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1.
Rev. argent. coloproctología ; 35(1): 6-12, mar. 2024. graf, tab
Article in Spanish | LILACS | ID: biblio-1551647

ABSTRACT

Introducción: la colocación de prótesis metálicas autoexpansibles (PAE) por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: como tratamiento paliativo y como puente a la cirugía curativa. Este procedimiento evita cirugías en dos tiempos y disminuye la probabilidad de colostomía definitiva y sus complicaciones con el consecuente deterioro de la calidad de vida. Objetivo: comunicar nuestra experiencia en la colocación de PAE para el tratamiento paliativo de la obstrucción colorrectal neoplásica. Diseño: retrospectivo, longitudinal, descriptivo y observacional. Material y métodos: se incluyeron todos los pacientes a quienes el mismo grupo de endoscopistas les colocó PAE con intención paliativa por cáncer colorrectal avanzado entre agosto de 2008 y diciembre de 2019. Fueron analizadas las variables demográficas y clínicas, el éxito técnico y clínico, las complicaciones tempranas y tardías y la supervivencia. Resultados: se colocó PAE en 54 pacientes. La media de edad fue 71 años. El 85% de las lesiones se localizó en el colon izquierdo. En el 57% de los pacientes se realizó en forma ambulatoria. El éxito técnico y clínico fue del 92 y 90%, respectivamente y la supervivencia media de 209 días. La tasa de complicaciones fue del 29,6%, incluyendo un 14,8% de obstrucción y un 5,6% de migración. La mortalidad tardía atribuible al procedimiento fue del 5,6%, ocasionada por 3 perforaciones tardías: 2 abiertas y 1 microperforación con formación de absceso localizado. Conclusiones: la colocación de PAE como tratamiento paliativo de la obstrucción neoplásica colónica es factible, eficaz y segura. Permitió el manejo ambulatorio o con internación breve y la realimentación temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterápico paliativo. Las mayoría de las complicaciones fueron tardías y resueltas endoscópicamente en forma ambulatoria. (AU)


Introduction: endoscopic placement of self-expanding metal stents (SEMS) emerges as a therapeutic option for neoplastic obstruction of the colon in two situations: as palliative treatment and as a bridge to curative surgery. This procedure avoids two-stage surgeries and reduces the probability of permanent colostomy and its complications with the consequent deterioration in quality of life. Objective: to report our experience in the placement of SEMS as palliative treatment in neoplastic colorectal obstruction. Design: retrospective, longitudinal, descriptive and observational study. Methods: all patients in whom the same group of endoscopists performed SEMS placement with palliative intent for advanced colorectal cancer between August 2008 and December 2019 were analyzed. Data collected were demographic and clinical variables, technical and clinical success, early and late complications, and survival. Results: SEMS were placed in 54 patients. The average age was 71 years. Eighty-five percent were left-sided tumors. In 57% of the patients the procedure was performed on an outpatient basis. Technical and clinical success was 92 and 90%, respectively, and median survival was 209 days. The complication rate was 29.6%, including 14.8% obstruction and 5.6% migration. Late mortality attributable to the procedure was 5.6%, caused by 3 late perforations: 2 open and 1 microperforation with localized abscess formation. Conclusions: The placement of SEMS as a palliative treatment for neoplastic colonic obstruction is feasible, effective and safe. It allowed outpa-tient management or brief hospitalization and early refeeding, improving the conditions to face an eventual palliative chemotherapy treatment. Most complications were late and resolved endoscopically on an outpatient basis. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colonoscopy/methods , Colonic Neoplasms/surgery , Self Expandable Metallic Stents , Intestinal Obstruction/surgery , Palliative Care , Quality of Life , Epidemiologic Studies , Survival Analysis , Epidemiology, Descriptive , Colonoscopy/adverse effects
2.
In. Rodríguez Temesio, Gustavo Orlando; Olivera Pertusso, Eduardo Andrés; Berriel, Edgardo; Bentancor De Paula, Marisel Lilian; Cantileno Desevo, Pablo Gustavo; Chinelli Ramos, Javier; Guarnieri, Damián; Lapi, Silvana; Hernández Negrin, Rodrigo; Laguzzi Rosas, María Cecilia. Actualizaciones en clínica quirúrgica. Montevideo, Oficina del Libro-FEFMUR, 2024. p.117-130, ilus, graf.
Monography in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1553196
3.
Rev. argent. coloproctología ; 34(3): 10-16, sept. 2023. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1552469

