Complicaciones de la quimioembolización transarterial (QETA) en el tratamiento de los tumores hepáticos / Complications of transarterial chemoembolization (TACE) in the treatment of liver tumors

INTRODUCCIÓN: La quimioembolización transarterial (QETA) es considerada una opción terapéutica utilizada en el tratamiento del carcinoma hepatocelular y de las metástasis hepáticas secundarias del carcinoma colorrectal, tumores neuroendocrinos y melanoma ocular. Aunque es un procedimiento seguro, no está exento de complicaciones, siendo la más frecuente la colecistitis aguda. Otras complicaciones descritas son el tromboembolismo pulmonar, el absceso hepático, lesiones de la mucosa gastrointestinal, lesiones de la vía biliar, etc. El objetivo principal del estudio es revisar y describir las complicaciones derivadas de la QETA en el tratamiento de los tumores hepáticos. MÉTODOS: Se ha realizado un análisis retrospectivo de todas las QETA practicadas en nuestro centro entre enero de 2013 y diciembre de 2016. En dicho periodo se realizaron 322 QETA en 196 pacientes. RESULTADOS: Del total de procedimientos, 258 (80%) fueron realizados en hombres y 64 (20%) en mujeres. Además, la edad media de los pacientes fue de 66,5años. Las complicaciones mayores derivadas de la QETA fueron descompensación edemo-ascítica (6 casos), colecistitis aguda (4), pancreatitis aguda (3), rotura hepática (1), absceso hepático (1) y deterioro de la función renal (1). Además, el síndrome postembolización se objetivó en 71 (22%) casos. En el análisis multivariante se observó que el antecedente cardiovascular (OR: 4,5; IC95%: 1,2-17; p = 0,025) es un factor de riesgo para el desarrollo de complicaciones post-QETA. CONCLUSIONES: Las complicaciones derivadas de la QETA son poco frecuentes y con una baja incidencia de mortalidad

INTRODUCTION: Transarterial chemoembolization (TACE) is considered a therapeutic option. It is mostly used in hepatocellular carcinoma or liver colorectal, neuroendocrine or melanoma metastases. Although it is considered a safe procedure, TACE presents complications, such as acute cholecystitis, which is the most common. Other procedure-related complications include pulmonary embolism, hepatic abscess, bile duct injury, gastric mucosa injury and, less frequently, acute pancreatitis. The aim of this study is to review the complications following TACE for liver tumors. METHODS: We performed a retrospective study including all the TACE procedures performed in a single center during the period between January 2013 and December 2016. RESULTS: Out of the 196 patients with liver tumors who had undergone 322 TACE, 258 (80%) were male and 64 (20%) were female. Mean patient age was 66.5years. Major complications after chemoembolization included: decompensation with edema/ascites (6 patients), acute cholecystitis (4), acute pancreatitis (3), liver rupture (1), liver abscess (1) and renal failure (1). Postembolization syndrome appeared in 71 (20%) patients. On multivariate analysis, it was observed that concomitant cardiovascular disease (OR: 4.5; 95%CI: 1.2-17; P=.025) is a risk factor for the development of complications. CONCLUSIONS: TACE is a safe and effective procedure for liver tumor treatment. The majority of the complications are rare and present a low incidence of mortality

Complications of transarterial chemoembolization (TACE) in the treatment of liver tumors. / Complicaciones de la quimioembolización transarterial (QETA) en el tratamiento de los tumores hepáticos.

