RESUMO
El adenocarcinoma de uraco es una enfermedad neoplásica rara, con una incidencia de 1 por 5 millones de habitantes. Clínicamente se manifiesta con hematuria (73%), dolor abdominal (14%), disuria (13%), mucosuria (10%), síntomas irritativos (40%), masa palpable en la parte baja del abdomen (17%), bacteriuria (8%), flujo mucoso umbilical (2%). Presentamos el caso de paciente de 45 años, con diagnóstico de adenocarcinoma de uraco, que recibió múltiples tratamientos sin respuesta, realizándose, cirugía radical con resección en bloque de ombligo, uraco, peritoneo, fascia posterior del musculo recto del abdomen y cistectomía parcial, por abordaje laparoscópico, con excelentes resultados oncológicos y estéticos, con recuperación rápida, y sin complicaciones. El papel de la quimioterapia y radioterapia y su beneficio para el paciente aún no está claro. Con este caso queremos aportar con un nuevo caso a la literatura, además de poder mostrar que el manejo con mínima invasión puede ser adecuada en manos expertas, con resultados iguales a la cirugía abierta, con el beneficio ya conocido del abordaje laparoscópico.
Urachal adenocarcinoma is a rare tumor entity, an average incidence of 1 case per 5 million inhabitants is described. Clinically it manifests with hematuria (73%), abdominal pain (14%), dysuria (13%), mucosuria (10%), irritative symptoms (40%), palpable mass in the lower abdomen (17% ), bacteriuria (8%), umbilical mucosal flow (2%). We present the case of a 45-year-old patient with a diagnosis of urachal adenocarcinoma, who received multiple treatments without response, performing radical surgery with en bloc resection of the umbilicus, urachus, peritoneum, posterior fascia of the rectus abdominis muscle and partial cystectomy. by laparoscopic approach, with excellent oncological and aesthetic results, with fast recovery, and without complications. The role of chemotherapy and radiation therapy and their benefit to the patient is still unclear. With this case we want to contribute a new case to the literature, in addition to being able to show that minimally invasive management can be adequate in expert hands, with results equal to open surgery, with the already known benefit of the laparoscopic approach.
Assuntos
Feminino , Pessoa de Meia-Idade , Úraco , Adenocarcinoma , Neoplasias , Dor Abdominal , AbdomeRESUMO
INTRODUCTION AND AIM: The main aim of the study was to establish the oncological safety of the laparoscopic approach to radical cystectomy for high-risk, non-organ-confined urothelial tumours. MATERIAL AND METHODS: A retrospective cohort study of 216 stage pT3-4 cystectomies operated between 2003 and 2016; using an open approach (ORC, n=108), and using a laparoscopic approach (LRC, n=108). RESULTS: Both groups have similar pathological features except, in G3 TUR, there were more lyphadenectomies and greater pN+, and more adjuvant chemotherapies using the LRC. The median follow-up of the series was 15 (IQR: 8-10.5) months. Sixty-eight point one percent of the series relapsed, with no differences between either group (p=.11). The estimated differences for cancer-specific survival was greater in the LRC group (p=.03), as was overall survival (p=.009). There were no differences between either group in estimated recurrence-free survival (p=.26). The type of surgical approach (p=.03), pTpN stage (p=.0001), and administration of adjuvant chemotherapy (p=.003) were related to cancer-specific mortality (CSM) in the univariate analysis. Only the pTpN stage (p=.0001), and not giving adjuvant chemotherapy (p=.003) behaved as independent predictive factors of CSM. CONCLUSION: The type of surgical approach to cystectomy (ORC vs. LRC) did not influence CSM. Lymph node involvement and not giving adjuvant chemotherapy were identified as predictive factors of CSM. Our study supports the oncological safety of the laparascopic approach for cystectomy in patients with locally advanced muscle-invasive bladder tumours.
