RESUMO
BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.
Assuntos
Neoplasias Duodenais , Tumores Neuroendócrinos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Resumen Introducción: La resección duodenal distal (RDD) es una técnica quirúrgica compleja e infrecuente usada para el tratamiento de patologías duodenales o extraduodenales, que no comprometen la papila duodenal mayor, siendo su indicación más frecuente la patología neoplásica. Objetivo: Dar a conocer nuestra experiencia con esta técnica quirúrgica. Materiales y Método: Serie de pacientes sometidos a RDD entre 2009-2020 en el Hospital Clínico UC. Resultados: Total 12 pacientes, mediana de edad 56 años. Diagnóstico preoperatorio: tumores primarios duodenales (4), tumores con compromiso duodenal por contigüidad (5) y patologías de urgencia (3). El abordaje fue abierto en 9 pacientes y laparoscópico en 3 (1 caso convertido). En 9 pacientes se resecó D3-D4, en 1 paciente incluyó parte de D2 y en 2, sólo D4. La anastomosis duodenoyeyunal fue manual en 10 casos, todas con ascenso transmesocólico del asa yeyunal. Hubo 33% (n: 4) de morbilidad, todos Clavien Dindo II y 8% de mortalidad (n: 1). No hubo filtración de la anastomosis duodenoyeyunal. En el seguimiento ninguno presentó complicaciones y 4 pacientes fallecieron por progresión oncológica. Conclusión: La principal indicación quirúrgica fue patología neoplásica y en nuestra serie no hubo morbilidad mayor ni filtración anastomótica.
Introduction: Distal duodenal resection is a complex and infrequent surgical technique used for the treatment of duodenal or extraduodenal pathologies that do not compromise the greater duodenal papilla, the most frequent indication being the neoplastic cause. Aim: To publicize our experience with this surgical technique. Materials and Method: Series of patients undergoing a distal duodenal resection between 2009-2020 at the UC Clinical Hospital. Results: Total 12 patients, median age 56 years. Preoperative diagnosis: primary duodenal tumors (4), tumors with duodenal involvement due to contiguity (5), and emergency pathologies (3). The approach was open in 9 patients and laparoscopic in 3 (1 converted). D3-D4 was resected in 10 patients, 1 included part of D2 and 2 only D4. The duodenojejunal anastomosis was manual in 10 cases, all with transmesocolic ascending of the jejunal loop. There were 33% (n: 4) morbidity, all Clavien Dindo II, and 8% mortality (n: 1). There was no leakage of the duodenojejunal anastomosis. During followup, none presented complications and 4 patients died of oncological progression. Conclusion: The main surgical indication was neoplastic pathology and in our series, there was no major morbidity or anastomotic leak.
Assuntos
Humanos , Masculino , Feminino , Duodenopatias/cirurgia , Neoplasias Duodenais/cirurgia , Resultado do Tratamento , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Neoplasias Duodenais/diagnóstico , Período PerioperatórioRESUMO
ABSTRACT BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.
RESUMO CONTEXTO: Tumores neuroendócrinos da papila duodenal (TNE-PD) são raros. A cirurgia deve ser recomendada para o tratamento. No entanto, apresentam altas taxas de morbimortalidade. A papilectomia endoscópica (PE) é segura e eficaz para a ressecção completa de tumores nesta região. OBJETIVO: Descrever uma série de casos de TNEs-PD ressecados por PE e realizar uma revisão da literatura. MÉTODOS: Pacientes com TNEs-PD submetidos a PE como tratamento primário com intenção curativa entre jan/2008 e mar/2020 em um centro de referência terciário foram estudados. Uma pesquisa abrangente foi feita no MEDLINE. A estratégia de busca foi desenhada para encontrar todos os artigos relacionados a TNEs-PD publicados na literatura, que haviam sido submetidos a PE. RESULTADOS: Seis pacientes foram submetidos a PE por apresentar TNEs-PD, sendo quatro mulheres, com média de idade de 66 anos (22-96). O diâmetro médio dos TNEs-PD foi de 1,8±0,4 cm. Quatro dos seis pacientes foram acompanhados, um dos quais sofreu recidiva no local da ressecção após 3 meses e foi encaminhado para cirurgia (pT3n1b), e os três pacientes restantes não apresentaram recorrência endoscópica ou histológica durante os períodos de acompanhamento de 10, 7 e 4 anos, respectivamente. Dezoito artigos foram encontrados no MEDLINE. Os artigos incluíram relatos de casos de TNEs-PD tratados pela PE. CONCLUSÃO: A PE é segura e eficaz para TNEs-PD ≤20 mm, confinados à camada submucosa, bem diferenciados e sem metástases locais ou remotas. Acompanhamento endoscópico adequado e tratamento cirúrgico definitivo na vigência de recidiva são necessários.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Neoplasias Duodenais , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Pessoa de Meia-Idade , Recidiva Local de NeoplasiaRESUMO
INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.
