Background. The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD. Methods. We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwent an open PD between January 2010 and December 2019 at our tertiary centre. Results. Independent preoperative predictors of mortality were the albumin-bilirubin (ALBI) grade 3 (OR: 21.7; CI 95: 2.1–226.9;
p
=
0.01
) and the estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (OR: 17.7; CI 95: 1.8–172.6;
p
=
0.013
). The eGFR <90 mL/min/1.73 m2 (OR = 6.6; CI 95: 1.9–23.4;
p
=
0.003
) and prothrombin time (OR = 1.5; CI 95; 1.1–2.1;
p
=
0.005
) were independent predictors for severe morbidity. Conclusion. These findings suggest that baseline renal function measured by the eGFR and liver function categorized with the ALBI grading are predictors of severe morbidity and mortality. Thus, they should be considered when selecting patients for PD or the use of neoadjuvant treatments. Further research is warranted.
Background: It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decisionmaking tools to inform intervention in these patients.Methods: We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables.Results: We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities.
Conclusion:We constructed a nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low-and middle-income countries where HCC is often diagnosed at advanced stages.
Gastrointestinal stromal tumors (GIST) are very infrequent neoplasms of the gastrointestinal tract, most commonly located in the stomach and small intestine. Due to the rising incidence of these tumors, a wide array of surgical approaches for diverse scenarios of this disease is currently being explored.Small GISTs in unfavorable locations of the stomach like those near the esophagogastric junction (EGJ) have different techniques for local resection such as: intragastric, transgastric, combined endoscopic-laparoscopic in order to preserve function and oncological principles. Many different minimally-invasive techniques have been proposed for these. A simplified laparoscopic approach, especially for those neoplasms located in the posterior wall adjacent to the EGJ is presented.
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