Tratamiento laparoscópico de seudoquiste intraabdominal como complicación de catéter ventriculoperitoneal / Laparoscopic treatment of an intra-abdominal pseudo-cyst as a ventriculo-peritoneal catheter complication

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[Inversion of the sequence of surgery after neoadjuvant chemotherapy for synchronous liver metastases from colorectal cancer]. / Cirugía secuencial inversa después de quimioterapia neoadyuvante por metástasis hepáticas sincrónicas de cáncer colorrectal.

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.

Cirugía secuencial inversa después de quimioterapia neoadyuvante por metástasis hepáticas sincrónicas de cáncer colorrectal / Inversion of the sequence of surgery after neoadjuvant chemotherapy for synchronous liver metastases from colorectal cancer

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)

[Surgical resection of liver metastases from colorectal carcinoma. Experience in Sant Pau Hospital]. / Resección quirúrgica de metástasis hepáticas de cáncer colorrectal. Experiencia del Hospital de Sant Pau.

INTRODUCTION: Surgical resection is the only available treatment that improves survival in patients with liver metastases from colorectal cancer, particularly when carried out by a multidisciplinary team. MATERIAL AND METHOD: We retrospectively analyzed a consecutive series of 116 patients who underwent 138 liver resections (65.4% minor and 35.5% major) for hepatic metastases from colorectal cancer between 1998 and 2004. In 34.5% of the patients, the lesions were synchronous. All patients were individually assessed by a multidisciplinary team. The mean number of metastases removed per patient was 2.43 (range: 1-10). The mean size of the largest tumor per patient was 40 mm (range: 12-90). In 67.3% of the patients, the primary tumor was at an advanced stage (III-IV). In 98% of the patients, the diagnosis was confirmed by helical computed tomography scans/magnetic resonance imaging and intraoperative ultrasonography. RESULTS: Postoperative morbidity was 31.2% and mortality was 2.2%. A mean of 2.7 units of blood was transfused per patient. Overall 5-year survival was 43.2% (median 50 months). Survival rates varied according to whether the patients had < 4 or > or = 4 colorectal liver metastases (50 and 43 months respectively), tumor size (more or less than 5 cm) (60 and 50.6 months respectively) and whether the site was monolobar or bilobar (60 and 43.11 months respectively). In 16 patients, recurrence of liver metastases led to 22 rehepatectomies. Overall 5-year survival was 36.7% (median 60 months) after the first rehepatectomy but was 36 and 12 months respectively after a second or third rehepatectomy. CONCLUSIONS: These results confirm that multidisciplinary decisions and interventions by specialist liver surgeons, as in our hospital, reduce postoperative morbidity and mortality and increase survival in patients requiring surgical removal of liver metastases from colorectal cancer.

Resección quirúrgica de metástasis hepáticas de cáncer colorrectal. Experiencia del Hospital de Sant Pau / Surgical resection of liver metastases from colorectal carcinoma. Experience in Sant Pau Hospital

Introducción. La resección quirúrgica es el único tratamiento capaz de incrementar la supervivencia de los pacientes con metástasis hepáticas de cáncer colorrectal (MHCCR), especialmente si la practica un equipo multidisciplinario. Material y método. Analizamos retrospectivamente una serie consecutiva de 116 pacientes sometidos a 138 resecciones hepáticas (el 64,5% menores y el 35,5% mayores) por metástasis hepáticas de cáncer colorrectal entre 1998 y 2004. Eran sincrónicas en el 34,5% de los casos. Un equipo multidisciplinario valoró todos los casos de forma individual. La media de metástasis resecadas por paciente fue 2,43 (1-10) y el tamaño medio de la mayor por paciente, 40 (12-90) mm. El estadio del tumor primario fue avanzado (III-IV) en el 67,3% de los casos. Las tomografía computarizada helicoidal y la resonancia magnética y la ecografía intraoperatoria (el 98% de los casos) confirmaron siempre el diagnóstico. Resultados. La morbilidad postoperatoria fue del 31,2% y la mortalidad, el 2,2%. La media de unidades sanguíneas transfundidas fue de 2,7 por paciente. La supervivencia general fue del 43,2% a los 5 años (mediana, 50 meses). Esta supervivencia varió según fueran pacientes con MHCCR 5 cm (60 y 50,6 meses respectivamente), o según su localización unilobular o bilobular (60 y 43,11 meses respectivamente). En 16 pacientes una recidiva hepática implicó 22 rehepatectomías. Su supervivencia general acumulada fue del 36,7% a los 5 años (mediana, 60 meses) tras la primera rehepatectomía, y de 36 y 12 meses respectivamente tras una segunda o una tercera rehepatectomía. Conclusiones. Estos resultados confirman que las decisiones multidisciplinarias y una específica dedicación a la cirugía hepática, tal como sucedió en nuestro medio, proporcionan una baja morbimortalidad postoperatoria e incrementan la supervivencia de los pacientes sometidos a una resección de metástasis hepáticas de cáncer colorrectal (AU)