Assuntos
Ingestão de Alimentos , Derivação Gástrica/métodos , Obstrução da Saída Gástrica/cirurgia , Trânsito Gastrointestinal , Neoplasias/complicações , Cuidados Paliativos/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias Duodenais/complicações , Feminino , Neoplasias da Vesícula Biliar/complicações , Obstrução da Saída Gástrica/etiologia , Humanos , Laparoscopia/métodos , Laparotomia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Neoplasias Pancreáticas/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/complicações , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: The mechanisms of brain metastasis are incompletely understood. Circulating tumor cells travel to the right heart and through the pulmonary circulation, where they may become lung metastases, and can circulate further to the left heart and brain. In patients who develop brain metastases without lung involvement, we hypothesized that cancer cells may travel directly from the right atrium to left atrium via a patent foramen ovale (PFO), akin to paradoxical embolism. If the prevalence of PFO is greater in these individuals compared to the general population (20-30%), PFO may play a role in brain metastasis, and prophylactic closure may provide benefit. Accordingly, we investigated the prevalence of PFO in patients with brain metastases without prior lung involvement. METHODS: We prospectively identified patients with brain metastases from a non-lung primary cancer with no preceding or concurrent lung involvement. Nine eligible participants underwent a transcranial Doppler study with intravenous agitated saline to assess for PFO. RESULTS: Among nine participants, primary cancers were breast (n = 6), upper gastrointestinal (n = 2), and thyroid (n = 1). A positive bubble study was identified in 2/9 (22.2%) participants: one female with breast cancer and one male with duodenal adenocarcinoma. No participants developed lung metastases on subsequent chest imaging. CONCLUSION: In this prospective pilot study, we found a similar prevalence of PFO in patients who developed brain metastases without preceding lung involvement compared to estimates for the general population. Through a larger study is needed, the development of brain metastases in these individuals may primarily reflect tumor-specific biological factors diecting metastasis organotropism.
Assuntos
Neoplasias Encefálicas/secundário , Forame Oval Patente/epidemiologia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Circulação Cerebrovascular/fisiologia , Neoplasias Duodenais/patologia , Neoplasias Esofágicas/patologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/patologia , Neoplasias Gastrointestinais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Estudos Prospectivos , Circulação Pulmonar/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Solução Salina/administração & dosagem , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia Doppler Transcraniana , Manobra de ValsalvaRESUMO
Tubulovillous adenomas of the duodenal ampulla are rare neoplasms. The present report describes a case with radiological-endoscopic and pathological correlation in which the patient underwent duodenal pancreatectomy with good postoperative progression. With advanced imaging methods, especially magnetic resonance and endoscopic ultrasound, locoregional aspects and extraluminal, lymphovascular, and metastatic invasion have been increasingly discussed as contributors to therapeutic decision making. This progression improves lesion staging and is especially useful in selecting eligible candidates for endoscopic treatment.
