Gonzalo Cardemil H

Sobrevida de pacientes con cáncer de esófago sometidos a esofagectomía total torácica

Background: Esophageal carcinoma has a dismal prognosis. Several authors have reported a very low survival in Chile. Aim: To report the survival of patients with esophageal carcinoma, subjected to esophageal resection. Material and methods: Analysis of 108 patients subjected to thoracic esophageal resection between 1985 and 1996. Patients were classified according to the location of the tumor and its staging. Results: Eleven patients died in the immediate postoperative period and 90 patients were followed. In 53 the exact cause of death was determined. Global five years survival was 29% and median survival was 18 months. Survival was 100% in stage I tumors. Adjuvant therapy resulted in a better survival of stage III tumors. Survival of stage IV tumors was worst than stage I to III tumors. There was no survival difference between squamous carcinoma or adenocarcinoma. Tumors located in the superior third of the esophagus had a worst prognosis. Causes of death were mediastinic metastases, local recidivism, pleural or pulmonary metastases and less frequently, brain, bronchial or bone metastases. Conclusions: The survival of these, patients with esophageal carcinoma did not differ from the figures reported abroad. (Rev Med Chile 2000; 128: 64-74)

Hemangioma esclerosante pulmonar como nódulo pulmonar solitario: comunicación de un caso

Lung sclerosing hemangioma is an uncommon tumor that pre-sents as a solitary asymptomatic nodule and that affects middle age women. It derives from typeII pneumocytes. We report a 52 years old female with a solitary lung nodule detected in a chestX ray requested for the diagnosis of an acute respiratory disease. The nodule was excised byvideo thoracoscopy and the frozen section biopsy was informed as a non small cell undifferenti-ated carcinoma. Therefore an inferior right lobectomy with lymph node resection was per-formed. The definitive biopsy was informed as a lung sclerosing hemangioma (Rev Med Chile2004; 132: 853-6).(

Impact of minimally invasive surgery in the treatment of esophageal cancer

BACKGROUND Surgical treatment of esophageal cancer is associated to a high morbidity and mortality rate. The open transthoracic or transhiatal esophagectomy are considerably invasive procedures and have been associated to high rates of complications and operative mortality. In this way, minimally invasive esophageal surgery has been suggested as an alternative to the classic procedures because would produce improvement in clinical longterm postoperative outcomes. AIM To assess survival, mortality and morbidity results of esophagectomy due to esophageal cancer submitted to minimally invasive techniques and compare them to results published in international literature. METHOD An observational, prospective study. Between 2003 and 2012, 69 patients were submitted to a minimally invasive esophagectomy due to cancer. It was recorded postoperative morbidity and mortality according to the Clavien-Dindo classification. The survival rate was analyzed with the Kaplan-Meier method. The number of lymph nodes obtained during the lymph node dissection, as an index of the quality of the surgical technique, was analysed. RESULTS 63.7% of patients had minor complications (type I-II Clavien Dindo), while nine (13%) required surgical re-exploration. The most common postoperative complication corresponded to leak of the cervical anastomosis seen in 44 (63.7%) patients but without clinical repercusion, only two of them required reoperation. The mortality rate was 4.34%, and reoperation was necessary in nine (13%) cases. The average survival time was 22.59 ± 25.38 months, with the probability of a 3-year survival rate estimated at 30%. The number of resected lymph nodes was 17.17 ± 9.62. CONCLUSION Minimally invasive techniques have lower morbidity and mortality rate, very satisfactory lymphnodes resection and similar long term outcomes in term of quality of life and survival compared to results observed after open surgery.BACKGROUND: Surgical treatment of esophageal cancer is associated to a high morbidity and mortality rate. The open transthoracic or transhiatal esophagectomy are considerably invasive procedures and have been associated to high rates of complications and operative mortality. In this way, minimally invasive esophageal surgery has been suggested as an alternative to the classic procedures because would produce improvement in clinical longterm postoperative outcomes. AIM: To assess survival, mortality and morbidity results of esophagectomy due to esophageal cancer submitted to minimally invasive techniques and compare them to results published in international literature. METHOD: An observational, prospective study. Between 2003 and 2012, 69 patients were submitted to a minimally invasive esophagectomy due to cancer. It was recorded postoperative morbidity and mortality according to the Clavien-Dindo classification. The survival rate was analyzed with the Kaplan-Meier method. The number of lymph nodes obtained during the lymph node dissection, as an index of the quality of the surgical technique, was analysed. RESULTS: 63.7% of patients had minor complications (type I-II Clavien Dindo), while nine (13%) required surgical re-exploration. The most common postoperative complication corresponded to leak of the cervical anastomosis seen in 44 (63.7%) patients but without clinical repercusion, only two of them required reoperation. The mortality rate was 4.34%, and reoperation was necessary in nine (13%) cases. The average survival time was 22.59±25.38 months, with the probability of a 3-year survival rate estimated at 30%. The number of resected lymph nodes was 17.17±9.62. CONCLUSION: Minimally invasive techniques have lower morbidity and mortality rate, very satisfactory lymphnodes resection and similar long term outcomes in term of quality of life and survival compared to results observed after open surgery.

