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Duodenopancreatectomía cefálica y tutorización externa del conducto de Wirsung. Resultados de una serie de 80 casos consecutivos
Pancreaticoduodenectomy and external Wirsung stenting: our outcomes in 80 cases
Carlos Jiménez Romeroa,
Autor para correspondencia
carlos.jimenez@inforboe.es

Autor para correspondencia.
, Laura Alonso Murilloa, Paula Rioja Condea, Alberto Marcacuzco Quintoa, Óscar Caso Maestroa, Anisa Nutua, Isabel Pérez Moreirasb, Iago Justo Alonsoa
a Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
b Servicio de Cirugía General, Hospital Lucus Augusti, Lugo, España
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como complicaciones postoperatorias m&#225;s graves&#44; que se presentan del 17&#44;8-34&#44;9&#37;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">5&#44;6&#44;8-13</span></a>&#46; A la hora de elegir una t&#233;cnica derivativa pancre&#225;tica-digestiva no se han observado diferencias significativas en cuanto a la incidencia de FP o morbilidad global al comparar la pancre&#225;tico-yeyunostom&#237;a con la pancre&#225;tico-gastrostom&#237;a<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">14-16</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Como consecuencia de las FP pueden presentarse complicaciones como abscesos&#44; peritonitis&#44; sepsis o hemorragia intraabdominal&#44; que se asocian con una estancia hospitalaria prolongada y mortalidad elevada<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">17-19</span></a>&#46; La patogenia de las FP se atribuye a la filtraci&#243;n de la secreci&#243;n exocrina pancre&#225;tica a trav&#233;s de la anastomosis pancre&#225;tico-yeyunal&#44; siendo el mecanismo m&#225;s probable la autodigesti&#243;n y destrucci&#243;n del tejido perianastom&#243;tico que conlleva una dehiscencia y filtraci&#243;n del contenido bilioent&#233;rico dentro de la cavidad abdominal<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo de este estudio&#44; descriptivo y retrospectivo&#44; es analizar los resultados obtenidos en tumores de cabeza de p&#225;ncreas y periampulares tratados mediante DPC y pancre&#225;tico-yeyunostom&#237;a utilizando una tutorizaci&#243;n externa del conducto de Wirsung&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Desde el 19 de enero de 2012 hasta el 31 de junio de 2019&#44; en la Unidad de Cirug&#237;a HBP&#44; se indic&#243; una laparotom&#237;a con intenci&#243;n de realizar una DPC en 178 pacientes con lesiones de cabeza de p&#225;ncreas&#44; duodeno o regi&#243;n periampular&#46; La DPC se llev&#243; a cabo en 139 &#40;78&#37;&#41; pacientes&#44; realiz&#225;ndose la reconstrucci&#243;n pancre&#225;tico-yeyunal t&#233;rmino-lateral con tutorizaci&#243;n externa del conducto de Wirsung en 80 pacientes&#46; Los 59 pacientes restantes resecados se manejaron con tutor interno o sin tutor&#46; El presente estudio consiste en el an&#225;lisis de una serie de 80 pacientes consecutivos&#44; intervenidos por cuatro cirujanos de la Unidad de Cirug&#237;a HBP&#46; La t&#233;cnica de reconstrucci&#243;n con tutor externo fue de libre elecci&#243;n por los cirujanos y sistem&#225;ticamente realizada en todos los casos con indicaci&#243;n de DPC&#44; sin excluir ning&#250;n paciente&#44; aunque pudiera presentar un potencial riesgo de FP&#46; El seguimiento m&#237;nimo de la serie es de siete meses post-DPC&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protocolo diagn&#243;stico preoperatorio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Desde que se inicio esta serie ha habido ciertos cambios en cuanto a utilizaci&#243;n de pruebas diagn&#243;sticas&#44; aunque b&#225;sicamente para el diagn&#243;stico y estadificaci&#243;n se ha realizado una tomograf&#237;a axial computarizada &#40;TAC&#41; a casi todos los pacientes&#44; complementando con colangiopancreatorresonancia magn&#233;tica &#40;CRM&#41;&#44; ecoendoscopia&#44; as&#237; como colangiopancreatograf&#237;a retr&#243;grada endosc&#243;pica &#40;CPRE&#41; y colangiograf&#237;a transparietohep&#225;tica &#40;CTPH&#41; para drenaje biliar&#46; Actualmente&#44; en l&#237;neas generales el protocolo estandarizado para tumores pancre&#225;ticos&#44; periampulares y de v&#237;a biliar distal consiste en&#58; TAC toraco-abdomino-p&#233;lvico y&#47;o CRM&#44; ecoendoscopia y biopsia y marcadores tumorales &#40;CEA y CA&#46;19&#46;9&#41;&#44; utilizando para drenaje biliar la CTPH y la CPRE para drenar la v&#237;a biliar y diagn&#243;stico de lesiones periampulares&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">T&#233;cnica quir&#250;rgica</span><p id="par0030" class="elsevierStylePara elsevierViewall">En todos los pacientes se realiz&#243; una laparotom&#237;a media supraumbilical&#44; colecistectom&#237;a&#44; secci&#243;n de la uni&#243;n del conducto hep&#225;tico com&#250;n con el col&#233;doco y resecci&#243;n de cabeza de p&#225;ncreas y duodeno incluyendo adem&#225;s unos 15&#160;cm del yeyuno proximal&#46; En patolog&#237;a maligna se efectu&#243; una linfadenectom&#237;a del ligamento hepatoduodenal&#44; arteria hep&#225;tica com&#250;n y vertiente lateral derecha de la arteria mesent&#233;rica superior&#46; Cuando el tumor estaba alejado del duodeno se realiz&#243; preservaci&#243;n pil&#243;rica&#44; o una antrectom&#237;a si el tumor estaba pr&#243;ximo al duodeno&#46; En casos de infiltraci&#243;n tumoral de vena porta o vena mesent&#233;rica superior se efectu&#243; una resecci&#243;n venosa segmentaria y anastomosis t&#233;rmino-terminal sin interposici&#243;n de injerto&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La pancre&#225;tico-yeyunostom&#237;a se realiz&#243; en dos planos&#58; el interno suturando la mucosa del Wirsung con la mucosa yeyunal mediante 6-8 puntos entrecortados con material reabsorbible&#44; monofilamento &#40;poligluconato de 5&#47;6-0&#41;&#44; y el