[Anorectal melanoma: Clinical case]. / Melanoma anorrectal: un caso clínico.

Background: Anorectal melanoma (AM) is a rare and aggressive type of tumor, with varied and inconclusive scientific information. Its preoperative diagnosis is challenging due to its rarity and similarity to other anorectal conditions. It represents only 1.3% of melanomas and affects more women than men. Approximately 20-30% of AM cases are amelanotic, complicating endoscopic detection and leading to misdiagnoses. AM is often confused with hemorrhoids, polyps, and rectal cancer in two thirds of patients due to similar symptoms. The causes and risk factors of AM are not well understood, but they are suspected to differ from cutaneous and ocular melanomas. Diagnosis is performed through biopsy and immunohistochemical staining. Colonoscopy helps to characterize the lesions, and histological examination is crucial for definitive diagnosis. Clinical case: 50-year-old woman with rectal bleeding and proctalgia. AM was diagnosed through colonoscopy, and transanal resection with hemorrhoidectomy was performed. Conclusions: Management of AM is complicated by the lack of randomized trials. Resection surgery is the standard treatment, but there is no established protocol. Wide local excision may be an option for limited cases. Further research is needed to improve the management and treatment of AM. Early detection and complete surgical removal are crucial for enhancing survival in these patients.

Introducción: el melanoma anorrectal (MA) es un tipo raro y agresivo de tumor, cuya información científica es variada y poco concluyente. Su diagnóstico preoperatorio es un desafío debido a su rareza y a su similitud con otras afecciones anorrectales. Representa solo el 1.3% de los melanomas y afecta más a mujeres que a hombres. Aproximadamente el 20-30% de los casos de MA son amelanóticos, lo que complica su detección endoscópica y conduce a diagnósticos erróneos. El MA se confunde con hemorroides, pólipos y cáncer de recto en dos tercios de los pacientes debido a síntomas similares. Las causas y factores de riesgo del MA aún no se conocen bien, pero se sospecha que son diferentes de los melanomas cutáneos y oculares. El diagnóstico se realiza mediante biopsia y tinción inmunohistoquímica. La colonoscopía permite caracterizar las lesiones y el examen histológico es crucial para el diagnóstico definitivo. Caso clínico: mujer de 50 años con rectorragia y proctalgia. Se diagnosticó MA mediante colonoscopía y se realizó una resección transanal con hemorroidectomía. Conclusiones: el manejo del MA es complicado por la falta de ensayos aleatorizados. La cirugía de resección es el tratamiento habitual, pero no hay un protocolo establecido. La escisión local amplia puede ser una opción para casos limitados. Se necesita más investigación para mejorar el manejo y tratamiento del MA. La detección temprana y la extirpación quirúrgica completa son cruciales para mejorar la supervivencia en estos pacientes.

The Role of Circulating Tumor DNA for Management of Patients With Rectal Cancer: Challenges and Opportunities.

ABSTRACT: Recently, organ preservation with total neoadjuvant therapy resulted in substantial progress in the management of locally advanced rectal cancer (LARC). The PROSPECT trial showed noninferiority of de-escalation of radiotherapy for patients with low-risk LARC who do not need abdominoperineal resection. Although these escalation and de-escalation approaches offer more personalized therapeutic approaches, the current state of care for patients with rectal cancer is far from individualized management. Circulating tumor DNA (ctDNA) is known to be one of the most powerful prognostic factors for early relapse and has been investigated in several interventional clinical trials to offer more precise treatment algorithms. In this review article, we discuss recent updates from studies examining the role of ctDNA for the prediction of treatment response and recurrence for patients with rectal cancer. We also elaborate on the future potential use of ctDNA in treatment escalation and de-escalation approaches for more personalized therapeutic interventions.