Exploración laparoscópica de la vía biliar: “¿cuándo?, ¿cómo?, ¿dónde?, ¿quién?”

El gold estandar de la cirugia actual conlleva la busqueda de los procedimientos mini invasivos, manteniendo o mejorando la efi ciencia sobre los tradicionales. En el tratamiento de la enfermedad litiasica biliar, se han desarrollado tecnicas que complementan la colecistectomia laparoscopica para la extraccion de calculos del coledoco. Se sabe que entre el 10 al 18% de los pacientes con enfermedad litiasica vesicular presentan calculos en el conducto biliar

Empiema Pleural: Etiología, tratamiento y complicaciones

Introduccion: Definido como la presencia de infeccion bacteriana en el espacio pleural, determina una importante morbimortalidad a pesar de los avances en el tratamiento antibiotico y las nuevas tecnicas quirurgicas. Objetivos: Comparar resultados de las distintas estrategias terapeuticas para el Empiema Pleural (EP). Material y Metodos: Revision retrospectiva de fichas clinicas de pacientes con diagnostico de EP manejados en el Hospital Clinico Universidad de Chile entre enero de 1994 y junio de 2007. Se considero significacion estadistica con p < 0,05. Resultados: De 77 pacientes, 48 fueron hombres y 29 mujeres, con edad promedio de 52,6 ± 19,9 anos. La causa mas frecuente de EP fue la neumonia (74%). En 55 pacientes se realizaron examenes imagenologicos complementarios a la radiografia de torax. Treinta y dos pacientes se manejaron inicialmente con pleurostomia percutanea (PP). Siete de ellos requirieron una nueva intervencion por empiema residual. Once se manejaron con toracotomia abierta (TA) y 34 con Toracoscopia Video asistida (TVA). La tasa de complicaciones y mortalidad fue: 34,37% y 25% para PP, 11,7% y 0% para TVA y 36,36% y 0% para TA, respectivamente (diferencias significativas). El tiempo de hospitalizacion promedio fue de 22,8 dias, y el de tubo pleural de 9,21 dias. Se encontro diferencias significativas entre los dias con tubo pleural de los pacientes sometidos a TVA (X = 5,56) respecto de los sometidos a PP (X = 14,24) y TA (X = 12,4). No se observan diferencias en tiempo de hospitalizacion. Conclusiones: La TVA demuestra obtener mejores resultados que la PP y la TA al evaluar mortalidad, complicaciones y dias de tubo pleural.

RECONSTITUCIÓN DE TRÁNSITO ESOFÁGICO CON INTERPOSICIÓN DE COLON DERECHO

esophageal reconstruction using right colon interposition background: Esophageal replacement therapy is indicated for benign and malignant esophageal lesions and can be performed using stomach, jejunum or colon. aim: To report the experience using right colon interposition for esophageal replacement. material and methods: Review of medical records of 41 patients aged 17 to 73 years (29 males), subjected to right colon interposition in the last 20 years. Indications, complications, mortality and long term results were recorded. results: Forty nine percent of patients had a malignant esophageal lesion. Esophagectomy was performed using a transhiatal route or thoracotomy in 44 and 30% of patients, respectively. Retroesternal ascension was the most common route used in 88% of patients. The most common surgical complication was cervical fistula in 29% of patients, followed by fistula of the anastomosis between colon and jejunum in 7% of patients. Pneumonia was the most common medical complication. Postoperative mortality was 7%. conclusions: The mortality in this series of patients is similar to that reported elsewhere.

Resultados de la esofaguectomía en 53 pacientes con adenocarcinoma del esófago y Barrett extenso

Resumen es: Introduccion: El adenocarcinoma esofagico es el tumor que ha experimentado el mayor aumento en su incidencia a nivel mundial. Objetivo: Determinar las ca...