externo mediante puntos entrecortados de polipropileno de 3&#47;4-0&#44; que atraviesan el par&#233;nquima pancre&#225;tico y 0&#44;5&#160;cm de la seromuscular del asa yeyunal&#44; sin invaginaci&#243;n del p&#225;ncreas dentro del yeyuno&#46; El extremo del tutor transanastom&#243;tico &#91;sonda uretral cil&#237;ndrica de polivinilo &#40;Drenoplex-DICLISA&#174;&#41;&#44; con tres orificios distales&#44; de 2&#44;0-390&#160;mm&#44; calibres 6 u 8&#44; dependiendo del di&#225;metro del Wirsung&#93; se introdujo unos 4-5&#160;cm en el conducto de Wirsung&#44; pasando a la luz yeyunal y exterioriz&#225;ndolo despu&#233;s a trav&#233;s del asa yeyunal aferente proximal ascendida&#44; fij&#225;ndose la salida intestinal del tutor seg&#250;n t&#233;cnica de Witzel&#46; El extremo distal del cat&#233;ter se exterioriz&#243; a trav&#233;s de la pared abdominal anterior izquierda&#44; donde se fij&#243; con dos puntos de seda 3&#47;0 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46; Una vez descartada una FP mediante un nivel de amilasa &#60;&#160;400&#160;UI por el orificio de drenaje de Penrose&#44; y antes del alta&#44; se tapona el tubo de tutorizaci&#243;n del Wirsung hasta su extracci&#243;n en la consulta ambulatoria a las 5-6 semanas de la cirug&#237;a&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La reconstrucci&#243;n cl&#225;sica de Child &#40;con un asa yeyunal&#41; se realiz&#243; en 65 casos y la t&#233;cnica con dos asas en 15 casos&#46; La anastomosis hep&#225;tico-yeyunal se confeccion&#243; a 10-15&#160;cm de la pancre&#225;tica con puntos entrecortados de poligluconato&#44; de 4&#47;5-0&#46; La anastomosis duodeno-yeyunal o la gastro-yeyunal se realiz&#243; a unos 55-60&#160;cm de la bilio-yeyunal&#44; en posici&#243;n t&#233;rmino-lateral&#44; en dos planos &#40;interno con sutura continua de poligluconato 4&#47;0 y externo con continua de polipropileno 4&#47;0&#41;&#46; Por otro lado&#44; la reconstrucci&#243;n con dos asas es igual a la anterior en cuanto a la anastomosis pancre&#225;tica y biliar&#44; difiriendo de la anterior en que&#44; despu&#233;s de una antrectom&#237;a&#44; se hizo una anastomosis gastroyeyunal t&#233;rmino-lateral y&#44; a 70&#160;cm de esta y de la bilio-yeyunal&#44; se efectu&#243; otra anastomosis yeyuno-yeyunal t&#233;rmino-lateral&#44; en Y&#44; con la intenci&#243;n de evitar el reflujo de la secreci&#243;n pancre&#225;tico-yeyunal hacia el est&#243;mago &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El drenaje de la cavidad abdominal se realiz&#243; con dos Penrose &#40;uno por encima y otro por debajo de la anastomosis pancre&#225;tica&#41;&#44; que se exteriorizaron por flanco derecho y flanco izquierdo&#44; respectivamente&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Manejo postoperatorio y seguimiento</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes permanecieron entre 24-48 horas en reanimaci&#243;n despu&#233;s de la cirug&#237;a&#46; La profilaxis antibi&#243;tica se realiz&#243; con 2&#160;g de cefazolina iv&#46; En los pacientes con pr&#243;tesis biliares&#44; ictericia o colangitis se realiz&#243; tratamiento con piperacilina&#160;&#43;&#160;tazobactam 4&#47;0&#44;5&#44; iv&#44; cada seis horas durante cinco d&#237;as&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los drenajes intraabdominales se retiraron a partir del 5&#176;-6&#176; d&#237;a&#44; siempre en ausencia de f&#237;stula&#44; hemorragia o infecci&#243;n y con cifras de amilasa &#60;&#160;400&#160;UI&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las f&#237;stulas pancre&#225;ticas se han clasificado seg&#250;n la actualizaci&#243;n del ISGPF<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">21</span></a>&#58; grado A o <span class="elsevierStyleItalic">f&#237;stulas bioqu&#237;micas</span> &#40;FB&#41;&#59; grado B &#40;precisan cambio de tratamiento o drenaje percut&#225;neo de colecciones&#41; y grado C &#40;presentan inestabilidad cl&#237;nica y desembocan en fallo org&#225;nico y&#47;o mortalidad&#44; precisando drenaje de colecciones o reintervenciones&#41;&#46; Las f&#237;stulas biliares se definieron seg&#250;n los criterios de Burkhart et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">22</span></a>&#46; La hemorragia post-DPC se clasific&#243; seg&#250;n la definici&#243;n del ISGPS<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">23</span></a> y el retraso del vaciamiento g&#225;strico &#40;RVG&#41; post-DPC seg&#250;n los criterios de Wente el al&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">24</span></a>&#46; Se registraron las complicaciones seg&#250;n la clasificaci&#243;n de Clavien et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">25</span></a>&#46; Se realizaron revisiones al mes y despu&#233;s cada tres meses&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables cualitativas se expresaron mediante n&#250;meros absolutos y frecuencias relativas en forma de porcentaje&#46; Las variables cuantitativas con distribuci&#243;n normal se expresaron mediante la media y la desviaci&#243;n est&#225;ndar y&#44; cuando la distribuci&#243;n no era normal&#44; se utiliz&#243; la mediana y los percentiles 0 y 100&#46; Previamente se estudi&#243; la normalidad de las variables cuantitativas mediante el <span class="elsevierStyleItalic">test</span> de Kolmogorov-Smirnov&#46; La relaci&#243;n entre variables cuantitativas se analiz&#243; mediante la prueba <span class="elsevierStyleItalic">t</span> de Student en caso de distribuci&#243;n normal y&#44; en caso de incumplir la normalidad&#44; se utiliz&#243; la prueba de Mann-Whitney&#46; La supervivencia de los pacientes se calcul&#243; seg&#250;n el m&#233;todo actuarial de Kaplan-Meier&#46; El valor de p&#160;&#60;&#160;0&#44;05 se consider&#243; estad&#237;sticamente significativo&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">La edad media fue de 68&#44;3&#160;&#177;&#160;9 