Identification of potential urinary protein biomarkers in colorectal cancer: a pilot study using a proteomic approach

Colorectal cancer (CRC) is among the most diagnosed malignancies worldwide, and it is also the second leading cause of cancer-related deaths. Despite recent progress in screening programs, noninvasive accurate biomarkers are still needed in the CRC field. In this study, we evaluated and compared the urinary proteomic profiles of patients with colorectal adenocarcinoma and patients without cancer, aiming to identify potential biomarker proteins. Urine samples were collected from 9 patients with CRC and 9 patients with normal colonoscopy results. Mass spectrometry (label-free LC—MS/MS) was used to characterize the proteomic profile of the groups. Ten proteins that were differentially regulated were identified between patients in the experimental group and in the control group, with statistical significance with a p value ≤ 0.05. The only protein that presented upregulation in the CRC group was beta-2-microglobulin (B2M). Subsequent studies are needed to evaluate patients through different analysis approaches to independently verify and validate these biomarker candidates in a larger cohort sample. (AU)

Estudo randomizado, aberto, utilizando protetor cutâneo em spray à base de terpolímero acrílico versus hidratante padrão na prevenção de radiodermatite aguda em pacientes com câncer de canal anal e reto / An open randomized study using a skin protector spray made of acrylic terpolymers versus and standardized moisturizer in preventing acute radiodermatitis in patients with anal and rectal cancer

Pacientes com câncer de canal anal e reto em tratamento por radioterapia apresentam alta prevalência de radiodermatite com descamação úmida, desfecho que causa impactos clínicos, econômicos e sociais. Estudos sobre a efetividade de produtos na prevenção das radiodermatites representam uma lacuna de conhecimento na área oncológica, podendo o seu desenvolvimento contribuir para a diminuição dos impactos negativos desse evento, do tempo ocioso do equipamento pela interrupção do tratamento e da possibilidade de falha local da doença. Objetivou-se analisar a efetividade do protetor cutâneo em spray à base de terpolímero acrílico na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto em comparação com um hidratante padronizado na instituição à base de Calendula officinalis L. e Aloe barbadensis. Ensaio clínico randomizado, aberto, em instituição única, referência nacional no tratamento de doenças oncológicas, com amostra 63 pacientes que foram randomizados nos grupos: experimental, com uso do protetor cutâneo em spray, e controle, usando o hidratante Dnativ Revita Derm. Os pacientes foram acompanhados na consulta de enfermagem, com cegamento do avaliador da pele quanto ao uso da intervenção. A escala de avaliação de pele utilizada foi a da Radiation Therapy Oncology Group. A coleta de dados ocorreu por meio dos formulários de avaliação inicial e subsequente, sendo o desfecho principal medido a ocorrência de radiodermatite com descamação úmida, e os secundários a ocorrência de interrupção temporária da radioterapia por radiodermatite, de eventos adversos aos produtos e de severidade da radiodermatite. As análises se deram por Intenção de Tratar e Protocolo, sendo utilizadas as estatísticas descritiva, analítica e inferenciais no tratamento dos dados, com nível de significância de ≤ 0,10. Pesquisa aprovada pelo Comitê de Ética sob parecer nº 5.322.985 e registrado no Clinical Trials sob número: NCT04067310T. A regressão logística binária mostrou que os participantes expostos ao protetor cutâneo em spray tiveram menor chance de apresentar a radiodermatite com descamação úmida quando comparados ao grupo controle. A redução absoluta do risco de radiodermatite foi de 18% no grupo experimental. A incidência geral de radiodermatite foi de 100%, sendo 36,5% graus mais severos. A incidência de radiodermatite Grau 1 foi maior no grupo experimental, enquanto os graus mais severos (Graus 3 e 4) tiveram maior incidência no grupo controle; 17,5% dos participantes tiveram interrupção da radioterapia por radiodermatite, variando de 3 a 15 dias, com média de seis dias interrompidos. Apesar de relevantes clinicamente, esses resultados sobre a interrupção temporária do tratamento e a severidade da radiodermatite não tiveram significância estatística. Foram considerados fatores de risco para a descamação úmida: sexo feminino, diagnóstico C.21 e C.21.8, altas doses de radioterapia (5400-6000cGy), tipo histológico carcinoma espinocelular, umidade antes e durante a radioterapia e uso de proteção íntima. Concluiu-se que o protetor cutâneo em spray é um produto efetivo na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto, afirmação que sustenta a tese defendida. Nesse sentido, os resultados podem orientar a revisão dos protocolos assistenciais de prevenção da radiodermatite utilizados pelo enfermeiro no âmbito da consulta de enfermagem em radioterapia, com vistas a reduzir os impactos no seguimento terapêutico e na qualidade de vida dos pacientes com câncer de canal anal e reto.

