Assuntos
Doença Diverticular do Colo/terapia , Idoso , Idoso de 80 Anos ou mais , Colo/fisiopatologia , Feminino , Humanos , Masculino , MéxicoAssuntos
Colangite/cirurgia , Doença Aguda , Colangiopancreatografia por Ressonância Magnética , Colangite/diagnóstico , Colangite/diagnóstico por imagem , Colecistectomia Laparoscópica , Descompressão Cirúrgica , Drenagem , Laparoscopia , Esfinterotomia Endoscópica , Esfincterotomia Transduodenal , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Congressos como Assunto , Cirurgia Geral , Gastroenterologia , Humanos , Sociedades Médicas , Estados UnidosRESUMO
Background. Gallbladder cancer is a rare and aggressive neoplasm. Objective. The purpose of this manuscript was to evaluate the prognostic factors associated with overall survival in gallbladder cancer patients. Methods. We performed a retrospective study of the patients with gallbladder cancer who received attention in a tertiary referral center in Mexico City during a 13 year period (1990-2002). We evaluated demographic, clinical, pathological and treatment variables. The main outcome variable was overall survival. The survival curves were constructed with the Kaplan and Meier method and compared with the log-rank test. Multivariate analyses was performed with the Cox regression method. We considered significant p < 0.05. Results. Fifty-one patients were registered, 35 of them women (69%). Median patient age was 63 years. Fifty-seven percent of patients had previous diagnosis of cholelithiasis. Seventy-one percent of patients underwent surgery. Ninety-eight percent of the tumors were adenocarcinoma and 25% were poorly differentiated. Eighty-six percent were found to have stage IV. Median survival for the entire cohort was six months (95% CI 0.5-7), and actuarial survival at one and three years was 22.7% and 3.9% respectively. On univariate analysis surgery, early stage, chemotherapy, Karnofsky > 80 and serum albumin > 3.0 g/dL were associated with better prognosis. On multivariate analysis, only surgery (p = 0.0001) and serum albumin > 3 g/dL (p = 0.002) remained significantly associated with better outcome. Conclusions. Most cases of gallbladder cancer presented with advanced stage. Serum albumin is a prognostic factor for survival in this group of patients.
Antecedentes. El carcinoma de la vesícula biliar es una neoplasia poco frecuente y agresiva. Objetivo. Determinar los factores pronósticos asociados con la supervivencia global en pacientes con esta neoplasia. Material y métodos. Estudio retrospectivo de pacientes con diagnóstico de cáncer de vesícula biliar atendidos en un centro de referencia de 1990 a 2002. Se analizaron variables demográficas, clínicas y patológicas, así como asociadas a tratamiento. El objetivo de medición fue la supervivencia global. Se construyeron curvas de supervivencia con el método de Kaplan y Meier y se compararon por medio de la prueba de log-rank. Se realizó análisis multivariado mediante regresión de Cox. Se definió significativa a una p < 0.05. Resultados. Se registraron 51 pacientes, 35 mujeres (69%), con una mediana de edad de 63 años. Setenta y uno por ciento de los pacientes fueron llevados a cirugía. Recibió quimioterapia 11.8%. En 98% el diagnóstico histopatológico fue de adenocarcinoma, 25% poco diferenciado. Se presentó 86.3% en estadio IV. En 57% se documentó a litiasis vesicular. La mediana de supervivencia para toda la cohorte fue de seis meses (95% IC 0.5-7), con supervivencia a uno y tres años de 22.7 y 3.9%, respectivamente. En el análisis univariado, la cirugía, estadio menos avanzado, la administración de quimioterapia, Karnofsky > 80 y albúmina > 3.0 g/dL se asociaron a mejor pronóstico. En el análisis multivariado, la cirugía (p = 0.0001) y albúmina sérica > 3 g/ dL (p = 0.002) fueron las únicas variables asociadas a mayor supervivencia. Conclusiones. El cáncer de vesícula biliar se presenta en estadios avanzados y su pronóstico es muy pobre. La albúmina sérica es un factor pronóstico significativo para supervivencia en esta neoplasia.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Vesícula Biliar/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaAssuntos
Adulto , Feminino , História do Século XX , Humanos , Transplante de Fígado/história , Circulação Extracorpórea/instrumentação , Imunossupressores/uso terapêutico , América Latina , Cirrose Hepática/cirurgia , Soluções para Preservação de Órgãos , Complicações Pós-Operatórias/mortalidade , Coleta de Tecidos e Órgãos , Preservação de Tecido/métodos , Estados UnidosAssuntos
