ABSTRACT
Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.
Subject(s)
Anastomotic Leak/surgery , Gastrectomy/methods , Gastric Bypass , Stomach Neoplasms/surgery , Surgical Flaps , Digestive System Surgical Procedures/methods , Female , Gastroenterostomy , Humans , Middle Aged , Rectus Abdominis/transplantationABSTRACT
OBJECTIVE: Determine the prognostic significance of metastatic lymph node ratio in 5-year survival of patients after curative distal gastrectomy for advanced gastric carcinoma. MATERIALS AND METHODS: This study survival analysis, prospective, observational, longitudinal, analyzed data from 68 patients with resectable advanced gastric adenocarcinoma treated at the Regional Institute of Neoplastic Disease Luis Pinillos Ganoza during the period 2008-2013. RESULTS: The number of metastatic lymph nodes ranged from 0-29 (mean, 3.9±5.8) and the number of resected lymph nodes understood ranges from 13 to 66 (mean 35.34±12.60). There was no significant correlation between the number of metastatic lymph nodes and number of resected lymph nodes (r=0.208, p=0.089). Survival of the total number at 5 years was 55.9%, with a median survival of 44.11±3.38 months According to regional nodal status (N) of the 7th edition of the UICC, patients with N0 (n=27), pN1 (n=12), pN2 (n=17) and pN3 (n=12) showed survival rates at 5 years of 77.2%, 27.2%, 46.3% and 40% respectively (p=0.005). Patients were stratified into NR0 (reason 0%), NR1 (ratio 1-59%) and NR2 (ratio >60%). Their survival rates at 5 years were 77.2%, 40.9% and 33.3% respectively (p=0.013). CONCLUSIONS: The metastatic lymph node ratio is a predictor system actuarial survival at 5 years compared consistent with regional nodal status (N) classification system of the International Union Against Cancer.
Subject(s)
Adenocarcinoma/surgery , Gastrectomy , Lymph Nodes/pathology , Stomach Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Longitudinal Studies , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prognosis , Prospective Studies , Stomach Neoplasms/diagnosis , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Survival AnalysisABSTRACT
OBJECTIVE: To determine the impact of postoperative infectious complications in the long term survival of patients gastrectomized for gastric carcinoma with curative intent. MATERIALS AND METHODS: The present cohort study evaluated a series of 79 patients diagnosed with resectable advanced gastric carcinoma with curative intent. They were grouped in: Group A (N=28): patients with postoperative infectious complications and Group B (N=51): patients who did not develop postoperative infectious complications. The study covered the years 2008-2013. RESULTS: In group A, the survival rates at 1, 3 and 5 years was 74%, 74% and 47.6% respectively. In group B, the survival rates at 1, 3 and 5 years was 80.3%, 56% and 49.8% respectively (p=0.365). The main postoperative infectious complications not related to the surgical technique were pneumonia (20.3%), followed by urinary tract infection (3.8%). The main postoperative infectious complications related to surgical technique was sepsis (n=5), two of which were related to dehiscence esophagojejunal anastomosis, two bye gastroyeyunal fistula, another bye enterocutaneous fistula and one patient who presented abscess and necrosis peripancreatic's tissue. CONCLUSIONS: There was no impact on survival at 5 years in patients with postoperative infectious complications after gastrectomy with curative intent. However, further studies should be carried over.
