Actuación quirúrgica urgente en un síndrome de Kasabach-Merrit asociado a angiosarcoma hepático gigante / Urgent surgery in a Kasabach-Merrit syndrome associated with a giant hepatic angiosarcoma

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Morbimortalidad de la resección pancreática / Morbidity and mortality in pancreatic resection

Objetivo Evaluar la morbimortalidad postoperatoria de la resección pancreática.Material y métodosEstudio observacional prospectivo que incluye 117 pacientes intervenidos quirúrgicamente de forma consecutiva por presentar tumoración pancreática o periampular. En 61 de ellos se hizo pancreatectomía cefálica; en 15, pancreatectomía total; en uno, enucleación y en 40, resección corporocaudal.ResultadosLa morbilidad global fue de 48,7% (59% para la pancreatectomía cefálica, 35% para la resección corporocaudal y 46,7% para la pancreatectomía total). Las complicaciones más frecuentes fueron las colecciones y abscesos intraabdominales, con un 15,38% y las complicaciones médicas, con un 13,68%. La incidencia de fístula pancreática fue de 9,83%, para la pancreatectomía cefálica y de 10% para la resección corporocaudal. La incidencia de reintervención fue de 14,53%. La mortalidad global fue de 5,12% (6,56% para la pancreatectomía cefálica, 2,5% para la resección corporocaudal y 6,67% para la pancreatectomía total). La presencia de complicaciones postoperatorias, la necesidad de reintervención y la edad superior a 70 años correlacionaron significativamente con la mortalidad.DiscusiónLa resección pancreática tiene una morbilidad alta. La mortalidad es baja y está prácticamente limitada a los pacientes mayores de 70 años (AU)

Aim Assess the postoperative morbidity rates in pancreatic resection.Material and methodProspective observational study which includes 117 patients who underwent surgery consecutively due to pancreatic or periampullary tumours. In 61 of the patients, cephalic pancreatectomy was carried out; 15 underwent total pancreatectomy; one underwent enucleation and 40 underwent distal pancreatectomy.ResultsOverall morbidity was 48.7% (59% for cephalic pancreatectomy, 35% for distal pancreatectomy and 46.7% for total pancreatectomy). The most frequent complications were intra-abdominal abscesses and collections (15.38%) and medical complications (13.68%). The incidence of pancreatic fistula was 9.83% for cephalic pancreatectomy and 10% for distal pancreatectomy. The reintervention incidence was 14.53%. Overall mortality was 5.12% (6.56% for cephalic pancreatectomy, 2.5% for distal pancreatectomy and 6.67% for total pancreatectomy). The presence of postoperative complications, the need for reintervention and the fact of being over 70 years of age correlated significantly with mortality.DiscussionPancreatic resection has high morbidity rates. Mortality is low and is practically limited to patients older than 70 years. (AU)

[Morbidity and mortality in pancreatic resection]. / Morbimortalidad de la resección pancreática.

AIM: Assess the postoperative morbidity rates in pancreatic resection. MATERIAL AND METHOD: Prospective observational study which includes 117 patients who underwent surgery consecutively due to pancreatic or periampullary tumours. In 61 of the patients, cephalic pancreatectomy was carried out; 15 underwent total pancreatectomy; one underwent enucleation and 40 underwent distal pancreatectomy. RESULTS: Overall morbidity was 48.7% (59% for cephalic pancreatectomy, 35% for distal pancreatectomy and 46.7% for total pancreatectomy). The most frequent complications were intra-abdominal abscesses and collections (15.38%) and medical complications (13.68%). The incidence of pancreatic fistula was 9.83% for cephalic pancreatectomy and 10% for distal pancreatectomy. The reintervention incidence was 14.53%. Overall mortality was 5.12% (6.56% for cephalic pancreatectomy, 2.5% for distal pancreatectomy and 6.67% for total pancreatectomy). The presence of postoperative complications, the need for reintervention and the fact of being over 70 years of age correlated significantly with mortality. DISCUSSION: Pancreatic resection has high morbidity rates. Mortality is low and is practically limited to patients older than 70 years.

Coincidence of GIST and pancreatic endocrine neoplasm in neurofibromatosis.

Carcinoids of the ampulla of Vater are infrequent tumors of which a quarter of cases have been detected in patients with type I neurofibromatosis. This hereditary disease is also associated with gastrointestinal stromal tumors (GIST). However, the coincidence of these three entities together have only been formerly detected in five cases. A 53 year-old female patient, diagnosed with type I neurofibromatosis, with a malignant carcinoid of ampulla of Vater and multiple gastrointestinal stromal tumors in the duodenum and jejunum, was treated with total pancreatectomy and the excision of her intestinal tumors. Five-years on, a follow-up showed the patient to be well, and free from tumor recurrence. The coexistence of an ampullary carcinoid tumor, GIST and neurofibramatosis is very rare. Radical curative surgical resection is a good treatment option, but the optimal management of this is not yet well established.