[Morbimortalidad de la pancreatoduodenectomía en pacientes con cáncer de páncreas y tumores periampulares en el Hospital de Oncología del Centro Médico Nacional Siglo XXI de 2008 a 2013]. / Morbimortality of pancreatoduenectomy in patients with cancer of pancreas and periampular tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI from 2008 to 2013.

INTRODUCTION: Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of 5-10% and a morbidity of 20-40%. OBJECTIVE: To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013. METHOD: Historical, observational and descriptive cohort carried out in the department of sarcomas and tumors of the upper digestive tube of the Oncology Hospital of Centro Médico Nacional Siglo XXI, postoperative pancreatoduodenectomy from 2008 to 2013. RESULTS: We included 71 patients who underwent pancreatoduodenectomy, 47 (66.2%) were female and 24 (33.8%) were male. The average age was 60.3 years. The most common histology was cancer of the Vater's ampulla (66.2%). The resections were R0 in 95.8% of the cases. Mortality was 4.22% and morbidity was 69%. The most frequent complication was pancreatic fistula (23.9%). In the statistical analysis, perioperative transfusion was associated with surgical complications (p < 0.007). CONCLUSIONS: The morbidity of pancreatoduodenectomy is greater than that reported in the literature, however, it does not influence mortality that is similar to that reported in other centers. The number of lymph nodes resected; as well as the percentage of negative margins are those accepted worldwide; It is concluded that this is derived from the experience of the center where these procedures are performed. No factor with statistical significance was found, only the transfusion that increased the complications.

INTRODUCCIÓN: Los tumores de páncreas y los tumores periampulares tienen una presentación clínica similar. La pancreatoduodenectomía representa la única posibilidad de curación o de aumentar la sobrevida, con una mortalidad promedio del 5-10% y una morbilidad del 20-40%. OBJETIVO: Determinar la morbilidad y la mortalidad secundarias a la intervención de pancreatoduodenectomía en pacientes con cáncer de páncreas o tumores periampulares en el Hospital de Oncología del Centro Médico Nacional SXXI de 2008 a 2013. MÉTODO: Cohorte histórica, observacional y descriptiva, realizada en el departamento de sarcomas y tumores de tubo digestivo alto del Hospital de Oncología del Centro Médico Nacional Siglo XXI, operados de pancreatoduodenectomía entre 2008 y 2013. RESULTADOS: Se incluyeron 71 pacientes que se sometieron a pancreatoduodenectomía; 47 (66.2%) eran de sexo femenino y 24 (33.8%) de sexo masculino. La edad promedio fue de 60.3 años. La histología más común fue cáncer de ámpula de Vater (66.2%). Las resecciones fueron R0 en el 95.8% de los casos. La mortalidad fue del 4.22% y la morbilidad fue del 69%. La complicación más frecuente fue la fístula pancreática (23.9%). En el análisis estadístico, la transfusión perioperatoria se asoció a complicaciones quirúrgicas (p < 0.007). CONCLUSIONES: La morbilidad de la pancreatoduodenectomía es mayor que lo reportado en la literatura; sin embargo, no influye en la mortalidad, que es similar a lo reportado en otros centros. El número de ganglios resecados, así como el porcentaje de márgenes negativos, son los aceptados internacionalmente. Se concluye que esto se deriva de la experiencia del centro donde se realizan estos procedimientos. No se encontró ningún factor con relevancia estadística, excepto la transfusión, que incrementaba las complicaciones.

[Prognostic factors for survival in patients with resectable advanced gastric adenocarcinoma]. / Factores pronóstico de sobrevida en adenocarcinoma gástrico avanzado resecable.

BACKGROUND: Patients under 45 years with gastric cancer are associated with a poor prognosis. Recent studies report that the 5-year survival is better in younger patients after curative resection. OBJECTIVE: To determine if prognostic factors such as age under 45 years old, anaemia, weight loss, tumour differentiation, histological sub-type, depth of invasion, and lymph node involvement, reduce the survival of patients with resectable advanced gastric adenocarcinoma undergoing gastrectomy with limited and extended lymphadenectomy. MATERIALS AND METHODS: This study included a cohort of consecutive cases treated in the Sarcomas Department of the Oncology Hospital of the Centro Médico Nacional Siglo XXI, of the Instituto Mexicano del Seguro Social, during the period between January 2000 and December 2006. RESULTS: Of the total of 588 patients evaluated, 112 (19%) were under 45 years, 43% classified as Borrmann IV, and 36% as Borrmann III. Metastatic disease was present in 39.3%, localised diffuse in 12.5%; lower resectability 52.7 vs. 61.3% in older than 45 years. At the end of the study 29.5% of patients under 45 years were alive; no recurrence in 26.8%, with an overall survival of 58.6±4.3 months, compared with 18.3% of patients alive over 45 years, 17.9% disease-free, and with overall survival 35.2±4.3 months resectable disease. CONCLUSIONS: Patients under 45 years have a better survival after a two-year disease-free period.

