Linitis plastica: current prognostic implication of a classic concept.

BACKGROUND: Despite having been described for several centuries linitis plastica's (LP) prognostic implication remain unclear. OBJECTIVE: To analyze the impact of LP on the survival of patients undergoing gastrectomy for gastric adenocarcinoma. METHOD: A single-center retrospective study of cases of LP diagnosed and confirmed by pathological anatomy has been carried out in a third-level center for 5 years. RESULTS: They were grouped into Linitis Plastica (LP), diffuse non-LP carcinomas (DNLP) and other adenocarcinomas (ADC). 199 gastrectomies performed in the same period of time were included in the comparative analysis. With a median follow-up of 54.5 months (95% CI: 37.0-65.0), the median survival of LP was 14 months (95% CI: 9-27) significantly lower (p = 0.002) compared to DNLP 51.5 months (95% CI: 25-70) and the rest of ADC 62 months (95% CI: 43-68). The OS at 1, 3 and 5 years was statistically worse in the LP group (69, 15, 8%) compared to DNLP (82, 54, 44%) and ADC (89, 63, 54%) (p = 0.073, p <0.001, p <0.001). In the multivariate analysis, LP was identified as an independent risk factor for OS with an HR of 3.26 (p = 0.001). CONCLUSIONS: LP is an independent prognostic factor associated with higher mortality in gastric cancer.

ANTECEDENTES: A pesar de haber sido descrita hace varios siglos, sigue sin estar clara la implicación pronóstica de la linitis plástica (LP). OBJETIVO: Analizar el impacto de la LP en la supervivencia de los pacientes intervenidos de gastrectomía por adenocarcinoma gástrico. MÉTODO: Estudio retrospectivo unicéntrico de los casos de LP diagnosticados en nuestro centro durante 5 años. RESULTADOS: Se agruparon en LP, carcinomas difusos no LP (DNLP) y resto de adenocarcinomas (ADC). En el análisis comparativo se incluyeron 199 gastrectomías realizadas en el mismo periodo de tiempo. Con una mediana de seguimiento de 54.5 meses (intervalo de confianza del 95% [IC 95%]: 37.0-65.0), la supervivencia mediana de la LP fue de 14 meses (IC 95%: 9-27), significativamente menor (p = 0.002) que en los DNLP, que fue de 51.5 meses (IC 95%: 25-70), y que en el resto de los ADC, en los que fue de 62 meses (IC 95%: 43-68). La supervivencia global a 1, 3 y 5 años fue estadísticamente peor en el grupo de LP (69, 15 y 8%) comparado con los grupos de DNLP (82, 54 y 44%) y ADC (89, 63 y 54%) (p = 0.073, p < 0.001 y p < 0.001, respectivamente). En el análisis multivariante se identificó la LP como un factor de riesgo independiente de supervivencia (hazard ratio: 3.26; p = 0.001). CONCLUSIONES: La LP es un factor pronóstico independiente asociado a mayor mortalidad por cáncer gástrico.

[Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma]. / Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único.

INTRODUCTION: We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. MATERIAL AND METHOD: We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). RESULTS: Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 +/- 286.38 pg/ml to 97.89 +/- 121.01 mg/dl (minute 5), 58.58 +/- 58.37 pg/ml (minute 10), 44.62 +/- 54.77 pg/ml (minute 15), and 38.42 +/- 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 +/- 1.04 mg/dl to 10.2 +/- 0.97 mg/dl (minute 5), 10.17 +/- 1.00 mg/dl (minute 10), 10.12 +/- 0.98 mg/ml (minute 15), and 10.09 +/- 1.03 mg/ml (minute 20). The results for ionized calcium were as follows: 4.90 +/- 0.63 mg/dl at induction, 4.84 +/- 0.61 mg/dl (minute 5), 4.84 +/- 0.66 mg/dl (minute 10), 4.82 +/- 0.63 mg/dl (minute 15), and 4.82 +/- 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 +/- 15.3 after excision). CONCLUSIONS: Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease.

Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único / Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma

Introducción. Evaluamos el calcio total en suero (CTS) y el calcio ionizado (CI) y su correlación con la paratirina intacta (iPTH) intraoperatoria en la cirugía del hiperparatiroidismo primario seleccionando los casos que correspondieron a adenoma único. Material y método. Ensayo prospectivo, determinando (iPTH, CTS y CI) y con enmascaramiento en una cohorte de pacientes quirúrgicos (n = 279; 244 válidos para el estudio) que fueron intervenidos en el Departamento de Cirugía del Hospital de Cruces (octubre de 1999 a abril de 2006). Se valoró: CTS, CI e iPTH medida en consulta, en admisión e intraoperatoriamente: inducción anestésica, y cada 5 min tras la exéresis quirúrgica. Resultados. Se logró corregir las concentraciones de calcio e iPTH en 234 (95,9%) pacientes. La iPTH descendió de valores patológicos preoperatorios 294,43 ± 286,38 pg/ml a 97,89 ± 121,01 mg/dl (minuto 5), 58,58 ± 58,37 pg/ml (minuto 10), 44,62 ± 54,77 pg/ml (minuto 15) y 38,42 ± 51,72 pg/ml (minuto 20). El CTS descendió de valores preoperatorios: 10,93 ± 1,04 mg/dl a 10,2 ± 0,97 mg/dl (minuto 5), 10,17 ± 1,00 mg/dl (minuto 10), 10,12 ± 0,98 mg/ml (minuto 15) y 10,09 ± 1,03 mg/ml (minuto 20). El CI ofreció los siguientes resultados: de 4,90 ± 0,63 mg/dl en tiempo de inducción a 4,84 ± 0,61 mg/dl (minuto 5), 4,84 ± 0,66 mg/dl (minuto 10), 4,82 ± 0,63 mg/dl (minuto 15) y 4,82 ± 0,63 mg/dl (minuto 20). Las muestras congeladas fueron concluyentes para tejido paratiroideo (19,56 ± 15,3 tras la exéresis). Conclusiones. La determinación intraoperatoria de CT puede ser de ayuda para predecir la eliminación adecuada de tejido paratiroideo en el hiperparatiroidismo primario cuando no sea posible la determinación intraoperatoria de iPTH. El CI no muestra la misma pauta de descenso (AU)

Introduction. We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. Material and method. We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). Results. Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 ± 286.38 pg/ml to 97.89 ± 121.01 mg/dl (minute 5), 58.58 ± 58.37 pg/ml (minute 10), 44.62 ± 54.77 pg/ml (minute 15), and 38.42 ± 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 ± 1.04 mg/dl to 10.2 ± 0.97 mg/dl (minute 5), 10.17 ± 1.00 mg/dl (minute 10), 10.12 ± 0.98 mg/ml (minute 15), and 10.09 ± 1.03 mg/ml (minute 20).The results for ionized calcium were as follows: 4.90 ± 0.63 mg/dl at induction, 4.84 ± 0.61 mg/dl (minute 5), 4.84 ± 0.66 mg/dl (minute 10), 4.82 ± 0.63 mg/dl (minute 15), and 4.82 ± 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 ± 15.3 after excision). Conclusions. Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease (AU)