Subject(s)
Gastrectomy , Infections/mortality , Postoperative Complications/mortality , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Follow-Up Studies , Humans , Infections/etiology , Male , Middle Aged , Risk Factors , Survival RateABSTRACT
OBJECTIVE: To determine trends in the prevalence and identify the main risk factors associated with the development of pancreatic cancer. MATERIALS AND METHODS: Study of trends in incidence and case-control population consisted of a total of 134 patients. Patients were grouped into: a) CASES: 67 patients diagnosed with pancreatic cancer treated at the Abdomen's Service of the Specialized Surgery Department of the Regional Institute of Neoplastic Diseases "Dr. Luis Pinillos Ganoza "- IREN North during the period 2008 to 2011; and b) CONTROLS: 67 patients diagnosed with gallstones and / or benign biliary disease treated at Belen Hospital in Trujillo during the period 2008 to 2011. RESULTS: The trend curve of incidence of pancreatic cancer showed a curve almost constant throughout the quadrennium 2008 to 2011, with incidence rates of 5.38%, 5.08%, 5.5% and 5.0% respectively. The overall incidence was 5.37%. The trend function was Y = (1756) ± (0.001) (x), with an R2 = 0.318 (p = 0.436). The main risk factors associated with pancreatic cancer were age bigger and equal to 60 years (p = 0.0001), male sex (p = 0.007), diabetes mellitus (p = 0.002) and family history of malignancy (p = 0.016). CONCLUSIONS: The trend in incidence in pancreatic cancer was low and constant in its appearance was significantly influenced by age, gender, and presence of diabetes mellitus and family history of cancer.
Subject(s)
Pancreatic Neoplasms , Adult , Age Factors , Aged , Case-Control Studies , Diabetes Mellitus, Type 2/complications , Female , Humans , Incidence , Male , Middle Aged , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/etiology , Peru/epidemiology , Risk Factors , Sex FactorsABSTRACT
Primary gastric inflammatory myofibroblastic tumor is a rare neoplasm developed from mesenchymal stem cells, infrequently discussed in the scientific literature. Clinical diagnosis through endoscopy and pathology is challenging for the medical team. We report the case of a female patient with gastric obstruction syndrome due to a 10 cm tumor diagnosed with this disease by histology and immunohistochemistry.El tumor miofibroblástico inflamatorio primario gástrico es una neoplasia rara desarrollada de células madre mesenquimales, e infrecuentemente discutido en la literatura científica. El diagnóstico clínico a través de endoscopia y patología es desafiante para el equipo. Nosotros reportamos el caso de una paciente mujer con síndrome de obstrucción gástrica por un tumor de 10 cm diagnosticado con esta enfermedad usando histología e inmunohistoquímica.
Subject(s)
Stomach Neoplasms , Humans , Adult , Female , Peru , Stomach Neoplasms/diagnosis , Retrospective StudiesABSTRACT
OBJECTIVE: Determine the effectiveness of surgical treatment and / or adjuvant to improve the quality of life in patients with colon cancer compared to rectal cancer. MATERIAL AND METHODS: Cohort study that evaluated 27 patients diagnosed with colon adenocarcinoma (Group A= 12) and rectum (Group B= 15) resectable treated at the Institute Regional of Neoplastic Diseases of Trujillo since the 1 January 2008 until 31 July 2009. RESULTS: The overall life quality, as assessed by the QLQ-C 30 at 3 months postoperatively was 67.86 +/- 17.90 points vs. 68.50 +/- 11.94 points respectively for the patients of groups A and B (p = 0.934).The social function was better in patients undergoing surgery for Group A than Group B , (37.50 + 13.36 points vs. 60.00 + 13.69 points, p = 0.018). Body image at 3 months assessed by the QLQ-CR-29 had an average score of 28.12 +/- 6.12 points and 50.00 +/- 25.00 points for Group A y B respectively (p = 0.034). The Group A patients had a mean score at 6 months for sexual function of 33.33 +/- 12.91 points, while Group B patients this average score was 65.00 +/- 22.36 points (p = 0.016). CONCLUSIONS: Both surgeries for colon and rectal cancer are as effective in improving the overall quality of life of these patients, however the social function, body image, and sexual function is better in colon surgery.