[Surgical prognostic factors of gastroenteropancreatic neuroendocrine tumors (GEP NET)]. / Tumor neuroendocrino gastroenteropancreático. Factores pronósticos quirúrgicos.

OBJECTIVE: to determine surgical prognostic variables from a retrospective cohort of histopathologically confirmed gastroenteropancreatic neuroendocrine tumors (GEP-NET) in Mexican subjects. METHODS: consecutive patients treated for GEP-NET from 1999 through 2007 at Oncological Hospital were included. Demographic, clinical variables, disease-free survival were retrieved. RESULTS: forty-eight patients were included, 29 (60.4 %) female with a mean age of 54 years. Overall survival time was 43.7 months and disease-free survival was 33 months. Negative statistically significant overall survival time predictors were 2 and 3 histological types (HR 5.5. CI 2.0-21, p = 0.0001), tumor size > 2 cm (HR 8.8, CI 1 .29-75, p = 0.002), the presence of metastasis (HR 2.4, CI 1.2-9.6, p = 0.0001) and tumor resectability (HR 9.8, CI 2.9-40.2, p = 0.0001). For the disease-free period, only the histological type (2 or 3) was a negative outcome variable. CONCLUSIONS: histological type, tumor size, the presence of metastasis, and tumor non resectability were significant survival predictors.

Resectability of primary gastroenteropancreatic neuroendocrine tumor as a prognostic factor for survival.

BACKGROUND: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) originate from gastrointestinal cells and pancreas; most are benign or well-differentiated. GEP-NET treatment objectives are tumor resection and reduction of tumor growth and dissemination, as well as symptom amelioration. We undertook this study to identify prognostic factors among patients with GEP-NETs. METHODS: A total of 48 patients with histopathological diagnosis of GEP-NET were examined. Dependent variables were disease-free survival (DFS) and overall survival rates. Independent variables were age, gender, primary tumor size, resectability, metastatic disease, and histological degree. RESULTS: In 48 patients (60.4% female, 39.6% male, median age 54 years), overall survival rate was 43.7%, and DFS was 33 months. The most common location was gastric. Factors related with the poorest prognosis were histological degree types 2 and 3, tumors >2 cm, metastatic disease, and primary tumor irresectability. For DFS, the only adverse factor was histological degree. CONCLUSIONS: Patients with recurrence of GEP-NET had a poorer prognosis. Complete resection of the lesion with negative margins is the most determining prognostic factor for overrall survival in patients with GEP-NET.

Reintervención para completar el tratamiento quirúrgico en cáncer de tiroides. Indicaciones y hallazgos histopatológicos / Reintervention to complete thyroid cancer surgical treatment. Indications and histopathological findings

En México, de 158 pacientes operados por cáncer de tiroides 39 por ciento requiere ser reintervenido para completar su tratamiento quirúrgico. Se revisaron las indicaciones y los hallazgos histopatológicos de 60 pacientes reoperados por: a) sospecha clínica de persistencia o recurrencia tumoral, b) pacientes con alto riesgo sometidos a lobectomía, c) histología diferente, d) carencia de información y e) metástasis distentes. La cirugía inicial correspondió en 53 casos (88 por ciento) a nodulectomía o lobectomía, en siete (11 por ciento) a tiroidectomía subtotal. En la reintervención se completó la tiroidectomía total en 50 casos y en 10 tiroidectomía "casi" total. Se les hizo además disección de cuello a 27 casos (45 por ciento). El estudio histopatológico mostró cáncer tiroideo en 32 casos (53 por ciento) y metástasis a ganglios en 28 (47 por ciento). Hubo seis casos (9 por ciento) de parálisis del nervio recurrente después de la primera intervención y dos (1.75 por ciento) en las reoperaciones. En cuatro pacientes reoperados (6.6 por ciento) se presentó hipoparatiroidismo permanente. Es indispensable completar la tiroidectomía y la disección de cuello en una alta proporción de pacientes con cáncer de tiroides operados inicialmente en los hospitales generales, debido al criterio inadecuado en la selección de la extensión de la tiroidectomía y en el tratamiento de las metástasis a ganglios cervicales. Los hallazgos histopatológicos justifican reintervenir para completar el tratamiento quirúrgico