INTRODUCTION: Transarterial chemoembolization (TACE) is considered a therapeutic option. It is mostly used in hepatocellular carcinoma or liver colorectal, neuroendocrine or melanoma metastases. Although it is considered a safe procedure, TACE presents complications, such as acute cholecystitis, which is the most common. Other procedure-related complications include pulmonary embolism, hepatic abscess, bile duct injury, gastric mucosa injury and, less frequently, acute pancreatitis. The aim of this study is to review the complications following TACE for liver tumors. METHODS: We performed a retrospective study including all the TACE procedures performed in a single center during the period between January 2013 and December 2016. RESULTS: Out of the 196 patients with liver tumors who had undergone 322 TACE, 258 (80%) were male and 64 (20%) were female. Mean patient age was 66.5years. Major complications after chemoembolization included: decompensation with edema/ascites (6patients), acute cholecystitis (4), acute pancreatitis (3), liver rupture (1), liver abscess (1) and renal failure (1). Postembolization syndrome appeared in 71 (20%) patients. On multivariate analysis, it was observed that concomitant cardiovascular disease (OR: 4.5; 95%CI: 1.2-17; P=.025) is a risk factor for the development of complications. CONCLUSIONS: TACE is a safe and effective procedure for liver tumor treatment. The majority of the complications are rare and present a low incidence of mortality.

Análisis retrospectivo en pacientes con cáncer de vesícula biliar: tratamiento quirúrgico y supervivencia en función del estadio tumoral / A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

Introducción: el cáncer de vesícula biliar es la neoplasia más frecuente de vías biliares y el sexto de los tumores del aparato digestivo, presentando un pronóstico ominoso, con una supervivencia a cinco años alrededor del 5%. Suele diagnosticarse de forma tardía y la única posibilidad de curación es la resección quirúrgica. Métodos: se realizó un estudio retrospectivo en el cual fueron analizados 92 pacientes (64 mujeres y 28 hombres) diagnosticados por anatomía patológica con cáncer de vesícula entre enero de 2000 y enero de 2016. Resultados: La edad media de la serie fue 72 ± 11 años. Los síntomas de los pacientes al ingreso fueron: dolor abdominal (78%), anorexia (77%), náuseas (76%) e ictericia (45%). La cirugía se indicó en los 92 (100%) pacientes y se realizó una resección con intención curativa en 59 (64%) de ellos. Entre los procedimientos quirúrgicos realizados en la cirugía inicial, la colecistectomía simple se efectuó en 69 (75%) y la colecistectomía extendida, en once (11%) pacientes. La cirugía de rescate se realizó en 15 pacientes después del hallazgo tumoral en la pieza de colecistectomía, realizando una resección curativa R0 en diez pacientes. Además, la terapia adyuvante se utilizó en 30 (33%) pacientes. La mediana de la supervivencia de nuestra serie fue de 12,5 meses, con supervivencias del 57%, 30% y 20% a uno, tres y cinco años, respectivamente. Conclusión: en conclusión, en todos los pacientes se debe plantear el tratamiento quirúrgico con resección tumoral completa, siempre y cuando la situación clínica del paciente lo permita

Introduction: gallbladder cancer is the most common biliary neoplasm and the sixth most common tumor of the digestive system. The disease has an ominous prognosis, with a 5-year survival rate of approximately 5%. It is usually diagnosed late and surgical resection is the only potential cure. Methods: a retrospective study was carried out in 92 patients with a pathological diagnosis of gallbladder cancer from January 2000 to January 2016. Results: the mean age of cases was 72 ± 11 years; 64 subjects were females and 28 were males. Symptoms at admission included abdominal pain (78%), anorexia (77%), nausea (76%) and jaundice (45%). Surgery was indicated in 92 (100%) patients and 59 (64%) underwent a curative/intent resection. The initial surgical procedures included simple cholecystectomy in 69 (75%) cases and extended cholecystectomy in eleven (11%) subjects. Rescue surgery was performed in 15 patients with tumor tissue in the cholecystectomy specimen; ten individuals underwent an R0 curative resection. Adjuvant therapy was administered in 30 (33%) patients. The median survival in our series was 12.5 months, with survival rates of 57%, 30% and 20% at one, three and five years, respectively. Conclusion: to conclude, surgical treatment with a complete tumor resection should be considered for all patients, provided that their clinical status allows it

Doble vena cava inferior con doble vena renal izquierda / Double inferior vena cava with double left renal vein

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A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage.