a&#241;os y el 97&#44;5&#37; presentaba un ASA II-III&#46; En cuanto a la cl&#237;nica se destac&#243; la presencia de ictericia en 56 &#40;70&#37;&#41; pacientes&#44; dolor abdominal en 43 &#40;53&#44;8&#37;&#41;&#44; p&#233;rdida de peso en 42 &#40;52&#44;5&#37;&#41;&#44; colangitis en 15 &#40;18&#44;8&#37;&#41; y pancreatitis en siete &#40;8&#44;8&#37;&#41;&#46; Las pruebas diagn&#243;sticas y sus hallazgos&#44; as&#237; como los valores anal&#237;ticos antes de la cirug&#237;a se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Previamente a la cirug&#237;a se coloc&#243; una pr&#243;tesis met&#225;lica en 12 &#40;15&#37;&#41; pacientes&#44; una pr&#243;tesis pl&#225;stica en 11 &#40;13&#44;8&#37;&#41; y un cat&#233;ter interno-externo en siete &#40;8&#44;8&#37;&#41;&#46; La tasa de resecabilidad global entre los pacientes con indicaci&#243;n quir&#250;rgica fue del 78&#37;&#44; desestim&#225;ndose la resecci&#243;n por los motivos indicados en el diagrama de flujo &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; En relaci&#243;n con las variables perioperatorias&#44; se transfundieron nueve &#40;11&#44;3&#37;&#41; pacientes con una mediana de 800&#160;mL&#44; hall&#225;ndose un p&#225;ncreas de consistencia blanda en 41 &#40;51&#44;2&#37;&#41; y dura en 39 &#40;48&#44;8&#37;&#41;&#46; Se realiz&#243; una pancre&#225;tico-yeyunostom&#237;a y drenaje abdominal con dos Penrose en todos los pacientes&#44; preservaci&#243;n pil&#243;rica en 35 &#40;43&#44;8&#37;&#41;&#44; tratamiento con nutrici&#243;n parenteral en 78 &#40;97&#44;5&#37;&#41; y con octreotida en 14 &#40;17&#44;5&#37;&#41; pacientes con FP fundamentalmente de grado B o C&#44; en los cuales no se observ&#243; mejor&#237;a&#46; No se realiz&#243; profilaxis con octreotida en ning&#250;n caso&#46; El tumor m&#225;s frecuente fue el adenocarcinoma &#40;68&#44;8&#37;&#41;&#44; seguido del colangiocarcinoma &#40;7&#44;5&#37;&#41;&#44; tumor neuroendocrino &#40;6&#44;3&#37;&#41; y neoplasia mucinosa papilar intraductal &#40;6&#44;3&#37;&#41;&#46; Con una mediana de 15 ganglios linf&#225;ticos aislados en la pieza resecada&#44; se detectaron met&#225;stasis en 47 &#40;58&#44;8&#37;&#41; pacientes&#46; El grado de invasi&#243;n tumoral del p&#225;ncreas&#44; ganglionar&#44; neural y vascular&#44; y tasa de resecci&#243;n portal se reflejan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Una resecci&#243;n R0 se consigui&#243; en 56 &#40;70&#37;&#41; pacientes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Se realiz&#243; una resecci&#243;n hep&#225;tica m&#237;nima en cu&#241;a &#40;m&#225;ximo de 3&#160;cm&#41;&#44; hall&#225;ndose una met&#225;stasis de peque&#241;o tama&#241;o en dos pacientes &#40;previamente tratados con neoadyuvancia&#41; y un hemangioma en otro&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Resecci&#243;n vascular por infiltraci&#243;n tumoral se realiz&#243; en 10 pacientes&#58; vena mesent&#233;rica superior en cinco &#40;parche de 1&#160;cm en todos&#41;&#44; vena porta en cuatro &#40;parche de 1&#160;cm en dos y resecci&#243;n de un cilindro de vena de aproximadamente 1&#160;cm en otros dos con anastomosis portal t&#233;rmino-terminal&#41; y resecci&#243;n en un paciente de la confluencia de arteria gastro-duodenal&#44; arteria hep&#225;tica com&#250;n y propia con posterior anastomosis t&#233;rmino-terminal entre arteria hep&#225;tica com&#250;n y propia&#46; Cuatro de estos pacientes se reintervinieron por hemorragia&#44; pero ninguno desarroll&#243; FP&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En 10 &#40;12&#44;5&#37;&#41; pacientes se present&#243; m&#225;s de una complicaci&#243;n&#46; Entre las complicaciones postoperatorias la FB &#40;antes denominada FP grado A&#41; se present&#243; en nueve &#40;11&#44;3&#37;&#41; pacientes&#44; FP grado B en 10 &#40;12&#44;5&#37;&#41; y FP grado C en dos &#40;2&#44;5&#37;&#41;&#46; En p&#225;ncreas de consistencia dura la FB se present&#243; en un &#40;2&#44;4&#37;&#41; caso frente a ocho &#40;20&#44;5&#37;&#41; en p&#225;ncreas de consistencia blanda &#40;p&#160;&#61;&#160;0&#44;02&#41;&#59; mientras que la tasa de FP tipos B&#160;&#43;&#160;C fue de cinco &#40;12&#44;2&#37;&#41; casos en p&#225;ncreas de consistencia dura frente a siete &#40;17&#44;9&#37;&#41; en p&#225;ncreas de consistencia blanda &#40;p&#160;&#61;&#160;0&#44;51&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La f&#237;stula biliar se observ&#243; en cinco &#40;6&#44;3&#37;&#41; pacientes&#58; grado A en 1&#44; B en tres y C en uno&#46; Hemorragia postoperatoria la presentaron nueve &#40;11&#44;3&#37;&#41; pacientes&#58; grado A en dos&#44; B en cuatro y C en tres&#46; La reintervenci&#243;n quir&#250;rgica se indic&#243; en ocho pacientes&#58; cinco por hemoperitoneo no relacionado con FP&#44; dos por FP y uno por evisceraci&#243;n&#44; precisando siete &#40;8&#44;8&#37;&#41; pacientes el drenaje de una colecci&#243;n intraabdominal mediante TAC-punci&#243;n&#46; La mediana de la estancia hospitalaria fue 16 d&#237;as y la mortalidad hospitalaria fue 2&#44;5&#37; &#40;dos pacientes&#41;&#46; Se realiz&#243; neoadyuvancia en nueve &#40;11&#44;2&#37;&#41; pacientes y quimioterapia adyuvante en 38 &#40;47&#44;5&#37;&#41;&#44; detect&#225;ndose insuficiencia exocrina <span class="elsevierStyleItalic">de&#160;novo</span> en 24 &#40;30&#37;&#41; e insuficiencia endocrina <span class="elsevierStyleItalic">de novo</span> en 10 &#40;12&#44;5&#37;&#41;&#46; Tambi&#233;n se diagnostic&#243; RVG en 29 &#40;36&#44;3&#37;&#41; pacientes&#46; La morbilidad a los 90 d&#237;as era del 46&#44;3&#37; y la mortalidad permaneci&#243; en 2&#44;5&#37;&#46; Las complicaciones&#44; seg&#250;n la clasificaci&#243;n de Clavien et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">25</span></a>&#44; quedan tambi&#233;n reflejadas en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; La supervivencia de los pacientes a 1&#44; 3 y 5 a&#241;os es del 80&#44;2&#44; 53&#44;6 y 19&#44;2&#37;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">La disparidad en la incidencia de FP post-DPC es tan llamativa que se han hallado diferencias significativas en estudios aleatorizados entre distintos hospitales y cirujanos<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">5</span></a>&#46; La tasa de FP va a ser diferente seg&#250;n la definici&#243;n adoptada&#44; de modo que&#44; seg&#250;n la serie de Winter el al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">8</span></a>&#44; la incidencia de FP es del 9&#44;4&#37; si se siguen los criterios del Johns Hopkins&#44; frente al 24&#44;4&#37; si se siguen los del ISGPF<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">26</span></a>&#46; La primitiva definici&#243;n de las FP&#44; atendiendo al ISGPF<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">26</span></a>&#44; ha sido criticada por varios autores<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">12&#44;27</span></a> en base a la nula repercusi&#243;n cl&#237;nica de las FP grado A y moderada de las grado B que rara vez van a precisar una reintervenci&#243;n&#46; Recientemente&#44; el ISGPS ha realizado una reclasificaci&#243;n de las FP&#44; considerando las de grado A como FB&#44; pero no FP propiamente dichas<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">21</span></a>&#46; Seg&#250;n esta definici&#243;n&#44; nuestra incidencia de las verdaderamente consideradas FP &#40;suma de B y C&#41; es del 15&#37; &#40;12 pacientes&#41;&#44; correspondiendo al 11&#44;3&#37; &#40;nueve pacientes&#41; las ahora llamadas FB &#40;grado A&#41;&#46; En una serie multic&#233;ntrica reciente&#44; de 4&#46;301 DPC&#44; la tasa conjunta de FP grados B y C fue del 11&#44;1&#37; frente al 8&#44;1&#37; de FB y&#44; al comparar la incidencia de FP grado C entre la utilizaci&#243;n de tutor interno y externo&#44; la incidencia ha sido significativamente superior con el interno<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En base a los resultados publicados&#44; en general&#44; se defiende m&#225;s el uso de tutores frente a no tutores debido a una menor tasa global de FP<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">29-32</span></a>&#44; observando tambi&#233;n una menor incidencia de FP graves &#40;tipos B y C&#41; y morbilidad postoperatoria<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En series comparativas entre dos t&#233;cnicas de las tres m&#225;s utilizadas &#40;no tutor&#44; tutor interno o externo&#41;&#44; la tasa de FP sin tutor se reporta entre 1&#44;4 y 40&#44;9&#37;&#59; entre 6&#44;1 y 47&#44;7&#37; con tutor interno y entre 8 y 36&#44;4&#37; con tutor externo<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">4&#44;5&#44;8-11&#44;13&#44;33</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En dos metaan&#225;lisis&#44; comparando el tutor interno con el externo&#44; la tasa de FP ha sido significativamente m&#225;s baja en los pacientes con tutor externo<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">34&#44;35</span></a> al igual que la morbilidad global y la tasa de RVG<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">35</span></a>&#46; En otro metaan&#225;lisis reciente se ha concluido tambi&#233;n que la tutorizaci&#243;n externa reduce significativamente la mortalidad relacionada con la FP<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">36</span></a>&#46; Se ha referido que cuando se seleccionan los pacientes con alto riesgo de FP &#40;puntuaci&#243;n 7-10&#41;&#44; seg&#250;n criterios de Callery et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">37</span></a>&#44; los mejores resultados se obtienen en pacientes con tutorizaci&#243;n externa del Wirsung&#44; pancre&#225;tico-yeyunostom&#237;a y drenaje intraabdominal pero no tratados con octreotida<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">38</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nuestra elecci&#243;n de la tutorizaci&#243;n externa del Wirsung&#44; desde hace 6&#44;5 a&#241;os&#44; la basamos en las ventajas te&#243;ricas del tutor externo sobre el interno por la creaci&#243;n de una f&#237;stula pancre&#225;tico-cut&#225;nea controlada mediante la derivaci&#243;n de gran cantidad de jugo pancre&#225;tico fuera de la anastomosis&#44; lo cual permite la cicatrizaci&#243;n de la anastomosis y la permeabilidad del Wirsung&#46; El tutor externo del Wirsung facilita la anastomosis ducto-mucosa y puede descomprimir el asa aferente y mejorar el control de las secreciones en caso de FP&#44; posibilitando tambi&#233;n el control radiol&#243;gico de la anastomosis<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">4&#44;6&#44;39-41</span></a>&#46; Por otro lado&#44; la colocaci&#243;n de un tutor interno tiene el inconveniente de su f&#225;cil desprendimiento y emigraci&#243;n&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Las FP grado B se caracterizan por presentar colecciones intraabdominales que suelen drenarse por TAC-punci&#243;n&#44; como en siete &#40;8&#44;8&#37;&#41; de nuestros pacientes&#46; La hemorragia intraabdominal no relacionada con la FP puede ser tambi&#233;n motivo de reintervenci&#243;n&#44; ocurrida en cinco &#40;6&#44;3&#37;&#41; de nuestros pacientes&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Las FP grado C post-DPC&#44; de extremada gravedad&#44; requieren reintervenci&#243;n o&#44; en caso contrario&#44; pueden desarrollar fallo multiorg&#225;nico y fallecer por dicha complicaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">21</span></a>&#46; En una serie multic&#233;ntrica francesa&#44; de 680 pacientes con DPC&#44; la incidencia de FP grado C ha sido del 5&#44;3&#37;&#44; asoci&#225;ndose a una tasa de reintervenci&#243;n del 97&#37; y de mortalidad del 25&#44;7&#37;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">41</span></a>&#46; En