Resultados tras resección hepática laparoscópica: una opción adecuada en patología maligna / Results after laparoscopic liver resection: An appropriate option in malignant disease

Introducción El abordaje laparoscópico no ha tenido una gran difusión en la cirugía hepática, aunque ha demostrado ser seguro y factible en pacientes seleccionados incluso en enfermedad maligna. Se presenta la experiencia y resultados en el tratamiento de la enfermedad hepática maligna por laparoscopia. Material y método Entre febrero de 2002 y mayo de 2011 se realizaron 71 resecciones hepáticas laparoscópicas, 43 por enfermedad maligna (solo se incluyó a pacientes con más de un año de seguimiento). La edad media fue de 63 años y el 58% fueron varones. El 49% de las lesiones estaban situadas en los segmentos ii - iii . Se realizaron 30 segmentectomías, 7 resecciones limitadas y 6 hepatectomías mayores. Resultados El tiempo operatorio fue de 163 min. Hubo 3 conversiones. Cinco casos (11%) fueron transfundidos. La ingesta se inició a las 32 h y la estancia hospitalaria fue de 6,7 días. No hubo reintervenciones y sí un caso de mortalidad. Nueve pacientes (21%) presentaron complicaciones. El número medio de lesiones resecadas fue 1,2, con un tamaño de 3,5 cm. Todas las resecciones fueron R0. La supervivencia fue del 69 y del 43,5% a los 36 y 60 meses en metástasis hepáticas de cáncer colorrectal (MHCCR), y del 89 y 68% a los 36 y 60 meses en hepatocarcinoma (HCC).Conclusiones La resección hepática por laparoscopia en enfermedad maligna es factible y segura. Debe cumplir los mismos preceptos oncológicos que la cirugía abierta. En pacientes seleccionados ofrece resultados oncológicos a largo plazo similares a los obtenidos en cirugía abierta (AU)

Introduction Treatment of oesophageal cancer with curative intent requires a multidisciplinary approach. Neoadjuvant therapy, the radicality of resection and extension of lymphadenectomy have been associated with increased operative morbidity and mortality. The aim of this study was to assess the results of surgical treatment of oesophageal cancer since the presence of an interdisciplinary esophagogastric tumour board. Methods Patients with cancer of the oesophagus and oesophagogastric junction who underwent oesophagectomy between January 2005 and March 2012 were included in this retrospective study. Data concerning type of resection, postoperative complications, mortality and survival were analysed. Results Of the 392 patients with a diagnosis of oesophageal cancer over the study period, 100 underwent oesophagectomy. Seventy-four patients received neoadjuvant treatment. Eighty-two patients underwent transthoracic resection while a transhiatal was used in 10 patients. Colon interposition was required in 8 cases. An R0 resection was achieved in 98 patients. Anastomotic leaks developed in 15 patients, 9 were intrathoracic and 6 were cervical. Postoperative morbidity occurred in 42% of patients, and intra-hospital and 90-day mortality was 2%. Median length of hospital stay was 16 days. The respective actuarial survival at 1 and 5 years were 82% and 56%.ConclusionsSurgical treatment with curative intention for oesophageal cancer is only possible in a quarter of patients diagnosed. The high morbidity rate was mainly due to intrathoracic complications (AU)

[Results after laparoscopic liver resection: an appropriate option in malignant disease]. / Resultados tras resección hepática laparoscópica: una opción adecuada en patología maligna.

INTRODUCTION: The laparoscopic approach is not yet widely used in liver surgery, but has proven to be safe and feasible in selected patients even in malignant disease. The experience and results of a hepato-pancreato-biliary (HPB) surgery unit in the treatment of malignant liver disease by laparoscopic approach is presented. MATERIAL AND METHODS: Between February 2002 and May 2011, 71 laparoscopic liver resections were performed, 43 for malignant disease (only patients with more than one year of follow-up were included). Mean age was 63 years old and 58% of the patients were male. Forty-nine per cent of the lesions were located in segments ii-iii. Thirty segmentectomies were performed, 7 limited resections and 6 major hepatectomies. RESULTS: The median operative time was 163 min. There were 3 conversions. Five cases (11%) required blood transfusion. The oral intake began at 32 h and the median hospital stay was 6.7 days. There were no reoperations and there was one case of mortality. Nine patients (21%) had postoperative complications. The mean number of resected lesions was 1.2, with an average size of 3.5 cm. All resections were R0. The median survival after resection of colorectal liver metastases (CLM) was 69% and 43.5% at 36 and 60 months, respectively, and 89% and 68% at 36 and 60 months, respectively, in hepatocellular carcinoma (HCC). CONCLUSION: The laparoscopic liver resection in malignant disease is feasible and safe in selected patients. The same oncological rules as for open surgery should be followed. In selected patients it offers similar long-term oncological results as open surgery.