Introduction. Surgical resection is the only available treatment that improves survival in patients with liver metastases from colorectal cancer, particularly when carried out by a multidisciplinary team. Material and method. We retrospectively analyzed a consecutive series of 116 patients who underwent 138 liver resections (65.4% minor and 35.5% major) for hepatic metastases from colorectal cancer between 1998 and 2004. In 34.5% of the patients, the lesions were synchronous. All patients were individually assessed by a multidisciplinary team. The mean number of metastases removed per patient was 2.43 (range: 1-10). The mean size of the largest tumor per patient was 40mm (range: 12-90). In 67.3% of the patients, the primary tumor was at an advanced stage (III-IV). In 98% of the patients, the diagnosis was confirmed by helical computed tomography scans/magnetic resonance imaging and intraoperative ultrasonography. Results. Postoperative morbidity was 31.2% and mortality was 2.2%. A mean of 2.7 units of blood was transfused per patient. Overall 5-year survival was 43.2% (median 50 months). Survival rates varied according to whether the patients had < 4 or ≥ 4 colorectal liver metastases (50 and 43 months respectively), tumor size (more or less than 5 cm) (60 and 50.6 months respectively) and whether the site was monolobar or bilobar (60 and 43.11 months respectively). In 16 patients, recurrence of liver metastases led to 22 rehepatectomies. Overall 5-year survival was 36.7% (median 60 months) after the first rehepatectomy but was 36 and 12 months respectively after a second or third rehepatectomy. Conclusions. These results confirm that multidisciplinary decisions and interventions by specialist liver surgeons, as in our hospital, reduce postoperative morbidity and mortality and increase survival in patients requiring surgical removal of liver metastases from colorectal cancer (AU)

[Curative partial hepatectomy in adult Caroli's disease]. / Hepatectomía parcial curativa en la enfermedad de Caroli del adulto.

Caroli's disease consists of a congenital malformation of the intrahepatic bile ducts characterized by saccular, segmental, cystic dilatations giving rise to recurrent cholangitis. The inheritance pattern is unclear and the disease may be associated with other hereditary diseases such as adult polycystic kidney disease. The most effective therapeutic option in symptomatic unilobar Caroli's disease is resection of the affected lobe. In bilobar involvement, liver transplantation should be considered. Due to their rarity, we report three cases of Caroli's disease successfully resolved through lobectomy of the affected lobe: two patients with recurrent cholangitis and one patient with associated adult polycystic kidney disease.

Hepatectomía parcial curativa en la enfermedad de Caroli del adulto / Curative partial hepatectomy in adult Caroli's disease

La enfermedad de Caroli consiste en una malformación congénita de la vía biliar intrahepática caracterizada por dilataciones saculares, segmentarias múltiples y quísticas, cuyas manifestaciones clínicas se centran en crisis repetitivas de colangitis. Esta enfermedad tiene una base hereditaria incierta y puede asociarse a otras enfermedades de carácter hereditario como la enfermedad poliquística renal del adulto (EPRAD). La mejor opción terapéutica en los casos sintomáticos unilobares hepáticos es la exéresis hepática del lóbulo afecto correspondiente; en caso de afección bilobar, debe plantearse el trasplante hepático. Presentamos por su rareza 3 casos de enfermedad de Caroli resueltos con éxito mediante una lobectomia hepática del lado afecto: 2 pacientes manifestaron la enfermedad en forma de episodios de colangitis de repetición y 1 paciente, con asociación a EPRAD (AU)

Caroli's disease consists of a congenital malformation of the intrahepatic bile ducts characterized by saccular, segmental, cystic dilatations giving rise to recurrent cholangitis. The inheritance pattern is unclear and the disease may be associated with other hereditary diseases such as adult polycystic kidney disease. The most effective therapeutic option in symptomatic unilobar Caroli's disease is resection of the affected lobe. In bilobar involvement, liver transplantation should be considered. Due to their rarity, we report three cases of Caroli's disease successfully resolved through lobectomy of the affected lobe: two patients with recurrent cholangitis and one patient with associated adult polycystic kidney disease (AU)

Quiste retroperitoneal gigante / Giant retroperitoneal cyst

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Cáncer colorrectal con metástasis hepáticas sincrónicas: ¿cuán agresivos podemos ser? / Colorectal cancer with synchronic hepatic metastases: how aggressive can we be?

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)

Hepatocellular carcinoma: surgical indications and results.

Hepatocellular carcinoma (HCC) is a tumour of increasing incidence that usually arises in cirrhotic liver. Untreated, the prognosis is grim and the only curative treatment is surgical resection. The practical application of segmental surgery to the liver together with the use of ultrasound and other imaging techniques, patient selection criteria and improvements in perioperative technique and postoperative care have contributed to better results in hepatic surgery. Today, less than 10% mortality for resection of cirrhotic livers, with up to 50% 5-year survival rates are to be expected. However, the limits of resection for cure: intrahepatic recurrence makes stringent follow-up necessary. In this way the available modalities of treatment can be applied so as to improve survival. Herein, a current 'state-of-the-art' of surgical indications and results for HCC is given.