INTRODUCTION: gallbladder cancer is the most common biliary neoplasm and the sixth most common tumor of the digestive system. The disease has an ominous prognosis, with a 5-year survival rate of approximately 5%. It is usually diagnosed late and surgical resection is the only potential cure. METHODS: a retrospective study was carried out in 92 patients with a pathological diagnosis of gallbladder cancer from January 2000 to January 2016. RESULTS: the mean age of cases was 72 ± 11 years; 64 subjects were females and 28 were males. Symptoms at admission included abdominal pain (78%), anorexia (77%), nausea (76%) and jaundice (45%). Surgery was indicated in 92 (100%) patients and 59 (64%) underwent a curative/intent resection. The initial surgical procedures included simple cholecystectomy in 69 (75%) cases and extended cholecystectomy in eleven (11%) subjects. Rescue surgery was performed in 15 patients with tumor tissue in the cholecystectomy specimen; ten individuals underwent an R0 curative resection. Adjuvant therapy was administered in 30 (33%) patients. The median survival in our series was 12.5 months, with survival rates of 57%, 30% and 20% at one, three and five years, respectively. CONCLUSION: to conclude, surgical treatment with a complete tumor resection should be considered for all patients, provided that their clinical status allows it.

Embolización esplénica completa como tratamiento de la ascitis refractaria Postrasplante / Complete splenic embolization for the treatment of refractory ascites after liver transplantation

La ascitis refractaria es una complicación infrecuente que puede aparecer en el posoperatorio de un trasplante hepático y cuyo diagnóstico y tratamiento suponen un verdadero reto. Presentamos dos casos de pacientes trasplantados por cirrosis criptogénica y que en el posoperatorio inmediato cursaron con ascitis refractaria, una complicación grave que se asocia con una disminución de la supervivencia de hasta un año y afecta la calidad de vida del paciente. Tras descartar las principales causas de ascitis en nuestros pacientes, se propuso como etiología el hiperaflujo portal, una condición que se perpetúa con la circulación esplénica y que condiciona una reducción del flujo arterial hepático. Por tanto, si se consigue disminuir el aflujo arterial al bazo, disminuyen el retorno venoso y la circulación portal, mejorando el flujo arterial. Con la embolización esplénica, procedimiento que surgió hace varios años como tratamiento al fenómeno del robo de la arteria esplénica y en los casos de "small for size" en el trasplante de donante vivo, se pretende disminuir el hiperaflujo portal y, por tanto, la ascitis.En conclusión, la embolización de arteria esplénica es una opción terapéutica como tratamiento de la ascitis refractaria en el postrasplante hepático

Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation

Complete splenic embolization for the treatment of refractory ascites after liver transplantation.

Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation.

Tumores malignos primarios de intestino delgado. Análisis de una experiencia de 15 años / Primary malignant tumors of the small intestine: A retrospective analysis of 15 years experience

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Pancreatitis aguda necrosante secundaria a quimioembolización transarterial en pacientes candidatos a trasplante hepático / Acute necrotizing pancreatitis after transarterial chemoembolization in candidates for a liver transplant

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Mucinous appendiceal neoplasms: Incidence, diagnosis and surgical treatment. / Tumores mucinosos del apéndice: incidencia, diagnóstico y tratamiento quirúrgico.

INTRODUCTION: Mucinous tumors of the appendix are a rare pathology, with a prevalence below 0.5%. Clinical presentation usually occurs during the sixth decade of life, and mucinous tumors can clinically mimic acute appendicitis. The aim of this study is to describe the clinical and demographic variables, therapeutic procedure and diagnosis of these tumors. We analyze the association between mucinous tumors and pseudomyxoma peritonei (PP), as well as the association with colorectal and ovarian tumors. METHODS: A retrospective study was performed including patients who underwent an appendectomy between December 2003 and December 2014. RESULTS: Seventy-two mucinous tumors of the appendix were identified among 7.717 patients reviewed, resulting in a prevalence of 0.9%. Mean age at presentation was 64 years, 62% patients were female and 38% males. An incidental diagnosis was made in 43% of patients. Mucinous tumors of low malignant potential were significantly related to the presence of pseudomyxoma peritonei, identified in 16 (22%) of the cases. We also observed an increased risk of ovarian mucinous tumors in patients with a diagnosis of appendiceal mucinous neoplasm. In our sample, 22 (30.5%) patients showed a synchronous or metachronous colorectal cancer. CONCLUSIONS: Appendiceal mucinous tumors are frequently an incidental finding. The diagnosis of mucinous tumors of low malignant potential is a factor associated with the development of pseudomyxoma peritonei. Histologic tumor grade and the presence of peritoneal dissemination will determine surgical treatment that can vary, from appendectomy to cytoreductive surgery.