otra serie multic&#233;ntrica&#44; donde se incluyen pacientes con tutor interno y externo&#44; se refiere una incidencia significativamente mayor de FP grado C en el grupo de tutor interno y una mortalidad del 2&#37; a 90 d&#237;as&#44; correspondiendo el 35&#37; de la mortalidad a las FP grado C<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">28</span></a>&#46; Los dos &#250;nicos pacientes fallecidos de nuestra serie &#40;2&#44;5&#37;&#41; lo hicieron por sepsis abdominal despu&#233;s de ser reintervenidos por FP grado C&#46; En la reintervenci&#243;n por FP se drena el absceso y&#44; en caso de dehiscencia o necrosis pancre&#225;tica&#44; se aconseja desmontar la anastomosis y cerrar el extremo yeyunal&#44; finalizando con una pancreatectom&#237;a parcial dejando la cola pancre&#225;tica o con una pancreatectom&#237;a total<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">41&#44;42</span></a>&#44; o simplemente colocando un drenaje del borde de secci&#243;n del p&#225;ncreas&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Dentro de los m&#250;ltiples factores de riesgo de FP descritos&#44; los m&#225;s frecuentemente referidos son&#58; conducto de Wirsung no dilatado &#40;&#60;&#160;3&#160;mm&#41; y p&#225;ncreas de textura blanda<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">4-6&#44;8-10&#44;13&#44;18&#44;28&#44;37&#44;41</span></a>&#44; esteatosis pancre&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">43&#44;44</span></a>&#44; transfusi&#243;n importante<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">18&#44;41</span></a>&#44; DPC por tumores duodenales o ampulares<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">18&#44;37&#44;41</span></a>&#44; edad mayor de 60 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">45</span></a>&#44; IMC&#160;&#62;&#160;25&#44; no utilizaci&#243;n de tutor<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">13</span></a> y tiempo prolongado de cirug&#237;a &#40;7&#44;3 vs&#46; 6&#44;6 horas&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La consistencia del p&#225;ncreas es un par&#225;metro subjetivo&#44; dif&#237;cil de estandarizar&#44; habi&#233;ndose correlacionado la textura blanda con un di&#225;metro del Wirsung &#60; 3 mm<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; La tasa de p&#225;ncreas de consistencia dura es del 46&#44;4 frente al 53&#44;6&#37; de consistencia blanda seg&#250;n una serie multic&#233;ntrica reciente<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">28</span></a>&#44; tasas similares a las nuestras &#40;p&#225;ncreas duro&#44; 51&#44;2 vs&#46; 48&#44;8&#37;&#44; blando&#41;&#46; En nuestro estudio solo hemos demostrado una incidencia significativamente mayor &#40;p&#160;&#61;&#160;0&#44;02&#41; de FB en pacientes con p&#225;ncreas blando frente a p&#225;ncreas duro&#44; pero la diferencia no ha sido significativa &#40;p&#160;&#61;&#160;0&#44;52&#41; al comparar la tasa de FP tipos B&#160;&#43;&#160;C entre los pacientes con p&#225;ncreas de consistencia dura y blanda&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se han mencionado una serie de estrategias para prevenir o disminuir la incidencia de FP&#44; como ciertas modificaciones en la t&#233;cnica<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">16</span></a>&#44; profilaxis con octreotida<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">46</span></a>&#44; refuerzo de la anastomosis con sellante de fibrina<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">47</span></a>&#44; colocaci&#243;n de drenajes intraperitoneales<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">48</span></a>&#44; y tutorizaci&#243;n transanastom&#243;tica interna en todos los pacientes<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">9&#44;10&#44;49</span></a> o en pacientes de alto riesgo<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">50</span></a>&#44; aunque es la tutorizaci&#243;n externa la estrategia m&#225;s frecuentemente referida para prevenir las FP<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">4&#44;6&#44;12&#44;13&#44;31&#44;32&#44;35&#44;36&#44;51&#44;52</span></a><span class="elsevierStyleBold">&#44;</span> fundamentalmente en pacientes con elevado riesgo de FP<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La colocaci&#243;n de drenajes abdominales post-DPC es un asunto controvertido&#46; As&#237;&#44; en un estudio prospectivo aleatorizado &#40;utilizaci&#243;n o no de drenajes de Jackson-Pratt en DPC y pancreatectom&#237;as distales&#41;&#44; se ha observado un aumento significativo de abscesos y colecciones intraabdominales y f&#237;stulas en el grupo con drenaje<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">53</span></a>&#46; Otro estudio&#44; prospectivo&#44; multic&#233;ntrico y aleatorizado&#44; demuestra que los pacientes con riesgo moderado o grave de FP post-DPC parecen beneficiarse del uso de drenajes abdominales&#44; mientras que en un tercio con riesgo bajo de FP los drenajes pueden evitarse<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">48</span></a>&#46; En una reciente publicaci&#243;n&#44; donde se compara la utilizaci&#243;n de drenajes aspirativos frente a pasivos&#44; se concluye que las tasas de mortalidad a 30 d&#237;as y las tasas globales de complicaciones son similares en ambos grupos&#44; aunque se observa&#44; con baja evidencia&#44; que el uso de drenajes aspirativos frente a los pasivos puede reducir ligeramente la estancia hospitalaria&#44; siendo mejor su retirada precoz en los pacientes con bajo riesgo de FP<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">54</span></a>&#46; Nosotros nos hemos decantado por la utilizaci&#243;n de drenajes de Penrose para evitar problemas de obstrucci&#243;n o succi&#243;n del drenaje aspirativo sobre la anastomosis que puede conllevar el desarrollo de una