RESUMEN
A combination of cytoreductive intervention with the intrahepatic hyperthermic chemotherapy is a well-established treatment of peritoneal carcinomatosis. There are many challenges in establishing a new peritoneal surface malignancy program in a low-income country regarding perioperative safety and resource allocation. We analyzed the retrospective database to determine the immediate surgical outcomes of the first 28 patients with peritoneal carcinomatosis and the impact of the program on allocation of general hospital and human resources. During the preparatory stage, web conferences with international experts established the goals and general requirements of the program, formalized in a written document; and a peritoneal surface malignancy multidisciplinary team was established. The team created the patient selection criteria, perioperative management checklists, and suggested material and staff requirements for surgical and anesthesia services. Twenty-nine cytoreduction were carried out, of which 18 were followed by HIPEC. The average operative time was 6.2 h. The median blood loss was 350 mL, which did not result in additional blood transfusion requirements for the blood bank. No additional nursing and supportive staff were provided for the ICU and the surgical unit. The average postoperative stay was 8.7 days. One patient died with 30-day mortality rate of 3%. Ten patients (34.5%) developed postoperative complications, of which 6 (20.6%) had grade III and higher Clavien-Dindo complications. Establishing a peritoneal surface malignancy program is possible via staged planning, liberal use of international mentors, and thoughtful resource allocation. This new program did not result in a significant redistribution of resources among other service lines of cancer care within the same institution.
RESUMEN
OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58â years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40â mm (2-200)), 9% had resection beyond 1â year of follow-up (3â years (1-20), size at diagnosis: 25â mm (4-140)) and 39% had no surgery (3.6â years (1-23), 25.5â mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1â year (n=1271), size increased in 37% (growth rate: 4â mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477.
Asunto(s)
Cistadenoma Seroso , Neoplasias Pancreáticas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cistadenoma Seroso/diagnóstico , Cistadenoma Seroso/mortalidad , Cistadenoma Seroso/patología , Cistadenoma Seroso/terapia , Europa (Continente) , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Estudios Retrospectivos , Sociedades Médicas , Adulto JovenRESUMEN
Radical surgery for tumors of the left anatomical and surgical segment of the pancreas proved for distal resection in various versions, central resection and enucleation of tumors. The causes of early postoperative complications and mortality in 129 patients aged from 14 to 81 years, operated on for neoplastic lesions of the left anatomical segment of the pancreas in the period from 2009 to 2014 were analysed. The influence of various factors of risk of complications and mortality were studied in particular, extended resection, for tumor invasion of adjacent organs, and adjacent vessels.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias , Neoplasias del Bazo/cirugía , Neoplasias Vasculares/cirugía , Adenocarcinoma/irrigación sanguínea , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Páncreas/irrigación sanguínea , Páncreas/patología , Páncreas/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/irrigación sanguínea , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo , Neoplasias del Bazo/irrigación sanguínea , Neoplasias del Bazo/mortalidad , Neoplasias del Bazo/secundario , Análisis de Supervivencia , Neoplasias Vasculares/irrigación sanguínea , Neoplasias Vasculares/mortalidad , Neoplasias Vasculares/secundarioRESUMEN
The results of treatment of 84 patients for chronic pancreatitis with the biliary hypertension signs were depicted. In 83 patients operative interventions were performed, and in 1--positive results were achieved after pancreatic cyst puncture under ultrasonographic control. In 51 patients the conduction of Frey operation have permitted to achieve a lower pressure inside biliary system, in 25--the additional procedures were applied for a biliary hypertension elimination. In 20 patients a method of pressure measurement in biliary system was used.
Asunto(s)
Conducto Colédoco/cirugía , Vesícula Biliar/cirugía , Páncreas/cirugía , Pancreatectomía/métodos , Seudoquiste Pancreático/cirugía , Pancreatitis Crónica/cirugía , Adulto , Anciano , Conducto Colédoco/diagnóstico por imagen , Conducto Colédoco/patología , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Humanos , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/patología , Pancreatitis Crónica/diagnóstico por imagen , Pancreatitis Crónica/patología , Presión , Estudios Retrospectivos , UltrasonografíaRESUMEN
The results of treatment of 231 patients, suffering tumoral affection of pancreatic left anatomical segment in period of 2009-2013 yrs were analyzed. Individualized approach, using modern technologies, was applied. Radical operations were performed in 129 patients, ageing 14-81 yrs old, including pancreatic distal resections in various modifications, central resection and tumoral enucleation. Possibilities of the extended pancreatic resection performance were studied in conditions of tumoral invasion of adjacent organs, regional vessels, as well as impact of such interventions on postoperative complications and lethality rate. While performing pancreatic subtotal distal resection with simultant resection of affected main venous vessels and adjacent organs the operative intervention risk is enhanced, but possibilities of a radical operations performance in previously considered inoperable patients are expanding.
