Application and validation of a surgical risk calculator in a liver surgery cohort of patients in Veracruz, Mexico.

OBJECTIVE: Multiple models have tried to predict the morbidity and mortality of liver resections (HR). This study aims to determine the efficacy and validity of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator in a cohort of patients undergoing HR in Veracruz, Mexico. MATERIAL AND METHODS: Retrospective analysis of patients undergoing HR between 2005 and 2019. To estimate the performance of the calculator, the observed results were compared with the average risk predicted by the calculator, using ROC curve, Brier score and Z test. RESULTS: 67 patients were evaluated, mean age 51.9 years of age, 50.7% female. The majority of resections (56.7%) were for malignancy and 62.1% were partial hepatectomies (up to 3 liver segments). The morbidity was 25.4% and the mortality 4.5%. There was a good prediction in the complications (serious complication: C = 0.725 statistic, Brier score 0.26, p = 0.006 and any statistical complication C = 0.731, Brier score 0.33, p = 0.005) and mortality (C = 0.922 statistic, Brier score 0.005, p = 0.014). CONCLUSIONS: The application of the ACS-NSQIP calculator in patients undergoing HR has good discrimination power and good predictive ability. Prediction of postoperative risks achieves a preoperative planning of the appropriate procedure.

OBJETIVO: Múltiples modelos han intentado predecir la morbilidad y mortalidad de las resecciones hepáticas (RH). Este estudio tiene por objetivo determinar la eficacia y validez de la calculadora de riesgo quirúrgico del American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) en una cohorte de pacientes sometidos a RH en Veracruz, México. MATERIAL Y MÉTODOS: Análisis retrospectivo de pacientes sometidos a RH entre 2005 y 2019. Se compararon los resultados observados con la media del riesgo previsto por la calculadora, mediante Curva ROC, score de Brier y prueba Z. RESULTADOS: Se evaluaron 67 pacientes, con 51.9 años de edad media, un 50.7% de sexo femenino. La mayoría de las resecciones (56.7%) fueron por patología maligna y el 62.1% fueron hepatectomías parciales. La morbilidad fue del 25.4% y la mortalidad del 4.5%. Hubo una predicción buena en las complicaciones (complicación seria, estadística: C: 0.725, score Brier: 0.26, p = 0.006 y cualquier complicación, estadística: C: 0.731, score Brier: 0.33, p = 0.005) y la mortalidad (estadística C: 0.922, score Brier: 0.005, p = 0.014). CONCLUSIONES: La aplicación de la calculadora ACS-NSQIP en pacientes sometidos a RH tiene buen poder de discriminación y buena habilidad predictiva. Predecir riesgos postoperatorios logra una adecuada planeación preoperatoria del procedimiento.

[Surgical treatment of liver haemangiomas in a third level hospital in south-east Mexico]. / Tratamiento quirúrgico de los hemangiomas hepáticos en una unidad médica de alta especialidad del sureste de México.

BACKGROUND: Liver haemangiomas are the most common benign tumours, commonly presented in women and considered giant when their diameter surpasses 4cm. They are mostly asymptomatic and incidental findings. They manifest with abdominal pain and mass effect. These tumours can be managed by observation, enucleation, resection, and embolisation. OBJECTIVE: To determine the experience in our unit as regards the treatment and post-surgical outcomes of patients with liver haemangiomas. MATERIALS AND METHODS: A retrospective study was performed on 14 patients with a histopathological diagnosis of liver haemangioma. An analysis was made using the sociodemographic, tumour-related and surgical related variables, as well as any complications. RESULTS: Of the 14 patients analyse, there were 7 males and 7 females, with a median age of 43.43±15.03 years, and a mean tumour size of 6.86±3.5cm. Eight (51.7%) of the tumours were located in the right lobe, 3 (21.4%) in the left lobe, and 3 (21.4%) in the caudate lobe. Resection was performed in 7 patients (50%), enucleation in 5 patients (35.7%), and biopsy in 2 patients (14.3). No relationship was found between sex, pathology, or tumour location. No morbidity or mortality was found. CONCLUSIONS: Liver haemangiomas in our unit have similar characteristics to those described in other studies. Surgical treatment in our hospital offers a positive outcome.

Caecum lipoma: a rare cause of lower gastrointestinal bleeding.

Gastrointestinal bleeding caused by benign tumours of the colon is rare. A 70-year-old woman with a significant medical history of diabetes, hypertension and ischaemic heart disease was presented in consultation with marked anaemia secondary to lower gastrointestinal bleeding with a right colonic tumour found by CT. The patient underwent a right colectomy without complications. Histopathological examination revealed a 4 cm transmural caecum lipoma with mucosal ulceration. The patient is asymptomatic without anaemia at 6 months follow-up.