En Perú, el carcinoma hepatocelular (CHC) ocupa el tercer lugar en incidencia entre los tumores del sistema digestivo, y tiene una alta tasa de mortalidad, 17.7 por 100,000 habitantes. La mayoría de los casos reportados no presentan la epidemiología clínica clásica del CHC observado en otras partes del mundo. Además, se ha identificado que estos pacientes presentan un perfil transcriptómico distinto y un proceso tumoral singular, sugiriendo un proceso particular de hepatocarcinogénesis en una fracción de la población peruana. El presente estudio busca comprender la implicancia clínica y biológica del perfil epigenético (metilación) y de expresión de los genes (transcriptómico) del CHC en los pacientes peruanos. Se evaluó el perfil de transcriptómico y de metilación de ADN de hígado y CHC en 74 pacientes peruanos. El agrupamiento por edades mostró una mayor metilación del ADN en los pacientes jóvenes con CHC, en contraste no se observaron diferencias en el perfil transcriptómico. Adicionalmente, también se evidenció una alta prevalencia del virus de hepatitis B (VHB) (> 90%) en los pacientes jóvenes con CHC. El análisis de enriquecimiento en ambos perfiles moleculares demostró que PRC2 es posiblemente uno de los principales actores moleculares en este proceso tumoral hepático en pacientes peruanos. El CHC peruano presenta un perfil molecular único, asociado a la presencia del VHB, y con una hipermetilación global del ADN asociado a células hepáticas indiferenciadas o a una reprogramación celular. Hepatocellular carcinoma (HCC) is the third most frequent cancer of digestive tract tumors in Peru, with a high mortality rate of 17.7 per 100,000 inhabitants. A significant number of HCC cases in Peru do not follow the classic clinical epidemiology of the disease described in other parts of the world. Those patients present with a distinct transcriptome profile and a singular tumor process, suggesting a particular type of hepatocarcinogenesis in a portion of the Peruvian population. Our aim was to understand the clinical and biologic involvement of the epigenetic profile (methylation) and gene expression (transcriptome) of HCC in Peruvian patients. HCC and liver transcriptome and DNA methylation profiles were evaluated in 74 Peruvian patients. When grouped by age, there was greater DNA methylation in younger patients with HCC but no differences with respect to the transcriptomic profile. A high prevalence of the hepatitis B virus (HBV) (> 90%) was also observed in the younger patients with HCC. Enrichment analyses in both molecular profiles pinpointed PRC2 as an important molecular effector of that liver tumor process in Peruvian patients. HCC in Peruvian patients has a unique molecular profile, associated with the presence of HBV, as well as overall DNA hypermethylation related to undifferentiated liver cells or cellular reprogramming.

In Peru, the incidence of gastric cancer is around 16.1 per 100 000 inhabitants making it the 4th most common cause of cancer and the second most deadly (12.8 cases per 100 000 inhabitants). Fifty-percent of them are poorly cohesive gastric carcinoma (PCGC). PCGC is frequently highly infiltrative and resistant to chemotherapy. Although radical gastrectomy is a standard treatment for PCGC, recurrence is a critical issue for long-term survival of patients and so far, the role of adjuvant chemotherapy in these patients is controversial. In this study, we evaluated the effect on disease-free survival (DFS) and overall survival (OS) of adjuvant chemotherapy with capecitabine or 5-fluorouracil plus oxaliplatin after D2 gastrectomy compared with only D2 gastrectomy in PCGC. We retrospectively reviewed patients diagnosed and treated for PCGC during 2014 – 2016 at the Peruvian National Cancer Institute (INEN). Patients with incomplete chemotherapy or those who died because of a postoperative complication were excluded. The Kaplan Meir method was used to estimate the OS and DFS and the Breslow test to compare the survival curves. The prognostic factors were identified with the Cox proportional hazard model. 116 patients were diagnosed and treated for PCGC. The median age was 54 (21-89) years and 62 (52.4%) patients were women. Fifty-six (48.3%) received only surgery while 60 (51.7%) received adjuvant chemotherapy and surgery. The median follow-up for DFS was 45.8 months (43.52-48.15) and 48.6 months for OS (44.85-52.34). Median DFS was 45.07 months in the chemotherapy and surgery group and not reached in the surgery group. The DFS rate was 50% in the chemotherapy and surgery group and 64.4% in the surgery only group (p=0.25). Median OS was 52.5 months in the chemotherapy and surgery group and not reached in the surgery group. The OS rate was 55% in the chemotherapy and surgery group and 64.3% in the surgery only group (p=0.56). On the other hand, univariate analysis identified lymphovascular infiltration, perineural infiltration, pT3, pT4, pN2, pN3, positive/resected nodes rate as prognostic factors for DFS and OS. In the multivariate analysis, pN3 was the only independent prognostic factor of DFS (HR=6.48; 95% CI: 1.09-43.05, p=0.001). The type of treatment was not a prognostic factor associated with DFS or OS (HR: 1.5, 95% CI: 0.85-2.64, p=0.164; HR: 1.32, 95% CI: 0.74-2.35, p=0.35). These data suggest that adjuvant chemotherapy did not significantly reduce recurrence and mortality after curative resection and D2 lymph node dissection in poorly cohesive gastric carcinoma.