Patients' ongoing anal and rectal cancer radiotherapy exhibit a high prevalence of radiodermatitis with moist desquamation, impairing clinical, economic, and social outcomes. Clinical trials targeting product efficacy in preventing radiodermatitis are lacking in the current literature. These products could contribute to diminishing adverse effects, reducing equipment idle time by therapy interruption, and increasing the cure rate. Our goal is to evaluate the effectiveness of cutaneous spray based on acrylic terpolymers in preventing radiodermatitis with moist desquamation in patients with rectal or anal cancer. Spray effectiveness was defied against a standardized moisturizer in the institution made of Calendula officinalis L. and Aloe barbadensis extracts. An open, single-blind, randomized clinical study was conducted in a single institution, reference in national treatment in oncological diseases, with a sample size (n) of 63 patients. Patients were randomized into two groups: (i) experimental, using cutaneous protector spray; and (ii) control, using moisturizer Dnativ Revita Derm. RTOC's scale was used for evaluating skin condition. Data was collected in forms, which considered: (i) the primary outcome of radiodermatitis with moist desquamation occurrence; and (ii) the secondary outcome of radiotherapy interruption caused by radiodermatitis occurrence and severity, and product adverse effects. Analyses were performed by intention to treat and per protocol, using descriptive, analytical, and inferential statistics, with a significance level of ≤ 0.10 (α). Research was approved by the Ethics committee under approval nº 5.322.985 and registered in Clinical Trials under number NCT04067310T. Binary logistic regression demonstrated that patients exposed to cutaneous spray protector were less prone to develop radiodermatitis with moist desquamation compared to the control group. Absolute reduction in radiodermatitis risk was 18% in the experimental group. The radiodermatitis overall incidence was 100%, with 36.5% of higher severity. The incidence of grade 1 radiodermatitis was higher in the experimental group, while the more severe grades (3 and 4) had a higher incidence in the control group; 17.5% of the participants had an interruption of radiotherapy due to radiodermatitis, ranging from 3 to 15 days, with an average of six interrupted days. Despite being clinically relevant, these results regarding the temporary interruption of treatment and the severity of radiodermatitis were not statistically significant. Risk factors for moist desquamation were considered: female gender, diagnosis of C.21 and C.21.8, high radiation doses (5400 to 6000 cGy), histological type squamous cell carcinoma, humidity before and during radiotherapy, and use of intimate protection. In conclusion, the skin protector spray is an effective product in the prevention of radiodermatitis with moist desquamation in patients with anal and rectal cancer. In this sense, the results can guide the review of care protocols for the prevention of radiodermatitis used by nurses in the context of nursing consultations in radiotherapy to reduce the impacts on therapeutic follow-up and the quality of life of patients with cancer of the anal canal and straight.

