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Introduction The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma. Methods The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019. Results The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86). Conclusion Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Resumen Introduccion La cirugia y la quimioterapia han aumentado la supervivencia de los pacientes con neoplasias pancreaticas. La disminucion de la morbimortalidad postoperatoria y el aumento de la esperanza de vida han ampliado las indicaciones de la duodenopancreatectomia cefalica (DPC), aunque sigue siendo controvertida en la poblacion geriatrica. Metodos Estudio observacional retrospectivo sobre una base de datos prospectiva, de pacientes con adenocarcinoma ductal de pancreas sometidos a una DPC entre 2007-2018. El objetivo principal fue analizar la morbimortalidad y supervivencia asociada a la DPC en pacientes ≥ 75 anos (ancianos). Resultados Se incluyeron 79 pacientes, 21 de ellos mayores de 75 anos (27%); dentro de este grupo el 23,9% tenian mas de 80 anos. El ASA de ambos grupos fue similar. Los pacientes ≥ 75anos requirieron mas transfusiones. No se observaron diferencias en el tiempo operatorio, aunque en los ancianos se realizaron mas resecciones vasculares (26 vs. 8,7%; p = 0,037). La morbilidad fue mayor en los ancianos (61,9 vs. 46,6%), aunque sin diferencias. Los ≥ 75anos presentaron mas complicaciones no quirurgicas (33,3%; p = 0,050) siendo la neumonia la mas frecuente. La mortalidad postoperatoria fue superior en los ≥ 75anos (9 vs. 0%; p = 0,017), constituyendo la reseccion venosa un factor de riesgo (p = 0,01). La supervivencia global y la supervivencia libre de enfermedad no mostraron diferencias significativas en ambos grupos. Conclusiones Los pacientes ancianos presentaron una mayor mortalidad postoperatoria y mas complicaciones no quirurgicas. La supervivencia no mostro diferencias, por lo que, con una adecuada seleccion de pacientes, la edad no debe constituirse por si misma como una contraindicacion para la DPC.

Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population.Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly).79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups.Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.

Resumen El uso de la fluorescencia en cirugia se ha ampliado y difundido en los ultimos anos, lo que ha constituido un autentico fenomeno tecnologico ligado a la aparicion de dispositivos adaptados a su utilizacion en los abordajes laparoscopicos y roboticos. La cirugia guiada por fluorescencia en el campo de la cirugia endocrina esta igualmente en auge. Cada vez son mas los articulos que describen su uso en la cirugia de las glandulas tiroides, paratiroides y suprarrenal, aunque con series aun modestas y con protocolos diversos no estandarizados. Existen actualmente diversas areas de desarrollo de la aplicacion de la fluorescencia en cirugia endocrina. Cabe destacar el uso de la fluorescencia con verde de indocianina en cirugia suprarrenal, la identificacion y prediccion de la perfusion paratiroidea con verde de indocianina, y la autofluorescencia de las glandulas paratiroides. El objetivo de este articulo es revisar las actuales aplicaciones de la fluorescencia en cirugia endocrina.

Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.

Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.

Mujer de 42 anos con antecedente de hepatopatia cronica alcoholica y malformacion hepatica congenita (shunt portocava parcial). Consulta, tras reinicio de ingesta alcoholica, por coluria, acolia e hiporexia. La exploracion fisica evidencia ictericia franca. El analisis sanguineo muestra colestasis y elevada citolisis. La TC en fase venosa objetiva imagen tipica de malformacion de Abernethy con comunicacion (flecha) entre venas porta (estrella) y cava (triangulo) asi como area isquemica hepatica derecha. Con diagnostico de fallo hepatico agudo de etiologia enolica e isquemica (por progresion del shunt portocava) se instaura tratamiento con pentoxifilina y suplementos nutricionales, apreciandose mejoria clinica (fig. 1).