RESUMO
PURPOSE: There are limited data on neoappendicostomy complications owing to small patient populations. This study compares appendicostomy and neoappendicostomy procedures with an emphasis on major postoperative complications requiring either a surgical or interventional radiology procedure. METHOD: A single-institution retrospective review included all patients with complete medical charts in the Cincinnati Children's Colorectal Database who underwent either an appendicostomy or neoappendicostomy from August 2005 through December 2016. Demographics, details of the procedure, and major postoperative complications were evaluated. RESULTS: 261 patients (appendicostomy nâ¯=â¯208, neoappendicostomy nâ¯=â¯53) with a median follow up time of 2.5â¯years resulted in 84 patients (appendicostomy nâ¯=â¯60, neoappendicostomy nâ¯=â¯24) experiencing a total of 118 complications requiring surgical or radiologic intervention with a significant difference between the groups (29% vs 45%, RRâ¯=â¯1.79 (95% CI: 1.24-2.60), pâ¯<â¯0.01). Skin level stricture was the most common complication (20% appendicostomies vs 30% neoappendicostomies, pâ¯=â¯0.13). CONCLUSIONS: Appendicostomies and neoappendicostomies can be an effective way to manage fecal incontinence; however, 32% of our patients experienced a complication that required either a surgical or interventional radiology procedure. Patients need to be informed of the possible complications that are associated with appendicostomy and neoappendicostomy construction. TYPE OF STUDY: Single institution retrospective review. LEVEL OF EVIDENCE: IV.
Assuntos
Apêndice/cirurgia , Enterostomia/efeitos adversos , Incontinência Fecal/cirurgia , Complicações Pós-Operatórias/etiologia , Pele/patologia , Adolescente , Criança , Pré-Escolar , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Enema/métodos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Radiologia Intervencionista , Estudos RetrospectivosRESUMO
Pancreatic cancer remains a daunting foe despite a vast number of accumulating molecular analyses regarding the mutation and expression status of a variety of genes. Indeed, most pancreatic cancer cases uniformly present with a mutation in the KRAS allele leading to enhanced RAS activation. Yet our understanding of the many epigenetic/environmental factors contributing to disease incidence and progression is waning. Epidemiologic data suggest that diet may be a key factor in pancreatic cancer development and potentially a means of chemoprevention at earlier stages. While diets high in ω3 fatty acids are typically associated with tumor suppression, diets high in ω6 fatty acids have been linked to increased tumor development. Thus, to better understand the contribution of these polyunsaturated fatty acids to pancreatic carcinogenesis, we modeled early stage disease by targeting mutant KRAS to the exocrine pancreas and administered diets rich in these fatty acids to assess tumor formation and altered cell-signaling pathways. We discovered that, consistent with previous reports, the ω3-enriched diet led to reduced lesion penetrance via repression of proliferation associated with reduced phosphorylated AKT (pAKT), whereas the ω6-enriched diet accelerated tumor formation. These data provide a plausible mechanism underlying previously observed effects of fatty acids and suggest that administration of ω3 fatty acids can reduce the pro-survival, pro-growth functions of pAKT. Indeed, counseling subjects at risk to increase their intake of foods containing higher amounts of ω3 fatty acids could aid in the prevention of pancreatic cancer.