FP&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El RVG post-DPC es una complicaci&#243;n frecuente que se presenta entre el 6 y 57&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">4&#44;6&#44;10&#44;24</span></a>&#44; siendo del 36&#44;3&#37; &#40;29 casos&#41; en nuestra experiencia&#46; La patogenia no est&#225; clara&#44; pudiendo aparecer tanto en la DPC con antrectom&#237;a como con preservaci&#243;n pil&#243;rica<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">24</span></a>&#46; Se ha demostrado que la FP relevante &#40;B o C&#41; y las complicaciones intraabdominales son factores de riesgo para el desarrollo del RVG<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">6&#44;55</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Entre las limitaciones de este trabajo se&#241;alamos que se trata de una serie descriptiva de casos&#46; No obstante&#44; de todos los pacientes valorados con indicaci&#243;n de DPC&#44; por parte de los cirujanos responsables&#44; no se ha excluido ning&#250;n caso para realizar una tutorizaci&#243;n externa&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; en esta serie preliminar de tutorizaci&#243;n externa del conducto de Wirsung post-DPC&#44; hemos observado una tasa de complicaciones concordante con la de otras series m&#225;s amplias recientemente publicadas y una baja tasa de mortalidad&#46; Con base en los resultados expuestos&#44; nuestra t&#233;cnica de elecci&#243;n es la tutorizaci&#243;n del Wirsung en todos los casos despu&#233;s de DPC&#46; Se precisa un an&#225;lisis comparativo con otras t&#233;cnicas para analizar los factores de riesgo de FP y mortalidad&#44; y as&#237; poder confirmar con mayor seguridad la mejor t&#233;cnica reconstructiva post-DPC&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Autor&#237;a&#47;colaboraciones</span><p id="par0165" class="elsevierStylePara elsevierViewall">Carlos Jim&#233;nez-Romero&#58; dise&#241;o del estudio&#59; redacci&#243;n del art&#237;culo&#59; revisi&#243;n cr&#237;tica y aprobaci&#243;n de la revisi&#243;n final&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Laura Alonso Murillo&#58; adquisici&#243;n y recogida de datos&#59; an&#225;lisis e interpretaci&#243;n de resultados&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Paula Rioja Conde&#58; dise&#241;o del estudio y adquisici&#243;n y recogida de datos&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Alberto Marcacuzco Quinto&#58; dise&#241;o del estudio y adquisici&#243;n y recogida de datos&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Oscar Caso Maestro&#58; adquisici&#243;n y recogida de datos&#59; an&#225;lisis e interpretaci&#243;n de resultados&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Anisa Nutu&#58; adquisici&#243;n y recogida de datos&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Isabel P&#233;rez Moreiras&#58; adquisici&#243;n y recogida de datos&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Iago Justo Alonso&#58; revisi&#243;n cr&#237;tica y aprobaci&#243;n de la revisi&#243;n final&#59; dise&#241;o del estudio&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0205" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Existe controversia respecto a la t&#233;cnica ideal de reconstrucci&#243;n pancre&#225;tico-yeyunal posresecci&#243;n duodeno-pancre&#225;tica&#46; La tutorizaci&#243;n externa del Wirsung se ha considerado por muchos autores como una t&#233;cnica con menor incidencia de f&#237;stulas y morbimortalidad&#46; Analizamos nuestra experiencia con esta t&#233;cnica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de la morbimortalidad&#44; de una serie de 80 pacientes consecutivos intervenidos&#44; durante 6&#44;5 a&#241;os&#44; por tumores pancre&#225;ticos cef&#225;licos o periampulares realizando resecci&#243;n y pancre&#225;tico-yeyunostom&#237;a con tutorizaci&#243;n externa del Wirsung&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La edad media de los pacientes fue 68&#44;3&#160;&#177;&#160;9 a&#241;os y la tasa de resecabilidad del 78&#37;&#46; La consistencia del p&#225;ncreas era blanda en 51&#44;2&#37; de pacientes y dura en 48&#44;8&#37;&#46; Se preserv&#243; el p&#237;loro en 43&#44;8&#37;&#46; El tumor m&#225;s frecuente fue el adenocarcinoma &#40;68&#44;8&#37;&#41; y se consigui&#243; un R0 en 70&#37;&#46; La f&#237;stula bioqu&#237;mica se present&#243; en 11&#44;2&#37;&#44; la f&#237;stula pancre&#225;tica grado B en 12&#44;5&#37; y la <span class="elsevierStyleSmallCaps">C</span> en 2&#44;5&#37;&#44; mientras que la tasa de reintervenci&#243;n abdominal fue del 10&#37;&#46; La mediana de estancia hospitalaria fue de 16 d&#237;as y la mortalidad postoperatoria y a 90 d&#237;as fue del 2&#44;5&#37;&#46; La tasa de retraso del vaciamiento g&#225;strico fue del 36&#44;3&#37;&#44; diabetes <span class="elsevierStyleItalic">de&#160;novo</span> del 12&#44;5&#37; e insuficiencia exocrina del 30&#37;&#46; La supervivencia a uno&#44; tres y cinco a&#241;os fue 80&#44;2&#44; 53&#44;6 y 19&#44;2&#37;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aunque nuestras tasas de morbimortalidad con la tutorizaci&#243;n externa del Wirsung son bajas&#44; coincidiendo con series m&#225;s amplias recientemente publicadas&#44; se precisa un an&#225;lisis comparativo con otras t&#233;cnicas reconstructivas&#44; con m&#225;s casos&#44; para elegir la mejor opci&#243;n despu&#233;s de una duodenopancreatectom&#237;a cef&#225;lica&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">There is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy&#46; Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula&#44; morbidity and mortality&#46; We analyse our experience with this technique&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6&#46;5-year period for pancreatic head or periampullary tumors&#44; performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mean patient age was 