ABSTRACT
Resumen Introducción: El cáncer colorrectal (CCR) es el segundo tipo más frecuente de cáncer en el mundo. La cirugía es la intervención terapéutica más común y se asocia con la reducción de 20-40% en la capacidad fisiológica y funcional. Un programa de prehabilitación podría mejorar la condición funcional basal de los pacientes previo a la cirugía. Objetivo: Describir los resultados funcionales de un programa de prehabilitación en personas adultas candidatos a cirugía electiva de CCR. Materiales y Método: Estudio descriptivo, longitudinal y retrospectivo. Se registraron los antecedentes sociodemográficos, clínicos y las variables funcionales como capacidad cardiorrespiratoria, fuerza de presión manual, fatiga, independencia en actividades de la vida diaria (AVDs) y equilibrio dinámico de 50 personas que ingresaron a un programa de prehabilitación entre mayo 2019 y febrero de 2020. Los datos fueron analizados con estadística descriptiva y pruebas de diferencia entre tiempo de evaluación, previo y posterior a la prehabilitación. Resultados: Posterior al programa de prehabilitación, los pacientes mejoraron la capacidad cardiorrespiratoria, fatiga, equilibrio dinámico y fuerza prensil (p 0,05; tamaño de efecto: 0,01). Conclusión: Un programa estructurado de prehabilitación para pacientes candidatos a cirugía electiva de CCR basado en ejercicios y educación, logró cambios significativos en los resultados funcionales en un período de 3 a 4 semanas previo a la cirugía.
Introduction: Colorectal cancer (CRC) is the second most frequent type of cancer in the world. Surgery is the most common therapeutic intervention and is associated with a 20-40% reduction in physiological and functional capacity. A prehabilitation program could improve the baseline functional condition of patients prior to surgery. Aim: To describe the functional results of a prehabilitation program in adults who will undergo elective surgery CCR. Materials and Method: Descriptive, longitudinal and retrospective study. The sociodemographic, clinical and functional variables such as cardiorespiratory capacity, manual pressure force, fatigue, independence in activities of daily living and dynamic balance of 50 people who entered a pre-rehabilitation program between may 2019 and february 2020 were compiled. Data were analyzed with descriptive statistics and difference tests between evaluation time, before and after prehabilitation. Results: After the prehabilitation program, the patients improved cardiorespiratory capacity, fatigue, dynamic balance and grip strength (p 0.05; effect size: 0.01). Conclusión: A structured prehabilitation program for patients who are candidates for elective colorectal cancer surgery based on exercises and education, achieved significant changes in functional results in a period of 3 to 4 weeks prior to surgery.
Subject(s)
Humans , Male , Female , Aged , Colorectal Neoplasms/surgery , Preoperative Exercise , Epidemiology, Descriptive , Retrospective Studies , Sample Size , FatigueABSTRACT
Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/surgery , Colorectal Neoplasms/therapy , Treatment Outcome , COVID-19ABSTRACT
<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) pretreatment on the intestinal function, inflammatory reaction and blood lactic acid in the patients of colorectal cancer surgery.</p><p><b>METHODS</b>Sixty patients of colorectal cancer laparotomy at selective period, aged from 18 to 59 years old were selected. According toⅠ-Ⅲ grade of American Society of Anesthesiologists (ASA), the patients were randomized into group A (total intravenous anesthesia), group B[total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side] and group C[total intravenous anesthesia combined with EA pretreatment at Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side], 20 cases in each one. The total intravenous anesthesia was applied to all of the three groups. EA pretreatment was used one day before surgery and 30 min before surgery at corresponding acupoints in the group B and group C separately, 30 min each time. After surgery, the recovery time of bowel sound, the recovery time of flatus, the recovery time of defecation, the duration of diet fasting, the time of peritoneal drainage tube withdrawal and the total peritoneal drainage volume were observed in the three groups. The venous blood was collected to determine white blood cell count (WBC) and neutrophil count (NEUT) before surgery (T), 24 h after surgery (T) and on the 5th day after surgery (T) separately. The arterial blood was collected to determine the level of lactic acid before surgery (T), after peritoneal douching (T) and 24 h after surgery (T)separately.</p><p><b>RESULTS</b>The recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal in the group C were apparently earlier than those in the group A (all<0.05). WBC and NEUT at Tin the group C were apparently less than those in the group A (both<0.05). The differences in lactic acid at T, Tand Twere not significant statistically in comparison of the three groups (all>0.05).</p><p><b>CONCLUSIONS</b>The total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25) and Zhongwan (CV 12) reduce the recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal so as to improve the recovery of intestinal function, reduce WBC in 24 h after surgery and alleviate inflammatory reaction. This therapy has no influence on blood lactic acid.</p>
ABSTRACT
BACKGROUND: Preoperative risk estimation evaluating mortality and morbidity might help surgical decision. AIMS: The aim of this study was to compare the sensitivities of physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), portsmouth‑POSSUM (P‑POSSUM), colorectal‑POSSUM (CR‑POSSUM), the Association of Coloproctology of Great Britain and Ireland colorectal cancer model (ACPGBI CRC) and revised ACPGBI CRC scoring systems that are used for evaluating mortality and morbidity in colorectal surgery performed in third‑level healthcare centers. SETTINGS AND DESIGN: A retrospective analysis has been performed on 335 consecutive patients undergoing colorectal cancer surgery between 2002 and 2012. MATERIALS AND METHODS: Mortality and morbidity risks of 335 patients who underwent colorectal cancer were evaluated using these scoring systems and the results were compared with actual mortality and morbidity within postoperative 30‑day that extend the duration of hospital stay. STATISTICAL ANALYSIS USED: The receiver operating characteristic (ROC) curves were designed to identify the score values. RESULTS: Results of POSSUM and P‑POSSUM systems showed statistical differences compared with those of CR‑POSSUM, ACPGBI CRC and revised ACPGBI CRC systems (P < 0.05). P‑POSSUM was found to be the best scoring system for predicting mortality risk, although all scoring systems seem to be appropriate for this parameter. On the other hand POSSUM, which can predict morbidity, was found to have moderate differentiation ability due to the magnitude of the area under the ROC curve. CONCLUSIONS: Despite altering patient demographics and surgical conditions, POSSUM seems to lead as the best scoring system for predicting mortality and morbidity among others including those most‑recently proposed.