Assuntos
Adenoma , Adenoma/cirurgia , Neoplasias Duodenais , Endoscopia , Endossonografia , Humanos , RadiografiaRESUMO
Resumen Introducción: Las lesiones duodenales son infrecuentes. Objetivo: Caracterizar a los pacientes con lesiones duodenales observados entre enero de 2008 y diciembre de 2013 en el Servicio de Salud Metropolitano Sur, en Santiago de Chile. Materiales y Método: Se obtuvieron los datos de los registros del Hospital Barros Luco Trudeau y Hospital El Pino. Los pacientes incluidos fueron los observados entre enero de 2008 y diciembre de 2013. Se analizaron edad, género, características clínicas, localización, métodos diagnósticos, hallazgos anatomopatológicos y tratamiento. El 24 de abril de 2019 se obtuvo la fecha de fallecimiento de todos los pacientes del Registro Civil. El análisis estadístico se realizó con el software STATA 15.1. Resultados: Se encontraron 157 pacientes con lesiones duodenales, 65 presentaron adenocarcinoma duodenal y 71 pacientes pólipos duodenales, 25 de ellos fueron adenomas. Análisis univariado de sobrevida evidenció que los pacientes con pólipos asociado a carcinoma y los adenocarcinomas duodenales, presentaron una sobrevida inferior (p = 0,013, HR 6,584 y p < 0,001, HR 7,604, respectivamente). En los pacientes con adenocarcinoma duodenal, aquellos que se sometieron a una cirugía con intención curativa, y aquellos que recibieron quimioterapia tuvieron una sobrevida global mejor que aquellos que no recibieron terapia (p < 0,001, HR 0,351 y p = 0,001, HR 0,276, respectivamente. Discusión: La incidencia estimada del adenocarcinoma duodenal en nuestra población es de 1,1 por cada 100.000 habitantes, la que es más alta que otras publicadas. Proponemos estudio endoscópico en poblaciones de riesgo y tratamiento con intención curativa para los pacientes con adenocarcinoma duodenal sin metástasis a distancia.
Introduction: Duodenal lesions are infrequent. Aim: To characterize patients with duodenal lesions observed between January 2008 and December 2013 at the Southern Metropolitan Health Service, in Santiago, Chile. Materials and Method: Data were obtained from the Barros Luco Trudeau Hospital and El Pino Hospital records. The patients included were those observed between January 2008 and December 2013. Age, gender, clinical characteristics, location, diagnostic methods, anatomopathological findings and treatment were analyzed. On April 24th 2019 was obtained the date of death of all patients at the National Civil Registry. The statistical analysis was performed with the software STATA 15.1. Results: 157 patients with duodenal lesions were found, 65 presented duodenal adenocarcinoma and 71 patients had duodenal polyps, 25 of them were adenomas. Univariate analysis of survival showed that patients with polyps associated with carcinoma and duodenal adenocarcinomas had a lower survival rate (p = 0.013, HR 6.584 y p < 0.001, HR 7.604, respectively). In patients with duodenal adenocarcinoma, those who underwent surgery with curative intent, and those who receive chemotherapy had a better overall survival than those who did not received therapy (p < 0.001, HR 0.351 y p = 0.001, HR 0.276, respectively). Discussion: We propose endoscopic study in at-risk populations and treatment with curative intent for patients with duodenal adenocarcinoma without distant metastases. The estimated incidence of duodenal adenocarcinoma in our population is 1.1 per 100,000 inhabitants and seem to be higher than other published.
Assuntos
Humanos , Masculino , Feminino , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/epidemiologia , Taxa de Sobrevida , Estudos de Coortes , Distribuição por Sexo , Distribuição por IdadeRESUMO
SUMMARY Tubulovillous adenomas of the duodenal ampulla are rare neoplasms. The present report describes a case with radiological-endoscopic and pathological correlation in which the patient underwent duodenal pancreatectomy with good postoperative progression. With advanced imaging methods, especially magnetic resonance and endoscopic ultrasound, locoregional aspects and extraluminal, lymphovascular, and metastatic invasion have been increasingly discussed as contributors to therapeutic decision making. This progression improves lesion staging and is especially useful in selecting eligible candidates for endoscopic treatment.
RESUMO Os adenomas túbulo-vilosos da ampola duodenal são neoplasias raras. Neste trabalho apresentamos um caso com correlação radiológico-endoscópica e patológica, tendo a paciente sido submetida à duodenopancreatectomia com boa evolução pós-operatória. Com os avanços dos métodos de imagem, em especial da ressonância magnética e ultrassonografia endoscópica, aspectos locorregionais, além da invasão extraluminal, linfovascular e metastática, têm sido discutidos de maneira crescente como contribuintes na decisão terapêutica. Essa evolução contribui para o melhor estadiamento destas lesões e é especialmente útil para selecionar candidatos elegíveis ao tratamento endoscópico.
Assuntos
Humanos , Adenoma/cirurgia , Radiografia , Endossonografia , Neoplasias Duodenais , EndoscopiaRESUMO
BACKGROUND: Periampullary adenocarcinoma is a major clinical problem in high-risk patients including FAP population. A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of AV using this cap-assisted endoscopy (CAE) approach to standard forward-viewing endoscopy (FVE). We also determined: (i) the rates of complications and additional sedation; (ii) the mean time required for duodenal examination; and (iii) the reproducibility among endoscopists performing this procedure. METHODS: We performed esophagogastroduodenoscopy for AV visualization in 102 > 18 years old using FVE followed by CAE. Video recordings were blinded and randomly selected for independent expert endoscopic evaluation. RESULTS: The complete visualization rate for AV was higher in CAE (97.0%) compared to FVE (51.0%) (p < 0.001). The additional doses of fentanyl, midazolam, and propofol required for CAE were 0.05, 1.9 and 36.3 mg. in 0.9, 24.5, and 77.5% patients, respectively. The mean time of duodenal examination for AV visualization was lower on CAE compared to FVE (1.41 vs. 1.95 min, p < 0.001). Scopolamine was used in 34 FVE and 24 CAE, with no association to AV complete visualization rates (p = 0.30 and p = 0.14). Three more ampullary adenomas were detected using CAE compared to FVE. Cap displacement occurred in one patient, and there was no observed adverse effect of the additional sedatives used. Kappa values for agreement between endoscopists ranged from 0.60 to 0.85. CONCLUSIONS: CAE is feasible, reproducible and safe, with a higher success rate for complete visualization compared to FVE. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02867826 , 16 August 2016.
Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Adolescente , Ampola Hepatopancreática/diagnóstico por imagem , Neoplasias do Ducto Colédoco/diagnóstico por imagem , Neoplasias Duodenais/diagnóstico por imagem , Endoscopia , Endoscopia do Sistema Digestório , Humanos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Given the lack of evidence on the best adjuvant approach, this review closely examines optimal adjuvant management for resected true ampullary cancer and its histological subtypes. MATERIALS AND METHODS: A comprehensive literature search of PubMed was performed to identify studies on resected true ampullary cancers, published between January 2010 and December 2018. Data including the use of radiation, chemotherapy or chemoradiation and the outcomes were extracted. RESULTS: A total of 116 records were identified, of which 65 screened were selected. Finally, nine studies were included. Only two of the studies reported separately the outcomes of pancreatobiliary and intestinal subtypes. Patients in the selected studies were treated with a pancreaticoduodenectomy with negative margins. Patients treated with adjuvant therapy were more likely to be pT3-4 and have positive nodes; median survival ranged from 30 to 47 months. A significant benefit for adjuvant treatment was observed in four of the studies, restricted to patients at stage IIB or higher. Likewise, patients with positive nodes may have a longer median survival with adjuvant chemoradiation compared to observation. CONCLUSIONS: The present review suggests a benefit for adjuvant treatment for patients with locally advanced tumors. Randomized trials are needed to ascertain the topic, as well as studies reporting toxicity and quality of life of resected true ampullary cancer patients.
Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco/terapia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/terapia , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Carcinoma/patologia , Carcinoma/cirurgia , Carcinoma/terapia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Ductal Pancreático/terapia , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Neoplasias Duodenais/terapia , Humanos , Pancreaticoduodenectomia , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Duodenal type follicular lymphoma is a rare malignancy accounting for less than 4% of primary non-Hodgkin lymphomas of the gastrointestinal tract and it is a new entity that was recently described in the new update WHO 2016. Data regarding long-term outcome are currently lacking, and for that reason, a consensus on the management of this disease has not been established and treatment. We report a case of a 57-year-old female patient diagnosed with duodenal- type follicular lymphoma grade 3a who was treated with R-CHOP. The aim of this study is to add more data for a greater characterization of the entity and thus select the best management for each case.
Assuntos
Neoplasias Duodenais , Linfoma Folicular , Neoplasias Duodenais/classificação , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/patologia , Feminino , Humanos , Linfoma Folicular/classificação , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/patologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Periampullary neoplasms account for over 30,000 cancer-related deaths per year in the United States. Pancreaticoduodenectomy (PD) is considered the surgical standard and is the only curative treatment option for these pathologies. OBJECTIVE: The objective of this study was to report the prognostic factors in survival and surgical complications in PD. MATERIALS AND METHODS: A total of 178 cases are reported, several variables were reviewed and the same surgical technique was used by the same surgeon. RESULTS: A total of 151 PD were reviewed. The most common initial symptoms were jaundice, 111 (73%), abdominal pain, 20 (13%), and oral intolerance, 10 (6%). Poor prognostic factors for survival were the presence of a previous pathology, days of hospitalization, positive margins, and weight loss. DISCUSSION: With the experience gained, a decrease in surgical time, intraoperative bleeding, and transfusions performed was achieved. Our complication rate remained at 20%, lower than that reported in literature. CONCLUSION: PD is the only option of cure for patients with pancreatic and periampullary tumors. This procedure has been linked to high morbidity and mortality even in high-volume centers. A pancreatic fistula is the most feared complication; therefore, multiple pancreatojejunostomy techniques have been described in literature. It is important to continue reporting these cases to reach a consensus on this technique.
ANTECEDENTES: Las neoplasias periampulares suponen más de 30.000 muertes relacionadas con el cáncer por año en los EE.UU. La pancreaticoduodenectomía (PD) se considera el estándar quirúrgico y es la única opción de tratamiento curativo para esta enfermedad. OBJETIVO: Reportar los factores de pronóstico en la supervivencia y las complicaciones quirúrgicas de la PD. . MÉTODO: Se reportaron 178 casos; se revisaron varias variables y se utilizó la misma técnica quirúrgica por el mismo cirujano. RESULTADOS: Se revisaron 151 DP. Los síntomas iniciales más comunes fueron ictericia (111; 73%), dolor abdominal (20; 13%) e intolerancia oral (10; 6%). Los factores de pronóstico para la supervivencia fueron la presencia de patología previa, los días de hospitalización, los márgenes positivos y la pérdida de peso. DISCUSIÓN: Con la experiencia adquirida, se logró una disminución del tiempo quirúrgico, del sangrado intraoperatorio y de las transfusiones realizadas. Nuestra tasa de complicaciones se mantuvo en un 20%, inferior a la reportada en la literatura. CONCLUSIÓN: La PD es la única opción de curación para los pacientes con tumores pancreáticos y periampulares. Este procedimiento se ha relacionado con una alta morbilidad y mortalidad incluso en centros de alto volumen. La fístula pancreática es la complicación más temida, por lo que se han descrito numerosas técnicas de pancreatoyeyunostomía. Es importante seguir informando de estos casos para llegar a un consenso sobre esta técnica.
