Localización atípica de tumor glómico en el hígado / Atypical location of a glomus tumor in the liver

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Consideraciones actuales sobre el diagnóstico de metástasis hepática / Current considerations on the diagnosis of hepatic metastasis

La metástasis hepática es frecuente en el curso de diversos tumores primarios y, en ocasiones, esta es la primera en ser diagnosticada. Lograr una certera descripción del hígado metastásico desde el punto de vista funcional y anatómico es indispensable para indicar un tratamiento oportuno. Sobre la base de tales reflexiones se exponen algunos aspectos relacionados con los principales medios de diagnóstico empleados en pacientes con este proceso morboso(AU)

Hepatic metastasis is frequent in the course of diverse primary tumors and, sometimes, this it is the first in being diagnosed. Achieving a precise description of the metastatic liver from the functional and anatomical point of view is indispensable to indicate an opportune treatment. On the base of these statements, some aspects related to the main diagnosis means used in patients with this morbid process are exposed(AU)

Consideraciones actuales sobre el diagnóstico de metástasis hepática / Current considerations on the diagnosis of hepatic metastasis

La metástasis hepática es frecuente en el curso de diversos tumores primarios y, en ocasiones, esta es la primera en ser diagnosticada. Lograr una certera descripción del hígado metastásico desde el punto de vista funcional y anatómico es indispensable para indicar un tratamiento oportuno. Sobre la base de tales reflexiones se exponen algunos aspectos relacionados con los principales medios de diagnóstico empleados en pacientes con este proceso morboso.

Hepatic metastasis is frequent in the course of diverse primary tumors and, sometimes, this it is the first in being diagnosed. Achieving a precise description of the metastatic liver from the functional and anatomical point of view is indispensable to indicate an opportune treatment. On the base of these statements, some aspects related to the main diagnosis means used in patients with this morbid process are exposed.

Alternativas en el tratamiento de pacientes con metástasis hepáticas de origen colorrectal / Alternatives in the treatment of patients with hepatic metastasis of colorrectal origin

La metástasis hepática de origen colorrectal se presenta con frecuencia al diagnosticar el tumor primario, aunque también puede aparecer tiempo después de haber resecado el cáncer. Anteriormente, la afección metastásica era considerada inoperable; sin embargo, los adelantos en la cirugía y la quimioterapia durante los últimos años constituyen opciones terapéuticas eficaces. El tratamiento multidisciplinario de los pacientes, unido a las nuevas técnicas y terapias medicamentosas, han revolucionado la terapéutica de la enfermedad hepática metastásica y ofrecen al afectado una mayor supervivencia, así como mejor calidad de vida. Sobre la base de tales reflexiones, se revisó la bibliografía médica con el propósito de abordar consideraciones importantes relacionadas con los tratamientos quirúrgico y médico de la metástasis antes citada(AU)

The hepatic metastasis of colorrectal origin is frequently presented when diagnosing the primary tumor, although it can also appear time after removing the cancer. Some time ago, the metastatic disorder was considered inoperable; however, the breakthroughs in the field of surgery and chemotherapy during the last years constitute effective therapeutic options. The multidisciplinary treatment of the patients, along with the new medicine techniques and therapies, have revolutionized the therapy of the metastatic hepatic disease and offer to the affected patient a greater survival, as well as better life quality. On the basis of such reflections, the medical literature was reviewed with the purpose of approaching important considerations related to the surgical and medical treatments of the metastasis above mentioned(AU)

Alternativas en el tratamiento de pacientes con metástasis hepáticas de origen colorrectal / Alternatives in the treatment of patients with hepatic metastasis of colorrectal origin

La metástasis hepática de origen colorrectal se presenta con frecuencia al diagnosticar el tumor primario, aunque también puede aparecer tiempo después de haber resecado el cáncer. Anteriormente, la afección metastásica era considerada inoperable; sin embargo, los adelantos en la cirugía y la quimioterapia durante los últimos años constituyen opciones terapéuticas eficaces. El tratamiento multidisciplinario de los pacientes, unido a las nuevas técnicas y terapias medicamentosas, han revolucionado la terapéutica de la enfermedad hepática metastásica y ofrecen al afectado una mayor supervivencia, así como mejor calidad de vida. Sobre la base de tales reflexiones, se revisó la bibliografía médica con el propósito de abordar consideraciones importantes relacionadas con los tratamientos quirúrgico y médico de la metástasis antes citada.

The hepatic metastasis of colorrectal origin is frequently presented when diagnosing the primary tumor, although it can also appear time after removing the cancer. Some time ago, the metastatic disorder was considered inoperable; however, the breakthroughs in the field of surgery and chemotherapy during the last years constitute effective therapeutic options. The multidisciplinary treatment of the patients, along with the new medicine techniques and therapies, have revolutionized the therapy of the metastatic hepatic disease and offer to the affected patient a greater survival, as well as better life quality. On the basis of such reflections, the medical literature was reviewed with the purpose of approaching important considerations related to the surgical and medical treatments of the metastasis above mentioned.

Recurrence of liver metastases from colorectal cancer and repeat liver resection.

OBJECTIVE: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. METHODS: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. RESULTS: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n=27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. CONCLUSION: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection.