Los pacientes con cáncer de canal anal y recto en tratamiento con radioterapia tienen una alta prevalencia de radiodermatitis con descamación húmeda, desenlace que genera impactos clínicos, económicos y sociales. Los estudios sobre la efectividad de los productos en la prevención de la radiodermatitis representan un vacío de conocimiento en el área de oncología y pueden contribuir para la reducción de los impactos negativos, el tiempo de inactividad de los equipos por interrupción del tratamiento y la posibilidad de falla local de la enfermedad. El objetivo de este estudio fue analizar la eficacia de un protector cutáneo en spray a base de terpolímero acrílico en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal frente a una crema hidratante estandarizada de la institución a base de Calendula officinalis L. y Aloe barbadensis. Ensayo clínico aleatorizado, abierto, en una sola institución, referente nacional en el tratamiento de enfermedades oncológicas, con una muestra de 63 pacientes que fueron aleatorizados en grupos: experimental, utilizando spray protector para la piel, y control, utilizando Dnativ Revita Derm hidratante. Los pacientes fueron seguidos en la consulta de enfermería, cegándose el evaluador de piel en cuanto al uso de la intervención. La escala de valoración de la piel utilizada fue la del RTOC. Los datos se recopilaron mediante formularios de evaluación inicial y posterior, siendo el resultado principal medido la aparición de radiodermatitis con descamación húmeda y los resultados secundarios la interrupción temporal de la radioterapia debido a la radiodermatitis, los eventos adversos de los productos y la gravedad de la radiodermatitis. Los análisis fueron realizados por Intención de Tratar y Protocolo, utilizando estadística descriptiva, analítica e inferencial en el procesamiento de datos, con nivel de significación ≤ 0,10. Investigación aprobada por el Comité de Ética con dictamen nº 5.322.985 y registrada en Ensayos Clínicos con el número: NCT04067310T. La regresión logística binaria mostró que los participantes expuestos al protector de piel en aerosol tenían menos probabilidades de tener radiodermatitis con descamación húmeda en comparación con el grupo de control. La reducción absoluta del riesgo de radiodermatitis fue del 18 % en el grupo experimental. La incidencia global de radiodermatitis fue del 100%, siendo el 36,5% grados más graves. La incidencia de radiodermatitis Grado 1 fue mayor en el grupo experimental, mientras que los grados más severos (3 y 4) tuvieron mayor incidencia en el grupo control; El 17,5% de los participantes tuvo interrupción de la radioterapia por radiodermatitis, variando de 3 a 15 días, con un promedio de seis días de interrupción. A pesar de ser clínicamente relevantes, estos resultados en cuanto a la interrupción temporal del tratamiento y la gravedad de la radiodermatitis no fueron estadísticamente significativos. Se consideraron factores de riesgo para descamación húmeda: sexo femenino, diagnóstico C.21 y C.21.8, dosis altas (5400-6000cGy), carcinoma epidermoide de tipo histológico, humedad antes y durante la radioterapia y uso de protección íntima. Se concluyó que el spray protector de piel es un producto eficaz en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal, afirmación que sustenta la tesis defendida. En ese sentido, los resultados pueden orientar la revisión de los protocolos de atención para la prevención de la radiodermitis utilizados por los enfermeros en el contexto de las consultas de enfermería en radioterapia, con el objetivo de reducir los impactos en el seguimiento terapéutico y en la calidad de vida de los pacientes con cáncer del canal anal y recto.

Lipoma de recto prolapsado e incarcerado: caso clínico y análisis de la literatura / Prolapsed and incarcerated rectal lipoma: case report and literature review / Prolapso e encarceramento de lipoma do reto: caso clínico e análise da literatura

Los lipomas colónicos son tumores benignos poco frecuentes, extremadamente raros a nivel rectal. A pesar de ello, ocupan el segundo lugar en frecuencia detrás de los pólipos adenomatosos. Aunque la mayoría de los lipomas colorrectales son asintomáticos y se descubren incidentalmente, en ocasiones pueden ser sintomáticos y determinar complicaciones agudas que requieren tratamiento quirúrgico de urgencia. Estas formas de presentación pueden confundirse con las del cáncer colorrectal, constituyendo un desafío diagnóstico y terapéutico. Presentamos el caso de una paciente que consultó en emergencia por una gran masa dolorosa de aparición aguda a nivel del ano, resultando ser un lipoma rectal prolapsado a través del canal anal.

Colonic lipomas are infrequent benign tumors, extremely rare at the rectum. Nevertheless, they follow in frequency polyp adenomas. Even though most colorectal lipomas are asymptomatic and incidental, they can occasionally be symptomatic and develop acute complications that require urgent surgical treatment. This form of presentation can be confounded with colorectal cancer, therefore impairing diagnosis and treatment. We present the case of a female patient who came to the emergency room with an acute painful mass through the anus, that resulted in a prolapsed rectal lipoma.