Subject(s)
Adenocarcinoma/psychology , Colonic Neoplasms/psychology , Digestive System Surgical Procedures/psychology , Patients/psychology , Quality of Life , Rectal Neoplasms/psychology , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Adenocarcinoma/surgery , Aged , Body Image , Chemotherapy, Adjuvant/psychology , Colonic Neoplasms/drug therapy , Colonic Neoplasms/radiotherapy , Colonic Neoplasms/surgery , Combined Modality Therapy/psychology , Humans , Middle Aged , Organ Specificity , Peru , Postoperative Complications/epidemiology , Postoperative Complications/psychology , Radiotherapy, Adjuvant/psychology , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/surgery , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/psychology , Social Behavior , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate the diagnostic validity of fine-needle capillary cytology (FNCC) in palpable tumours. MATERIAL AND METHODS: A retrospective, single-tray, cross-sectional diagnostic test study was carried out. We reviewed the cytological reports of the case files of the Cytology Unit of the Northern Regional Institute of Neoplastic Diseases (IREN) from January 2012 to December 2016. RESULTS: A total of 332 patients were selected, with an average age of 54.77 years (range 13-90 years); 61.4% of patients were female. The most frequent anatomical sites were lymph nodes (49.7%), thyroid (13.3%), breast (12.3%) and soft tissues (11.4%). Twenty-five cytologies did not have a histological correlation and six showed an atypical result. In the lymph node study, the most frequent pathology was metastatic carcinoma (49.7%), followed by lymphoma (13.3%). The FNCC had a sensitivity of 99.55%, a specificity of 98.77%, a positive predictive value of 99.55% and a negative predictive value of 98.77%. The positive likelihood ratio was 80.63%. CONCLUSIONS: FNCC is a useful, safe, reliable and economical ambulatory technique with minimal complications and high diagnostic accuracy.
ABSTRACT
Los liposarcomas son neoplasias malignas raras que se originan en el tejido adiposo, con mayor frecuencia en el retroperitoneo. De todas las variantes histológicas, el diferenciado es el más común y el de mejor pronóstico. El diagnóstico se establece con pruebas imagenológicas con o sin ayuda de biopsia. El tratamiento consiste en la resección completa del tumor, que puede o no acompañarse de terapia adyuvante. Se presenta el caso de un paciente de 41 años con distensión abdominal y pérdida de peso, en el que se confirma un liposarcoma retroperitoneal mediante una TC abdominal, por lo que fue sometido a una resección quirúrgica completa que resultó exitosa. El paciente se recuperó satisfactoriamente y se mantuvo sin recidivas durante el seguimiento. Se concluye que el diagnóstico y terapéutico varían de acuerdo con las características del tumor y su riesgo de recidiva; por lo que hasta la actualidad continúa siendo un desafío multidisciplinario.
SUMMARY Liposarcomas are rare malignant neoplasms that originate in adipose tissue, most frequently in the retroperitoneum. Of all histological variants, differentiated liposarcoma is the most common and has the best prognosis. Diagnosis is established by imaging tests with or without the aid of biopsy. Treatment consists of complete resection of the tumour, which may or may not be accompanied by adjuvant therapy. We present the case of a 41-year-old patient with abdominal distension and weight loss, who was confirmed to have retroperitoneal liposarcoma by abdominal CT scan and underwent successful complete surgical resection. The patient recovered satisfactorily and remained free of recurrence during follow-up. It is concluded that diagnosis and therapy vary according to the characteristics of the tumour and its risk of recurrence, which is why it remains a multidisciplinary challenge to this day.