Transplante de Fígado/história , Adulto , Circulação Extracorpórea/instrumentação , Feminino , História do Século XX , Humanos , Imunossupressores/uso terapêutico , América Latina , Cirrose Hepática/cirurgia , Soluções para Preservação de Órgãos , Complicações Pós-Operatórias/mortalidade , Preservação de Tecido/métodos , Coleta de Tecidos e Órgãos , Estados UnidosRESUMO
BACKGROUND: Gallbladder cancer is a rare and aggressive neoplasm. OBJECTIVE: The purpose of this manuscript was to evaluate the prognostic factors associated with overall survival in gallbladder cancer patients. METHODS: We performed a retrospective study of the patients with gallbladder cancer who received attention in a tertiary referral center in Mexico City during a 13 year period (1990-2002). We evaluated demographic, clinical, pathological and treatment variables. The main outcome variable was overall survival. The survival curves were constructed with the Kaplan and Meier method and compared with the log-rank test. Multivariate analyses was performed with the Cox regression method. We considered significant p < 0.05. RESULTS: Fifty-one patients were registered, 35 of them women (69%). Median patient age was 63 years. Fifty-seven percent of patients had previous diagnosis of cholelithiasis. Seventy-one percent of patients underwent surgery. Ninety-eight percent of the tumors were adenocarcinoma and 25% were poorly differentiated. Eighty-six percent were found to have stage IV. Median survival for the entire cohort was six months (95% CI 0.5-7), and actuarial survival at one and three years was 22.7% and 3.9% respectively. On univariate analysis surgery, early stage, chemotherapy, Karnofsky 2 80 and serum albumin > 3.0 g/dL were associated with better prognosis. On multivariate analysis, only surgery (p = 0.0001) and serum albumin > 3 g/dL (p = 0.002) remained significantly associated with better outcome. CONCLUSIONS: Most cases of gallbladder cancer presented with advanced stage. Serum albumin is a prognostic factor for survival in this group of patients.
Assuntos
Neoplasias da Vesícula Biliar/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Treatment of portal hypertension has evolved widely during the last decades. Advances in physiopathology have allowed better application of therapeutic options and also have permitted to know the natural history of varices and variceal bleeding, predicting which patients have a higher risk of bleeding. It also permits probability of designing patient treatment. According to liver function and subadjacent liver disease, it is possible to offer different alternatives within the three possible scenarios (primary prophylaxis, acute bleeding episode, and secondary prophylaxis). For primary prophylaxis, pharmacotherapy offers the best choice. Endoscopic banding is also growing in these scenarios and probably will be accepted in the near future. For the acute bleeding episode, endoscopic therapy (sclerosis and/or bands) and/or pharmacologic therapy (octreotide, terlipresin) represent best choice, considering TIPS as a rescue option. Surgery is not used routinely in this scenario in most centers. For secondary prophylaxis, pharmaco- and endoscopic therapy are first-line treatments, while TIPS and surgery as second-line treatments. TIPS is mainly used in patients on a waiting list for liver transplantation. Surgery offers good results for low-risk patients, with good liver function and with portal blood-flow preserving procedures (selective shunts, extensive devascularizations). Liver transplantation is recommended for patients with poor liver function because together with portal hypertension, it treats subadjacent liver disease.
Assuntos
Hipertensão Portal/terapia , Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Guias como Assunto , HumanosRESUMO
El trabajo revisa el estado actual del tratamiento de pacientes con metástasis hepáticas, provenientes de tumores endocrinos. La parte inicial del trabajo discute los estudios diagnósticos y la forma de presentación de estas neoplasias; posteriormente se analizan las alternativas terapeúticas con énfasis en el papel de la cirugía, radioterapia, quimioterapia y embolización; y al final se muestran los resultados obtenidos con las diversas modalidades