Os lipomas colônicos são tumores benignos pouco frequentes, extremamente raros no nível retal. Apesar disso, ocupam o segundo lugar em frequência atrás dos pólipos adenomatosos. Embora a maioria dos lipomas colorretais sejam assintomáticos e descobertos incidentalmente, às vezes eles podem ser sintomáticos e levar a complicações agudas que requerem tratamento cirúrgico de emergência. Essas formas de apresentação podem ser confundidas com as do câncer colorretal, constituindo um desafio diagnóstico e terapêutico. Apresentamos o caso de um paciente que consultou na sala de emergência por uma grande massa dolorosa de início agudo ao nível do ânus, que acabou por ser um lipoma retal prolapsado pelo canal anal.

Rectal leiomyosarcoma as the initial phenotypic manifestation of Li-Fraumeni-like syndrome: a case report and review of the literature.

BACKGROUND: Leiomyosarcoma is a rare malignant tumor of smooth muscle origin and represents 10-20% of all soft tissue sarcomas. Primary colon and rectal sarcomas constitute < 0.1% of all large bowel malignancies. In Li-Fraumeni syndrome, sarcomas are the second most frequent cancer (25%). Li-Fraumeni syndrome is a genetic disease with a familial predisposition to multiple malignant neoplasms. This syndrome has an autosomal dominant pattern of inheritance and high penetrance characterized by germline TP53 mutations. Patients with a history of cancer who do not meet all the "classic" criteria for Li-Fraumeni syndrome are considered to have Li-Fraumeni-like syndrome. To the best of our knowledge, this article is the first report of a patient with rectal leiomyosarcoma as the initial phenotypic manifestation of Li-Fraumeni-like syndrome. The authors also present a literature review. CASE PRESENTATION: A 67-year-old Brazilian woman underwent anterior rectosigmoidectomy and panhysterectomy secondary to rectal leiomyosarcoma. She subsequently developed carcinomatosis and died 2 years after the operation. Her family medical history consisted of a daughter who died at 32 years of age from breast cancer, a granddaughter diagnosed with adrenocortical carcinoma at 6 years of age and two siblings who died from prostate cancer. A genetic study was carried out to identify a pathogenic variant of Li-Fraumeni syndrome. In the DNA extracted from the peripheral blood leukocyte, restriction fragment length polymorphism was analyzed to search for mutations in the TP53 gene. The DNA sequencing identified the germline pathogenic variant p. R337H heterozygous in exon 10 of TP53. The patient was classified as having Li-Fraumeni-like syndrome. CONCLUSION: In patients with rectal leiomyosarcoma, it is advisable to investigate the family history of cancer and perform genetic studies to screen for Li-Fraumeni syndrome.

Pattern of rectal cancer recurrence following potentially curative surgical treatment

Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between June 2003 and July 2021. After applying the exclusion criteria to 305 patients, 166 patients were analyzed. Global recurrence was found in 18.7% of them, while 7.8% have had local recurrence. Recurrences were diagnosed from 5 to 92 months after the surgical procedure, with a median of 32.5 months. Follow-up varied from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years and shows a 5-year survival rate of only 5%. In around 50% of cases, recurrence is local, confined to the pelvis. This study was consonant with the literature in most aspects evaluated, although a high rate of local recurrence remains a challenge in seeking better surgical outcomes. (AU)

Diagnosis of advanced disease in cases of colorectal cancer in a developing country

Objectives Colorectal cancer (CRC) is the second leading cause of cancer death in the world, with survival correlated with the extension of the disease at diagnosis. In many low-/middle-income countries, the incidence of CRC is increasing rapidly, while decreasing rates are observed in high-income countries. We evaluated the anatomopathological profile of 390 patients diagnosed with CRC who underwent surgical resection, over a six-year period, in the state of Paraíba, northeastern Brazil. Results Adenocarcinomas accounted for 98% of the cases of primary colorectal tumors, and 53.8% occurred in female patients. The average age of the sample was 63.5 years, with 81.8% of individuals older than 50 years of age and 6.4% under 40 years of age. The most frequent location was the distal colon; pT3 status was found in 71% of patients, and pT4 status, in 14.4%. Angiolymphatic and lymph-node involvements were found in 48.7% and 46.9% of the cases respectively. Distant metastasis was observed in 9.2% of the patients. Advanced disease was diagnosed in almost half of the patients (48.1%). The women in the sample had poorly-differentiated adenocarcinomas (p=0.043). Patients under 60 years of age had a higher rate of lymph-node metastasis (p=0.044). Tumor budding was present in 27.2% of the cases, and it was associated with the female gender, themucinous histological type, and the depth of invasion (pT3 and pT4). Conclusions We conclude that the diagnosis of advanced disease in CRC is still a reality, with a high occurrence of aggressive prognostic factors, which results in a worse prognosis. (AU)

Brazilian society of surgical oncology: Guidelines for the surgical treatment of mid-low rectal cancer.

