RESUMEN
BACKGROUND: This study examined the feasibility of early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) according to the Tokyo guidelines severity grade, and analyzed the changes in the therapeutic strategy for AC after the Tokyo guidelines were published. METHODS: A total of 225 patients were enrolled in this study. The therapeutic period was divided into two periods: before and after the publication of the Tokyo guidelines (prior to and including 2007, and from 2008, respectively). RESULTS: Comparing the surgical strategy between ELC and delayed laparoscopic cholecystectomy (DLC), significant differences were found in the length of preoperative hospital stay and total hospital stay for cases of mild AC compared with moderate AC. With conversion to open surgery, postoperative complications including postoperative bile leak were not significantly different. Since ELC was performed significantly more often after publication of the guidelines, preoperative, postoperative, and total hospital stays were significantly shorter in the later period. CONCLUSION: ELC is a safe and effective therapeutic strategy for both mild and moderate AC. The Tokyo guidelines resulted in a significant increase in the performance of ELC and significantly reduced preoperative and total hospital stays without increasing intra- and postoperative complications.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Colecistitis Aguda/cirugía , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report three cases of biliary tract cancer with positive surgical margin obtained a long-term survival after multimodality therapy. Case 1: A 58-year-old man had operated PPPD for middle part of biliary tract cancer. Final pathological findings revealed HM2. Hepatic metastasis and anastomotic recurrence were observed, postoperatively. RFA and chemoradiation therapy were performed against these lesions. Nevertheless, the patient died of sepsis associated with hepatic abscess caused by cholangitis 5 years and 10 months after surgery. Case 2: A 72-year-old man had operated for upper part of biliary tract cancer. Intra-operative pathological findings revealed HM 2 and DM 2, extra-bile duct resection was performed for this lesion. After surgery, radiation therapy, systemic chemotherapy and hepatic arterial chemotherapy were performed, nevertheless the patient died of cancer 2 years and 6 months after surgery. Case 3: A 75-year-old man had operated for upper part of biliary tract cancer. Intra-operative pathological findings revealed HM 2 and DM 2, an extra-bile duct resection was performed for this lesion. After surgery, chemoradiation therapy, hepatic arterial chemotherapy and systemic chemotherapy were performed, nevertheless the patient died of cancer 3 years and 6 months after surgery.
