RESUMO
In advanced lower rectal cancer tubular abdomino-perineal resection (APR) in combination with simultaneous extended distally pedicled vertical rectus abdominis muscle flap (VRAM) facilitates a more radical tumor resection. Additionally a prolapse of small intestine into the pelvis can be blocked and a perineal defect coverage can be achieved. 4 patients have been treated with an interdisciplinary one stage combined tubular APR and extended VRAM. In all cases a R0 resection and a complete defect closure could be achieved.The extended VRAM is an appropriate technique to close the pelvic defect because it originates from a non irradiated area, has a monitor island, and the donor site does not handicap the patient as much as local flaps. This interdisciplinary approach facilitates a more radical tumor resection and thus reduces the risk of recurrence.
Assuntos
Adenocarcinoma/cirurgia , Períneo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Retalhos Cirúrgicos/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Comportamento Cooperativo , Feminino , Seguimentos , Humanos , Comunicação Interdisciplinar , Masculino , Terapia Neoadjuvante , Estadiamento de Neoplasias , Diafragma da Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/patologia , ReoperaçãoAssuntos
Dermatomiosite/patologia , Dermatomiosite/cirurgia , Poliarterite Nodosa/patologia , Poliarterite Nodosa/cirurgia , Amputação Cirúrgica , Desbridamento , Progressão da Doença , Feminino , Humanos , Perna (Membro)/patologia , Perna (Membro)/cirurgia , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Reoperação , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia , Retalhos CirúrgicosRESUMO
BACKGROUND: The pancreatic anastomosis is still the Achilles heel in partial pancreatoduodenectomy (PPD). METHODS: This study describes retrospectively a series of 441 patients who underwent standard or extended PPD and reconstruction by either pancreatogastrostomy or pancreatojejunostomy over a period of 13 years (1988-2000). RESULTS: Reconstruction of the pancreatic remnant was achieved by pancreatogastrostomy in 250 patients (56.7 per cent) and by pancreatojejunostomy in 191 patients (43.3 per cent). The leakage rate of the pancreatic anastomosis was 2.8 per cent after pancreatogastrostomy versus 12.6 per cent after pancreatojejunostomy (P < 0.001), whereas other surgical complications (bile leakage, haemorrhage, pancreatitis) were identical in the two groups. The leakage rate after standard PPD with or without vascular reconstruction was 2.0 per cent (four of 205 patients) after pancreatogastrostomy and 11.5 per cent (18 of 156) after pancreatojejunostomy (P < 0.001); following extended PPD it was 6.7 per cent (three of 45) after pancreatogastrostomy and 17.1 per cent (six of 35) after pancreatojejunostomy. The mortality rate due to leakage was 1.6 per cent (four of 250 patients) after pancreatogastrostomy versus 5.2 per cent (ten of 191) after pancreatojejunostomy (P = 0.037). CONCLUSION: Pancreatogastrostomy is a safe and reliable method of reconstruction after PPD that may be associated with a lower leakage and mortality rate than pancreatojejunostomy.