BACKGROUND: Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. OBJECTIVES: The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. METHODS: Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. RESULTS: The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. CONCLUSION: These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.

Diffuse cavernous hemangioma of the rectum.

Diffuse cavernous hemangioma (DCH) is a rare benign vascular lesion. The rectosigmoid colon is the most common site of this disease. It affects mainly young adults. The most frequent symptom is chronic rectal bleeding which is painless, often begins in the infancy and sometimes is uncontrollable. Endoscopy is the diagnose method of choice and complete surgical excision with sphincter-saving procedure is the primary mode of treatment. A high index of suspicion and a correct diagnose is necessary. We present a 34-year-old male with a DCH of the rectum and anus who required an APR because of affection of dentate line.

El hemangioma cavernoso difuso (HCD) es un tumor vascular benigno raro. Su localización más habitual es el rectosigma. Se presenta en adultos jóvenes como rectorragia indolora y recurrente, que suele aparecer en la infancia y puede llegar a ser incontrolable. La endoscopia digestiva es el método diagnostico de elección. El único tratamiento eficaz consiste en la resección completa siendo deseable la realización de una técnica con conservación esfinteriana. Un alto índice de sospecha y un correcto diagnóstico son necesarios. Presentamos el caso de un varón de 34 años con un HCD del anorecto que requirió una resección abdominoperineal.

Caracterización de enfermos operados de cáncer rectal. Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández / Characterization of patients operated of rectal cancer. Teaching Clinic-Surgical Hospital Faustino Pérez Hernández

RESUMEN Introducción: el cáncer de recto se considera una de las neoplasias más frecuentes del siglo XXI, con elevada mortalidad. Objetivo: caracterizar a los pacientes operados de cáncer rectal en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2015 y diciembre de 2018. Materiales y métodos: se realizó un estudio observacional descriptivo. El universo fue de 97 pacientes de ambos sexos, operados de cáncer rectal. Se obtuvieron los datos de las historias clínicas individuales. Se analizaron variables como edad, sexo, localización específica del tumor, manifestaciones clínicas, características anatomopatológicas y estadios de la enfermedad, técnica quirúrgica empleada y complicaciones postoperatorias durante los primeros siete días. El método estadístico utilizado fue la distribución de frecuencia, en valores absolutos y porcentajes. Resultados: entre los pacientes operados de cáncer rectal, predominaron las personas de 70 a 79 años y el sexo masculino. El recto superior fue el sitio de mayor localización. El sangrado rectal, la expulsión de flemas y los cambios del hábito intestinal fueron los síntomas más frecuentes. El adenocarcinoma bien diferenciado fue la variedad histológica de mayor incidencia, y los estadios que prevalecieron fueron el II y el III. La técnica quirúrgica más empleada fue la resección anterior, y la complicación más frecuente la infección del sitio quirúrgico. Conclusiones: prevenir los factores de riesgo, sus causas predisponentes y desencadenantes, utilizar los medios diagnósticos convencionales y de avanzada. Detectar y tratar de forma temprana la enfermedad puede lograr mejor calidad de vida en estos pacientes (AU).