SUBJECT:To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru.METHODS:In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones.RESULTS:A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy.CONCLUSIONS:The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

Leiomyosarcomas of vascular origin is a rare and aggressive pathology, its presentation on the renal vein is infrequent, of which 29 cases have been reported world-wide. We describe a case of a 76 year-old woman, who presented with intermittent left flank pain, irradiated to the lumbar region of 6 months duration. A left radical nephrectomy with en-bloc resection of a para-aortic tumor was performed. Microscopic examination of the specimen reported a moderately differentiated leiomyosarcoma, originated in the wall of the renal vein. The patient received adjuvant chemotherapy and radiation therapy. The tumor recurred in the liver. After 24 months from the primary surgery, the patient is alive with evidence of multiple metastatic spread to the liver. She is now under palliative care.

OBJECTIVEDetermine the clinical features and the survival of patients with gastric cancer invading the muscularis propia.MATERIAL AND METHODSWe reviewed the clinical records of the patients with gastric cancer invading the muscularis propia, that had undergone surgical treatment at the National Cancer Institute (INEN) between 1950 and 1999. We considered age, sex, location of the tumor, regional lymph node metastases (N), distant metastases (M), TNM stage and survival.RESULTS202 patients had gastric cancer invading the muscularis propia, the mean age was 60.03 years, 105 (52%) were females, in 69% the neoplasm was in the antrum and in 22% in the body. We found regional lymph node metastases in 48% and distant metastases in 1%; 52.1% was in the IB TNM stage and 3.1% in the IV. The five year survival rate using Kaplan Meier was 66%, patients with N0, N1, N2 and N3 had 78%, 70%, 25% and 0% respectively.

Journal of Surgical OncologyVolume 76, Issue 2 p. 138-140 How I Do It Safe pancreaticojejunostomy after Whipple procedure: Modified technique Juan Celis MD, Corresponding Author Juan Celis MD jcelis@inen.sld.pe Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúDepartment of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Av Angamos Este 2520, Lima 34-Peru. Fax: 00-51-1-4481214.Search for more papers by this authorFrancisco Berrospi MD, Francisco Berrospi MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this authorEloy Ruiz MD, Eloy Ruiz MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this authorEduardo Payet MD, Eduardo Payet MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this author Juan Celis MD, Corresponding Author Juan Celis MD jcelis@inen.sld.pe Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúDepartment of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Av Angamos Este 2520, Lima 34-Peru. Fax: 00-51-1-4481214.Search for more papers by this authorFrancisco Berrospi MD, Francisco Berrospi MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this authorEloy Ruiz MD, Eloy Ruiz MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this authorEduardo Payet MD, Eduardo Payet MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Lima, PerúSearch for more papers by this author First published: 14 February 2001 https://doi.org/10.1002/1096-9098(200102)76:2<138::AID-JSO1025>3.0.CO;2-PCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume76, Issue2February 2001Pages 138-140 RelatedInformation

OBJECTIVE:To determine if the morbidity and postoperative mortality after a full gastrectomy for gastric cancer performed on patients of more than 70 years of age were different from those of younger patients.MATERIAL AND METHODS:Between 1980 and 1999, a total of 411 gastrectomies for gastric adenocarcinoma were performed at the Institute of Cancer Diseases (INEN). Of these, 87 were inpatients older than 70 years of age (elderly group) and 92 were inpatients between 50 and 59 years of age (young group). The clinical record of both groups were studied and the clinical-pathological features, morbidity and postoperative mortality, staying time in hospital and survival rate were compared.RESULTS:There was no significant difference between the two groups regarding clinical-pathological features except in the TNM stage. In the elderly group 23.0% had stage IV and 43.5% in the young group (p=0.007). The average operating time in the elderly group was shorter than in the young group (5.5 hours versus 6.0 hours, p=0.015). The morbidity for the elderly group was 29.9% and that of the young group was 34.8%, whereas the postoperative mortality for the elderly and young groups was 4.6% and 2.2%, respectively. Pneumonia was the most frequent postoperative complication (14.8%) and the primary cause of postoperative death in the elderly group. Time in hospital and survival were similar between both groups.CONCLUSIONS:The morbidity and postoperative mortality after a full gastrectomy for cancer of the stomach in the elderly is no different from those found in younger patients.

