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Objective: To describe five cases of solid-cystic papillary tumor of thepancreas regarding clinical and radiological findings, together withsurgical treatment. Methods: The authors presented five patients withpancreatic solid-cystic papillary tumors. All patients were treated by theGeneral Surgery Service of the Teaching Hospital, Faculdade de Medicinado ABC – Santo André - São Paulo. There were four female and onemale patients, age range of 15-36 years. The study period spanned fromJanuary 2000 to November 2006. The main aspects concerning clinical,epidemiological and radiological findings were investigated. Results: Alltumors were resectable. The surgical procedures performed were: twocephalic gastroduodenopancreatectomies, one subtotal pancreatectomyplus splenectomy, one distal pancreatectomy plus splenectomy and onetotal gastroduodenopancreatectomy plus splenectomy. The mortalityrate was nil, whereas postoperative morbidity rate was 20%. All patientssurvived tumor resection and presented no recurrence (the follow-upperiod ranged from 6 to 54 months). Conclusion: The solid-cysticpapillary tumors of the pancreas are neoplasms with a good prognosis.Both clinical-epidemiological and radiological findings are important forcorrect diagnosis.

Hemangiomas are the most common hepatic benign lesions. They occur most frequently in young female patients. These tumors are generally found by radiological imaging and, of such examinations, nuclear magnetic resonance is the best diagnostic method. Although highly frequent, it presents few symptoms. Most cases are asymptomatic and thus must be followed up by means of periodic radiological examination. Surgical treatment should be restricted to unusual situations. Spontaneous or traumatic rupture, Kasabach-Merritt syndrome, uncertain diagnosis and pain have been the most common indications. The authors describe a successfully treated case of painful hemangioma of the left hepatic lobe submitted to left hepatectomy.

ABSTRACT Although colorectal tumors are fairly common surgical conditions, 5 to 12% of these tumors are locally advanced (T4 tumors) upon diagnosis. In this particular situation, the efficacy of en bloc multivisceral resection has been proven. When right-colon cancer invades the proximal duodenum or even the pancreatic head, a challenging dilemma arises due to complexity of the curative surgical procedure. Therefore, en bloc pancreaticoduodenectomy with right hemicolectomy should be performed to obtain free margins. The present study reports three cases of locally advanced right-colon cancer invading the proximal duodenum. All of these cases underwent successful en bloc pancreaticoduodenectomy plus right hemicolectomy, with no death occurrence. Long-term survival was observed in two cases (30 and 50 months). In the third case, the patient did not present any recurrence twelve months after surgical treatment. Multivisceral resection with en bloc pancreaticoduodenectomy should be considered for patients who present acceptable risk for major surgery and no distant dissemination. This approach seems justified since the length of postoperative survival is longer in radically ressected groups (R0) than in palliativelly resected groups (R1-2).

Objective: To report on a group of 12 patients with advanced gallbladder adenocarcinoma at a General Hospital and describe the outcomes (surgical morbidity - mortality and long-term survival) following hepatic resection. Methods: The authors present a series of twelve patients with invasive gallbladder adenocarcinoma who underwent hepatic resection at the General Surgery Service of the Hospital de Ensino da Faculdade de Medicina do ABC, in Santo Andre. The study period was from 2001 to 2007. There were twelve hepatic resections, all associated with hilar lymphadenectomy (IVB-V bisegmentectomy = 9 and right trisectionectomy = 3). There were ten women and two men and all patients were Caucasian. The age range was 52 to 72 years. The preoperative symptoms were biliary colic (n = 6), dyspepsia (n = 4), acute cholecystitis (n = 1) and jaundice (n = 1). The diagnosis was made by radiographic images in the preoperative period in seven patients; all of them were confirmed by frozen section during surgery. Five patients submitted to open cholecystectomy (n = 4) and laparoscopic cholecystectomy (n = 1) had their diagnoses confirmed postoperatively by histological analysis. Rresults: The operative time varied between 180 and 340 minutes. Four patients received transfusions. The blood loss varied between 200 and 2500 ml. The hospital stay varied from 7 to 16 days. There were two major complications in two patients and both were treated conservatively, one biliary leakage and one reversible hepatic failure. There was no mortality. The TNM stage distribution was: T2N0M0 (n = 4), T2N1M0 (n = 2), T3N0M0 (n = 4) and T3N1M0 (n = 2). Only one patient presented affected surgical margin (T3N1M0) and died with both peritoneal and liver recurrence after a 9-month follow-up. Other three patients presented recurrence(13 to 28 months of follow-up) and died. The three-year survival rate was 33.3% (n = 4). Cconclusion: The radical surgical treatment with hepatectomy plus hilar lymphadenectomy may offer a long term prognosis to localized gallbladder adenocarcinoma with both minimal morbidity and mortality.

Objective: To report the early postoperative results and long-termsurvival on ten patients undergoing hepatectomy for treatmentof non-colorectal and non-neuroendocrine hepatic metastases.The study was carried out by the General Surgery Service of theDepartment of Digestive Tract Surgery of the Teaching Hospital ofthe Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.Methods: Complete follow-up data were available on 28 patientswith hepatic metastases who were operated on between January2002 and January 2007. Ten patients presented non-colorectal andnon-neuroendocrine primary neoplasms, and comprised the sampleof this study. There were five males and five females, mean age of53 years (28 to 68 years). The right lobe was involved in five patientsand the left lobe in five individuals. The number of metastasesranged from one to four. All metastases were unilateral. All primarytumors were identified. The histological types were adenocarcinoma(n = 7), germinative tumor (n = 1), melanoma (n = 1) and sarcoma(n = 1). The primary sites were: gastric (n = 1), kidney (n = 1),adrenal (n = 1), breast (n = 2), testicle (n = 1), ovary (n = 2),acral melanoma (n = 1) and retroperitoneal sarcoma (n = 1). Allpatients presented metachronous metastases. The median intervalbetween primary tumor treatment and diagnosis of metastases was20 months (12 to 33 months). Six patients received chemotherapyand four patients underwent exclusively surgical treatment. Results:There were seven major hepatic resections (three or more Couinaudsegments) and three minor hepatic resections. The operative timevaried from 180 to 425 minutes with a median duration of 240minutes. Five patients received transfusions; blood loss ranged from200 to 3,000 ml. There were two postoperative complications andboth patients were re-operated (biliary fistula = 1; intra-abdominalabscess = 1). There were no postoperative deaths. All resectionswere R0. The three-year overall survival rate was 50%. Five patientsdeveloped tumor recurrence (50%). Conclusions: Hepatic resectionfor liver metastases other than of colorectal or neuroendocrine originpresents acceptable morbidity and no mortality. This approach mayresult in long-term survival in this group of patients.