Rol de la cirugía mínimamente invasiva en la patología esofágica benigna: reporte de una serie de casos

BACKGROUND Minimally invasive surgery has the advantage of a lower rate of complications and can be used for benign esophageal diseases. AIM To report a single surgeon experience with laparoscopic surgery for benign esophageal diseases. MATERIAL AND METHODS Prospective analysis of 421 patients (160 males) with benign esophageal disease, who were subjected to laparoscopic surgery by a single surgeon. Immediate mortality, surgical complications and long term results in terms of symptoms recurrence, were analyzed. RESULTS The underlying diagnoses of the operated patients were Barretts esophagus or esophagitis in 257, hiatal hernia in 91, achalasia in 68 and esophageal diverticula in five. Surgery obtained successful results in 90% of patients with Barretts esophagus. Among patients with hiatal hernia, there was a 12% rate of complications and a 30% recurrence, when a mesh was not used. Among patients with achalasia the recurrence rate was less than 5%. CONCLUSIONS Laparoscopic surgery has a fair success rate in benign esophageal diseases, with a lower rate of complications.Minimally invasive surgery has the advantage of a lower rate of complications and can be used for benign esophageal diseases. Aim: To report a single surgeon experience with laparoscopic surgery for benign esophageal diseases. Material and Methods: Prospective analysis of 421 patients (160 males) with benign esophageal disease, who were subjected to laparoscopic surgery by a single surgeon. Immediate mortality, surgical complications and long term results in terms of symptoms recurrence, were analyzed. Results: The underlying diagnoses of the operated patients were Barretts esophagus or esophagitis in 257, hiatal hernia in 91, achalasia in 68 and esophageal diverticula in five. Surgery obtained successful results in 90% of patients with Barretts esophagus. Among patients with hiatal hernia, there was a 12% rate of complications and a 30% recurrence, when a mesh was not used. Among patients with achalasia the recurrence rate was less than 5%. Conclusions: Laparoscopic surgery has a fair success rate in benign esophageal diseases, with a lower rate of complications

Resultados del tratamiento quirúrgico en pacientes con enfermedad de Caroli

Resumen: La enfermedad de Caroli corresponde a la dilatacion sacular congenita de la via biliar intrahepatica1. Objetivo: Revisar la experiencia del Servicio de Cirugia del Hospital Clinico de la Universidad de Chile en el diagnostico y tratamiento quirurgico de esta enfermedad entre 1994 y 2005. Resultados: La serie consta de 18 pacientes, 11 mujeres (61,1%) y 7 hombres (38,8%), con 49.8 + 14,5 anos de edad promedio. El principal sintoma de presentacion fue el dolor abdominal en 16 de 18 pacientes (88,8%). La enfermedad se presento localizada en 16 de 18 pacientes (14 lob. izquierdo y 2 lob. derecho), y generalizada en 2. El 100% de los pacientes fueron estudiados con algun metodo de imagen, siendo el mas usado la ecografia abdominal (10 de 18). Los hallazgos mas comunes fueron dilatacion de la via biliar intrahepatica, litiasis intrahepatica, e imagenes quisticas. El diagnostico fue confirmado por Colangiografia Endoscopica Retrograda (CER) o Colangio Pancreato Resonancia Magnetica (CPRM) en 10 de 18 pacientes. Todos los enfermos recibieron tratamiento quirurgico, 17 de ellos (94,4%) segmentectomia y 1 (5,88%) destechamiento de quiste. La cirugia duro en promedio 3,4 horas, y la hospitalizacion 8,7 dias. La incidencia de complicaciones fue 11,76%. No hubo mortalidad en el intra o postoperatorio. El seguimiento promedio fue de 29,38 meses, encontrandose aparicion de enfermedad en el lobulo hepatico contralateral en un paciente

RESULTADOS DE LA CIRUGÍA ACTUAL PARA EL TRATAMIENTO DEL CÁNCER DE ESÓFAGO

Resumen La cirugia del cancer de esofago ha sido y sigue siendo un desafio pese a los avances en tecnica quirurgica y cuidados peri operatorios y a pesar de que las complicaciones postoperatorias y la morbimortalidad sigue siendo alta, aun en centros con alto volumen de procedimientos y mas aun en centros no dedicados a laatencion de estos pacientes. En este articulo se revisaran algunos aspectos epidemiologicos, las herramientasdiagnosticas actuales, su etapificacion, y las opciones terapeuticas de acuerdo al estadio, sea en etapas precoces o avanzadas, la localizacion y tipo de tumor, opciones de reconstruccion del transito digestivo en base alo reportado en la literatura internacional, la experiencia nacional y en base a nuestros propios resultados enel Departamento de Cirugia del Hospital Clinico de la Universidad de Chile.