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Antecedentes: los programas fast-track en cirugía hepática muestran ventajas con respecto al manejo perioperatorio tradicional al favorecer principalmente una disminución de la estancia hospitalaria y, por ende, de los costos hospitalarios. Material y métodos: en un estudio observacional y descriptivo se analizan resecciones hepáticas abiertas dentro de un programa de recuperación rápida, haciendo especial hincapié en la adherencia a este, la recuperación total de los enfermos, la morbilidad y la estancia hospitalaria. Resultados: se realizaron 32 hepatectomías en 30 pacientes, 27 de los cuales fueron oncológicos. La adherencia al programa utilizado fue del 78,1% y la recuperación total al momento del alta del 75%. La morbilidad fue del 12,5% y las complicaciones fueron de baja complejidad, aunque 2 pacientes necesitaron reingresar. La estancia hospitalaria tuvo una media de 3,4 días y, sumando los reingresos, de 3,6 días. Conclusión: la aplicación de un ERP en cirugía hepática no solo es factible sino trae aparejada como principal beneficio una disminución en la estancia hospitalaria y, por ende, de los costos. Pero no estamos convencidos de que un ERP mejore la morbilidad de los pacientes.

Background: Background: Fast-track programs in liver surgery offer advantages over traditional perioperative management, particularly in terms of reducing length of hospital stay and hospital costs. Material and methods: We conducted an observational and descriptive analysis of patients undergoing open liver resections as part of an enhanced recovery program. Adherence to the program, full recovery of the patients, complications and length of hospital stay were assessed. Results: A total of 32 liver resections were performed in 30 patients, 27 with cancer. The adherence to the program was 78.1% and full recovery on discharge was 75%. The incidence of complications was 12.5%; most of them were not severe but two patients required rehospitalization. Mean length of hospital stay was 3.4 days and 3.6 days when readmissions were considered. Conclusion: The implementation of an ERP after liver resections is feasible and offers advantages in terms of reducing length of hospital stay and hospital costs. We do not think that ERP improves morbidity in these patients.

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INTRODUCCIÓN: El 20-40% de las metástasis hepáticas de origen colorrectal son de tipo sincrónico. Actualmente existen tres estrategias quirúrgicas; dos de ellas proponen resecciones diferidas, y la otra, la resección simultánea. OBJETIVO: evaluar los resultados a corto y largo plazo de las resecciones simultáneas. MÉTODO: Evaluamos 212 metástasis hepáticas sincrónicas resecadas en dos centros y comparamos las intervenidas de forma simultánea con aquellas de manera diferida. Evaluamos las características demográficas, las resecciones hepáticas y las características de las metástasis. También evaluamos la morbimortalidad. RESULTADOS: Fueron resecados de manera simultánea con el tumor primario 63 pacientes, y no hubo diferencias significativas en las características demográficas. Hubo más resecciones mayores (p = 0.005) en el grupo de las diferidas. La morbimortalidad fue comparable. La insuficiencia hepática (p = 0.037) fue mayor en el grupo de las diferidas. La morbilidad fue del 33.2% en las diferidas y del 10.1% en las simultáneas (p = 0.256). La mortalidad fue del 2.83% en las diferidas y del 0.94% en las simultáneas (p = 0.508). CONCLUSIÓN: Los resultados a corto y largo plazo en ambos grupos son similares. Queda el interrogante de si la necesidad de una hepatectomía mayor favorecería la elección de un tratamiento diferido. INTRODUCTION: Between 20 and 40% of liver metastases from colorectal tumor are synchronous. Three types of surgical approaches are proposed; two of them propose a deferred resection and the other, simultaneous resection. The aim of this analysis is to assess the short- and long-term outcomes of simultaneous resections. METHOD: 212 synchronous liver metastases resected in two centers were evaluated. Comparison between those resected simultaneously with those that were in a deferred way was made. Demographics, liver resections and metastatic characteristics were evaluated. Morbidity and mortality of both alternatives are also evaluated. RESULTS: 63 patients were resected simultaneously with the primary tumor, there were no significant differences in demographic characteristics. There was a greater number of major resections (p = 0.005) in the deferred group. Morbidity and mortality was comparable in both groups. Liver failure (p = 0.037) was higher in the deferred group. Morbidity was 33.2% in the deferred and 10.1% for the simultaneous (p = 0.256). Mortality rate was 2.83% in the deferred and 0.94% in the simultaneous group (p = 0.508). CONCLUSION: Short and long-term outcomes for both groups are similar. A question remains to be answered: the need of a major hepatectomy will favor the election of a deferred treatment?

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INTRODUCCIÓN: Un alto porcentaje de pacientes que reciben una hepatectomía por metástasis de cáncer colorrectal presentarán recidiva hepática, y en algunas será posible una nueva resección. La utilidad de las hepatectomías repetidas continúa siendo discutida. OBJETIVO: Evaluar los resultados obtenidos a corto y largo plazo. MÉTODO: Fueron analizadas 68 rehepatectomías de dos instituciones. Se analizaron datos demográficos y características de la enfermedad metastásica y de las resecciones hepáticas. Los tipos de complicaciones y la morbimortalidad también fueron analizados, al igual que la supervivencia y el tiempo libre de enfermedad. Se evaluaron algunos de los factores de mal pronóstico mencionados en la literatura. RESULTADOS: El análisis de los datos de corto plazo no mostró diferencias significativas entre los pacientes de primera hepatectomía y de hepatectomías repetidas, a excepción del porcentaje de fístulas biliares posoperatorias (p = 0.001). La supervivencia a 1 año es similar, mientras que a 3 y 5 años mostró diferencias significativas (p = 0.024 y 0.004, respectivamente). Los factores de mal pronóstico referidos en la literatura no fueron representativos en esta serie. CONCLUSIÓN: Los resultados a corto plazo de los pacientes con rehepatectomía son similares a los de aquellos resecados una vez. Los resultados a largo plazo de las rehepatectomías son inferiores a otros publicados. INTRODUCTION: A high percentage of patients undergoing hepatectomy for metastatic colorectal liver disease will have a recurrence. Of these, some can be subject to a new resection. The usefulness of repeated hepatectomy remains controversial. The aim of this study is to evaluate the results of short and long-term outcomes in repeated hepatectomies. METHODS: They were re-analyzed 68 repeated hepatectomies from two institutions. Demographics, characteristics of metastatic disease and hepatic resections were analyzed. Types of complications, morbidity and mortality were also analyzed as survival and disease-free time. Some of the factors of poor prognosis mentioned in the literature were evaluated. RESULTS: The analysis of short-term data showed no statistically significant differences between patients with first and repeated hepatectomy, except the percentage of postoperative biliary leakage (p = 0.001). The 1-year survival was similar while 3 and 5 years survival showed significant differences (p = 0.024 and 0.004, respectively). The factors of poor prognosis referred in the literature were not representative in this series. CONCLUSION: The short-term results of repeated hepatectomy are similar to those resected once. Long term result are inferior to other published series.

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INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10%) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

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INTRODUCTION: Surgical treatment of hilar cholangiocarcinoma remains a challenge. Multiple prognostic factors have been proposed. The number of positive nodes and the ratio between positive lymph node and total lymph node (G+/Gt) are considered by some authors as the most important factor. MATERIAL AND METHODS: We analyzed a series of 58 patients with Klatskin tumors. We evaluated the prognostic factors and survival with emphasis on the prognostic impact of the number of positive nodes and its relation to total lymph nodes. RESULTS: Resectability was 78% with a 5-year survival of 32%. The median number of nodes examined was 9.5. No significant differences were found in several of the proposed prognostic factors. The presence of 2 or more positive nodes or a ratio G+/Gt ≥ 0.2 were found to be poor prognostic factors. CONCLUSION: The relationship between positive lymph nodes and total lymph nodes and the number of positive lymph nodes are important prognostic factors.

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INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

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INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

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