Recurrencia de la cirugía de las metástasis hepáticas de cáncer colorrectal y repetición de la resección / Recurrence of liver metastases from colorectal cancer and repeat liver resection

OBJETIVO: el objetivo de este estudio es evaluar la resecabilidad efectividad de las rehepatectomías en metástasis hepáticas de origen colorrectal recidivadas en términos de morbimortalidad, supervivencia global y libre de enfermedad. MÉTODOS: se realizó un estudio retrospectivo de una cohorte prospectiva de pacientes con metástasis hepáticas de origen colorrectal con cirugía de repetición en el Hospital Universitario San Cecilio de Granada de marzo de 2003 hasta junio de 2013. Las variables principales de resultado fueron la supervivencia y la morbilidad antes de los 30 días del postoperatorio. RESULTADOS: un total de 147 pacientes con metástasis hepáticas de origen colorrectal se sometieron a la extirpación quirúrgica durante el periodo de estudio; 61 pacientes presentaron una recidiva hepática de los cuales 34 se sometieron a una cirugía de repetición. La tasa global de supervivencia a 5 y 10 años para los pacientes resecados fue del 48 y el 48%. La estancia media hospitalaria fue de 8,9 ± 3,5 días, la morbilidad del 9% y la mortalidad del 0%. CONCLUSIÓN: las resecciones hepáticas repetidas para las metástasis hepáticas de origen colorrectal constituyen una operación segura y eficaz, con resultados similares a los obtenidos tras una primera resección hepática

OBJECTIVE: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. METHODS: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. RESULTS: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n=27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. CONCLUSION: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection

Tumor desmoplásico de células redondas pequeñas peritoneal. Una entidad infrecuente con un mal pronóstico / Desmoplastic small-round-cell tumor of the peritoneum: An uncommon entity with poor prognosis

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[Acute abdomen due to complicated intramural duodenal haematoma. Report of a case and review of the literature]. / Abdomen agudo por hematoma duodenal intramural complicado. Presentación de un caso y revisión en la literatura.

BACKGROUND: Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. CLINICAL CASE: The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. DISCUSSION: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. CONCLUSIONS: Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

Metástasis hepáticas de origen colorrectal sincrónicas: ¿intervención simultánea o secuencial? / Simultaneous or sequential treatment of liver metastases of colon cancer?: experience in 76 patients

Background: Synchronous liver metastases of colon cancer can be managed with sequential or simultaneous surgical management of the primary tumor and the metastases. Aim: To compare the evolution of patients whose liver metastases were treated sequentially or simultaneously. Material and Methods: Retrospective analysis of 76 patients aged 63 +/- 11 years (67 percent males). In 25, metastases were managed simultaneously and in 51 there were treated sequentially after a period of chemotherapy. All interventions were performed by the same surgeon. Results: Patients treated sequentially had a higher number of metastases andmore lymph nodes involved than their counterparts treated simultaneously. The overall resectability index was 78 percent. Eighteen major and 28 minor hepatic resections were carried out. Significantly more major resections were carried out in the sequential treatment group. Mean hospital stay was 11 days and 20 percent of patients had complications, with no differences between groups. Survival at one, three and five years was 75, 45 and 36 percent in the simultaneous treatment and 76, 49 and 29 percent in the sequential treatment group (with no significant differences between groups). Conclusions: In this group of patients no differences in complications or survival were observed when liver metastases were treated simultaneously or sequentially. However groups were not homogeneous.

Introducción: Existen distintas estrategias para el tratamiento de las metástasis hepáticas de origen colorrectal sincrónicas (MHCRS): cirugía secuencial, según respuesta a quimioterapia, intervención simultá-nea del tumor y las metástasis o cirugía hepática previa al tumor primario; el uso de una u otra estrategia es aún controvertido. Objetivo: Comparar la morbimortalidad y supervivencia en dos grupos de pacientes con MHCRS intervenidos de forma simultánea versus secuencial. Pacientes y Métodos: Definimos las MHCRS como aquellas que se diagnostican antes o durante la intervención del tumor primario. Se comparan dos grupos de pacientes con MHCRS, 25 sometidos a intervención simultánea (grupo 1) y 51 tras quimioterapia (intervención secuencial: grupo 2). La cirugía hepática la realizó el mismo cirujano. Revisamos datos del paciente, del tumor primario, intervención quirúrgica, transfusión perioperatoria, morbimortalidad y supervivencia. Resultados: 76 pacientes, con edad media de 62,79 +/- 11,3 años. El número de metástasis y la invasión ganglionar del tumor primario fueron mayores en el grupo 2 de forma estadísticamente significativa. Índice de resecabilidad: 77,6 por ciento: 18 resecciones hepáticas mayores y 28 menores, con diferencias significativas entre ambos grupos (p = 0,05). La estancia media (10,89 días), Índice de morbilidad (19,7 por ciento) y supervivencia actuarial a 1,3 y 5 años fueron similares (75 por ciento, 45 por ciento y 36 por ciento en el grupo 1 y de 76 por ciento, 49 por ciento y 29 por ciento en el grupo 2). Mortalidad: 1,6 por ciento. Conclusiones: Las MHCRS pueden ser intervenidas de forma simultánea al tumor primario en pacientes seleccionados siempre que el equipo sea especializado. La morbimortalidad y la supervivencia son similares tanto en la intervención simultánea como en la secuencial.

Pancreatitis del surco en el diagnóstico diferencial del adenocarcinoma de páncreas / Groove pancreatitis in the differential diagnosis of pancreatic adenocarcinoma

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