoplasms/drug therapyABSTRACT
Objetivo. Conocer la opinión de los cirujanos miembros de la Societat Catalana de Cirugía (SCC) sobre la aplicabilidad, ventajas e inconvenientes de la cirugía laparoscópica (CL).Material y métodos. Encuesta de opinión remitida a todos los miembros de la SCC entre febrero y abril de 2001, que incluía aspectos generales y situaciones clínicas. Resultados. Han contestado 194 cirujanos (30,4 por ciento).Sólo 50 (26 por ciento) cirujanos realizan procedimientos avanzados. La experiencia del cirujano es el factor que más influye en los resultados de la CL para 87 cirujanos (45 por ciento) y 89 (46 por ciento) creen que la CL acabará siendo una superespecialidad. La CL es considerada de primera elección en la colelitiasis (99 por ciento), cirugía del reflujo gastroesofágico (RGE) (94 por ciento) y colecistitis aguda (88 por ciento). Otras afecciones como la hernia inguinal, bazo, colon benigno y suprarrenal lo serían en casos seleccionados. El cáncer de colon, la apendicitis y la eventración tienen baja aceptación como primera indicación en CL. El 44 por ciento de cirujanos consideran que la CL no ha tenido el crecimiento esperado. Conclusiones. La CL, en nuestro medio y para un amplio colectivo de cirujanos, es ampliamente aceptada en la colelitiasis y el RGE, mientras la CL avanzada es realizada por pocos cirujanos. Aspectos como la formación en CL y superespecialización restan por perfilar en un futuro (AU)
Subject(s)
Data Collection/methods , Data Collection , Cholelithiasis/surgery , Cholelithiasis , Gastroesophageal Reflux/surgery , Gastroesophageal Reflux , Referral and Consultation/standards , Referral and Consultation/trends , Laparoscopy/classification , Laparoscopy/adverse effects , Laparoscopy , Laparoscopy/methods , Data Collection/legislation & jurisprudence , Data Collection/standards , Data Collection/supply & distribution , Colon/surgery , Spleen/surgery , Adrenal Glands/surgery , Appendicitis/surgery , Abdomen, Acute/surgery , Abdominal Injuries/surgery , Diaphragmatic Eventration/surgery , Laparoscopy/standards , Laparoscopy/trends , Laparoscopy/statistics & numerical data , Laparoscopy , Colonic Neoplasms/surgeryABSTRACT
BACKGROUND: Since 1992 conservative treatment of breast cancer (stage I and II: clinical TNM) has been established as an alternative to mastectomy in our hospital. The aim of this retrospective study was to analyse locoregional recurrence features and to compare prognosis with regard to to site of recurrence. METHOD: Between 1987 and 1993, 489 patients with breast cancer (stages I and II) were treated with conservative surgery and radiation therapy at the Hospital Sant Pau of Barcelona. Mean follow-up was 58.8 months [between 12-144]. 35 patients developed locoregional recurrence. We considered two groups: local recurrence in breast only; and locoregional recurrence such as nodal recurrence with or without simultaneous breast recurrence. Diagnosis was confirmed by histopathologic analysis. An extensive study was performed in all patients to rule out distant metastasis. Last follow-up was December 1999. RESULTS: The locoregional recurrence rate after conservative treatment was 7.5% and that of local recurrence was 3.06%. Recurrences were diagnosed in 80% of patients by physical examination, while 20% of patients had noticed the tumor recurrence themselves. Histologic grade III tumors had a higher number of locoregional recurrences than local recurrences (p = 0.030). Locoregional recurrences had lower overall survival rate (p = 0.0005), lower disease-free survival rate (p = 0.0012) and shorter time period without distant metastasis (p < 0.0005) than local recurrences. CONCLUSIONS: Most recurrences were diagnosed by clinical examination during follow up. Histologic grade III was related to locoregional recurrences. Local recurrences had a better prognosis than locoregional recurrences.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Neoplasm Recurrence, Local/epidemiology , Adult , Female , Humans , Middle Aged , Neoplasm Staging , RecurrenceABSTRACT
FUNDAMENTO: Desde 1992 el tratamiento conservador del cáncer de mama (estadios I y II, TNM clínico) se establece en nuestro hospital como la alternativa a la mastectomía. La finalidad de este estudio retrospectivo fue analizar las características de estos casos de recidiva locorregional y comparar el pronóstico en relación con la localización de las recidivas. MÉTODO: Entre 1987 y 1993 en el Hospital de la Santa Creu i Sant Pau de Barcelona se trataron 489 pacientes afectadas de carcinoma de mama en estadios I y II con cirugía conservadora y radioterapia. La mediana de seguimiento fue de 58,8 meses (extremos, 12 y 144). Presentaron recidiva locorregional 35 pacientes. La recidiva locorregional se clasificó en dos grupos: recidiva local, en mama únicamente; recidiva locorregional, como la presentada en ganglios regionales con recidiva simultánea en mama o sin ella. El diagnóstico se confirmó con estudio anatomopatológico y en todos los casos se efectuó estudio de extensión para descartar metástasis. La última revisión fue en diciembre de 1999. RESULTADOS: La tasa de recidiva locorregional después del tratamiento conservador fue de un 7,5 por ciento y la de recidiva local del 3,06 por ciento. La recidiva fue diagnosticada en el 80 por ciento de los casos en la exploración física y sólo en el 20 por ciento fue detectada por la misma paciente. Los tumores con grado histológico III presentaron mayor número de recidivas locorregionales que locales (p = 0,030). Las recidivas locorregionales se asociaron a una tasa de supervivencia global (p = 0,0005), una supervivencia libre de enfermedad (p = 0,0012) y un intervalo libre de metástasis (p < 0,0005) inferiores a los observados en la recidiva local. CONCLUSIONES: La mayor parte de las recidivas locorregionales fueron diagnosticadas en el control clínico durante el seguimiento. El grado histológico III se relacionó con las recidivas locorregionales. La recidiva local tuvo mejor pronóstico que la recidiva locorregional. (AU)