Asunto(s)
Adenocarcinoma/cirugía , Cistadenocarcinoma/cirugía , Páncreas/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/prevención & control , Adenocarcinoma/irrigación sanguínea , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cistadenocarcinoma/irrigación sanguínea , Cistadenocarcinoma/mortalidad , Cistadenocarcinoma/patología , Femenino , Venas Hepáticas/patología , Venas Hepáticas/cirugía , Humanos , Masculino , Venas Mesentéricas/patología , Venas Mesentéricas/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Metástasis de la Neoplasia , Páncreas/irrigación sanguínea , Páncreas/patología , Neoplasias Pancreáticas/irrigación sanguínea , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Estudios Retrospectivos , Riesgo , Análisis de SupervivenciaAsunto(s)
Laparoscopía/métodos , Páncreas/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/cirugía , Femenino , Humanos , Laparoscopía/instrumentación , Páncreas/diagnóstico por imagen , Páncreas/patología , Pancreatectomía/rehabilitación , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Radiografía , Adulto JovenRESUMEN
Experience of pancreaticoduodenal resection performance was summarized in 163 patients in 2005-2009 yrs. Duodeno(gastro)enterostomy was formed in anterior position, taking an objective to reduce the risk of postoperative gastrostasis occurrence; and formation of invagination ductojejunal anastomosis--for prophylaxis of pancreatogenic complications. External pancreatic duct drainage and medicinal therapy conduction do not guarantee reduction of the postoperative complications occurrence risk.
Asunto(s)
Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreatitis/prevención & control , Complicaciones Posoperatorias , Anastomosis Quirúrgica/métodos , Antiinflamatorios/uso terapéutico , Drenaje/métodos , Neoplasias Duodenales/patología , Duodeno/patología , Duodeno/cirugía , Humanos , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/métodos , Pancreatitis/etiología , Pancreatitis/patología , Pancreatitis/cirugíaRESUMEN
In 2009-2013 yrs in 7 patients, suffering insulin-producing pancreatic tumors, the ASVS-test was conducted, the result of which was compared with data of standard methods of investigation, including abdominal ultrasound, computer tomography and magnetic resonance imaging. The insuloma enucleation was performed in 3 patients, distal subtotal pancreatectomy with splenectomy--in 1 and the completed total pancreatectomy--in 1. The ASVS-test conduction is indicated in patients with diagnosed hyperinsulinism while impossibility to perform a topic diagnosis of insulinoma, in accordance to data of other noninvasive methods of diagnosis.
Asunto(s)
Gluconato de Calcio , Hiperinsulinismo/diagnóstico , Insulinoma/diagnóstico , Páncreas/cirugía , Neoplasias Pancreáticas/diagnóstico , Adulto , Anciano , Gluconato de Calcio/administración & dosificación , Femenino , Humanos , Hiperinsulinismo/complicaciones , Hiperinsulinismo/patología , Hiperinsulinismo/cirugía , Infusiones Intraarteriales , Insulina/sangre , Insulinoma/complicaciones , Insulinoma/patología , Insulinoma/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Páncreas/patología , Pancreatectomía , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Esplenectomía , Tomografía Computarizada por Rayos XRESUMEN
Experience of their own on performance of pancreatic resection interventions, using laparoscopic access, conducted in the clinic in 2009 - 2013 yrs, was presented. In 8 patients laparoscopic distal pancreatic resection was conducted, in 5--laparoscopic enucleation of pancreatic tumor, in 1--laparoscopic pancreaticoduodenal resection. The results were compared with such after open operations, performed in this period of time. There was not a trustworthy difference in the postoperative complications rate, intraoperative blood loss severity and the distal resection duration. The patient stationary treatment duration was trustworthy less after conduction of laparoscopic operations. The intraoperative blood loss severity and duration of laparoscopic enucleation of pancreatic tumor are trustworthy less.
