Obstrucción intestinal secundaria a aneurisma de arteria hipogástrica / Intestinal obstruction secondary to hypogastric artery aneurysm

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Asociación de tumores del estroma gastrointestinal con otros tumores primarios. Propuesta de una nueva clasificación / Additional primary malignancies in patients with gastrointestinal stromal tumors. Proposal for a new classification

La asociación de gastrointestinal stromal tumor (GIST, «tumor del estroma gastrointestinal») con otras neoplasias primarias en un mismo paciente es un hecho no solo frecuente, sino con un interés creciente en la literatura científica. Esta asociación tiene una enorme importancia tanto por el desafío clínico, diagnóstico y terapéutico como por el impacto pronóstico que implica. En las series publicadas existe una tendencia a agrupar a estos pacientes para determinar que los GIST asociados a otras neoplasias tienen características concretas y diferenciables. Por el contrario, no existe un consenso general ni una clasificación unificada. Esta clasificación sería de gran interés, pues permitiría unificar criterios, consensuar los grupos para comparar las distintas series y demostrar si realmente la etiopatogenia subyacente a ambos tumores y las características del propio GIST varían según el tipo de que se trate. Realizamos una revisión de la literatura médica actual y una propuesta de nueva clasificación para pacientes con GIST asociados a otros tumores (AU)

Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST) is not only common but of growing interest in the scientific literature. This association is of great importance in terms of clinical challenge, diagnosis and therapy as well as for the prognosis impact it implies. In the published series there is a tendency to group these patients to determine the specific and distinguishable characteristics of GIST associated with other malignancies. On the other hand, there is no general consensus or unified classification. This classification would be of great interest, as it would unify criteria, agree groups to compare different series and demonstrate whether the aetiology underlying both tumours and the GIST’s own characteristics really vary according to the type in question. We undertook a medical literature review and proposed a new classification for patients with GIST associated with other tumours (AU)

[Additional primary malignancies in patients with gastrointestinal stromal tumors. Proposal for a new classification]. / Asociación de tumores del estroma gastrointestinal con otros tumores primarios. Propuesta de una nueva clasificación.

Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST) is not only common but of growing interest in the scientific literature. This association is of great importance in terms of clinical challenge, diagnosis and therapy as well as for the prognosis impact it implies. In the published series there is a tendency to group these patients to determine the specific and distinguishable characteristics of GIST associated with other malignancies. On the other hand, there is no general consensus or unified classification. This classification would be of great interest, as it would unify criteria, agree groups to compare different series and demonstrate whether the aetiology underlying both tumours and the GIST's own characteristics really vary according to the type in question. We undertook a medical literature review and proposed a new classification for patients with GIST associated with other tumours.

Extracción de un cuchillo ingerido impactado en el esófago mediante endoscopia flexible / Removal of an ingested knife impacted in the esophagus using flexible endoscopy

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Resección hepática por laparoscopia: lecciones aprendidas tras 132 resecciones / Laparoscopic liver resection: lessons learned after 132 resections

Introducción Tras 20 años de experiencia en cirugía hepática laparoscópica, aún no están bien definidos el mejor abordaje (totalmente laparoscópico [CTL] o asistido con la mano [CLA]), indicaciones quirúrgicas, posición, instrumentación, resultados postoperatorios inmediatos y a largo plazo, etc. Objetivo Presentar nuestra experiencia en resecciones hepáticas laparoscópicas (RHL).Pacientes y método En 10 años hemos realizado 132 RHL en 129 pacientes: 112 tumores malignos (90 metástasis hepáticas; 22 tumores malignos primarios) y 20 lesiones benignas (18 tumores benignos; 2 quistes hidatídicos). Veintiocho casos se realizaron por CTL y 104 por CLA. Técnica quirúrgica: 6 hepatectomías derechas (2 como segundo tiempo de una resección hepática en 2 tiempos); 6 hepatectomías izquierdas; 9 resecciones de 3 segmentos; 42 resecciones de 2 segmentos; 64 resecciones de un segmento y 5 casos de resecciones locales. Resultados No existió mortalidad perioperatoria. Morbilidad: 3%. Con CTL se completó la resección en 23/28 casos, mientras que con CLA se completó en los 104 casos. Transfusión 4,5%; tiempo quirúrgico 150 min y estancia media de 3,5 días. La supervivencia a 1, 3 y 5 años de los tumores malignos primarios fue del 100, 86 y 62%, mientras que la supervivencia de las metástasis colorrectales fue del 92, 82 y 52%, respectivamente. Conclusión La RHL, tanto por CTL como por CLA, en casos seleccionados, reproduce los resultados de la cirugía abierta (morbimortalidad y supervivencia a 5 años similares), con las ventajas de la cirugía mínimamente invasiva (AU)

Introduction After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. Aim To report our experience in laparoscopic liver resections (LLRs).Patients and method Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. Surgical technique: 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. Results There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150 min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. Conclusion LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery (AU)

[Laparoscopic liver resection: lessons learned after 132 resections]. / Resección hepática por laparoscopia: lecciones aprendidas tras 132 resecciones.

INTRODUCTION: After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. AIM: To report our experience in laparoscopic liver resections (LLRs). PATIENTS AND METHOD: Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. SURGICAL TECHNIQUE: 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. RESULTS: There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. CONCLUSION: LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery.