Background: Reports of periampullary adenocarcinomas are scarce in Latin-America. Pancreatic adenocarcinoma (PA) has the highest incidence in western countries, but also worse survival compared to distal bile duct (DBD), ampullary (AA) and duodenal (DA) adenocarcinomas, even after being resected by pancreaticoduodenectomy (PD). In this study, we analyze the survival of patients with resected periampullary adenocarcinomas and determined factors that influence this outcome. Methods: We retrospectively analyzed patients undergoing PD for periampullary adenocarcinoma from 2002 to 2011 in the three major pancreatic surgery centers in Peru. Postoperative mortalities (90-day) were excluded. Clinicopathologic features that may influence overall survival (OS) were collected and analyzed by Kaplan–Meier method. Log-Rank test and Cox regression modelling were used for univariate and multivariate analysis, respectively. Results: 473 Periampullary adenocarcinomas (153 PA, 258 AA, 33 DBD and 29 DA) treated by PD were identified. 5-year OS was 34% with a median survival of 28 months for the entire cohort. PA was associated with the worst 5-year OS (11%) compared to DBD (24%), DA (41%) and AA (47%), respectively (p < 0.01). Predictors of poor survival were site of primary, age ≥ 70 years, tumor size ≥ 2.5 cm, high-grade tumors, nodal metastases, lymphovascular invasion, perineural invasion and positive resection margin. On multivariate analysis, site of primary and nodal metastases were the strongest predictors of survival. Conclusion: We report the oncologic outcomes of the largest multi-institutional series of resected periampullary adenocarcinomas in Peru and Latin-America. AA is the most frequently resected tumor and portent the best prognosis, while PA has the worst OS. Patient selection could account for differences with reports of developed countries.Table 1Univariate and multivariate analysis of predictors of OS in patients undergoing PD for periampullary adenocarcinomasVariableNumber of patients5 years OSUnivariate analysisMultivariate analysisHazzard ratio (95% CI)PHazzard ratio (95% CI)PSex Man21780(37%) Woman25679 (31%)1.1 (0.9–1.4)0.304––Age <70 years332118 (36%) ≥70 years14141 (29%)1.3 (1.1–1.7)0.0171.4 (1.1–1.8)0.008Tumor size <2.5 cm14676 (41%) ≥2.5 cm28783 (29%)1.5 (1.2–1.9)0.0011.1 (0.8–1.4)0.549Site of primary Pancreas15317 (11%)ReferenceReference Distal Bile Duct333 (24%)0.6(0.4–0.9)<0.0010.7 (0.4–1.0)0.008 Duodenum2912 (41%)0.3 (0.2–0.6)0.0080.6 (0.3–0.9)0.036 Ampulla of Vater258122 (47%)0.3 (0.2–0.4)<0.0010.5 (0.4–0.7)<0.001Nodal metastases Negative237116 (49%) Positive23643 (18%)2.5 (2.0–3.1)<0.0011.7 (1.3–2.2).<0.001Degree of differentiation G115772 (46%) G2 + G3 + G431687 (23%)1.8 (1.4–2.3)<0.0011.4 (1.1–1.8)0.016Lymphovascular invasion Negative17294 (55%) Positive30165 (22%)2.7 (2.1–3.4)<0.00115.(1.1–2.1)0.011Invasionperineural Negative240115 (48%) Positive23344 (19%)2.4 (1.9–3.0)<0.0011.2 (0.9–1.6)0.205Resection margin Negative419153 (37%) Positive546 (11%)2.8 (2.4–3.9)<0.0011.6 (1.1–1.3)0.007OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated. Open table in a new tab OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated.

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.

We present results from the pilot implementation of an innovative redesign of a Leadership in Sustainable Development course offered at the Monterrey Institute of Technology (Mexico) involving the coupling of a project-oriented methodology with a place-based approach to learning. During the fall semester of 2003, the course used the western frontier (San Pedro, Santa Catarina and García municipalities) of the Monterrey metropolitan area in northeastern Mexico as the new classroom to learn about the concept of sustainable development and the challenges to put it into practice. Above all, the redesign resulted in an enriched educational experience with a deeper and more realistic understanding of the theory and practice behind the concept. Simultaneous outreach and research benefits were also observed. The pilot effort yielded a preliminary diagnosis of sustainable development issues covering a large geographic zone and a whole sweep of topics that already suggests priorities for policy and research. Key opportunities for improvements in the course redesign are the scaling down of the scope of student projects along with the inclusion of a second case study.