Assuntos
Colectomia , Doença Diverticular do Colo , Complicações Pós-Operatórias , Pontuação de Propensão , Humanos , Colectomia/métodos , Feminino , Masculino , Doença Diverticular do Colo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Idoso , Doenças do Colo Sigmoide/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Adulto , Estudos de Coortes , Colo Sigmoide/cirurgiaRESUMO
AIM: The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. METHOD: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. RESULTS: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. CONCLUSION: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.
Assuntos
Anastomose Cirúrgica , Fístula Anastomótica , Doença Diverticular do Colo , Humanos , Estudos Retrospectivos , Masculino , Feminino , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Pessoa de Meia-Idade , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Doença Diverticular do Colo/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Reto/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Colo/cirurgia , Fatores de Risco , França/epidemiologia , Abscesso/etiologia , Abscesso/cirurgiaRESUMO
BACKGROUND: The observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis. METHOD: The primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results. RESULTS: Between 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks. CONCLUSION: The present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis.
Assuntos
Doença Diverticular do Colo , Humanos , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Fatores de Risco , França/epidemiologia , Idoso , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/epidemiologia , Emergências , Adulto , Doenças do Colo Sigmoide/cirurgia , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricosRESUMO
OBJECTIVE: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.
Assuntos
COVID-19 , Doença Diverticular do Colo , Divertículo , Humanos , Anastomose Cirúrgica/métodos , Colo Sigmoide/cirurgia , Colostomia/métodos , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Divertículo/complicações , Complicações Pós-Operatórias , Reto/cirurgia , Estudos RetrospectivosRESUMO
Targetable kinase fusions are extremely rare (<1%) in colorectal cancers (CRCs), making their diagnosis challenging and often underinvestigated. They have been shown particularly frequently among MSI-High, BRAF/KRAS/NRAS wild-type CRCs with MLH1 loss (MLH1loss MSI-High wild-type). We searched for NTRK1, NTRK2, NTRK3, ALK, ROS1, BRAF, RET, and NRG1 kinase fusions in CRCs using methods easy-to-implement in pathology laboratories: immunohistochemistry (IHC), fluorescent in situ hybridization (FISH), and fully automated real-time PCR targeted analyses. RNA-sequencing analyses were used for confirmation. Among 84 selected MLH1 deficient (IHC) CRCs cases, MLH1loss MSI-High wild-type CRCs consisted first in 19 cases after Idylla™ analyses and finally in 18 cases (21%) after RNA-sequencing (detection of one additional KRASG12D mutation). FISH (and when relevant, IHC) analyses concluded in 5 NTRK1, 3 NTRK3, 1 ALK, 2 BRAF, and 2 RET FISH positive tumors. ALK and NTRK1 rearranged tumors were IHC positive, but pan-TRK IHC was negative in the 3 NTRK3 FISH positive tumors. RNA-sequencing analyses confirmed 12 of 13 fusions with only one false positive RET FISH result. Finally, 12/18 (67%) of MLH1loss MSI-High wild-type CRCs contained targetable kinase fusions. Our study demonstrates the feasibility, but also the cost-effectiveness, of a multistep but rapid diagnostic strategy based on nonsequencing methods to identify rare and targetable kinase fusions in patients with advanced CRCs, as well as the high prevalence of these kinase fusions in MLH1loss MSI-High wild-type CRCs. Nevertheless, confirmatory RNA-sequencing analyses are necessary in case of low FISH positive nuclei percentage to rule out FISH false-positive results.
Assuntos
Adenocarcinoma/genética , Biomarcadores Tumorais/genética , Neoplasias Colorretais/genética , Fusão Gênica , Genes ras , Instabilidade de Microssatélites , Técnicas de Diagnóstico Molecular , Proteína 1 Homóloga a MutL/genética , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Automação Laboratorial , Neoplasias Colorretais/patologia , Análise Custo-Benefício , Análise Mutacional de DNA , Reações Falso-Positivas , Estudos de Viabilidade , Feminino , França , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/economia , Valor Preditivo dos Testes , Reação em Cadeia da Polimerase em Tempo Real , Reprodutibilidade dos Testes , Análise de Sequência de RNARESUMO
BACKGROUND: Only a few series have demonstrated the safety of laparoscopic resection for hepatocellular carcinoma (HCC) and the benefits of this approach. Moreover, these studies reported mostly minor and nonanatomic hepatic resections. This report describes the results of a pair-matched comparative study between open and laparoscopic liver resections for HCC in a series of essentially anatomic resections. METHODS: Patients were retrospectively matched in pairs for the following criteria: sex, age, American Society of Anesthesiology (ASA) score, severity of liver disease, tumor size, and type of resection. A total of 42 patients undergoing laparoscopy were compared with patients undergoing laparotomy during the same period. Surgeons from the authors' department not trained in laparoscopy performed open resections. Operative, postoperative, and oncologic outcomes were compared. RESULTS: The mean duration of surgery was similar in the two groups. Significantly less bleeding was observed in the laparoscopic group (364.3 vs. 723.7 ml; p < 0.0001). Transfusion was required for four patients (9.5%) in the laparoscopic group and seven patients (16.7%) in the open surgery group (p = 0.51). Postoperative ascites was less frequent after laparoscopic resections (7.1 vs. 26.1%; p = 0.03). General morbidity was similar in the two groups (9.5 vs. 11.9%; p = 1.00). The mean hospital stay was significantly shorter for the patients undergoing laparoscopy (6.7 vs. 9.6 days; p < 0.0001). The surgical margin and local recurrence adjacent to the liver stump were not affected by laparoscopy. The overall postoperative survival rates in the laparoscopic group were 93.1% at 1 year, 74.4% at 3 years, and 59.5% at 5 years and, respectively, 81.8, 73, and 47.4% in the open surgery group (p = 0.25). The postoperative disease-free survival rates in the laparoscopic group were at 81.6% at 1 year, 60.9% at 3 years, and 45.6% at 5 years, respectively, 70.2, 54.3, and 37.2% in the open surgery group (p = 0.29). CONCLUSIONS: Laparoscopic resection of HCC for selected patients gave a better postoperative outcome without oncologic consequences. Prospective trials are required to confirm these results.
Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , França/epidemiologia , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
We report the first description of portal and mesenteric vein thrombosis associated with suppurative mesenteric adenitis in a 71-year-old woman. The bacterium detected in mesenteric lymph nodes was Fusobacterium nucleatum, an anaerobic Gram-negative bacillus. Our patient had a clinical syndrome of pharyngitis and fever preceding portal vein thrombosis. Abdominal symptoms improved with antibiotics and anticoagulant therapy. This location of F. nucleatum in mesenteric lymph nodes provides an interesting insight into the occurrence of septic thrombosis in the portal vein following pharyngo-tonsillar infection.
Assuntos
Infecções por Fusobacterium/complicações , Fusobacterium nucleatum , Linfadenite Mesentérica/microbiologia , Oclusão Vascular Mesentérica/microbiologia , Veia Porta , Trombose/microbiologia , Idoso , Feminino , Infecções por Fusobacterium/diagnóstico por imagem , Fusobacterium nucleatum/isolamento & purificação , Humanos , Linfonodos/microbiologia , Linfadenite Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Because of their rarity, chemical burns of rectum and colon have been poorly studied. This clinical report studies the epidemiologic, diagnostic, and therapeutic features of rectal and colonic burns after enema with caustics. METHODS: This is a retrospective clinical report of a personal series of 21 patients admitted in our hospital from January 1990 to January 2000 for an acute chemical colitis after enema. RESULTS: Inpatient prevalence: 0.04%. Mean age: 29.7 +/- 12 years (range 17 to 19). Sex ratio: 16 female and 5 male. Circumstances: suicide (n = 14), abortion (n = 3), murder (n = 3), mistake (n = 1). Responsible caustic: sulphuric acid (n = 12), chlorhydric acid (n = 5), potash (n = 2), unknown acid (n = 1), plant decoction (n = 1). Injected quantity: 50 to 250 mL. Ten patients suffered light damage and had an early favorable course under medical treatment, 8 of them had a secondary rectal-sigmoid stenosis. Eleven patients presented with severe necrotic damage, of difficult and often delayed diagnosis based on an enduring symptomatology without clear peritoneal syndrome. Upon surgery, necrotic damage spread on rectum and sigmoid colon (n = 2), up to the transverse colon (n = 4), to the right colonic angle (n = 3), to the right colon (n = 2); once a 10 cm long necrosis of the ileum was associated (n = 1); only 1 patient had a colonic perforation. Performed surgery: 11 resections of necrotic colon and proximal colostomy (Hartman operation). Mortality: 6 patients. Morbidity: 3 of 5 patients. CONCLUSIONS: Chemical burns of rectum and colon produced by strong acid or basic products are necrotizing lesions whose gravity is often hidden by the absence of peritoneal inflammation signs, thus mortality is high. Only early surgery is likely to improve the poor prognosis of severe chemical damage of the rectum and colon.
Assuntos
Queimaduras Químicas , Cáusticos/administração & dosagem , Colo/lesões , Enema , Reto/lesões , Aborto Criminoso , Adulto , Queimaduras Químicas/etiologia , Queimaduras Químicas/cirurgia , Criança , Colite/induzido quimicamente , Côte d'Ivoire , Emergências , Feminino , Homicídio , Humanos , Estudos Retrospectivos , Tentativa de SuicídioRESUMO
Isolated duodenal injury in blunt abdominal trauma is unusual. Diagnosis requires a complete exploration of the abdominal cavity. The authors present a rare case of disruption and necrosis of the second duodenum with periampullary duodenal detachment.
Assuntos
Duodeno/lesões , Duodeno/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Ampola Hepatopancreática , Anastomose em-Y de Roux , Duodeno/patologia , Humanos , Jejuno/cirurgia , Masculino , Necrose/cirurgiaRESUMO
Primary hepatic leiomyoma is a very rare tumor secondary to benign smooth muscle proliferation. The primary location in the liver is usually found in adult women. A 36-year-old woman with right upper quadrant abdominal pain had primary hepatic leiomyoma. The presenting features of primary leiomyoma and the diagnostic approach for these lesions are discussed, in particular the role of immunohistochemistry.