68&#46;3&#160;&#177;&#160;9 years&#44; and the resectability rate was 78&#37;&#46; The texture of the pancreas was soft in 51&#46;2&#37; of patients and hard in 48&#46;8&#37;&#46; Pylorus-preserving resection was performed in 43&#46;8&#37;&#46; Adenocarcinoma was the most frequent tumor &#40;68&#46;8&#37;&#41;&#44; and R0 was confirmed in 70&#37; of patients&#46; Biochemical fistula was observed in 11&#46;2&#37;&#44; pancreatic fistula grade B in 12&#46;5&#37; and C in 2&#46;5&#37;&#44; whereas the abdominal reoperation rate was 10&#37;&#46; Median postoperative hospital stay was 16 days&#44; and postoperative and 90-day mortality was 2&#46;5&#37;&#46; Delayed gastric emptying was observed in 36&#46;3&#37; of patients&#44; <span class="elsevierStyleItalic">de&#160;novo</span> diabetes in 12&#46;5&#37;&#44; and exocrine insufficiency in 3&#46; Patient survival rates after 1&#44; 3 and 5 years were 80&#46;2&#44; 53&#46;6 and 19&#46;2&#37;&#44; respectively&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Although our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series&#44; it is necessary to perform a comparative analysis with other techniques&#44; including more cases&#44; to choose the best reconstruction technique after pancreaticoduodenectomy&#46;</p></span>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CPRE&#58; colangiopancreatograf&#237;a retr&#243;grada endosc&#243;pica&#59; CEA&#58; ant&#237;geno carcinoembrionario&#59; CTPH&#58; colangiograf&#237;a transparietohep&#225;tica&#59; DMID&#58; diabetes mellitus insulinodependiente&#59; HDA&#58; hemorragia digestiva alta&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal&#59; RM&#58; resonancia magn&#233;tica&#59; TAC&#58; tomograf&#237;a axial computarizada&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">68&#44;3&#160;&#177;&#160;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">42 &#40;52&#44;5&#37;&#41; &#47;38 &#40;47&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;41&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45 &#40;56&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&#44;9&#160;&#177;&#160;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46 &#40;57&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;23&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DMID&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bebedor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;16&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor abdominal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;53&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#233;rdida de peso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;52&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hallazgo incidental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colangitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obstrucci&#243;n duodenal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pancreatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;96&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasi&#243;n vascular &#40;imagen&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VMS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AMS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vena porta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tama&#241;o m&#225;ximo tumor &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5 &#40;0&#44;6-5&#44;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calibre de v&#237;a biliar &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1 &#40;0&#44;3-2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calibre del Wirsung &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#160;&#40;2-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CPRE precirug&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;43&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CTPH precirug&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;16&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ecoendoscopia y biopsia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pr&#243;tesis pl&#225;stica previa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cat&#233;ter interno-externo previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;2&#160;&#177;&#160;1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Plaquetas &#215;10<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;59-431&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>INR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;02&#160;&#177;&#160;0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;74&#160;&#177;&#160;0&#44;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucemia &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#160;&#177;&#160;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alb&#250;mina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1 &#40;2&#44;5-4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bilirrubina total &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;2-16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CA 19-9 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;0-1&#46;420&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CEA &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9 &#40;0-831&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quimioterapia neoadyuvante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo de cirug&#237;a &#40;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;4&#160;&#177;&#160;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transfusi&#243;n &#40;n&#250;m&#46; pacientes&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Volumen transfundido &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">800 &#40;400-2&#46;400&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Consistencia del