ABSTRACT

Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)


Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colonic Neoplasms/surgery , Colon, Ascending/anatomy & histology , Colon, Ascending/blood supply , Lymph Node Excision , Mesocolon/surgery , Argentina , Tomography, X-Ray Computed/methods , Cross-Sectional Studies , Mesenteric Artery, Superior/anatomy & histology , Sex Distribution , Colectomy/methods , Ethnic Distribution , Anatomic Variation , Mesenteric Veins/anatomy & histology
4.
Rev. Asoc. Méd. Argent ; 136(3): 4-7, sept. 2023.
Article in Spanish | LILACS | ID: biblio-1553342

ABSTRACT

Se define «síndrome febril prolongado¼ a todo cuadro de hipertermia que persiste al menos 10 días sin ser diagnosticado. El síndrome de Good es una inmunodeficiencia primaria del adulto que se caracteriza por presentar hipogammaglobulinemia, disminución de linfocitos B y anormalidades en los linfocitos T. Entre el 15 y el 20% de los casos de «fiebre de origen desconocido¼ ocurren debido a neoplasias, y el cáncer de colon representa menos del 1% de todos estos casos. Se presenta una paciente de 49 años admitida en el hospital por presentar síndrome febril con un mes de evolución, con antecedentes de síndrome de Good. Se le diagnostica cáncer de colon. (AU)


A prolonged febrile syndrome (PFS) is defined as any episode of hyperthermia that persists for at least 10 days without being diagnosed. Good's syndrome is a primary immunodeficiency in adults characterized by hypogammaglobulinemia, decreased B lymphocytes, and abnormalities in T lymphocytes. Between 15 to 20% of fever of unknown origin (FOD) cases are due to neoplasms, and colon cancer represents less than 1% of all these cases. A 49-year-old patient with a history of Good's syndrome was admitted to the hospital due to a febrile syndrome lasting for a month. She was diagnosed with colon cancer. (AU)


Subject(s)
Humans , Female , Adult , Colonic Neoplasms/diagnosis , Primary Immunodeficiency Diseases/complications , Hyperthermia/etiology , Comorbidity , Colectomy , Colonic Neoplasms/surgery , Fever of Unknown Origin , Laparotomy
5.
J. coloproctol. (Rio J., Impr.) ; 43(2): 82-92, Apr.-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1514426

ABSTRACT

Background: Anastomotic leakage (AL) is still the most annoying postsurgery complication after colorectal resection due to its serious complications up to death. Limited data were available regarding differences in AL incidence, management, and consequences for different types of colorectal resection. The aim of the present work was to evaluate differences in incidence of AL, incidence of postoperative complications, and length of hospital stay in a large number of patients who underwent elective colorectal resection for management of colorectal lesions. In addition to detect when and what type of reoperation for management of AL occur after colorectal resection. Patients: All 250 included patients underwent elective surgeries for colorectal resection with performance of primary anastomosis for management of colorectal neoplastic and non-neoplastic diseases in the period between May 2016 and July 31, 2021. We followed the patients for 90 days; we registered the follow-up findings. Results: the rates of AL occurrence were variable after the different procedures. The lowest rate of AL occurrence was found in patients who underwent right hemicolectomy, then in patients who underwent sigmoidectomy, left hemicolectomy, transversectomy and anterior resection (p= 0.004). A stoma was frequently performed during reoperation (79.5%) which was significantly different between different procedures: 65.5% in right hemicolectomy, 75.0% in transversectomy, 85.7% in left hemicolectomy, and 93.0% in sigmoid resection (p< 0.001). Conclusion Rates, types, time of occurrence and severity of AL vary according to the type of colectomy performed and selective construction of stoma during AL reoperation is currently safely applied with comparable mortality rates for patients who did and who did not have a stoma after reoperation. (AU)


Subject(s)
Humans , Male , Female , Postoperative Complications , Colonic Neoplasms/surgery , Anastomotic Leak/epidemiology , Reoperation , Health Profile , Risk Factors , Treatment Outcome , Neoplasm Staging
6.
Article in Chinese | WPRIM | ID: wpr-971232

ABSTRACT

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.


Subject(s)
Humans , Quality of Life , Self Expandable Metallic Stents/adverse effects , Colonic Neoplasms/surgery , Stents/adverse effects , Intestinal Obstruction/surgery , Treatment Outcome , Colorectal Neoplasms/complications , Retrospective Studies
7.
Article in Chinese | WPRIM | ID: wpr-986834

ABSTRACT

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.


