RESUMO
The Authors analyze a series of 441 patients affected by carcinoma of the colon operated on between June 1980 and November 1993. The incidence of the different stages of the disease according to Dukes resulted comparable to that reported in the literature as well as the incidence of morbidity and mortality. Recostruction was performed in all cases with mechanical sutures (T-L for the right colon and L-T for the left colon) and without protection enterostomy. Long-term results evaluated by actuarial methods were influenced by the stage of the disease, and not by sex or duration of symptoms. The need of early diagnosis as well as oncologically correct surgical technique is furthermore confirmed. The importance of clinical trials on adjuvant chemotherapy is emphasized in order to improve survival in patients operated for stage B and C colon cancer.
Assuntos
Neoplasias do Colo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de SobrevidaRESUMO
The treatment of liver metastases should be addressed in a multidisciplinary way, considering the manifold therapeutic options available, for each of which corresponds a particular indication. The best results are obtainable with resective surgery in cases in which there is a partial involvement of the liver (25-50%) and a variable intra-hepatic distribution (monolobar), situations that correspond to Gennari stages I and II. In the authors' experience, the extent of the liver resection does not influence possible survival and oncologically correct resections should be carried out such as segmentectomies, pluri-segmentectomies or wedge resection in compliance with the principle of removing at least 1.5 cm of healthy perineoplastic tissue. The authors reserve major hepatectomies to special situations: voluminous metastases, diffuse involvement of a single lobe, topographic localisation contraindicating segmentary resection.
Assuntos
Carcinoma/secundário , Carcinoma/terapia , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Carcinoma/mortalidade , Carcinoma/patologia , Quimioterapia do Câncer por Perfusão Regional , Neoplasias Colorretais/mortalidade , Terapia Combinada , Etanol/administração & dosagem , Floxuridina/administração & dosagem , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , PrognósticoRESUMO
The authors retrospectively evaluate their 10-year experience in the surgical management of pancreatic cancer, and analyze their results in terms of morbidity and long-term survival. The comparison between curative and palliative surgery shows, in this series, a better long-term survival and a better performance status for the patients in the curative group, although postoperative morbidity and mortality are higher. The difficulty of an early diagnosis as well as a correct preoperative staging is confirmed. Finally, the authors propose a personal, totally mechanic technique of digestive tract restoration after gastric resection during pancreatic surgery underlining this procedure is easy, safe, fast and functional.
Assuntos
Cuidados Paliativos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Complicações Pós-Operatórias/epidemiologiaRESUMO
Primary and metastatic gastrointestinal tumours in the liver have been treated by intrahepatic artery infusion of chemotherapeutic drugs in an attempt to increase the efficacy of the administered agents. Among the several active agents, 4' epidoxorubicin, an anthracycline analogue, was selected for this study because of the therapeutic level reached in the liver by this drug. Seven patients with primary hepatic carcinoma and twenty with metastatic adenocarcinoma of the colon to the liver received intraarterial hepatic infusion of epidoxorubicin at the dosage of 30 mg weekly. No haematological or gastrointestinal grade 3-4 toxicity was recorded, only one patient experienced transient cardiac toxicity. No objective response was observed in primary hepatic carcinoma and six objective responses, 1 complete and 5 partial (30%), were achieved in metastatic colorectal cancer patients. This results is not far from those reported with FUDR, but does not justify epidoxorubicin in colorectal cancer patients as first line intraarterial treatment.
Assuntos
Neoplasias do Colo/tratamento farmacológico , Epirubicina/toxicidade , Neoplasias Hepáticas/tratamento farmacológico , Contagem de Células Sanguíneas , Avaliação de Medicamentos , Epirubicina/administração & dosagem , Epirubicina/uso terapêutico , Feminino , Artéria Hepática , Humanos , Infusões Intra-Arteriais , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-IdadeRESUMO
In a review of personal experience of major liver surgery, 2 very rare cases of primary liver tumours, one lymphoma and one leiomyosarcoma are presented. The world literature on the subject is also reviewed and follow-up results are reported after indicating the surgical techniques adopted.
Assuntos
Leiomiossarcoma/cirurgia , Neoplasias Hepáticas/cirurgia , Linfoma Difuso de Grandes Células B/cirurgia , Adolescente , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Hepatite B/complicações , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/etiologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/etiologia , Masculino , Prednisona/administração & dosagem , Vincristina/administração & dosagemAssuntos
Neoplasias Gastrointestinais/cirurgia , Transtornos Linfoproliferativos/cirurgia , Transtornos Mieloproliferativos/cirurgia , Esplenectomia , Neoplasias Gastrointestinais/secundário , Humanos , Leucemia de Células Pilosas/cirurgia , Leucemia Linfocítica Crônica de Células B/cirurgia , Linfoma não Hodgkin/cirurgia , Mielofibrose Primária/cirurgiaAssuntos
Hepatectomia , Neoplasias Hepáticas/cirurgia , Adenoma de Ducto Biliar/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Metástase Neoplásica , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios XAssuntos
Hipertensão Portal/terapia , Emergências , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Derivação Portocava CirúrgicaAssuntos
Infecções Bacterianas/etiologia , Complicações Pós-Operatórias/fisiopatologia , Injúria Renal Aguda/etiologia , Infecções Bacterianas/fisiopatologia , Pressão Venosa Central , Coagulação Intravascular Disseminada/etiologia , Humanos , Fator Depressor Miocárdico/fisiologia , Peritonite/terapia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Choque Séptico/fisiopatologia , Choque Séptico/terapiaRESUMO
A series of cases of acute pancreatitis treated between 1-XI-1972 and 1-XI-1975 is presented. A division is made between cases acute ab initio and postoperative pancreatitis, the latter further subdivided into pancreatic necroses, oedemas, and slight affections. The question of diagnosis is examined and elements indicative of prognosis are stressed. Results obtained in the surgical and medical management of 59 ab initio, 3 necrosis, 11 oedemas, and 79 slight involvement cases are described.
Assuntos
Pancreatite , Doença Aguda , Humanos , Pancreatite/complicações , Pancreatite/diagnóstico , Pancreatite/terapia , Complicações Pós-Operatórias , PrognósticoRESUMO
The frequency of alithiasic cholecystitis is considered and the various forms are subdivided into diffuse and localized dyskinesia. Symptomatology is described and the former are indicated as being electively medical and the latter surgical forms whether the condition is congenital or acquired. The various forms of cholecystosis are also distinguished with full documentation. Symptomatological techniques and diagnostic conclusions are illustrated for all forms and personal experience with their therapy reported.
Assuntos
Doenças da Vesícula Biliar , Colangiografia , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Colecistografia , Doença Crônica , Vesícula Biliar/anormalidades , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/diagnóstico por imagem , Pólipos/cirurgiaRESUMO
After a brief review of modern techniques for correct diagnosis and therapy of bile duct pathology, a personal series of 955 operations (between 1-XI-1972 and 30-X-1975) is presented. The need for routine peroperative control of VBP and the usefulness of respecting the papilla where it is anatomo-functionally undamaged are stressed. Personal experience shows that the most rational methodology is after papillotomy the application of a prepapillary Kehr incision through a choledochotomy because this presents fewer complications than the transpapillary Kehr incision in calculosis or stenosis of the VBP where bile duct suture is not advisable. With regard to bilio-digestive anastomosis, indications and limitations are discussed and it is suggested that where the patient's general and local states permit, choledochojejunal anastomosis should permit, choledochojejunal anastomosis should be used, with choledocho-duodenostomy only in special cases. Cholecysto-gastro and cholecystoduodenostomy should be reserved for patients in very serious conditions.