ABSTRACT
AIM: This study evaluated the accuracy of chest computed tomography (CCT) in the preoperative staging of patients with potentially resectable colorectal cancer (CRC). An attempt was made to determine whether CCT has a significant influence on management and clinical outcome. METHOD: A review was conducted of all preoperative CCTs and X-rays performed in patients submitted to elective resection of CRC at our institution between 2005 and 2012. All scans were revised by an independent radiologist who was unaware of the circumstances of each case. The findings were classified as benign, malignant or indeterminate. Patients were followed for at least 12 months after surgery to assess the clinical evolution of any lesion found on CCT and the oncological outcome. RESULTS: Two hundred and twenty-three patients were included. The CCT showed normal or benign findings in 157 (70.4%) patients, a malignant lesion in 17 (7.6%), and an indeterminate lung lesion (ILL) in 49 (22%). Of the 30 patients with proven lung metastases, a plain X-ray detected lesions in only 11 (36.7%) patients. During the postoperative follow-up, 14 (28.6%) of the 49 patients with ILL demonstrated malignant progression of the lung lesions. Among all 223 patients, only six (2.7%) underwent lung resection. CONCLUSION: CCT is superior to plain X-ray for the detection of lung metastases. Despite the medical and financial implications of preoperative CCT, only a small number of patients will eventually undergo lung resection. We call into question the role of routine CCT in the staging of patients with CRC. A more selective approach, reserving CT for patients at high risk of lung metastases, is suggested.
Subject(s)
Adenocarcinoma/surgery , Colorectal Neoplasms/surgery , Elective Surgical Procedures/methods , Lung Neoplasms/diagnostic imaging , Radiography, Thoracic/statistics & numerical data , Tomography, X-Ray Computed/statistics & numerical data , Adenocarcinoma/secondary , Adult , Aged , Aged, 80 and over , Brazil , Cohort Studies , Colorectal Neoplasms/pathology , Female , Humans , Lung Neoplasms/secondary , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Preoperative Care/methods , Prognosis , Radiography, Thoracic/methods , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Survival Analysis , Tomography, X-Ray Computed/methods , Treatment Outcome , Unnecessary Procedures/statistics & numerical dataABSTRACT
To investigate the discrepancy between the distal resection margin (DRM) assessed by surgeons and pathologists, and the impact of neoadjuvant chemoradiotherapy (nCRT) on DRM. This study included 67 rectal cancer patients undergoing elective surgery. DRMs were assessed through four different techniques: in vivo subjective estimative, made by the surgeon before the rectal resection (by palpation and visual estimative); in vivo objective, measured with a ruler before the rectal transection; ex vivo objective, measured right after resection of the specimen; post-fixation objective measurement, conducted by the pathologist. The DRMs subjectively and objectively assessed by the surgeons were not significantly different (3.40 cm vs. 3.45 cm). There was a mean reduction in the length of DRMs of 35.6%, from 3.45 cm objectively measured by the surgeon to 2.20 cm measured by the pathologist. This difference was significant among patients that did not receive nCRT (3.90 cm vs. 2.30 cm, P < 0.001), but not among those who received nCRT (2.30 vs. 2.05 cm). Surgeons are accurate in assessing rectal cancer DRMs. There are significant differences between intraoperative measurements of DRMs and the final pathologic results. However, these differences are not seen when nCRT is used, a finding that may be useful when sphincter preservation is being considered.
Subject(s)
Rectal Neoplasms , Surgeons , Chemoradiotherapy , Humans , Margins of Excision , Neoadjuvant Therapy , Pathologists , Rectal Neoplasms/surgery , Treatment OutcomeABSTRACT
A retrospective analysis on the clinical-surgical handling of patients with enterocutaneous fistula (ECF) was performed, where an alternative surgical technique was discussed: intestinal bypass. Fistula with draining over 500 ml/24 h, which were present in 13 patients, were classified as high debit. We defined as complex, the fistula with multiple orifices, high defect of the abdominal wall or through the mesh. The population studied consisted of 25 patients, 11 male, in a total of 34 ECF and mean age of 41.9 years. At clinical treatment with TPN for high debit ECF, 2 patients (16.6%) were cured, another 2 died and 8 (66.8%) needed surgical treatment. The surgery cured 7 patients (77.7%) with high debit ECF but 2 (22.3%) died. In the patients with low debit ECF, TPN cured 2 patients (40%) but failed in another 3 (60%). All patients with low debit ECF resolved with surgical treatment.
Subject(s)
Cutaneous Fistula/surgery , Intestinal Fistula/surgery , Adult , Algorithms , Anastomosis, Surgical/methods , Cutaneous Fistula/complications , Cutaneous Fistula/pathology , Cutaneous Fistula/therapy , Female , Humans , Intestinal Fistula/complications , Intestinal Fistula/pathology , Intestinal Fistula/therapy , Male , Middle Aged , Nutrition Disorders/etiology , Nutrition Disorders/therapy , Parenteral Nutrition, Total , Retrospective Studies , Sepsis/complications , Treatment OutcomeABSTRACT
A 44-year-old man presented with a large and rapidly growing skin lesion approximately six months after resection of a rectal carcinoma. The lesion measured 40 cm in size, extended from the suprapubic area to the proximal half of the left groin, and showed a particular zosteriform aspect. Biopsy confirmed a metastatic skin adenocarcinoma. Cutaneous metastases from rectal cancer are very uncommon. Their gross appearance is not distinctive, although the skin tumors are usually solid, small (less than 5 cm) and painless nodules or papules. Early biopsies for suspicious skin lesions are needed in patients with a history of colorectal cancer.