Assuntos
Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias Duodenais/mortalidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of 5-10% and a morbidity of 20-40%. OBJECTIVE: To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013. METHOD: Historical, observational and descriptive cohort carried out in the department of sarcomas and tumors of the upper digestive tube of the Oncology Hospital of Centro Médico Nacional Siglo XXI, postoperative pancreatoduodenectomy from 2008 to 2013. RESULTS: We included 71 patients who underwent pancreatoduodenectomy, 47 (66.2%) were female and 24 (33.8%) were male. The average age was 60.3 years. The most common histology was cancer of the Vater's ampulla (66.2%). The resections were R0 in 95.8% of the cases. Mortality was 4.22% and morbidity was 69%. The most frequent complication was pancreatic fistula (23.9%). In the statistical analysis, perioperative transfusion was associated with surgical complications (p < 0.007). CONCLUSIONS: The morbidity of pancreatoduodenectomy is greater than that reported in the literature, however, it does not influence mortality that is similar to that reported in other centers. The number of lymph nodes resected; as well as the percentage of negative margins are those accepted worldwide; It is concluded that this is derived from the experience of the center where these procedures are performed. No factor with statistical significance was found, only the transfusion that increased the complications.
INTRODUCCIÓN: Los tumores de páncreas y los tumores periampulares tienen una presentación clínica similar. La pancreatoduodenectomía representa la única posibilidad de curación o de aumentar la sobrevida, con una mortalidad promedio del 5-10% y una morbilidad del 20-40%. OBJETIVO: Determinar la morbilidad y la mortalidad secundarias a la intervención de pancreatoduodenectomía en pacientes con cáncer de páncreas o tumores periampulares en el Hospital de Oncología del Centro Médico Nacional SXXI de 2008 a 2013. MÉTODO: Cohorte histórica, observacional y descriptiva, realizada en el departamento de sarcomas y tumores de tubo digestivo alto del Hospital de Oncología del Centro Médico Nacional Siglo XXI, operados de pancreatoduodenectomía entre 2008 y 2013. RESULTADOS: Se incluyeron 71 pacientes que se sometieron a pancreatoduodenectomía; 47 (66.2%) eran de sexo femenino y 24 (33.8%) de sexo masculino. La edad promedio fue de 60.3 años. La histología más común fue cáncer de ámpula de Vater (66.2%). Las resecciones fueron R0 en el 95.8% de los casos. La mortalidad fue del 4.22% y la morbilidad fue del 69%. La complicación más frecuente fue la fístula pancreática (23.9%). En el análisis estadístico, la transfusión perioperatoria se asoció a complicaciones quirúrgicas (p < 0.007). CONCLUSIONES: La morbilidad de la pancreatoduodenectomía es mayor que lo reportado en la literatura; sin embargo, no influye en la mortalidad, que es similar a lo reportado en otros centros. El número de ganglios resecados, así como el porcentaje de márgenes negativos, son los aceptados internacionalmente. Se concluye que esto se deriva de la experiencia del centro donde se realizan estos procedimientos. No se encontró ningún factor con relevancia estadística, excepto la transfusión, que incrementaba las complicaciones.
Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Especializados , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: Pancreaticoduodenectomy (PD) is a procedure associated with significant morbidity and mortality. Initially described as gastropancreaticoduodenectomy (GPD), the possibility of preservation of the gastric antrum and pylorus was described in the 1970s. AIM: To evaluate the mortality and operative variables of PD with or without pyloric preservation and to correlate them with the adopted technique and surgical indication. METHOD: Retrospective cohort on data analysis of medical records of individuals who underwent PD from 2012 through 2017. Demographic, anthropometric and operative variables were analyzed and correlated with the adopted technique (GPD vs. PD) and the surgical indication. RESULTS: Of the 87 individuals evaluated, 38 (43.7%) underwent GPD and 49 (53.3%) were submitted to PD. The frequency of GPD (62.5%) was significantly higher among patients with pancreatic neoplasia (p=0.04). The hospital stay was significantly shorter among the individuals submitted to resection due to neoplasias of less aggressive behavior (p=0.04). Surgical mortality was 10.3%, with no difference between GPD and PD. Mortality was significantly higher among individuals undergoing resection for chronic pancreatitis (p=0.001). CONCLUSION: There were no differences in mortality, surgical time, bleeding or hospitalization time between GPD and PD. Pancreas head neoplasm was associated with a higher indication of GPD. Resection of less aggressive neoplasms was associated with lower morbidity and mortality.