Subject(s)
Humans , Mesentery/surgery , Colonic Neoplasms/surgery , Colorectal Surgery , Digestive System Surgical Procedures , Peritoneum/surgery , Rectal Neoplasms/surgery , Laparoscopy
8.
Article in Chinese | WPRIM | ID: wpr-986832

ABSTRACT

Complete mesocolic excision (CME) and D3 resection of right colon cancer have been widely implemented, but the definition and identification of the completeness of the mesentery have not been fully agreed, especially the dorsal and medial borders. In this paper, we proposed the dorsal fascia of the colonic mesentery as the dorsal border of the mesocolon and the line connecting the roots of the ileocolic artery and the middle colic artery (ICA-MCA line) as the medial border of the CME by systematically studying the relationship between the mesentery and the mesenteric bed from the theory of membrane anatomy, combined with surgical experience and in-depth review of ontogenetic anatomy. We also proposed the visible "superior mesenteric vein notch" and "middle colic artery triangle" on surgical specimens as identifiers of mesocolic completeness.


Subject(s)
Humans , Mesocolon/surgery , Lymph Node Excision , Colectomy , Laparoscopy , Colonic Neoplasms/surgery
9.
J. coloproctol. (Rio J., Impr.) ; 43(1): 12-17, Jan.-Mar. 2023. tab, graf, ilus
Article in English | LILACS | ID: biblio-1430693

ABSTRACT

Introduction: The second most common cause of cancer-related mortality is colorectal cancer, and laparoscopic-assisted colectomy (LAC) has gained popularity among surgeons as an alternative to the conventional approach, which is open colecrtomy (OC). The differences between LAC and OC in terms of short-term outcomes have not been well documented, and the aim of the present work is to compare the short-term outcomes of both procedures. Materials and Methods: The present prospective study comprised 164 participants submitted to LAC (n = 82) and OC (n = 82) at the Helwan and Zagazig University hospitals between January 2018 and January 2022. We collected and analyzed demographic data, surgical data, and the short-term outcomes. Results: The LAC group had a significantly lower estimated amount of blood loss, shorter hospital stay, lower rates of incisional surgical site infection, and fewer cases of burst abdomen postoperatively, but with a considerably longer operative time (30.3 minutes) than the OC group. Conclusions: Our findings show that LAC is favorable option to OC, with superior outcomes. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Treatment Outcome , Colonic Neoplasms/surgery , Postoperative Complications , Digestive System Surgical Procedures/methods , Blood Loss, Surgical , Laparoscopy
10.
Cir. Urug ; 6(1): e502, jul. 2022. 1 vídeo en línea (7 min.)^cdigital
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1384413

ABSTRACT

El cáncer de colon es frecuente en nuestro medio. Aquellos situados sobre el colon derecho tienen peor pronóstico. La linfadenectomía D3 implica la resección de los ganglios centrales, por delante del eje mesentérico superior. Complementariamente, la escisión mesocolónica completa ha demostrado mejorar los resultados oncológicos.


Subject(s)
Humans , Female , Aged, 80 and over , Laparoscopy/methods , Colonic Neoplasms/surgery , Lymph Node Excision/methods , Audiovisual Aids , Video-Audio Media , Octogenarians
11.
Cir. Urug ; 6(1): e405, jul. 2022. ilus
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1384417

ABSTRACT

La fístula gastrocólica descrita en 1755 por Albrecht von Haller, se define como la comunicación anormal entre el colon generalmente transverso y estómago en su curvatura mayor. Se conocen distintas etiologías, siendo un hallazgo poco frecuente con escasos reportes en la literatura. Se presenta el caso de una paciente de 85 años con historia de anemia y adelgazamiento que consulta por cuadro de vómitos fecaloideos, sin alteraciones de tránsito digestivo bajo, sin dolor ni distensión abdominal con ruidos hidroaéreos normales y sonda nasogástrica con contenido fecaloideo. La Tomografía (fig. 1) confirma una lesión de probable etiología maligna del ángulo esplénico del colon fistulizado a estómago por lo que se decide la realización de una colectomía sectorial con anastomosis primaria y gastrectomía subtotal, evolucionando favorablemente con un alta a los 6 días. La anatomía patológica informa adenocarcinoma de colon moderadamente diferenciado con compromiso gástrico.


