Extension of surgical treatment and adjuvant chemotherapy in patients with incidental gallbladder cancer.

OBJECTIVE: To describe the results of the extension of surgical treatment and adjuvant chemotherapy (ACT) in incidental gallbladder cancer (CVB), in terms of postoperative morbidity (POM) and 5-year overall survival rate. METHOD: Case series of patients operated on for incidental GBC in Clínica Mayor, Temuco, Chile (2001-2016). All cases were treated by partial hepatectomy (segments IVb and V), and regional lymphadenectomy. The minimum follow-up time was 12 months. Outcome variables were MPO and 5-year overall survival rate. Other variables of interest were: infiltration depth in vesicular wall, lymph nodes and resected liver; surgical time, need for reoperation, hospital stay, follow-up and mortality. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact and t-test and non-parametrical tests for continuous variables and Kaplan Meier curves. RESULTS: The series was composed of 50 patients, whose average age was 58.6 ± 9.6 years; 68.0% of which were women. The mean surgical time and hospital stay were 224 ± 93 min (90 to 480) and 6.9 ± 2.9 days (4 to 20), respectively. POM was 28.0%. 5-year overall survival rate was 47%. There were no reoperations or mortality. CONCLUSIONS: The results verified in terms of POM and 5-year overall survival rate are similar to previously reported series.

OBJETIVO: Describir los resultados de la extensión del tratamiento quirúrgico y la quimioterapia adyuvante en el cáncer de vesícula biliar (CVB) incidental, en términos de morbilidad posoperatoria (MPO) y de supervivencia global (SVG) a 5 años. MÉTODO: Serie de casos de pacientes intervenidos por CVB incidental en Clínica Mayor, Temuco, Chile (2001-2016). Todos los casos fueron tratados mediante hepatectomía parcial de segmentos IVb y V, y linfadenectomía regional. El tiempo mínimo de seguimiento fue de 12 meses. La variables resultado fueron: MPO y la SVG a 5 años. Otras variables de interés fueron: profundidad de infiltración en la pared vesicular, de linfonodos y del hígado resecado, tiempo quirúrgico, necesidad de reintervención, estancia hospitalaria, seguimiento y mortalidad. Se aplicó estadística descriptiva, y análisis bivariados, aplicando prueba exacta de Fisher y t-test; o pruebas no paramétricas para variables continuas; y curvas de Kaplan-Meier. RESULTADOS: La serie está compuesta por 50 pacientes, con edad media de 58.6 ± 9.6 años; 68.0% de los cuales eran mujeres. La media del tiempo quirúrgico y de estancia hospitalaria fueron 224±93 minutos (90 a 480) y 6.9±2.9 días (4 a 20) respectivamente. La MPO fue 28.0%. La SVG a 5 años fue 47%. No hubo reintervenciones ni mortalidad. CONCLUSIONES: Los resultados verificados en términos de MPO y SVG a 5 años, son similares a los reportados anteriormente.

Neoplasia papilar intracolecística: reporte de un caso y revisión de la evidencia existente / Intracholecystic papillary neoplasia: report of a case and review of existing evidence

La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.

Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.

Características ultrassonográficas de fígado, vesícula biliar, rins, vesícula urinária e jejuno em coelhos jovens e adultos / Ultrasound features of liver, gallbladder kidneys, urinary bladder and jejunum in young and adult rabbits

O presente trabalho descreveu características e comparou mensurações do fígado, vesícula biliar, rins, vesícula urinária e jejuno de coelhos da raça Nova Zelândia Branco (NZB) jovens e adultos. O grupo dos jovens foi composto por 39 coelhos de ambos os sexos (20 machos e 19 fêmeas), desmamados aos 30-31 dias de idade, sendo as avaliações realizadas aos 35, 56 e 77 dias de idade. O grupo dos adultos foi composto por 23 fêmeas e 15 machos, com idade superior a 6 meses, sendo realizada uma avaliação ultrassonográfica por animal. O exame consistiu na avaliação do fígado, vesícula biliar, rins direito e esquerdo, jejuno e vesícula urinária. Todos os animais foram pesados antes dos exames. O peso médio dos animais aumentou (p<0,05) dos 35 dias até a idade adulta. Tanto nos adultos quanto nos jovens, o fígado apresentou-se predominantemente isoecogênico ao rim direito e com textura homogênea. A vesícula biliar apresentou-se em formato ovoide alongado, variando de piriforme à amendoado, com conteúdo anecogênico, não sendo visível em 2,6% dos coelhos jovens e em 26,3% dos adultos. O comprimento e a largura da vesícula biliar nas idades de 35, 56, 77 dias e adultos foram: 1,06 e 0,39; 1,44 e 0,53; 1,41 e 0,58; 1,57 e 0,67cm, respectivamente. Considerando jovens e adultos, as mensurações da vesícula biliar e dos rins esquerdo e direito apresentaram correlação positiva (p<0,05) com o peso. Os rins apresentaram-se no formato de elipse e com superfície regular, com aumento (p<0,05) dos 35 dias à idade adulta. Houve correlação positiva (p<0,05) entre os volumes renais direito e esquerdo. A descrição da vesícula urinária mais encontrada (86%) foi a com conteúdo anecogênico, com pequenas estruturas ecogênicas livres no lúmen, tanto em jovens quanto em adultos. Não houve diferença (p>0,05) da espessura das camadas do jejuno entre as idades, apresentando média de 0,23 cm para todos os animais. Estes são os primeiros dados brasileiros de características ultrassonográficas de fígado, vesícula biliar, rins, jejuno e vesícula urinária para coelhos NZB de 35, 56 e 77 dias de vida e adultos.(AU)

This study described characteristics and measurements of the liver, gallbladder, kidney, urinary bladder and jejunum of young and adults New Zealand White (NZW) rabbits. The young rabbits's group was composed of 39 rabbits of both sexes (20 males and 19 females), weaned at 30-31 days of age, and the evaluations carried out at 35, 56 and 77 days of age. The adults group was composed of 23 females and 15 males, with more than 6 months of age, and one ultrasonographic evaluation per animal. The exam consisted in the evaluation of liver, gallbladder, right and left kidneys, jejunum and urinary bladder. All the animals were weighed before the evaluations. The average weight increased (p<0.05) from 35 days to adults. Both in adult and in young rabbits, the liver presented predominantly isoechogenic in relation of right kidney and with homogeneous texture. The gallbladder had an elongated ovoid shape, ranging for pear-shaped to almond, with anechogenic content, not being visible in 2.6% of young rabbits and 26.3% of adults. The length and width were 1.06 and 0.39; 1.44 and 0.53; 1.41 and 0.58; 1.57 and 0.67cm, respectively at 35, 56, 77 days and adults. For young and adults rabbits, the gallbladder and the left and right kidneys were positively correlated (p<0.05) with weight. The kidneys had an ellipse shape with smooth surface, increasing (p>0.05) from 35 days to adulthood. There was a positive correlation (p<0.05) between the right and left kidney volumes. The description of urinary bladder more frequently (86%) observed was anechogenic content, with small free echogenic structure within the lumen, both in young and in adult rabbits. There was no difference (p>0.05) in the thickness of the layers of the jejunum among ages, with the mean of 0.23cm for all animals. With the results, the first Brazilian ultrasonographic data for liver, gallbladder, kidney, jejunum and urinary bladder were defined to NZW rabbits in 35, 56 and 77days of life, as well as adults.(AU)