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1.
International journal of surgery ; 7(6): 534-538, Sep. 2009. tab, graf
Artigo em Inglês | MedCarib | ID: med-17696

RESUMO

OBJECTIVE: To evaluate the risk-adjusted perioperative outcome of colorectal cancer surgery, applying the Colorectal Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (CR-POSSUM). METHODS: A retrospective chart review of patients who underwent colorectal cancer surgery from 2004 to 2007 was done. Data including demographics and physiological data for CR-POSSUM were recorded. Predicted mortality was calculated; validation of CR-POSSUM was done using Hosmer-Lemeshow goodness-of-fit and Receiver Operating Characteristic (ROC) Curve analyses. RESULTS: 232 patients were studied. The overall mean CR-POSSUM score was 18.3+/-3.8 (SD). Predicted mortality was 7.7%, observed mortality was 6.9% and the standardized mortality ratio was 0.9. 34.4% of patients presented with Duke's Stage C or D and had a higher risk of mortality (Odds Ratio (OR) 3.1, 95% Confidence Intervals (CI) 1.1, 9.1). Emergency surgery was associated with a higher risk of mortality (OR 4.7, 95% CI 1.5, 14.1). CR-POSSUM calibrated well (Hosmer-Lemeshow Chi-square value 4.3; df: 8; p=0.82) and fairly discriminated outcome as shown by the area under the ROC Curve 0.69, (Standard Error: 0.07). CONCLUSIONS: Perioperative outcome of colorectal surgery in Trinidad and Tobago is comparable to the developed countries as evaluated by the CR-POSSUM. Patients presenting for emergency surgery and those with advanced stages of cancer had higher perioperative mortality.


Assuntos
Humanos , Masculino , Feminino , Cirurgia Colorretal , Neoplasias Colorretais , Países em Desenvolvimento , Trinidad e Tobago
2.
West Indian med. j ; 49(Suppl. 2): 50, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-926

RESUMO

OBJECTIVE: This review was designed as a pilot study to collect data on colorectal cancer surgery which would provide the basis for conducting formal prospective data collection on the patterns of this disease and its clinical presentation. DESIGN AND METHOD: A comprehensive audit of all patients with a diagnosis of colorectal carcinoma was undertaken over a 2 year period (January 1996 to December 1997). RESULTS: A total of seventy-nine patients were studied. There were 47 females and 32 males. The median age was 64.5 years (range 19 to 91 years). The predominant presenting symptoms were abdominal pain in 44 patients (55.7 percent), change in bowel habit in 38 patients (48.1 percent) and rectal bleeding in 37 patients (46.8 percent). The presence of an abdominal mass in 18 patients was the most frequently detected sign. Rectal examination detected the presence of a mass in 14 (17.7 percent) patients. Forty-seven percent of patients present with anaemia. The most common location was the right colon in 21 patients (26.5 percent) followed by sigmoid colon in 15 (18.9 percent) and rectum in 14 (17.7 percent). Left and transverse colon accounted for 7 and 5 cases, respectively. Resection with restorative anastomosis was the most common procedure for primary disease with colostomy being performed infrequently (in 3 cases). Seventeen patients presented with advanced disease. There were 14 deaths, 10 due to metastatic disease and 4 from postoperative complications. Our findings indicate an increased incidence of right-sided colonic carcinomas which has also been reported by other recent series. Although this colorectal audit provides some information about the patterns of disease seen in our unit, further study of a larger group of patients will be necessary before accurate conclusion can be made. CONCLUSION: The detection of early colorectal carcinoma will require screening at a stage when the disease is asymptomatic in order to improve the chance for cure. The data presented here indicate that the majority of patients presented with advanced right sided lesions that could have been detected earlier with an established screening programme.(AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , Adolescente , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal , Auditoria Médica , Jamaica
3.
West Indian med. j ; 38(Suppl. 1): 58, Apr. 1989.
Artigo em Inglês | MedCarib | ID: med-5650

RESUMO

Ultrasound has a well-established role in the detection of intra-abdominal pathology except for those conditions affecting the hollow visceral organs. This paper examines the role of real-time ultrasonography in a prospective study involving 25 patients with suspected large and small bowel masses and compares the sensitivity, specificity and accuracy of the technique with the double contrast barium examination and operative findings. In the 20 cases where direct comparison between ultrasound and surgery was possible, the data were concordant in 16 (80 per cent) cases and discordant in 4 (20 per cent) cases. Ultrasound was falsely negative and falsely positive in 2 cases, each, respectively. Ultrasound had a detection sensitivity of 90 per cent, specificity of 72 per cent and accuracy of 84 per cent. Discordant data were obtained in 6 cases between barium and ultrasound and in 4 cases between barium and surgery. Ultrasound allowed accurate separation from mesenteric, retroperitoneal, pelvic and other intra-abdominal masses but was less precise in differentiating bowel masses arising from the caecum and terminal ileum, and between the pelvic colon and distal small bowel loops. Additional features of ultrasound are the ability to attempt a prediction of benignity or malignancy of masses and to assess for ascites, metastases or lymphadenopathy. In those situations, therefore, where a mass of the hollow abdominal viscera is suspected and where double contrast barium studies are not possible, the use of real-time ultrasonography is advocated as a useful alternate approach (AU)


Assuntos
Estudo Comparativo , Humanos , Adulto , Ultrassonografia de Intervenção , Vísceras , Cirurgia Colorretal , Bahamas
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