Asunto(s)
Adenocarcinoma/cirugía , Duodeno/cirugía , Páncreas/cirugía , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/patología , Pérdida de Sangre Quirúrgica/prevención & control , Duodeno/patología , Humanos , Laparoscopía , Tiempo de Internación , Páncreas/patología , Pancreatectomía , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de TiempoRESUMEN
An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.7% in performance of saving duodenal outflow of operations of pancreatic juice. Change of the surgical strategy has led to decreased number of postoperative complications by 4.6% and to satisfactory long-term results in 92.6% of the patients.
Asunto(s)
Enfermedades del Conducto Colédoco/cirugía , Descompresión/métodos , Dolor Postoperatorio , Pancreatectomía , Pancreatoyeyunostomía , Pancreatitis Crónica , Dolor Abdominal/etiología , Dolor Abdominal/fisiopatología , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Enfermedades del Conducto Colédoco/etiología , Enfermedades del Conducto Colédoco/fisiopatología , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Pancreatoyeyunostomía/efectos adversos , Pancreatoyeyunostomía/métodos , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/fisiopatología , Pancreatitis Crónica/cirugía , Satisfacción del Paciente , Calidad de Vida , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
In 115 patients, suffering malignant pancreatic tumors as well as those, localized in periampullar zone, a CT angiography was performed preoperatively to study up the variants of vascular anatomy. The data obtained were depicted by a surgeon, anatomic variants of truncus coeliacus and mesenterical vessels were recorded in accordance with classification of Michels, Hiatt. Individualized approach for surgical treatment, using CT angiography data, was applied. In 30 patients the operative intervention with the vessels resection was performed and in 6--a no-touch method. Distal pancreatic resection, using the RAMPS technology. was performed in 7 patients for malignant tumors. Complications have had occurred in 12 (10%) patients, 2 (1.7%) of them died. Lethality after operations with vessels resection have constituted 6.6%. The data on variants of vascular anatomy, obtained preoperatively, have permitted to escape massive intraoperative blood loss with subsequent irreversible necrotic changes in the abdominal cavity organs.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Ampolla Hepatopancreática/diagnóstico por imagen , Vasos Sanguíneos/patología , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Angiografía , Femenino , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/patología , Tasa de Supervivencia , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
Experience of 84 patients treatment for complicated pancreatic gland pseudocysts is presented. Tactics of diagnosis and treatment for complicated pancreatic gland pseudocysts was elaborated and substantiated. Individualized treatment-diagnosis approach provides, first of all, the complications elimination, an adequate surgical treatment of pancreatic gland pseudocyst is possible in late period. For complicated pancreatic pseudocysts treatment miniinvasive methods were used predominantly, when their application is impossible or fails the open procedure is performed.
Asunto(s)
Drenaje/métodos , Páncreas/cirugía , Seudoquiste Pancreático , Adulto , Anciano , Angiografía , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Procedimientos Endovasculares , Femenino , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Hemorragia/cirugía , Humanos , Masculino , Persona de Mediana Edad , Páncreas/irrigación sanguínea , Páncreas/diagnóstico por imagen , Fístula Pancreática/diagnóstico por imagen , Fístula Pancreática/etiología , Fístula Pancreática/cirugía , Seudoquiste Pancreático/complicaciones , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/cirugía , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/etiología , Enfermedades Pleurales/cirugía , Supuración , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
The experience of performance of pancreaticoduodenal resection (PDR) in 412 patients in 1998-2009 yrs for malignant periampullar tumors was analyzed. In 296 patients a standard PDR was done and in 116, with tumoral affection of distal part of common biliary duct and duodenal large papilla - pylorus-preserving PDR Individualized approach was used, exploiting modern technologies of pylorus-preserving PDR: saving gastroduodenal artery, selective ligation of right branch of dorsal pancreatic and lower pancreatoduodenal artery, dorsal and translateral surgical approaches usage. In 26 patients PDR was accomplished with resection of vessels. In 12 patients a no-touch procedure of PDR was applied. There were analyzed the results of application of modified extended lymphadenectomy while PDR performance. Complications had occurred in 29.5% patients, lethality was 2.7%. The survival indices had constituted at average 24 mo--in pancreatic tumors, 48 mo--in tumors of a distal part of common biliary duct and 72 mo--for localized in duodenal large papilla. Introduction of a new methods of PDR would permit to improve an early and late results of treatment.