Tumores mucinosos del apéndice: incidencia, diagnóstico y tratamiento quirúrgico / Mucinous appendiceal neoplasms: Incidence, diagnosis and surgical treatment

Introducción: El tumor mucinoso de apéndice tiene una incidencia inferior al 0,5% entre todos los tumores digestivos. Suele presentarse en la sexta década de la vida, con una clínica parecida a la de la apendicitis aguda. El objetivo de este estudio es describir los aspectos demográficos, clínicos, diagnósticos y terapéuticos de estos tumores. Además, se analiza la asociación entre tumores mucinosos con pseudomixoma peritoneal (PP) y la relación que presentan con los tumores de ovario y colorrectales. Métodos: Se realizó un estudio retrospectivo de todas las apendicectomías practicadas en nuestro centro desde diciembre de 2003 hasta diciembre de 2014. Resultados: Entre 7.717 apendicectomías diagnosticamos un tumor mucinoso apendicular en 72 pacientes, lo que representa una incidencia de 0,9%. La edad media era de 64 años; eran mujeres el 62% y hombres, el 38%. El diagnóstico fue incidental en el 43% de los casos. El PP se presentó en 16 casos (22%), con una asociación estadísticamente significativa entre este tumor y el tumor de bajo potencial maligno. La cirugía programada se realizó en 42 casos y la urgente en 30. De los 72 tumores mucinosos del apéndice, 22 (30,5%) también presentaron cáncer de colon sincrónico o metacrónico. Conclusiones: Los tumores mucinosos de apéndice son con frecuencia hallazgos incidentales. El PP se asocia con un tumor mucinoso de bajo potencial maligno y el tratamiento puede comprender desde una apendicectomía hasta una cirugía citorreductiva, dependiendo del grado histológico del tumor y de la diseminación peritoneal (AU)

Introduction: Mucinous tumors of the appendix are a rare pathology, with a prevalence below 0.5%. Clinical presentation usually occurs during the sixth decade of life, and mucinous tumors can clinically mimic acute appendicitis. The aim of this study is to describe the clinical and demographic variables, therapeutic procedure and diagnosis of these tumors. We analyze the association between mucinous tumors and pseudomyxoma peritonei (PP), as well as the association with colorectal and ovarian tumors. Methods: A retrospective study was performed including patients who underwent an appendectomy between December 2003 and December 2014. Results: Seventy-two mucinous tumors of the appendix were identified among 7.717 patients reviewed, resulting in a prevalence of 0.9%. Mean age at presentation was 64 years, 62% patients were female and 38% males. An incidental diagnosis was made in 43% of patients. Mucinous tumors of low malignant potential were significantly related to the presence of pseudomyxoma peritonei, identified in 16 (22%) of the cases. We also observed an increased risk of ovarian mucinous tumors in patients with a diagnosis of appendiceal mucinous neoplasm. In our sample, 22 (30.5%) patients showed a synchronous or metachronous colorectal cancer. Conclusions: Appendiceal mucinous tumors are frequently an incidental finding. The diagnosis of mucinous tumors of low malignant potential is a factor associated with the development of pseudomyxoma peritonei. Histologic tumor grade and the presence of peritoneal dissemination will determine surgical treatment that can vary, from appendectomy to cytoreductive surgery (AU)