Subject(s)
Humans , Female , Aged, 80 and over , Intestinal Fistula/surgery , Colonic Neoplasms/surgery , Colonic Neoplasms/diagnostic imaging , Anastomosis, Surgical , Intestinal Fistula/etiology , Colectomy , Colonic Neoplasms/complications , Gastrectomy , Octogenarians
12.
Cir. Urug ; 6(1): e301, jul. 2022. ilus
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1384406

ABSTRACT

Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.


Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.


Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.


Subject(s)
Female , Middle Aged , Colonic Neoplasms/surgery , Adenocarcinoma, Mucinous/surgery , Intestinal Fistula/etiology , Psoas Abscess/etiology , Colectomy , Colonic Neoplasms/complications , Colonic Neoplasms/diagnostic imaging , Adenocarcinoma, Mucinous/complications , Abdominal Wall/pathology , Ilium/pathology
13.
Rev. chil. infectol ; 39(3): 354-356, jun. 2022.
Article in Spanish | LILACS | ID: biblio-1407789

ABSTRACT

Resumen La asociación entre algunas infecciones bacterianas y cáncer de colon está bien documentada. La más descrita es la infección por Streptococcus bovis. Otra bacteria relacionada a neoplasias intestinales es Clostridium septicum. Presentamos el caso clínico de un varón de 62 años que consultó por dolor abdominal, diarrea y fiebre. Se realizó una tomografía computada de abdomen y pelvis que evidenció un engrosamiento de las paredes del ciego con una aparente solución de continuidad en su borde libre. En una laparotomía exploradora se confirmó la presencia de peritonitis y perforación cecal, siendo sometido a una hemicolectomía derecha e ileostomía terminal. El estudio histopatológico reveló la presencia de un adenocarcinoma de tipo células en anillo de sello asociado a isquemia. Los hemocultivos fueron positivos a C. septicum. El paciente falleció por una sepsis fulminante.


Abstract The association between some bacterial infections and colon cancer is well documented. The most described is Streptococcus bovis infection. Another bacteria related to intestinal neoplasms is Clostridium septicum. We present the case of a 62-year-old man who consulted for abdominal pain associated with diarrhea and fever. A computed tomography scan of the abdomen and pelvis was performed, which revealed thickening of the cecum walls with an apparent break in continuity at its free edge. An exploratory laparotomy was performed which confirmed the presence of peritonitis and cecal perforation. A right hemicolectomy and terminal ileostomy were performed. The histopathological study revealed the presence of signet ring cell type adenocarcinoma associated with ischemia. The blood cultures results demonstrated the presence of C. septicum. The patient died due to fulminant sepsis.


Subject(s)
Humans , Male , Middle Aged , Clostridium Infections/complications , Colonic Neoplasms/surgery , Colonic Neoplasms/complications , Sepsis , Clostridium septicum , Intestinal Perforation/diagnostic imaging
14.
Int. j. morphol ; 40(3): 855-859, jun. 2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1385666

ABSTRACT

RESUMEN: Gran parte de los pacientes con cáncer de colon (CC), son diagnosticados y tratados de forma electiva. Sin embargo, aproximadamente un 20 % de ellos debutará como una emergencia (obstrucción o perforación). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia global (SVG) en pacientes resecados por CC perforado (CCP). Serie de casos retrospectiva de pacientes con CCP, sometidos a colectomía y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor y Hospital de Temuco, Chile, entre 2010 y 2019. Las variables resultados fueron SVG y MPO. Otras variables de interés fueron: tiempo quirúrgico, resecabilidad, número de linfonodos resecados, estancia hospitalaria, mortalidad operatoria, recurrencia y supervivencia libre de enfermedad (SLE). Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 15 pacientes (60 % mujeres), con una mediana de edad de 62 años. La localización más frecuente fue sigmoides (6 casos; 40,0 %). La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, número de linfonodos resecados y estancia hospitalaria; fueron 80 min, 20 y 5 días respectivamente. La MPO fue 26,7 % (4 casos). Con una mediana de seguimiento de 36 meses, se verificó una recurrencia de 40,0 %. Por otra parte, la SVG y SLE a 5 años fue 46,7 % y 33,3 % respectivamente. Los resultados obtenidos, en términos de MPO y SVG, fueron similares a series internacionales.