ABSTRACT
Introducción: El portafolio educativo sirve como instrumento usado en el proceso de desarrollo de capacidades reflexivas y de aprendizaje autodirigido (AAD) en la formación de profesionales de la salud. El objetivo de la presente investigación de tipo pretest y postest de un solo grupo fue evaluar la efectividad del portafolio virtual autorreflexivo en el aprendizaje autodirigido en los estudiantes del curso de Cirugía I en el semestre académico 2019-I de la Escuela de Medicina de la Universidad Privada Antenor Orrego.Material y métodos.Se analizó una base de datos que incluyó a 189 estudiantes (75 hombres y 114 mujeres). Para la evaluación del AAD se utilizó la escala validada de Fisher, King y Tague, conformada por tres dimensiones y 40 ítems (autogestión: 13 ítems; deseo de aprendizaje: 12 ítems, y autocontrol: 15 ítems).Resultados.En esta cohorte de estudiantes hubo un incremento significativo en la puntuación global del AAD al final del curso, en comparación con su nivel inicial después de la aplicación del portafolio virtual autorreflexivo (p = 0). Asimismo, este instrumento fue efectivo en la mejora en las dimensiones autogestión (p = 0), deseo de aprendizaje (p = 0) y autocontrol (p = 0).ConclusiónEl portafolio autorreflexivo es una herramienta educativa efectiva en la mejora del AAD. (AU)
Introduction: The educational portfolio serves as an instrument used in the process of development of reflective capacities and self-directed learning (SDL) in the training of health professionals. The objective of the present investigation of a single group pre-test and post-test type was to evaluate the effectiveness of the self-reflective virtual portfolio in self-directed learning in students of the Surgery I course in the academic semester 2019-I of the Universidad Privada Antenor Orrego School of Medicine, Trujillo, Perú.Material and methods.A database that included 189 students (75 men and 114 women) was analyzed. For the evaluation of the SDL, the validated scale of Fisher, King and Tague was used, made up of three dimensions and 40 items (self-management: 13 items, desire to learn: 12 items, and self-control: 15 items).Results.In this cohort of students, there was a significant increase in the overall SDL score at the end of the course, compared to its initial level, after the application of the self-reflective virtual portfolio (p = 0). Likewise, this instrument was effective in improving the dimensions of self-management (p = 0), desire to learn (p = 0) and self-control (p = 0).Conclusion.The self-reflective portfolio is an effective educational tool in enhancing SDL. (AU)
Subject(s)
Humans , Self-Directed Learning as Topic , Self-Control , Self-Management , Education, Medical , Health , PeruABSTRACT
El tumor miofibroblástico inflamatorio primario gástrico es una neoplasia rara desarrollada de células madre mesenquimales, e infrecuentemente discutido en la literatura científica. El diagnóstico clínico a través de endoscopia y patología es desafiante para el equipo. Nosotros reportamos el caso de una paciente mujer con síndrome de obstrucción gástrica por un tumor de 10 cm diagnosticado con esta enfermedad usando histología e inmunohistoquímica.
Primary gastric inflammatory myofibroblastic tumor is a rare neoplasm developed from mesenchymal stem cells, infrequently discussed in the scientific literature. Clinical diagnosis through endoscopy and pathology is challenging for the medical team. We report the case of a female patient with gastric obstruction syndrome due to a 10 cm tumor diagnosed with this disease by histology and immunohistochemistry.
ABSTRACT
Introducción: Determinar la efectividad del portafolio electrónico basado en casos combinado con el aula invertida y el aprendizaje basado en equipos en el rendimiento académico.Sujetos y métodos.Estudio cuasi experimental pretest-postest de un solo grupo realizado durante 2020 en 15 estudiantes de medicina (seis varones y nueve mujeres) de un módulo en línea de oncología quirúrgica en la Universidad Privada Antenor Orrego, Trujillo, Perú.Resultados.La puntuación promedio del examen teórico al final (13,8 ± 13,12) fue significativamente más alta que la obtenida al inicio del módulo (8,64 ± 2,29) (aumento promedio de 5,17 ± 0,83; intervalo de confianza al 95%, 3,92-6,43; p < 0,001). La puntuación promedio en el examen clínico objetivo estructurado virtual al final del módulo fue 12,34 ± 2,21.Conclusiones.El modelo de portafolio electrónico basado en casos combinado con el aula invertida y el aprendizaje basado en equipos es efectivo en el rendimiento académico en la enseñanza de oncología quirúrgica. (AU)
