RESUMO
Metastasis of colorectal cancer (CRC) in an adrenal gland develops in 1.8% of cases (in synchrony or in metachrony) for patients with liver metastatic lesion and aggravates for certain prognosis for long-term survival. There are no data concerning colorectal metastasis in an adrenal gland with tumor thrombosis of inferior vena cava (IVC) in world-wide literature. A patient, 57 years old, on 04.29.11 underwent palliative distal sigmoid colectomy in respect of CRC pT3N2M1 (metastatic lesion of liver right lobe). Process stabilization was noticed after 4 courses of polychemotherapy. On 07.28.11 she underwent right-sided hemihepatectomy. She underwent further 4 courses in accordance with the same scheme. On 12.06.13 case-control USI and multi-layer spiral CT of abdominal cavity detected mass lesion in the right adrenal gland, it was estimated as metastatic lesion with compression of inferior vena cava and thrombosis in its lumen at retroliver segment level. Right-sided adrenalectomy. Thrombectomy of IVC was carried out in the condition of total vascular isolation. Taking into account metastasis respectability in an adrenal gland and small extent of a tumor thrombus we suppose the described surgical practice to be justified. The problem of neoadjuvant chemotherapy prescription is still controversial.
Assuntos
Adenocarcinoma , Neoplasias das Glândulas Suprarrenais , Adrenalectomia/métodos , Neoplasias Colorretais , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Compostos Organoplatínicos/administração & dosagem , Trombectomia/métodos , Trombose , Veia Cava Inferior , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Antineoplásicos/administração & dosagem , Capecitabina , Colectomia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Terapia Combinada , Desoxicitidina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Oxaliplatina , Trombose/etiologia , Trombose/cirurgia , Resultado do Tratamento , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaRESUMO
Results of treatment of 124 patients (228 operations) were analyzed. Complication rate was 19.2%, whereas severe complications were observed in 4.3%. Complications, requiring minimally invasive surgery, on the contrary, conservative treatment , as well as risk actors were defined. Possibilities of radio-frequency thermoablation complications prophylaxis were suggested.
Assuntos
Ablação por Cateter/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/métodos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Prognóstico , Reoperação , Estudos RetrospectivosRESUMO
The results of clinical and complex ultrasonic examination of 95 patients with large and gigantic liver non-parasitic cysts (LNC) are analyzed. The morphological examination was performed in all the cases. The mean diameter of large LNC was 105+/-7 mm, of gigantic cysts -- 149+/-33 mm (p<0,05), cyst volume was respectively 600+/-142 and 1721+/-954 ml (p<0,05). Analysis of clinical, ultrasonic and laboratory data allowed to describe three variants of large and gigantic, complicated and non-complicated cysts with 97,9% accuracy. The 3-D US reconstruction permitted to precise the anatomic structure and trace selection during transcutaneous US-assisted treatment.