SUMMARY: Most patients with colon cancer (CC) are diagnosed and treated electively. However, a fifth of them will debut as an emergency (obstruction or perforation). The aim of this study was to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by perforated CC (PCC). Retrospective case series of patients with PCC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Clinic and Temuco hospital, Chile, between 2010 and 2019. The outcome variable were POM and OS. Other variables of interest were surgical time, resectability, number of resected lymph nodes, hospital stay, mortality, recurrence, and disease-free survival (DFS). Patients were followed clinically. Descriptive statistics was used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves.15 patients (60 % women) were intervened, with a median age of 62 years. The most frequent location was the sigmoid colon (6 cases, 40.0 %). Resectability of the series was 100 %. Median surgical time, number of lymph nodes resected, and hospital stay; they were 80 min, 20 and 5 days respectively. POM was 26.7 % (4 cases). With a median follow-up of 36 months, recurrence was 40.0 %. On the other hand, OS and DFS at 5 years were 46.7 % and 33.3 %, respectively. The observed results, in terms of POM and OS, were like international series.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colectomy , Colonic Neoplasms/surgery , Colonic Neoplasms/complications , Intestinal Perforation/etiology , Postoperative Complications , Colon, Sigmoid , Survival Analysis , Retrospective Studies , Follow-Up Studies , Emergencies , Lymph Node Excision , Neoplasm Recurrence, Local
15.
Rev. cuba. cir ; 61(1)mar. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1408226

ABSTRACT

Introducción: Con la introducción del programa de recuperación acelerada en el servicio de Cirugía General del Hospital Militar de Ejército "Dr. Mario Muñoz Monroy" han ocurrido cambios en la atención perioperatoria del paciente con cirugía electiva para el cáncer de colon. Es de vital importancia conocer sus beneficios en relación al procedimiento tradicional desde que se decide la intervención quirúrgica. Objetivo: Evaluar los beneficios de la recuperación acelerada en pacientes operados de colon por cirugía electiva. Métodos: Se realizó un estudio analítico de caso y control durante el período de enero de 2015 a diciembre de 2019. El grupo de casos cumplió con 12 acciones perioperatorias definidas por el programa de recuperación acelerada y el de control siguió el procedimiento tradicional. Se realizó análisis bivariable de Chi cuadrado y Odds Ratio con intervalo de confianza del 95 por ciento. Resultados: Con la implementación del programa de recuperación acelerada desde el preoperatorio, los pacientes llegaron a la cirugía con adecuada capacidad funcional y compensación de sus comorbilidades. Esta conducta favoreció la evolución posoperatoria, redujo las complicaciones en un 33 por ciento Odds Ratio de 0,05 y la estadía hospitalaria en 5,67 días con Odds Ratio de 2[10,4-5,1]. Conclusiones: Los pacientes con el procedimiento de recuperación acelerada en su preoperatorio recibieron beneficios en relación a reducir el estrés quirúrgico, mayores reservas fisiológicas y mejor recuperación posoperatoria. La estadía hospitalaria está asociada significativamente a la edad de los pacientes, las comorbilidades y número de estas(AU)


Introduction: With the introduction of the accelerated recovery program in the general surgery service of Dr. Mario Muñoz Monroy Military Hospital of the Army (Matanzas, Cuba), changes have occurred in the perioperative care of the patient with elective surgery for colon cancer. It is of vital importance to know its benefits with respect to the traditional procedure from the moment the surgical intervention is decided. Objective: To assess the benefits of accelerated recovery in patients undergoing elective colon surgery. Methods: An analytical case-control study was carried out during the period from January 2015 to December 2019. The case group completed 12 perioperative actions defined by the accelerated recovery program, while the control group followed the traditional procedure. A bivariate analysis of chi-square and odds ratio (OR) with 95 percent confidence interval was performed. Results: With the implementation of the accelerated recovery program from the preoperative period, patients arrived at surgery with adequate functional capacity and compensation of their comorbidities. This behavior favored postoperative evolution, reduced complications by 33 percent (OR: 0.05) and hospital stay by 5.67 days (OR: 2) [10.4-5.1]. Conclusions: With the accelerated recovery procedure in their preoperative period, patients received benefits associated with reduced surgical stress, greater physiological reserves and better postoperative recovery. Hospital stay is significantly associated with patient age, comorbidities and number of comorbidities(AU)


Subject(s)
Humans , Surgical Procedures, Operative , Colonic Neoplasms/surgery , Perioperative Care , Case-Control Studies , Preoperative Period
16.
J. coloproctol. (Rio J., Impr.) ; 42(1): 47-53, Jan.-Mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1375755

ABSTRACT

Background: There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective: In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results: We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion: We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Digestive System Surgical Procedures/methods , Colonic Neoplasms/surgery , Postoperative Period , Survival Rate , Treatment Outcome
17.
Chinese Journal of Oncology ; (12): 436-441, 2022.
Article in Chinese | WPRIM | ID: wpr-935233

ABSTRACT

Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.