Introduction: To determine the effectiveness of the electronic case-based portfolio combined with the flipped classroomand team-based learning on academic performance.Subjects and methods. Quasi-experimental pretest-post study of a single group carried out during the year 2020, in 15medical students (6 men, 9 women) of an online module of surgical oncology at the Antenor Orrego Private University,Trujillo, Peru.Results. The average score of the theoretical exam at the end (13.8 ± 13.12) was significantly higher than that obtained atthe beginning of the module (8.64 ± 2.29) (average increase of 5.17 ± 0.83; 95% confidence interval, 3.92 - 6.43;p <0.001). The average score in the virtual OSCE at the end of the module was 12.34 ± 2.21.Conclusions. The case-based electronic portfolio model combined with the flipped classroom and team-based learning iseffective in academic performance in the teaching of surgical oncology. (AU)
Subject(s)
Humans , Learning , Students, Medical , Surgical Oncology , Education, Medical , General Surgery , ThinkingABSTRACT
This discriptive and retrospective study evaluated 44 patients with histological proven node negative gastric cancer who underwent subtotal gastrectomy (n=42) or total gastrectomy (n=2) at Hospital Belen, Trujillo, Peru, between 1966 and 1996. The main objective was to determine the prognostic factors which influenced the five-year survival rate. There were 23 male, and 21 female (M:F = 1.1:1). Mean age was 60 10 years (which ranged from 26 to 81 years). Pathology mean time was of 16.3 13.6 month (which ranged from 1 to 84 months). The types of lymph node dissections were Do (n=2), D1 (n=29), and D2/D3 (n=3). The postoperative mortality rate was of 15.9%. In the total series, the 5-year survival rate was of 38%; although, this rate increased to 56% in those patients who underwent D1D3 lymphadenectomy. According to univariate analysis, using the log-rank test, prognosis was related with serum level of hemoglobin (p<0.05), clinical stage (p<0.01), curability (p<0.01), and type of lymphadenectomy (p<0.05). The clinical course was not related to age, gender, length of disease, palpable mass, gastric outlet obstructive syndrome, digestive hemorrhage, tumor size, location, macroscopic type, tumor depth, nor histologic type. We concluded that an early detection, the feasibility of a curative resection, and an extended lymphadenectomy were factors that affected survival in an individual patient with gastric cancer without lymph node involvement. These parameters must be considered to stratify patients for an adjuvant treatment.
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This study evaluated 115 patients with complicated primary gastrointestinal cancers which underwent surgical resection at Belen Hospital, Trujillo, Per , since 1966 to 1996, with the aim to determine their clinical-pathological features and to identify some prognostic factors that influenced five-year survival rate in those complicated with obstruction. Median age was 55 19 years (range, 4 to 91 years) and the male: femaleratio was of 1.5: 1. Abdominal pain was the most common symptom (100%). The most frequent complication was obstruction (72%), followed by perforation (17%) and massive haemorrage (11%). The gastric adenocarci noma was most frequently associated w th obstruction and massive haemorrage; whilst perforation ocurred meanly in small bowei neoplasms, especially in lymphomas. Five year survival rate in the total series was of 13%, and this was greater in those cases with obstruction. In patients with gastric outlet obstructive syndrome the tumor size (p<0.05) and macroscopic type (p<0.05) were factors related with the 5 - year - survival rate and in those with intestinal obstruction by colon cancer prognostic factors were the tumor size (p<0.05) and the clinical stage (p<0.05). We concluded that an early diagnosis in these patients is very important to define an opportune surgical treatment.
ABSTRACT
It is postulated that duplications of the intestinal tract have malignant potential. A case of double epidermoid carcinoma derived from a tubular duplication of the terminal ileum is described. The neoplasias came from areas of squamous metaplasia located in the mucosal lining at both ends of the duplication, invading the wall of the duplicated intestine. No metastasizing to the regional lymph nodes appeared. The 32-years-old patient has no longer the disease eleven years after the surgical treatment. The purpose of this paper is to review the literature focusing on etiology, diagnosis and treatment.
ABSTRACT
The gastric leiomyoblastoma is a benign neoplasia -extremely uncommon and potentially malignant-, which arises from the muscular layer of the stomach. We present the case of a 21 year old male patient with this disease, who suddenly had intraperitoneal hemorrhage. He underwent an exploratory operation and the surgical findings showed an ulcerated and bleeding nodular tumor, located on the anterior wall and minor curvature of the gastric antrum, ulcerated and with active bleeding. A distal subtotal gastrectomy was performed, as well as a Billroth II-type gastroenteroanastomosis from the Hoffmeister-Finsterer variety. The anatomopathologic report was, "malignant gastric leiomyoblastoma". We discuss the clinical features and therapeutical options used.