Asunto(s)
Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/irrigación sanguínea , Neoplasias del Conducto Colédoco/irrigación sanguínea , Neoplasias Duodenales/irrigación sanguínea , Femenino , Humanos , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/irrigación sanguínea , Resultado del TratamientoRESUMEN
The results of pancreaticoduodenal resection (PDR), performed in 163 patients in 2006-2010 yrs, are summarized. In 51 (31.3%) patients the complications have occurred. All the patients are alive. The trustworthy connection was established between the rate of the early postoperative complications occurrence and the volume blood flow velocity in a portal vein as well as index of the common hepatic artery resistance before the operation. The indices of regional hemodynamics influence the results of PDR performance. The simultant vascular resection performance do not impact the operative risk level, when compared with such while a standard resection conduction. The risk of the early postoperative complications occurrence is not influenced by the antisecretory therapy regime choosed, using somatostatin analogues.
Asunto(s)
Arteria Hepática/fisiopatología , Pancreaticoduodenectomía/efectos adversos , Vena Porta/fisiopatología , Adolescente , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenRESUMEN
Experience of pancreaticoduodenal resection (PDR) performance in 81 patients in 2007-2008 yrs was summarized. There were studied up the risk of postoperative gastrostasis occurrence and factors, promoting such a risk lowering. In 24 patients (the main group) gastro- and duodenoenteroanastomosis were formatted in antecolic position, while in 57 (the control group) the gut continuity was restored according to standard method. Postoperative gastrostasis in a control group had occurred in 10 (17.5%) patients, while in the main group this complication was absent. Formation of gastro- and duodenoenteroanastomoses in antecolic fashion and absence of early postoperative complications are considered the factors, trustworthy influencing the risk of postoperative gastrostasis occurring. Application of a pylorus--preserving procedure of PDR had not promoted the risk of raising of postoperative gastrostasis occurrence.
Asunto(s)
Gastroparesia/prevención & control , Enfermedades Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Pancreatoyeyunostomía/métodos , Nutrición Enteral , Vaciamiento Gástrico/fisiología , Gastroparesia/epidemiología , Gastroparesia/etiología , Humanos , Intubación Gastrointestinal , Neoplasias Pancreáticas/cirugía , Índice de Severidad de la EnfermedadAsunto(s)
Cistoadenoma/diagnóstico , Cistoadenoma/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Adolescente , Adulto , Anciano , Cistoadenoma/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Adulto JovenRESUMEN
The experience of application of shortly acting and durably acting preparations--analogues of somatostatin in complex therapy of various pancreatic diseases was summarized. There was established similar efficacy of the preparations in blockade of the pancreatic external secretion and the various duration of their inhibiting influence on the blood flow. The trustworthy differences in the complications frequency and lethality while application of various preparations--analogues of somatostatin were not revealed.
Asunto(s)
Fármacos Gastrointestinales/uso terapéutico , Octreótido/uso terapéutico , Páncreas , Enfermedades Pancreáticas , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/efectos adversos , Humanos , Octreótido/administración & dosificación , Octreótido/efectos adversos , Páncreas/irrigación sanguínea , Páncreas/efectos de los fármacos , Páncreas/metabolismo , Enfermedades Pancreáticas/tratamiento farmacológico , Enfermedades Pancreáticas/metabolismo , Enfermedades Pancreáticas/cirugía , Péptidos Cíclicos/administración & dosificación , Péptidos Cíclicos/efectos adversos , Somatostatina/administración & dosificación , Somatostatina/efectos adversos , Somatostatina/uso terapéutico , Circulación Esplácnica/efectos de los fármacos , Resultado del TratamientoRESUMEN
During 2007-2008 yrs 55 patients, suffering an acute necrotic pancreatitits, were followed up. In the main group 7 patients were included, in the complex treatment of whom the lumbotomy transcutaneous sanation of necrotic foci, using nephroscope, was done. In patients of a control group the conventional operative interventions were performed. In the main group in one patient relaparotomy was performed, all the patients are alive. In a control group in 7 patients relaparotomy was performed, 5 patients died. The results of investigation performed had permitted to recommend the method of the lumbotomy transcutaneous retroperitoneal necrsequestrectomy, using nephroscope, for practical application in the staged treatment of patients, suffering infected pancreonecrosis.