RESUMO
Resumen El tratamiento primario de elección para los pacientes con una tumoración GIST localizada es la extirpación quirúrgica completa con márgenes microscópicos negativos. Sin embargo, en un espacio tan reducido como el de la pelvis, la resección completa de una tumo-ración rectal grande es difícil y necesita en ocasiones una amputación abdomino-perienal. En nuestro caso, con la finalidad de reducir el tamaño del tumor y la morbilidad asociada a procedimientos quirúrgicos más agresivos se introdujo el tratamiento con imatinib, con intención neoadyuvante monitorizando la respuesta mediante ecoendoscopia. La respuesta obtenida, rediciendo el volumen tumoral, modificó la estrategia quirúrgica inicial y fue posible conseguir una resección satisfactoria mediante cirugía transanal mínimamente invasiva (TAMIS), preservando los esfínteres anales y soslayando la morbilidad genitourinaria asociada a la excisión mesorectal.
Abstract The primary treatment of choice for patients with a localised gastro-intestinal stromal tumour (GIST) is complete surgical excision with negative microscopic margins. However, in a space as small as that of the pelvis, complete resection of a large rectal tumour is difficult, and sometimes requires an abdominoperineal amputation. In order to reduce the size of the tumour, as well as the morbidity associated with more aggressive surgical procedures, neoadjuvant treatment with Imatinib was introduced in this case, with the response being monitored by of endoscopic ultrasound. The response obtained by reducing the tumour volume modified the strategy, making it possible to obtain a satisfactory resection using transanal minimally invasive surgery (TAMIS), preserving the anal sphincters and avoiding the genitourinary morbidity associated with the mesorectal excision.
Assuntos
Humanos , Canal Anal , Mesilato de Imatinib , Cirurgia Endoscópica Transanal , Amputação CirúrgicaRESUMO
INTRODUCTION: The aim of the study was to present and analyse our experience in laparoscopic adrenalectomy (LA). MATERIALS AND METHODS: Descriptive and retrospective study including LA performed over 8 years, between 2000 and 2008 in our hospital. RESULTS: A total of 43 LA were performed to 41 patients using a transperitoneal lateral approach. Indications for adrenalectomy included hyperaldosteronism (19), non-functioning adenoma (8), phaeochromocytoma (6), Cushing's syndrome (6), metastasis (3) and adrenal primary tumour (1). Median postoperative hospital stay was 3 days and the median size of the masses was 30mm (range: 4-155mm) Complications occurred in 3 patients (2 respiratory infections, and 1 intraoperative bleeding). There was no mortality. Only one case needed conversion to open adrenalectomy; no patients required reintervention. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective method in the treatment of adrenal masses and it can be performed with minimal risk and morbidity.