RESUMEN
BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.
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Laparoscopía , Neoplasias del Recto , Cirugía Endoscópica Transanal , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Recto/cirugía , Recto/patología , Estudios Retrospectivos , Calidad de Vida , Complicaciones Posoperatorias/cirugía , Cirugía Endoscópica Transanal/métodos , Tempo Operativo , Neoplasias del Recto/patología , Laparoscopía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this study was to assess factors associated with outcomes after surgery for colorectal cancer and to design and internally validate a simple score for predicting perioperative mortality. METHODS: Patients undergoing surgery for primary invasive colorectal cancer in 22 centres in Spain between June 2010 and December 2012 were included. Clinical variables up to 30 days were collected prospectively. Multiple logistic regression techniques were applied and a risk score was developed. The Hosmer-Lemeshow test was applied and the area under the receiver operating characteristic (ROC) curve (AUC, with 95 per cent c.i.) was estimated. RESULTS: A total of 2749 patients with a median age of 68·5 (range 24-97) years were included; the male : female ratio was approximately 2 : 1. Stage III tumours were diagnosed in 32·6 per cent and stage IV in 9·5 per cent. Open surgery was used in 39·3 per cent, and 3·6 per cent of interventions were urgent. Complications were most commonly infectious or surgical, and 25·5 per cent of patients had a transfusion during the hospital stay. The 30-day postoperative mortality rate was 1·9 (95 per cent c.i. 1·4 to 2·4) per cent. Predictive factors independently associated with mortality were: age 80 years or above (odds ratio (OR) 2·76), chronic obstructive pulmonary disease (COPD) (OR 3·62) and palliative surgery (OR 10·46). According to the categorical risk score, a patient aged 80 years or more, with COPD, and who underwent palliative surgery would have a 23·5 per cent risk of death within 30 days of the intervention. CONCLUSION: Elderly patients with co-morbidity and palliative intention of surgery have an unacceptably high risk of death.
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Neoplasias Colorrectales/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Comorbilidad , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Reoperación/estadística & datos numéricos , Adulto JovenRESUMEN
We report a case of anterior inferior pancreaticoduodenal artery aneurysm fissured to the duodenum, which obliged to an emergency operation. This is an infrequent cause of upper gastrointestinal bleeding. Diagnosis, therapeutic options and prognosis of this pathology are discussed.
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Aneurisma Infectado/complicaciones , Enfermedades Duodenales/etiología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Retroperitoneal liposarcomas are unusual tumors. Their biological and clinical features different from other retroperitoneal sarcomas. AIM: To analyze our series of retroperitoneal liposarcomas. PATIENTS AND METHODS: Retrospective study of 10 patients with retroperitoneal liposarcoma diagnosed in the last 16 years at our institution. Symptoms, diagnosis, treatment and prognosis were analyzed. RESULTS: Radical resection was done in all cases. Postoperative mortality was 10%. Complementary treatment was considered in each patient. Recurrent disease occurred in 8 patients (14 recurrences), during follow up. In 42% of them recurrences were resected. Actuarial 5-year survival rate was 44%. CONCLUSION: Poor prognosis of retroperitoneal liposarcoma is due to its high recurrence rate.
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Liposarcoma , Neoplasias Retroperitoneales , Adulto , Anciano , Femenino , Humanos , Liposarcoma/diagnóstico , Liposarcoma/mortalidad , Liposarcoma/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/cirugía , Estudios RetrospectivosRESUMEN
Presentation of a malignant rhabdoid renal tumour. This type of sarcoma which occurs commonly during the paediatric age is exceptional in the adult, this being the reason for reviewing this clinical case and its management. The term rhabdoid includes several types of morphologically similar tumours which make analysis and pathological categorization difficult. A description of the classification criteria and likely origin of the tumour is included.
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Neoplasias Renales , Tumor Rabdoide , Factores de Edad , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Tumor Rabdoide/patologíaRESUMEN
OBJECTIVE: To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. RESULTS: ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. CONCLUSIONS: A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.
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Colangiopancreatografia Retrógrada Endoscópica , Pruebas Diagnósticas de Rutina , Cálculos Biliares/diagnóstico por imagen , Colecistectomía Laparoscópica , Humanos , Estudios ProspectivosRESUMEN
No disponible
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Adulto , Masculino , Humanos , Intestino Delgado , Tomografía Computarizada por Rayos X , Distrofia Miotónica , Radiografía Abdominal , Seudoobstrucción Intestinal , Urgencias MédicasRESUMEN
La hemorragia renal espontánea o síndrome de Wünderlich es una afección de presentación rara pero, dada la situación urgente y en ocasiones vital que plantea, es de gran importancia. La etiología más frecuente es la causa tumoral. El diagnóstico se realiza principalmente por técnicas de imagen. Presentamos dos casos clínicos de este síndrome de origen tumoral y analizamos su diagnóstico y tratamiento (AU)