Assuntos
Gastrostomia/mortalidade , Gastrostomia/métodos , Pancreaticoduodenectomia/mortalidade , Pancreaticoduodenectomia/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/cirurgia , Índice de Massa Corporal , Colangiocarcinoma/mortalidade , Colangiocarcinoma/cirurgia , Neoplasias Duodenais/mortalidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Pancreatite Crônica/mortalidade , Pancreatite Crônica/cirurgia , Gravidez , Antro Pilórico/cirurgia , Piloro/cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do TratamentoAssuntos
Adenocarcinoma/complicações , Anemia/etiologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Duodenais/complicações , Neoplasias do Jejuno/complicações , Neoplasias Pulmonares/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Duodenais/secundário , Humanos , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , MasculinoRESUMO
INTRODUCTION AND AIMS: Neuroendocrine tumors are of great scientific interest, given that they are difficult to diagnose and treat. Despite being relatively rare (< 1/100,000 individuals, 1-2% of the gastrointestinal neoplasias) and indolent, their potential malignancy must not be forgotten. An increase in the number of diagnosed tumors has been observed in recent years. The aim of the present study was to update a published case series of 19 patients suspected of presenting with pancreatic neuroendocrine tumor with 51 current cases, to study and compare the new results with those of the previous case series, as well as with other recent publications from Spain, the United States, China, and India. MATERIALS AND METHODS: A retrospective, multicenter case series was conducted on 70 patients (19 cases published in 2011), whose data has been collected over a period of 23 years. The variables analyzed were: age, sex, symptomatology, tumor size, location, metastasis, final diagnosis, and surgery, among others. RESULTS: Mean patient age was 55 years and 60% of the patients were men. Disease location was the pancreatic head in 28.5% of the patients and the tail in 27.1%, mean tumor size was 3.9cm (0.2-10cm), 71.4% of the patients had non-functioning tumors, 32.8% had metastases (100% to the liver), 74.2% of the patients were operated on, and actuarial survival was 75%. CONCLUSIONS: Differences were observed between the previously published case series and the current results. There was an increase in incidentalomas and non-functioning tumors, but no variation in the overall survival rate. The differences with other case series (age, sex, and tumor location) were dependent on the country where the cases were compiled. The increase in tumors could be related to a higher number of diagnoses made through imaging studies and to the greater sensitivity of the devices employed.
Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/diagnóstico , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/diagnóstico por imagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Adenocarcinomas of the ampulla of Vater account for 0.5% of malignant neoplasms of the gastrointestinal tract and 6% to 20% of malignant periampullary neoplasms, with most patients being candidates for elective surgery. Our objective was to evaluate the clinicopathological prognostic factors of ampullary adenocarcinomas after surgical resection in a Mexican population. From the records of the Department of Pathology at the Instituto Nacional de Cancerología, México, cases diagnosed as adenocarcinomas of the ampulla of Vater were selected over a period of 11 years, from January 2005 to September 2015. Cases with a pancreaticoduodenectomy report were included, and from each case, demographic and pathological data of the surgical specimen were obtained. Univariate and multivariate statistical analyses were performed using the log-rank test and Cox regression. Of 157 cases diagnosed as ampullary adenocarcinomas, 104 patients were excluded as not eligible for surgical treatment at the time of diagnosis. In the remaining 53 patients, a pancreaticoduodenectomy was performed. The mean age of the entire group was 55.4 years, and most were men. Intestinal-type adenocarcinomas were more frequent (77.4%) than pancreatobiliary-type (15.1%), with most being without perineural invasion, well to moderately differentiated, and less than 3 cm in size. Lymph node metastasis and age greater than 65 years had a negative impact on overall survival of the patients. The most convenient classification of malignant epithelial tumors of the Vaterian system is according to the histopathologic phenotype grouped into intestinal-, pancreatobiliary-, and mixed-type adenocarcinomas, as well as uncommon variants.