ABSTRACT
This prospective, non-controlled study assessed clinico pathologic features and 5 year survival of 62 patients with gastric cancer seen at Belen Hospital, between 1990 and 1994. Mean age was 59,3 years. There were 38 men and 24 women. Mean length of disease was 16 months. The most frequent symptoms were abdominal pain and pallor. The overall endoscopic and biopsy accuracy was 100% as compared to 94% for endoscopy alone. We found improvement in endoscopy biopsy after obtaining more than 6 biopsies, in Borrmann's types I and II, located in the body or histologically diffuse. Most patients with inoperable and nonresectable disease were women (P = 0,006), had tumors greater than 10cm (p = 0,0001), stages III and IV (p = 0,0001) or diffuse tumors (p = 0,007) as compared with resectable cases. Most nodes were found in the perigastric region. The survival rate was different among patients with inoperable (n=10), non-resectable (n = 1 8), and resectable (n = 34) disease, with the 5-year survival rate being 0%, 0%, and 15%, respectively (p < 0,001). The survival rates of patients were significantly different among DO(n = 8), D1 (n = 9), and D2-D3(n = 17) dissections, with the 5-year survival rate being 0%, 23%, and 41%, respectively (p < 0,0001). The 5 year survival rates for patients who underwent curative and palliative operation were 60% and 7%, respectively (p < 0,0001). The 5-year survival rate for the total series was 10%. We concluded that only the patients that could be submitted to gastric resection had a survival perspective of more than 5 years, mainly those underwent extended lymphadenectomy.
ABSTRACT
Primary or metastatic neoplasms of the small bowel are rare. The most common cause of intestinal intussusceptionin adults are tumors of the small bowel. The intraluminal lesion alters the normal peristalsis of the intestine and permits the displacement of the proximal intestine to the interior of a segment of the distal intestine generally fixed. The preoperative diagnosis is difficult and computed tomography and intestinal barium are the most useful studies in order to define this entity. The management is surgical and consists in the reduction of the affected segment and the surgical resection with margin of mesentery. The prognosis correlates with the result of the histopathological study of the original tumor. The present study analyzes a case of lipoma of small bowel causing intussusception and intestinal occlusion. At laparotomy an ileocecal intussusception caused by an intraluminal tumor in the terminal ileon was evidenced, performing right hemicolectomy and end- to- end ileotransverse colostomy. The microscopic study revealed a lipoma of ileum.
ABSTRACT
Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.
Las dehiscencias anastomóticas en el sitio de gastroyeyunostomía son difíciles de reparar, debido a la compleja anatomía gastrointestinal. Este es el primer estudio que comunica el uso clínico del colgajo del músculo recto abdominal (MRA) para la reparación de la dehiscencia de gastroyeyunostomía. A un paciente con dehiscencia de gastroyeyunostomía, luego de una gastrectomía distal con anastomosis Billrroth II para cáncer gástrico, se le realizó una reparación utilizando colgajo izquierdo del MRA, basado en la arteria epigástrica superior. El colgajo del músculo recto abdominal, después de ser extraído, se fijó a los bordes de la dehiscencia de la gastroyeyunostomía con pocas suturas de vicryl 2-0 interrumpidas. La dehiscencia de la gastroyeyunostomía fue sellada. El colgajo del músculo reto abdominal para el cierre del defecto gastrointestinal es un procedimiento simple, técnicamente fácil y confiable, que puede realizarse rápidamente en pacientes críticamente enfermos. Se puede utilizar para la reparación de un gran defecto gastrointestinal con bordes friables cuando el omento no está disponible o cuando otros métodos convencionales no son prácticos.
