BRCA gene mutations are found in up to 10% of pancreatic adenocarcinoma cases. We present a description of 4 cases along with a review of the current literature regarding pathogenesis, target treatment, response and survival rates in these types of malignancies. We describe four cases of pancreatic adenocarcinoma, in three of which the BRCA2 mutation was identified, in one - BRCA1 gene alteration. Two patients underwent surgery following the neoadjuvant treatment with Folfirinox and radiotherapy; in the first case, a distal pancreatectomy with splenectomy was performed and in the second one - the Whipple's procedure. In both cases, a complete pathological response was reported. Other 2 patients were treated with Folfirinox after BRCA mutation identification and acceptable life expectancy was obtained. The association of pathologic complete response (PCR) with lower rates of local recurrence and better survival in patients with various types of adenocarcinomas is well known. Identification of such patients carrying BRCA mutations could provide an application of better personalized treatment. In some patients with pancreatic cancer, especially when there is clinical or demographic reason to suspect a genetic predisposition, a confirmation of the presence of BRCA mutations could provide an opportunity to use target treatment with beneficial outcomes regarding survival.
Background: Single-incision laparoscopic right colectomy (SILRC) has been reported in 2008, and since that time an increased number of reports appeared in literature. Currently, it remains popular between the centers with achieved experience. Adoption of suprapubic access, instead of umbilical or other access-sites, allows to enhance the final cosmetic outcomes, together with the realization of complete mesocolic excision (CME) and intracorporeal anastomosis (ICA). Methods: Between January 2016 and August 2018, 20 patients (10 females, 10 males) were submitted to suprapubic single-incision laparoscopic right colectomy (SSILRC) for adenocarcinoma. Mean age was 74 years and mean body mass index was 24 kg/m 2. Sixteen patients have already been submitted to open abdominal surgery. Results: Mean total operative time was 233.9 minutes and mean laparoscopic time was 199.4 minutes. Mean time for ICA was 34 minutes. Mean blood loss was 279.5 mL. One additional 5-mm trocar was necessary in 1 patient (5.0%). Mean length scar was 60.5 cm. Mean hospital stay was 7.8 days. A minimal use of pain killers was registered postoperatively. Mean number of lymph nodes retrieved was 24.5. Early complications were one suprapubic abscess and one suprapubic hematoma. No late complications, including suprapubic incisional hernia, were achieved. Conclusion: Since the specimen has to be removed from the abdomen after conventional laparoscopic right colectomy, the suprapubic access can be an option. SSILRC allows to join the surgical procedure, the specimen's removal and the enhanced cosmetic results through the same access. Other advantages are the CME, the ICA, the reduced postoperative pain, and the decreased incisional hernia's rate.
Paciente mujer de 51 años, con antecedentes de dislipemia, HTA y hernia de hiato. Acude a urgencias por dolor abdominal de carácter subagudo y punzante que se ha ido incrementando desde hace 3 días, acompañada de náuseas y deposiciones diarreicas. Al examen físico presenta, mucosas secas y dolor a la palpación del abdomen localizado en ambos flancos y fosa ilíaca derecha, con signos de irritación peritoneal y Blumberg positivo. La analítica muestra leucocitosis de 12.9x103 /ul con leve neutrofilia y una proteína C reactiva de 6.09mg/dl. La radiografía simple de abdomen es anodina. Se completa el estudio con ecografía y tomografía axial computarizada (TAC) urgentes, evidenciándose hallazgos sugestivos de trombosis de vena esplénica y proceso inflamatorio en fosa ilíaca derecha, de probable origen apendicular, con cambios inflamatorios que se extienden a grasa pericecal e íleon terminal.
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