ABSTRACT Introduction: rectal cancer is considered one of the most frequent neoplasia of the 21st century, with high mortality. Objective: to characterize patients who underwent rectal cancer surgery at the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, of Matanzas, between January 2015 and December 2018. Materials and methods: a descriptive observational study was carried out. The universe was 97 patients of both sexes, who underwent a rectal cancer surgery. Data were obtained from individual medical records. Variables such as age, sex, specific tumor location, clinical manifestations, anatomopathologic characteristics and stages of the disease, surgical technique used and post-surgery complications during the first seven days were analyzed. The statistical method used was the frequency distribution, in absolute values and percentages. Results: people aged 70-79 years and men predominated among patients with rectal cancer. The upper rectum was the site of most common location. Rectal bleeding, phlegm expulsion, and changes in bowel habit were the most frequent symptoms. Well-differentiated adenocarcinoma was the most prevalent histological variety, and the stages that prevailed were II and III. The most commonly used surgical technique was anterior resection, and the most common complication was surgical site infection. Conclusions: to prevent risk factors, their predisposing causes and triggers; to use conventional and advanced diagnostic means. Early detection and treatment of the disease can achieve better quality of life in these patients (AU).

Anorectal Mucosal Melanoma: A Case Report and Literature Review.

BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. CASE REPORT We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month follow-up, the anal lesion had relapsed, and the patient died 10 months after the procedure. CONCLUSIONS AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.

Linfografía como opción diagnóstica y terapéutica en la fuga quilosa posoperatoria de cáncer colorrectal.

La fuga quilosa es una complicación muy poco frecuente tras la cirugía colorrectal. Se presenta el caso de un paciente de 70 años con neoplasia de recto medio intervenido de forma electiva tras un ciclo largo de neoadyuvancia mediante una resección anterior de recto por laparoscopia. El cuarto día de posoperatorio presentó un drenaje pélvico de aspecto quiloso y el día 13 se confirmó la fuga quilosa en la linfografía. Posteriormente el débito se redujo de forma rápida. La linfografía no solo es un método diagnóstico, sino que en el 35-70% de los casos puede también ser terapéutica.Chylous leakage is an extremely rare complication after colorectal surgery. We report the case of a 70 year-old male with a mid-rectal cancer who underwent a laparoscopic anterior resection of the rectum after long course neoadjuvant therapy. On postoperative day 4 the patient presented with chylous pelvic drainage, and a chylous leakage was proved by lymphography on postoperative day 13. Hereinafter, the drainage was drastically reduced. The lymphography is not only a diagnostic technique, but it can be also a therapeutic method in up to 35-70% of the cases.

Perianastomotic cyst following rectosigmoidectomy due to adenocarcinoma of the proximal rectum: a case report / Cisto perianastomótico pós-retossigmoidectomia por adenocarcinoma dereto alto: relato de caso

ABSTRACT The implantation cyst occurs from the imprisonment and subsequent proliferation of the colonic mucosa below the submucosa during mechanical stapling. The understanding and definition of the evaluation protocol of these lesions is important, since they can generate the need for a new complex surgical procedure and cause anxiety in patients and surgeons. This case reports the occurrence of a subepithelial lesion in follow-up imaging of a patient who underwent videolaparoscopic rectosigmoidectomy for adenocarcinoma of the proximal rectum, submitted to an endoscopic attempt to drain/detangle the lesion and subsequent histopathological analysis showing colic mucosa without changes. In line with Katsumata,it is suggested to asymptomatic patients without alteration of the CEA or suspicious imaging signs a follow up with periodic imaging methods. For symptomatic patients with normal CEA, or whose lesions are growing at follow-up exams, it is suggested to continue with the investigation, with biopsy and/or effluent sample for histopathological study in addition to an attempt at symptomatic resolution. Finally, in the presence of an alteration in CEA, despite symptoms, it is suggested that the lesion be managed as a suspected local tumor recurrence.

RESUMO O cisto de implantação ocorre a partir do aprisionamento e subsequente proliferação da mucosa colônica abaixo da submucosa durante o grampeamento mecânico. A compreensão e definição do protocolo de avaliação dessas lesões é importante, pois podem gerar a necessidade de um novo procedimento cirúrgico complexo e causar ansiedade em pacientes e cirurgiões. Este caso relata a ocorrência de uma lesão sub-epitelial na imagem de seguimento de um paciente submetido à retossigmoidectomia por via videolaparoscópica devido a adenocarcinoma do reto proximal, submetido a uma tentativa endoscópica de drenar/remover a lesão e subsequente análise histopatológica mostrando a mucosa cólica sem alterações. De acordo com Katsumata, sugere-se que pacientes assintomáticos sem alteração do CEA ou sinais de imagem suspeitos tenham um seguimento com métodos de imagem periódicos. Para pacientes sintomáticos com CEA normal, ou cujas lesões mostrem crescimento nos exames de seguimento, sugere-se continuar a investigação, com biópsia e / ou amostra de efluente para estudo histopatológico, além de uma tentativa de resolução sintomática. Finalmente, na presença de uma alteração no CEA, apesar dos sintomas, sugere-se que a lesão seja tratada como uma suspeita de recorrência local do tumor.