p&#225;ncreas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;51&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blando&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;48&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pancreato-yeyunostom&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reconstrucci&#243;n con un asa intestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;81&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reconstrucci&#243;n con dos asas intestinales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preservaci&#243;n pil&#243;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;43&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Drenajes de Penrose &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Citolog&#237;a intraoperatoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;17&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nutrici&#243;n parenteral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;97&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uso de octreotida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;17&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Amilasa por drenaje al tercer d&#237;a &#40;UI&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;11-2&#46;319&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Datos histol&#243;gicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Histolog&#237;a tumoral</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;68&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colangiocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuroendocrino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia mucinosa papilar intraductal &#40;NMPI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tumor duodenal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carcinoma <span class="elsevierStyleItalic">in&#160;situ</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma de c&#233;lulas escamosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Met&#225;stasis de c&#225;ncer renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pancreatitis cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grado de diferenciaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bien diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;23&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderadamente diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;28&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pobremente diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No valorable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;28&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Invasi&#243;n T</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In situ</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;&#160;2&#160;cm limitado al p&#225;ncreas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;58&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#176; ganglios resecados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;4-42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#176; ganglios positivos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasi&#243;n macrovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;16&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resecci&#243;n R0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resecci&#243;n hep&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vena mesent&#233;rica superior &#40;parche de pared&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vena porta &#40;parche de pared&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vena porta &#40;cilindro completo de 1&#160;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Confluencia de AGD&#44; AHC y AHP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecci&#243;n de la herida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>F&#237;stula biliar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colecci&#243;n intraabdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pancreatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Evisceraci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reintervenci&#243;n por complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoperitoneo &#40;no FP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fistula pancre&#225;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Evisceraci&#243;n &#40;no FP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Drenaje de colecci&#243;n &#40;TAC-punci&#243;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones &#40;Dindo-Clavien&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#40;53&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;16&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IIIb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estancia hospitalaria &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;6-37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mortalidad hospitalaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Seguimiento pos-DPC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quimioterapia adyuvante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;47&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia endocrina <span class="elsevierStyleItalic">de&#160;novo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia exocrina <span class="elsevierStyleItalic">de&#160;novo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retraso del vaciamiento g&#225;strico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;36&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trombosis venosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tromboembolismo pulmonar &#40;TEP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Accidente cerebrovascular agudo &#40;ACVA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morbilidad &#40;90 d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 0009739X
Idioma original: Español
DOI:10.1016/j.ciresp.2020.07.002
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