Subject(s)
Humans , Anastomosis, Surgical/methods , Colectomy/methods , Colonic Neoplasms/surgery , Feasibility Studies , Gastrointestinal Tract/surgery , Laparoscopy/methods , Retrospective Studies , Treatment Outcome
18.
Article in Chinese | WPRIM | ID: wpr-943035

ABSTRACT

At present, comprehensive treatment dominated by surgical procedures is an important measure for colon cancer to obtain the chance of cure. Surgical intervention, while removing the tumor, carries the risk of postoperative gastroparesis (PG) . Because of the low incidence rate and insignificant early clinical symptoms, early stage PG is often overlooked clinically. However, PG can increase the risk of malnutrition, delay postoperative antitumor treatment, and increase the risk of tumor recurrence and metastasis. This review focuses on the mechanisms, clinical risk factors, preventive measures, and advances in treatment of PG due to colon cancer. Aim to increase the clinician's adequate attention to PG in colon cancer and from a surgical point to reduce the risk of gastroparesis in colon cancer by optimizing the surgical strategy.


Subject(s)
Humans , Colonic Neoplasms/surgery , Digestive System Surgical Procedures/adverse effects , Gastroparesis/therapy , Neoplasm Recurrence, Local
19.
Article in Chinese | WPRIM | ID: wpr-943025

ABSTRACT

Delayed gastric emptying is a syndrome of gastric motility disorder with slow gastric emptying as the main sign, provided that mechanical factors such as intestinal obstruction and anastomotic stricture are excluded. The incidence of delayed gastric emptying after colon cancer surgery is 1.4%, mainly after transverse colon cancer surgery. Most of the studies on delayed gastric emptying are case reports, lacking systematic studies. The diagnoses and treatments can be draw on the experience of delayed gastric emptying after pancreatic surgery. Our retrospective study indicated that the incidence of delayed gastric emptying after surgery for transverse colon cancer was 4.0%, higher than that for other colon cancer. Patients who underwent gastrocolic ligament lymph node dissection were at higher risk than those who did not (3.6% vs. 0.8%). Gastrocolic ligament lymph node dissection and stress are causative factors for delayed gastric emptying after surgery for transverse colon cancer. We add the gastrografin test upon the diagnostic criteria of the International Study Group for Pancreatic Surgery, which is simple and practical. Nasogastric tube decompression, enteral nutrition combined with parenteral nutrition, glucocorticoids, and prokinetic agents can cure most patients with postoperative delayed gastric emptying. All the patients with postoperative delayed gastric emptying were cured in our studies. Strict indications for gastrocolic ligament lymph node dissection (patients with cT3-4 and cN+) may decrease the occurrence of delayed gastric emptying after surgery for transverse colon cancer.


Subject(s)
Humans , Colon, Transverse/surgery , Colonic Neoplasms/surgery , Gastric Emptying , Gastroparesis/surgery , Lymph Node Excision , Retrospective Studies
20.
Article in Chinese | WPRIM | ID: wpr-971226

ABSTRACT

In recent years, the incidence of early colon cancer (ECC) in China showed a rising trend. Accurate definition of ECC is of great significance for disease assessment, treatment decision-making and prognosis judgment. Although endoscopic resection has become an option in the treatment of ECC, surgical intervention is still needed for tumor residue and high risk pT1 tumors in order to prevent recurrence and metastasis. There is no consensus on indication, timing, radical resection range and tumor location of ECC surgery. The innovation of laparoscopic surgical techniques strongly promoted the progress of ECC minimally invasive surgery. Postoperative follow-up should be systematic, standardized and individualized, based on the stratification of ECC recurrence risk factors.


Subject(s)
Humans , Colonic Neoplasms/surgery , Laparoscopy , Prognosis , Digestive System Surgical Procedures , Minimally Invasive Surgical Procedures
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