Experimental Model of Rectal Carcinogenesis Induced by N-Methyl-N-Nitrosoguanidine in Mice with Endoscopic Evaluation.

Background and purpose: The discovery of chemical substances with carcinogenic properties has allowed the development of several experimental models of colorectal cancer (CRC). Classically, experimental models of CRC in mice have been evaluated through clinical or serial euthanasia. The present study aims to investigate the role of low endoscopy in the analysis of carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Methods: Thirty C57BL6 mice were divided into two groups: a control group with fifteen animals that underwent rectal instillation of saline solution on day 0 and a carcinogen group with fifteen animals that underwent a 100 mg/kg MNNG rectal instillation on day 0. In both groups, low endoscopies were performed on weeks 4 and 8. We used a validated endoscopic scoring system to evaluate the severity of colitis and colorectal tumor. Euthanasia was carried out at week 12. Results: We observed higher inflammation scores (p <0.001) and a higher number of tumors (p <0.05) in the MNNG group than the control group, both at weeks 4 and 8. A worsening of inflammation scores from the first to the second endoscopy was also noticeable in the MNNG group. There were no bowel perforations related to the procedure, and there was one death in the control group. Conclusion: Low endoscopy in experimental animals allows safe macroscopic evaluation of colorectal carcinogenesis without the need for euthanasia.

Do We Have to Treat All T3 Rectal Cancer the Same Way?

Chemoradiotherapy (CRT) followed by surgery is the recommended approach in the last years for stage II and III rectal cancer with the intention to decrease the risk of local recurrence. However, fewer patients benefit from this strategy in terms of overall survival and long-term adverse outcomes because T3 rectal cancer has a broad range of prognosis, as shown by recent publications. Many patients with cT3 rectal cancer have a substantial risk of overtreatment with long-term toxicity related to radiotherapy that could be avoided in a subset group of cT3 tumors with good prognosis. These findings raised the question of whether all cT3 rectal cancer should receive preoperative radiotherapy and if a selected cT3 subgroup could be treated by surgery alone. This review addresses the rationale of selecting good prognosis cT3 rectal cancer for surgery alone and analyzes the data to support this recommendation.

[Cystic lymphangioma of the rectum-sigmoid in a public hospital in Lima-Peru: case report]. / Linfangioma quístico de recto-sigmoides en un hospital público de Lima, Perú: reporte de caso.

Lymphangiomas are benign lesions due to a developmental malformation in the lymphatic system that occurs during the embryonic stage. They are more frequent in children. They can be found in the abdominal cavity, being the involvement of the gastrointestinal tract occasionally. The clinical presentation is varied, depending on the location of the lymphangiomas, and may have asymptomatic forms and, occasionally, present with abdominal pain, changes in defecation, rectal bleeding, etc. The diagnosis is made by endoscopy, auxiliary images and is confirmed by histology. We present a case of cystic rectal-sigmoid lymphangioma that we had in our hospital; the patient presented with proctalgia, alternating evacuation and intermittent rectal bleeding. Physical examination was without significant alterations. During the colonoscopy, at the level of the rectum and sigmoids, multiple protruded lesions were found, whose surface was smooth, translucent and bluish in color, with some pseudodiverticular holes, predominantly of the rectum. Endoscopic ultrasound revealed thickening of the submucosa at the level of the rectum with multiple anechoic, microcystic images, some of them with fine septa. The definitive diagnosis was made by histopathology, which describes dilated lymphatic ducts, surrounded by endothelial cells, findings consistent with cystic rectal-sigmoid lymphangioma.