RESUMEN
BACKGROUND: The standard treatment of T2-T3ab,N0,M0 rectal cancers is total mesorectal excision (TME) due to the high recurrence rates recorded with local excision. Initial reports of the combination of pre-operative chemoradiotherapy (CRT) and transanal endoscopic microsurgery (TEM) have shown reductions in local recurrence. The TAU-TEM study aims to demonstrate the non-inferiority of local recurrence and the improvement in morbidity achieved with CRT-TEM compared with TME. Here we describe morbidity rates and pathological outcomes. PATIENTS AND METHODS: This was a prospective, multicentre, randomised controlled non-inferiority trial including patients with rectal adenocarcinoma staged as T2-T3ab,N0,M0. Patients were randomised to the CRT-TEM or the TME group. Patients included, tolerance of CRT and its adverse effects, surgical complications (Clavien-Dindo and Comprehensive Complication Index classifications) and pathological results (complete response in the CRT-TEM group) were recorded in both groups. Patients attended follow-up controls for local and systemic relapse. TRIAL REGISTRATION: NCT01308190. RESULTS: From July 2010 to October 2021, 173 patients from 17 Spanish hospitals were included (CRT-TEM: 86, TME: 87). Eleven were excluded after randomisation (CRT-TEM: 5, TME: 6). Modified intention-to-treat analysis thus included 81 patients in each group. There was no mortality after CRT. In the CRT-TEM group, one patient abandoned CRT, 1/81 (1.2%). The CRT-related morbidity rate was 29.6% (24/81). Post-operative morbidity was 17/82 (20.7%) in the CRT-TEM group and 41/81 (50.6%) in the TME group (P < 0.001, 95% confidence interval 42.9% to 16.7%). One patient died in each group (1.2%). Of the 81 patients in the CRT-TEM group who received the allocated treatment, 67 (82.7%) underwent organ preservation. Pathological complete response in the CRT-TEM group was 44.3% (35/79). In the TME group, pN1 were found in 17/81 (21%). CONCLUSION: CRT-TEM treatment obtains high pathological complete response rates (44.3%) and a high CRT compliance rate (98.8%). Post-operative complications and hospitalisation rates were significantly lower than those in the TME group. We await the results of the follow-up regarding cancer outcomes and quality of life.
Asunto(s)
Neoplasias del Recto , Microcirugía Endoscópica Transanal , Humanos , Microcirugía Endoscópica Transanal/métodos , Resultado del Tratamiento , Estudios Prospectivos , Calidad de Vida , Recurrencia Local de Neoplasia/patología , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Quimioradioterapia , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/métodos , Estadificación de NeoplasiasRESUMEN
Retroperitoneal primitive neuroectodermal tumour is an uncommon disease. The main treatment consists of surgical resection, which can require resection of great vessels, depending on the location. We present a single case of a 19-year-old male with a large tumour. To achieve R0 resection we needed to remove the vena cava. Venous flow reconstruction was performed with a cava prosthesis.
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Tumores Neuroectodérmicos Primitivos/patología , Tumores Neuroectodérmicos Primitivos/cirugía , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Adulto , Implantación de Prótesis Vascular , Humanos , Masculino , Venas Cavas/cirugíaRESUMEN
INTRODUCTION: Mucinous adenocarcinoma on perianal fistula is a rare entity; it could be underdiagnosed because it behaves often as a regular perianal fistula. MATERIALS AND METHODS: We have recently treated four cases in our unit. We present them and review the literature, emphasizing on clinical characteristic and therapeutic options. The four patients were male with a mean age of 64. Three of them were classified as locally advances cases and therefore treated with neoadjuvant therapy. RESULTS: All of them underwent laparoscopic abdominoperineal escisión. Surgical specimens are described and clinical characteristic specified. Review of the literature shows that this disease has a very high potential risk of local recurrence and we must be aggressive with the resection. Sometimes plastic surgery is needed to reconstruct the perianal wound. CONCLUSIONS: Mucinous adenocarcinoma associated with anal fistula is a rare disease. Neoadjuvant chemoradiotherapy followed by an adequate abdominoperineal excision may result in favourable outcomes.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/patología , Neoplasias del Ano/complicaciones , Neoplasias del Ano/patología , Fístula Rectal/complicaciones , Fístula Rectal/patología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
We evaluate 5-year results of a prospective randomized trial that compared cyclosporine microemulsion (CsA-me) and Tacrolimus (Tac) for primary immunosuppression. One hundred one adult patients undergoing liver transplantation were randomized to receive Tac (n = 50) or CsA-me (n = 51). The most frequent indication for the procedure was cirrhosis due to virus C followed by alcoholism. Survival rates at 1, 3, and 5 years were 86%, 75%, and 72%, respectively; there was no significant difference between CsA-me versus Tac arms. Acute rejection occurred in 30 cases (30%), independent of the type of primary immunosuppression. Serious adverse events were reported significantly more among patients under CsA-me (48 episodes) than under Tac (32 episodes). Nineteen patients were switched to the other calcineurin inhibitor. The switch was much more frequent from CsA-me to Tac (n = 15; 29.4%), mainly because of lack of efficacy (n = 10; 19.6%). There were no cases of chronic rejections in the Tac arm. Four patients were switched from Tac to CsA-me for side effects; only 1 remains alive, after treatment was changed from CsA-me to an antimetabolite. There were no statistical differences in renal dysfunction, diabetes, hypertension, neurologic disorders, new-onset malignancies, or infections. There were no differences in survival or rejection among the intention-to-treat groups. Serious adverse events, total patients with switch of calcineurin inhibitor, as well as switches due to lack of efficacy, were statistically more frequent under CsA-me. Tacrolimus seems to be a more appropriate drug to be used for primary immunosuppression in liver transplantation.
Asunto(s)
Ciclosporina/uso terapéutico , Trasplante de Hígado/inmunología , Tacrolimus/uso terapéutico , Ciclosporina/administración & dosificación , Emulsiones , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Cirrosis Hepática Alcohólica/cirugía , Trasplante de Hígado/mortalidad , Periodo Posoperatorio , Reoperación/estadística & datos numéricos , Análisis de Supervivencia , Factores de TiempoRESUMEN
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Humanos , Masculino , Persona de Mediana Edad , Aneurisma Falso/complicaciones , Arterias , Hemorragia Gastrointestinal/etiología , Seudoquiste Pancreático/complicacionesRESUMEN
Retroperitoneal primitive neuroectodermal tumour is an uncommon disease. The main treatment consists of surgical resection, which can require resection of great vessels, depending on the location. We present a single case of a 19-year-old male with a large tumour. To achieve R0 resection we needed to remove the vena cava. Venous flow reconstruction was performed with a cava prosthesis (AU)
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Tumores Neuroectodérmicos Primitivos/patología , Tumores Neuroectodérmicos Primitivos/cirugía , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular , Venas Cavas/cirugíaRESUMEN
The occurrence of small bowel intussusception due to metastatic lung cancer is very infrequent. We present a case of young man recently diagnosed of non small cell lung cancer that had a unique small intestine metastasis. We discuss the diagnostic and therapeutic issues (AU)