Journal of Surgical OncologyVolume 77, Issue 2 p. 132-135 How I Do It Central pancreatectomy for tumors of the neck and body of the pancreas Juan Celis MD, Corresponding Author Juan Celis MD jcelis@inen.sld.pe Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruChief of the Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34-Peru.Search for more papers by this authorFrancisco Berrospi MD, Francisco Berrospi MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorEloy Ruiz MD, Eloy Ruiz MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorEduardo Payet MD, Eduardo Payet MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorCarlos Luque MD, Carlos Luque MD Oncologic Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this author Juan Celis MD, Corresponding Author Juan Celis MD jcelis@inen.sld.pe Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruChief of the Department of Abdominal Surgery, Instituto de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34-Peru.Search for more papers by this authorFrancisco Berrospi MD, Francisco Berrospi MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorEloy Ruiz MD, Eloy Ruiz MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorEduardo Payet MD, Eduardo Payet MD Department of Abdominal Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this authorCarlos Luque MD, Carlos Luque MD Oncologic Surgery, Instituto de Enfermedades Neoplasicas, Lima, PeruSearch for more papers by this author First published: 01 June 2001 https://doi.org/10.1002/jso.1083Citations: 20AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume77, Issue2June 2001Pages 132-135 RelatedInformation

OBJECTIVE: In order to determine a the clinicopatological features in young patients with gastric cancer and compare them with aged patients.PATIENTS AND METHODS: For this study, we selected the clinical charts from the total of patients with histological proved diagnosis of gastric adenocarcinoma admitted at the INEN between 1980 and 1996 whose age was less than 31 year (Young group, n =92). As a comparison group (Average Group) we chose of the same universe, a random sample of 184 patients between 50 to 70 years of age. Epidemiological, clinical and histological features, operability and resecability, TNM stage, type of surgery and follow-up of both groups were analyzed.RESULTS: In the Young Group in compared with Average Group, females were more frequent (73.9% vs. 50.5% p<0.001); mucocelular type (70% vs. 31.0%, p<0.001) and undifferentiated carcinoma (75% vs. 32.6%, p>0.001). The mean survival time in the Young Group was 74.9 months and in the Average Group was 36.03 months (p=0.26), there were no significant differences in the survival between resecability and sex (p=0.10 and p=0.41).CONCLUSION: The females and undifferentiated carcinoma was the most frequent features in the young patients with gastric cancer. The survival in this group is better than the average group but this was a no significant difference because the diagnosis was made in late stages.

Usually primary cancer originating in the hepatic duct confluence (Klatskin Tumor) is regarded as unresectable at diagnosis and therefore percutaneously or endoscopically placed stents have been advocated. Unfortunately with these palliative modalities the median survival is only 3-6 months. However with aggressive surgical resection of the tumor 17% of five year survival have been obtained. The present paper summarizes our experience from three patients with Klatskin tumor which underwent surgery. The Klatskin tumors were Type II (one case), Type IIIa (one case) and Type IIIb (one case). The patient with tumor Type II had wide tumor excision and extrahepatic bile duct resection at the liver hilum. The patients with tumor Type III had extrahepatic bile duct resection at the liver hilum with left and right hepatectomy respectively. Reconstruction was made with Roux-en-Y biliary enteric anastomosis, the mean post operative stay was 9 days. The mean post operative survival of two patients undergoing surgery with curative intent was 21 months, in contrast to 10 months for the patient with palliative surgery. One patient is alive 22 months with no evidence of disease. Our results supports an aggressive surgical approach in patients with Klatskin tumor which should include Hepatectomy to obtain free resection margins.

OBJECTIVE:Determination of the postoperative morbidity and mortality after gastroenterostomy in patients with unresectable gastric cancer.STUDY DESIGN:Retrospective review of clinical records of all patients with obstructive distal gastric cancer who underwent gastroenterostomy at the Instituto de Enfermedades Neoplásicas between 1980 and 1993. The following factors were analyzed: age, sex, hemoglobin, albumin, preoperative risk, ascites, extent of disease, operative time, hospital stay, morbidity and mortality.RESULTS:198 gastroenterostomy were done with a morbidity and mortality rates of 20% and 10%, respectively. Pneumonia was the principal cause of postoperative morbidity and mortality. High operative risk, adjacent organ invasion by the tumor and peritoneal metastasis were factors associated with increased postoperative morbidity (p > 0.05). High operative risk was the only prognostic factor for postoperative mortality (p < 0.01).CONCLUSIONS:Because of high postoperative morbidity and mortality, gastroenterostomy should not be done in patients with unresectable gastric cancer and high preoperative risk.