Duodenopancreatectomía cefálica y tutorización externa del conducto de Wirsung. Resultados de una serie de 80 casos consecutivos / Pancreaticoduodenectomy and external Wirsung stenting: our outcomes in 80 cases

Introducción: Existe controversia respecto a la técnica ideal de reconstrucción pancreático-yeyunal posresección duodeno-pancreática. La tutorización externa del Wirsung se ha considerado por muchos autores como una técnica con menor incidencia de fístulas y morbimortalidad. Analizamos nuestra experiencia con esta técnica. Pacientes y métodos: Análisis retrospectivo de la morbimortalidad, de una serie de 80 pacientes consecutivos intervenidos, durante 6,5 años, por tumores pancreáticos cefálicos o periampulares realizando resección y pancreático-yeyunostomía con tutorización externa del Wirsung. Resultados: La edad media de los pacientes fue 68,3 ± 9 años y la tasa de resecabilidad del 78%. La consistencia del páncreas era blanda en 51,2% de pacientes y dura en 48,8%. Se preservó el píloro en 43,8%. El tumor más frecuente fue el adenocarcinoma (68,8%) y se consiguió un R0 en 70%. La fístula bioquímica se presentó en 11,2%, la fístula pancreática grado B en 12,5% y la C en 2,5%, mientras que la tasa de reintervención abdominal fue del 10%. La mediana de estancia hospitalaria fue de 16 días y la mortalidad postoperatoria y a 90 días fue del 2,5%. La tasa de retraso del vaciamiento gástrico fue del 36,3%, diabetes de novo del 12,5% e insuficiencia exocrina del 30%. La supervivencia a uno, tres y cinco años fue 80,2, 53,6 y 19,2%. Conclusiones: Aunque nuestras tasas de morbimortalidad con la tutorización externa del Wirsung son bajas, coincidiendo con series más amplias recientemente publicadas, se precisa un análisis comparativo con otras técnicas reconstructivas, con más casos, para elegir la mejor opción después de una duodenopancreatectomía cefálica. (AU)

Introduction: There is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique. Patients and methods: A retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting. Results: Mean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2, 53.6 and 19.2%, respectively. Conclusions: Although our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy. (AU)

Pancreaticoduodenectomy and external Wirsung stenting: Our outcomes in 80 cases.

INTRODUCTION: There is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique. PATIENTS AND METHODS: A retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting. RESULTS: Mean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2%, 53.6% and 19.2%, respectively. CONCLUSIONS: Although our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy.

Enfermedad residual después de cirugía conservadora por cáncer de mama / Residual disease after breast conserving surgery for breast cancer

Objetivo: El objetivo de este estudio es evaluar los factores relacionados con la presencia de tumor residual, después de tumorectomía por cáncer de mama y así poder determinar la óptima distancia tumor-margen de resección que nos garantice la ausencia de enfermedad residual.Material y métodos: Se revisaron retrospectivamente las historias clínicas de 118 pacientes con cáncer de mama, intervenidas inicialmente con tumorectomía en nuestro servicio, durante el período comprendido entre junio de 2004 y diciembre de 2006.Los parámetros analizados fueron: edad, palpabilidad, método diagnóstico, tipo de cirugía inicial y definitiva, tipo histológico, tamaño, invasión vasculolinfática, grado, componente intraductal extenso (CIE), receptores de estrógenos (RE), márgenes quirúrgicos, rescisión y existencia de tumor residual.Resultados: Se demostró tumor residual en el 27%. En el análisis univariante de las variables analizadas, sólo han sido estadísticamente significativas, en relación con la presencia de tumor residual, los márgenes (p = 0,015), el CIE (p = 0,026) y el tamaño (p = 0,025). En el análisis de regresión lineal simple sólo lo fueron los márgenes (p = 0,008) y el CIE (p = 0,025).Conclusiones: Consideramos suficiente para garantizar la ausencia de tumor residual una distancia mínima de 2 mm si no hay CIE. En pacientes con márgenes ≤ 2 mm, la presencia de CIE es una indicación de alto riesgo de enfermedad residual (AU)

Objective: To evaluate which factors are related to the presence of residual tumor after lumpectomy for breast cancer with a view to determining the excisional biopsy margins that guarantee a complete excision.Material and methods: The records of 118 women with invasive breast carcinoma who were treated with lumpectomy in our service between June 2004 and December 2006 were retrospectively reviewed. The parameters evaluated were age, palpability, diagnostic method, type of initial and definitive surgery, histologic type, tumor size, lymphovascular invasion, presence/absence of extensive intraductal component (EIC), estrogen receptors, surgical margins, reexcision, and the presence of residual tumor.Results: Residual disease was found in 27%. In the univariate analysis, only margins (P=.015), EIC (P=.026) and size (P=.025) were significantly associated with the presence of residual tumor. With simple lineal regression analysis, only margins (P=.008) and EIC (P=.025) showed a significant association.Conclusions: We believe that a minimum margin of 2 mm is enough to guarantee the absence of residual breast cancer if there is no EIC. In patients with margins ≤ 2 mm, the presence of EIC is an indication of high risk of residual disease (AU)