Subject(s)
Female , Humans , Middle Aged , Stomach Neoplasms/surgery , Surgical Flaps , Gastric Bypass , Anastomotic Leak/surgery , Gastrectomy/methods , Digestive System Surgical Procedures/methods , Gastroenterostomy , Rectus Abdominis/transplantationABSTRACT
Objetivo: Identificar los principales factores predictivos de recurrencia luego de gastrectomía por carcinoma gástrico avanzado resecable. Material y métodos: Estudio de casos y controles analizó información de una serie total de 61 pacientes con diagnóstico anatomopatológico de carcinoma gástrico resecable atendidos en Instituto Regional de Enfermedades Neoplásicas del Norte "Luis Pinillos Ganoza" de Trujillo - Perú, periodo de enero del 2008 al diciembre del 2015. Resultados: Se evaluaron un total de 61 historias clínicas, las cuales se agruparon en casos (n = 14) y controles (n = 47). Del total de 61 pacientes, en 14 (22,9%) de ellos se observó recurrencia de enfermedad, con un tiempo promedio de recurrencia de 24.02 meses ± 15,95 meses (rango: 2,60 64,40 meses). Se determinó recurrencia de tipo distante en 7 pacientes, el siguiente tipo de recurrencia fue la recurrencia peritoneal en 04 pacientes, finalmente el tipo de recurrencia locorregional solo se presentó en 04 casos. Conclusiones: No hubo diferencias significativas entre los factores de riesgo clínicopatológicos - quirúrgicos evaluados y la recurrencia luego de cirugía por carcinoma gástrico avanzado resecable. Sin embargo, hubo diferencias estadísticamente significativas en la tasa de sobrevida a 5 años en los pacientes que presentaron recurrencia de aquellos que no.
Objetive: To identify the main predictors of recurrence after gastrectomy for resectable advanced gastric adenocarcinoma. Material and methods: Case-control study analyzed information from a total series of 61 patients with an anatomopathological diagnosis of resectable gastric adenocarcinoma treated at the Regional Institute of Neoplastic Diseases of the North "Luis Pinillos Ganoza" of Trujillo - Peru, from January 2008 to December 2015. Results: A total of 61 clinical histories were evaluated, which were grouped into cases (n = 14) and controls (n = 47). Of the total of 61 patients, disease recurrence was observed in 14 (22.9%) of them, with an average recurrence time of 24.02 months ± 15.95 months (range: 2.60 - 64.40 months). Recurrence of distant type was determined in 7 patients, the next type of recurrence was peritoneal recurrence in 04 patients , finally the type of locoregional recurrence only occurred in 04 cases. Conclusions: Therewere no significant differences between the clinical - pathological risk factors evaluated and the recurrence after surgery for resectable advanced gastric carcinoma. However, there were statistically significant differences in the 5year survival rate in the patients who presented recurrence of those who did not.
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Objetivo: Describir y comparar las características clínico anatomopatológicas, pronóstico y sobrevida a 5 años en carcinoma gástrico resecable con linfadenectomia D2 con diámetro tumoral < 10 cm. (SG1) y >10 cm. grande (Sg2). Material y métodos: Cohorte que analizó a 139 pacientes con carcinoma gástrico avanzado con diámetro tumoral < 10 cm (n = 120) y grande resecable > 10 cm (n = 19) con linfadenectomía D2 atendidos en el Instituto Regional de Enfermedades Neoplásicas del Norte, durante el periodo 2009-2014. Resultados: La edad media en el SG1 fue de 60,91 + 13,06 años, mientras que en SG2, fue de 64,84 + 15,01 años respectivamente. En el SG1 los factores pronósticos asociados a la sobrevida fueron el tumor primario (p = 0.007), estado ganglionar regional (p = 0.0001), estadio clínico (p = 0.0001) y el tipo histológico (p = 0.028). En el SG2 las características anatomopatológicas fueron en mayor frecuencia, localización tumoral en el tercio inferior (52,6%), Borrmann III (31,6%), tumor primario T4a (47,4%), estado ganglionar N3b (36,8%), estadio clínico III (78,9%) y tipo intestinal difuso (47,4%). La tasa de sobrevida global a 5 años para el SG1 y SG2 fue 42% vs 13,6% respectivamente (p = 0,001). Conclusiones: Las características clínicas y anatomopatológicas fueron similares en ambos grupos de estudio independientemente del tamaño del tumor. Sin embargo hay diferencia estadísticamente significativa con relación a la sobrevida a 5 años, por lo que este factor pronóstico importante que debería ser incluido en este sistema para una mejor estratificación y manejo individualizado de pacientes.