[Extremity soft tissue sarcoma: does surgical margin impact survival?] / Sarcomas de tejidos blandos en las extremidades: ¿el margen quirúrgico impacta la sobrevida?

Objective: To define the impact of surgical margins on local recurrence (LR), distant recurrence (DR) and overall survival (OS) in patients with soft tissue sarcomas of the extremities (eSTS). Method: Patients treated for a primary eSTS from 2006 to 2010 were analyzed. Rates of local recurrence, distant recurrence, and overall survival were estimated using the Kaplan-Meier method. The association of possible prognostic factors such as local recurrence, metastasis, and survival was performed using the Cox proportional hazards model. Results: 128 patients were analyzed. The surgical margins were positive (R1 resection) in 22.7% and negative in 77.3%. The LR was 27%, the DR was 13% (70% of the population was free of disease at 5 years) and OS at 5 years was 84%. The prognostic factors for OS at 5 years were clinical stage, type and histological grade. The surgical margin had no impact on OS. Conclusions: Although an adequate oncological resection cannot be underestimated, this should be considered in the decision of the optimal treatment of eSTS when amputation or significant functional impairment of the limb is required to obtain negative surgical margins.

Objetivo: Definir el impacto de los márgenes quirúrgicos sobre la recurrencia local (RL), la recurrencia a distancia (RD) y la supervivencia global (SG) en pacientes con sarcomas de tejidos blandos de las extremidades (STBe). Método: Se analizaron pacientes tratados por un STBe primario desde 2006 hasta 2010. Las tasas de recurrencia local, recurrencia a distancia y sobrevida global se estimaron mediante el método de Kaplan-Meier. La asociación de posibles factores pronósticos como recidiva local, metástasis y supervivencia se realizó mediante el modelo de riesgos proporcionales de Cox. Resultados: Se analizaron 128 pacientes. Los márgenes quirúrgicos fueron positivos (resección R1) en el 22.7% y negativos en el 77.3%. La RL fue del 27% y la RD fue del 13% (el 70% de la población está libre de enfermedad a 5 años) y la SG a 5 años fue del 84%. Los factores pronósticos para la SG a 5 años fueron el estadio clínico, el tipo y el grado histológico. El margen quirúrgico no tuvo impacto en la SG. Conclusiones: Aunque no se puede subestimar una resección oncológica adecuada, esto se debe considerar en la decisión del tratamiento óptimo de los STBe cuando se requiere una amputación o un deterioro funcional significativo de la extremidad para obtener márgenes quirúrgicos negativos.

Giant liver teratoma with gliosis peritonei treated by right extended hepatectomy: Overview and case report.

Germ cell tumors (GCTs) are considered as extragonadal if there is no evidence of a primary tumor in the testes or ovaries. GCTs can be classified as seminomas, non-seminomatous, mature teratomas, and immature teratomas based upon histology. Mature teratomas are generally found in prepuberal children. Less than 1% of them have been reported in the gastrointestinal tract and liver. Liver teratomas are extremely rare. There are only 11 cases reported in adults up to 2018. Isolated liver metastasis of ovarian teratoma is also very rare. We present a case of a late metachronous recurrence of liver cystic teratoma with gliosis peritonei in a female adult treated by a right extended hepatectomy along with a literature review.

[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.

Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico.

INTRODUCTION: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. OBJECTIVES: Determine risk factors for early catheter dysfunction that result in the need for replacement. METHODS: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. RESULTS: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). CONCLUSIONS: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement.