RESUMO
INTRODUCTION AND AIMS: Cholangiocarcinoma accounts for 3% of gastrointestinal tumors and is the second most frequent hepatic neoplasia after hepatocellular carcinoma. The primary aim was to evaluate the median disease-free period and survival in patients with cholangiocarcinoma diagnosis through the comparison of R0 and R1 resection margins. MATERIAL AND METHODS: A retrospective analysis was conducted on 36 patients that underwent some type of surgical resection due to cholangiocarcinoma diagnosis, within the time frame of 2000-2017, at a center specializing in hepatopancreatobiliary surgery. Population, preoperative, and oncologic variables were included. The IBM Statistical Package for the Social Sciences for Mac, version 16.0, software (IBM SPSS Inc., Chicago, IL, USA) was employed. RESULTS: Thirty-one patients underwent hepatectomy, the Whipple procedure, or bypass surgery, depending on tumor location. The statistical significance of survival between patients with positive margins and those with negative margins was evaluated through the Mann-Whitney U test, with a P<.05 as the reference value. No statistically significant difference was found. The overall morbidity rate was 58.06% (n=18) and the mortality rate was 12.9% (n=4). CONCLUSIONS: No statistically significant difference in relation to the incidence of disease recurrence or general survival resulted from the comparison of microscopically positive surgical margins (R1) and negative surgical margins (R0). There was also no correlation between preoperative CA 19-9 levels and disease prognosis.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia , Margens de Excisão , Pancreaticoduodenectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Feminino , Seguimentos , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Acute cholecystitis is one of the most frequent diseases faced by the general surgeon. In recent decades, different prognostic factors have been observed, and effective treatments described, to improve the results in patients with said pathology (lower morbidity and mortality, shorter hospital stay, and minimum conversion of laparoscopic to open procedures). In general, laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, but it is not exempt from complications, especially in patients with numerous comorbidities or those that are critically ill. Percutaneous cholecystostomy emerged as a less invasive alternative for the treatment of acute cholecystitis in patients with organ failure or a prohibitive surgical risk. Even though it is an effective procedure, its usefulness and precise indications are subjects of debate. In addition, there is little evidence on cholecystostomy catheter management. We carried out a review of the literature covering the main aspects physicians involved in the management of acute cholecystitis should be familiar with.
Assuntos
Colecistite Aguda/cirurgia , Colecistostomia/métodos , Algoritmos , Humanos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Benign and malignant bile duct strictures require multidisciplinary management. The radiologist, endoscopist and surgeon must assess the general conditions of the patient, as well as the etiology of the stenosis and the therapeutic options (palliative, temporal, or definitive). Stenotic injuries that maintain bilioenteric continuity are susceptible to radiologic and/or endoscopic treatment, specially benign lesions, usually appearing in the postsurgical period. Injuries with loss of continuity require surgical management in almost every case. Iatrogenic bile duct injuries with preserved continuity (Strasberg A and D) may be treated by endoscopy. Types B and C, in which a liver segment loses communication with the remaining bile tree, need surgical repair and/or resection. Complete sections of the bile ducts require surgical intervention, with hepatojejunostomy being the best choice. The use of metallic endoluminal stents is almost prohibited in these types of injuries. Benign, non-iatrogenic injuries (sclerosing cholangitis, autoimmune cholangiopathy) require surgical intervention in rare occasions. Malignant injuries are extremely aggressive and only a small percentage (less than 15%) is candidate for curative resection, which unfortunately does not preclude recurrence.
Assuntos
Colestase/terapia , Neoplasias dos Ductos Biliares/complicações , Procedimentos Cirúrgicos do Sistema Biliar , Colestase/classificação , Colestase/etiologia , Colestase/cirurgia , Humanos , Recidiva , StentsRESUMO
BACKGROUND: The most efficient surgical procedure to treat bile duct injuries is a Roux en Y hepatoyeyunoanastomosis (RY-HYA). A small group of patients who have undergone a RY-HTA develop cholangitis without jaundice, with proven permeability of the anastomosis. OBJECTIVE: To describe our experience in this subgroup of patients. PATIENTS AND METHODS: 355 patients received surgical treatment for BDI with a RY-HYA. Medical charts of patients diagnosed with segmentary cholangitis involving a single hepatic lobe were reviewed. Segmentary cholangitis with intra-hepatic abscess was diagnosed through computer tomography, endoscopic retrograde cholangiopancreatography or by percutaneous transhepatic cholangiography. RESULTS: We found 10 patients with segmentary cholangitis within the 355 cases in our series. Eight of them received treatment with a right hepatectomy and two of them with a left hepatectomy. In every patient, the hepatoyeyunoanastomosis was dismantled during the reoperation, corroborating the presence of a wide and permeable anastomosis. Surgical exploration was conducted through the hepatic ducts. After the affected lobe hepatectomy a new hepatoyeyunoanastomosis was performed. Out of the 10 patients one died (mortality 10%) due to hepatic cirrhosis. In the rest of the group a satisfactory resolution of the segmentary cholangitis was observed. CONCLUSIONS: In our series, 3% of the patients required a mayor hepatectomy for the persistent cholangitis to resolve, despite the presence of a functional bilioenteric anastomosis. Segmentary cholangitis must be suspected in patients with normal levels of direct bilirubin and abnormal liver function tests with clinical manifestations of cholangitis.
Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Hepatectomia , Feminino , Humanos , Doença Iatrogênica , MasculinoRESUMO
BACKGROUND: The liver is the organ in which often metastasize primary tumors. Knowledge of the etiology and forms of presentation of metastatic disease is key to deciding on the different treatment options. OBJECTIVE: Describe the surgical management of liver metastases in colorectal cancer and factors that affect the survival of patients. PATIENTS AND METHODS: We reviewed 43 cases of patients with metastatic liver cancer of the colon or rectum, who underwent liver surgery, attended January 1990 to December 2007. We analyzed demographic variables and perioperative associated with the survival of patients. There was the course and type of postoperative complications as well as the direct causes of mortality. RESULTS: Were conducted mostly metastasectomies (n = 25), followed by right hepatectomy (n = 9),and left hepatectomy (n = 9). Surgical mortality was 4.6% (n = 2). The survival rate at 1, 3 and 5 year were 45% (18 patients), 42.5% (18 patients)and 12.5% (5 patients), respectively. The presence of a single metastatic lesion (p = 0.006), size of the lesion larger than 5 cm (p = 0.003), positive lymph nodes (p = 0.002), synchronous tumor (p = 0.04),presence of extra hepatic disease (p = 0.01), positive margin (p = 0.001) and blood loss >2000 mL were significantly associated with a lower survival rate. CONCLUSION: After hepatic resection for metastatic colorectal cancer the presence of more than one tumor, > of 5 cm, with presence of synchronous tumor, nodes and positive margins, extra hepatic disease, as well blood loss > 2000 mL are factors associated with a worse survival.
Assuntos
Carcinoma/mortalidade , Carcinoma/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/secundário , Estudos Transversais , Feminino , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.
Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia , Complicações Intraoperatórias/cirurgia , Colangite/cirurgia , HumanosRESUMO
BACKGROUND: An immediate repair is considered optimal in acute biliary duct injuries; however, it may prove to be a challenge, because such repairs are usually performed on small ducts whose viability cannot always be determined. METHODS: We performed a retrospective review of the charts of patients with acute bile duct injury who underwent repair at a tertiary care academic university hospital. A total of 204 patients with acute bile duct injury were seen between 1989 and 2002. Of these, 30 were repaired within minutes to hours after the injury. These patients were divided into two groups. Group I patients had a Roux-en-Y hepatojejunostomy below the hepatic junction; Group II patients had a Roux-en-Y hepatojejunostomy at the junction level. We then performed a long-term evaluation of anastomosis function in these patients, using clinical, radiological, and laboratory. RESULTS: Twenty-eight injuries were secondary to a laparoscopy; the other two resulted from open cholecystectomies. All of the patients suffered complex injuries with complete section of the duct and substance loss (Strasberg E). There were 12 patients in group I and 18 in group II. Three cases in group I (25%) and one in group II (5%) developed anastomosis dysfunction. Mean follow-up was 56 months (range, 12-80) in group I and 52 months (range, 10-76) in group II. Two cases in group I (16%) and none in group II (0) required reoperation (p < 0.05). CONCLUSIONS: In the acute setting, complex lesions should be treated with a high bilioenteric anastomosis (at the junction level) in the first attempt at repair. Lower-level anastomoses are associated with a higher dysfunction rate and the need for radiological manipulation and reoperation. Also, stenosis of the anastomosis secondary to undetected duct ischemia in the acute repair is more frequent in low bilioenteric anastomoses.
Assuntos
Anastomose em-Y de Roux/métodos , Ductos Biliares/lesões , Complicações Intraoperatórias/cirurgia , Doença Aguda , Adulto , Ductos Biliares/cirurgia , Colecistectomia , Colecistectomia Laparoscópica , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Jejuno/cirurgia , Tempo de Internação , Fígado/cirurgia , Masculino , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Stents , Resultado do TratamentoRESUMO
UNLABELLED: Surgical treatment of liver cystic disease is reserved for symptomatic patients. The surgical approach is chosen according to the size and distribution of the cysts. In patients with massive hepatomegaly secondary to polycystic liver disease, liver transplantation is indicated with excellent results and quality of life. OBJECTIVE: To evaluate over 20-year period, the results in terms of clinical outcome of three groups of patients with cystic liver disease (EQ) who received surgical treatment and to determine postoperative quality of life. MATERIALS AND METHODS: In a 20-year period, 44 patients were operated on; 24 had simple liver cyst, 13 had polycystic liver disease, and seven cystadenomas. Using the SF36 questionnaire, self-perception of quality of life was evaluated using eight scales in two major categories: Physical component summary (PCS) and mental component summary (MCS). RESULTS: Upper abdominal pain was the main clinical symptom. Fenestration was the most frequent procedure performed. No differences in quality of life were observed in all, while good quality of life was recorded in all groups at a median follow-up of 39 months. CONCLUSIONS: Surgical treatment of cystic liver disease is reserved for symptomatic patients or complications such as rupture, infection, and hemorrhage. Therapeutic alternatives should been chosen on an individual basis. Good quality of life is obtained after surgery in these patients.