RESUMEN
BACKGROUND AND OBJECTIVES: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Neoplasias Pancreáticas , Humanos , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Estudios Retrospectivos , Pancreatectomía/métodos , Neoplasias Pancreáticas/patología , Neoplasias Renales/cirugía , Neoplasias Renales/patología , RecurrenciaRESUMEN
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Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/diagnóstico , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Colon/patología , Colon , Adenocarcinoma/patologíaAsunto(s)
Humanos , Femenino , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Neoplasias Ductales, Lobulillares y Medulares/complicaciones , Neoplasias Ductales, Lobulillares y Medulares/cirugía , Carcinoma Ductal de Mama/complicaciones , Plexo Braquial/patología , /métodos , Biopsia con Aguja/métodosRESUMEN
Introducción. Tras la implantación en nuestro hospital de los sistemas de prescripción electrónica, presentamos los protocolos farmacoterapéuticos que empleamos en la atención de nuestros pacientes. Material y métodos. Diseño por consenso de 6 protocolos farmacoterapéuticos en una unidad de cirugía coloproctológica y aplicación de éstos durante un período de 2 años. Se excluye del estudio a los pacientes intervenidos de urgencias y a los intervenidos en el programa de cirugía sin ingreso. Resultados. Con este recurso se trató a 772 pacientes. El 28,5% se asignó al protocolo de preoperatorio en cirugía proctológica menor. Una vez intervenidos se incluyó a todos ellos en el protocolo de postoperatorio de cirugía proctológica menor. Se asignó a los 552 pacientes restantes a los protocolos de cirugía colorrectal mayor. El protocolo de preoperatorio en cirugía colorrectal mayor se indicó en 542 casos y su variante para alérgicos a los betalactámicos, en 10 casos. El protocolo postoperatorio asignado dependió de si el paciente tenía colocada una vía venosa central (57,4%) o si, por el contrario, sólo disponía de una o varias vías periféricas (42,6%). Conclusiones. Es responsabilidad de cada unidad clínica la realización y actualización, siempre con las mejores pruebas científicas disponibles, de los protocolos consensuados que se pueden aplicar a los procesos atendidos en ella. La utilización de éstos muestra un alto grado de aceptación por parte de los prescriptores y de enfermería, permitiendo estandarizar la práctica clínica y homogeneizar los procesos asistenciales (AU)
Introduction. Computerized physician order entry was introduced in our hospital. We present the pharmacotherapeutic protocols that we use in patient care. Material and methods. Six pharmaceutical protocols were designed by consensus in a colorectal surgery unit and were applied over a 2-year period. Patients undergoing ambulatory or urgent surgery were excluded. Results. We treated 772 patients. Two hundred twenty patients (28.5%) were assigned to the preoperative protocol for minor proctologic surgery. After surgery, all 220 patients were included in the postoperative protocol for minor proctologic surgery. The remaining 552 patients (71.5%) were assigned to the protocol for major colorectal surgery. The preoperative protocol for major colorectal surgery was indicated in 542 patients (98.2%) and its variant for patients allergic to beta-lactam antibiotics was used in 10 patients (1.8%). The postoperative pharmacotherapeutic protocol assigned depended on whether a central venous line (317 patients; 57.4%) or only peripheral venous access (235 patients; 42.6%) was used. Conclusions. Each clinical unit has a duty to carry out and update consensus protocols (always based on the best scientific evidence available) that can be used in the processes managed in that unit. The use of these protocols shows a high degree of acceptance among physicians and nurses, allowing clinical practice to be standardized and healthcare processes to be homogenized (AU)