Association between microsatellite status and characteristics and outcomes of early-onset compared to late-onset rectal cancer.

BACKGROUND: Microsatellite instability (MSI) is an important prognosticator for colorectal cancer (CRC). The present study aimed to assess the impact of MSI status on the characteristics and outcomes of early-onset compared to late-onset rectal cancer. METHODS: This retrospective cohort study used data from the US National Cancer Database (2004-2019) to assess the baseline characteristics, treatment patterns, short-term outcomes, and overall survival (OS) of early-onset rectal adenocarcinoma affecting patients < 50 years compared to late-onset rectal adenocarcinoma according to the MSI status. RESULTS: The present study included 48,407 patients (59.9% male) with rectal cancer, 17.3% of patients were < 50 years and 6.3% had MSI-H tumors. In the early-onset group, patients with MSI-H tumors had a lower mean age (41.5 vs 43 years, p < 0.001) and presented less often with stage IV disease (22.1% vs 17.7%, p = 0.03) and liver metastasis (9.1% vs 13.5%, p = 0.011) than patients with MSS tumors. In the late-onset group, patients with MSI-H and MSS tumors had similar demographics, disease stage, and metastatic pattern, yet MSI-H patients more often received neoadjuvant radiation therapy (58.9% vs 55.1%, p = 0.009) and neoadjuvant systemic therapy (40% vs 36.2%, p = 0.005). In both age groups, MSI-H tumors were associated with more pathologic T3-4 stage and were more likely mucinous and poorly differentiated carcinomas than MSS tumors. The median OS of MSI-H tumors was similar to MSS tumors (108.09 vs 102.31 months, p = 0.1), whether in the early-onset (139.5 vs 134.2 months, p = 0.821) or late-onset groups (106.1 vs 104.3 months, p = 0.236). CONCLUSIONS: In both age groups, MSI-H rectal cancers were more often mucinous and poorly differentiated carcinomas and had pT3-4 stage more often than MSS cancers. MSI-H rectal cancers tend to present less often with distant metastases and nodal involvement than MSS cancers only in early-onset, but not in late-onset rectal cancers. The association between MSI status and survival was not notable in this study, whether in the early-onset or late-onset groups.

Propensity-Score Matched Analysis of Survival Outcomes of Adjuvant Therapy in Stage II-III Signet-Ring Cell Carcinoma of the Colon.

BACKGROUND: Colonic signet ring cell carcinoma (SRCC) is a mucinous adenocarcinoma subtype often associated with poor prognosis. This study assessed the survival benefits of adjuvant therapy after curative resection of stage II-III colonic SRCC. METHODS: This was a retrospective analysis of outcomes of adjuvant therapy in colonic SRCC using National Cancer Database (2010-2019) data. Patients who received adjuvant therapy were matched to those who did not use the nearest neighbor propensity-score matching. The primary outcome was 5-year overall survival (OS). RESULTS: The unmatched cohort included 3530 patients. Patients who received adjuvant therapy were significantly younger, more often male, and more often had Charlson scores 0-1, left-sided cancers, stage III disease, lymphovascular invasion, and perineural invasion. The matched cohort included 958 patients (53.6% female); 479 received adjuvant therapy and 479 did not. Adjuvant therapy was associated with longer mean OS (39.9 vs. 29.2 months; P < .001). Survival benefit of adjuvant therapy was evident in stage III disease (37.5 vs. 24.7 months; P < .001), right-sided colon cancer (40.2 vs. 27.7 months; P < .001), and transverse colon cancer (40.6 vs. 31.1 months; P = .002), but not stage II disease (52.1 vs. 53.1 months; P = .694) or left-sided colon cancer (35.8 vs. 32.6 months; P = .417). Independent predictors of improved OS were adjuvant therapy (HR: 0.539; P < .001), laparoscopic surgery (HR: 0.829; P = .001), robotic-assisted surgery (HR: 0.63; P = .007), and number of harvested lymph nodes (HR: 0.976; P < .001). CONCLUSIONS: Adjuvant therapy was associated with improved OS in stage III, right-sided, and transverse colon SRCC. The survival benefit of adjuvant therapy in stage II and left-sided colon SRCC was limited.

Outcomes of transanal total mesorectal excision compared to laparoscopic total mesorectal excision: A meta-analysis of randomized controlled trials.

BACKGROUND: Transanal dissection is increasingly used in laparoscopic surgery for total mesorectal excision of lower rectal cancers. Several studies compared outcomes of laparoscopic total mesorectal excision with and without transanal dissection, yet there is a paucity of high-quality evidence. This meta-analysis aimed to provide a pooled comparative analysis of outcomes of laparoscopic total mesorectal excision with and without transanal dissection based on evidence from randomized controlled trials. METHODS: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022-compliant systematic review of randomized controlled trials compared laparoscopic total mesorectal excision with and without transanal dissection. PubMed, Scopus, and Web of Science were searched through March 2023. The Medical Subject Headings terms used in the search were Rectal neoplasms, Proctectomy, Laparoscopy, and Transanal. The main outcomes included operative and pathologic outcomes. The risk of bias was assessed using the Risk of Bias version 2 tool, and certainty of the evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary study outcome was conversion to open surgery. RESULTS: Four randomized controlled trials (1,339 patients; median age 61.2 years) were included; 671 patients underwent laparoscopic total mesorectal excision with transanal dissection, and 668 underwent laparoscopic total mesorectal excision without transanal dissection. Both groups were similar in age, body mass index, and disease stage, but the laparoscopic total mesorectal excision with transanal dissection group had a higher male-to-female ratio, received neoadjuvant therapy and had a hand-sewn anastomosis more often. Patients who underwent laparoscopic total mesorectal excision with transanal dissection had lower conversion rates (odds ratio = 0.179; P = .001), a higher likelihood of achieving complete total mesorectal excision (odds ratio = 1.435; P = .025), and fewer harvested lymph nodes (weighted mean difference = -1.926; P = .035). The groups had similar operative times (weighted mean difference = -3.476; P = .398), total complications (odds ratio = 0.94; P = .665), major complications (odds ratio = 1.112; P = .66), anastomotic leak (odds ratio = 0.67; P = .432), positive circumferential resection margin (odds ratio = 0.549; P = .155), and positive distal margins (odds ratio = 0.559; P = .171). CONCLUSION: Laparoscopic total mesorectal excision with transanal dissection was associated with lower odds of conversion to open surgery, greater likelihood of achieving complete total mesorectal excision, and fewer harvested lymph nodes than laparoscopic total mesorectal excision without transanal dissection.

Stapler size independently predicts postoperative complications following stapled ileocolic anastomosis: A retrospective cohort study.

AIM: Staplers used in ileocolic anastomosis construction differ in length and height. We assessed the impact of stapler type in creating ileocolic anastomoses on postoperative outcomes. METHODS: This retrospective cohort study of an Institutional Review Board approved database included patients who underwent laparoscopic right colectomy for cancer between January 2011 and August 2021. All patients had construction of extracorporeal antiperistaltic stapled ileocolic anastomosis using a linear cutting stapler. Main outcome measures were short-term (<30 day) morbidity and mortality. RESULTS: In all, 270 patients (136 men; median age 70.2 years) were included. A 75 mm stapler was used in 49 (18.1%) patients, 80 mm in 97 (35.9%) and 100 mm in 124 (45.9%). Blue cartridge (stapler height 3.5 mm) was used in 175 (64.5%) and green cartridge (4.8 mm) in 18 (7%) patients; this information was unavailable in 77 (28.5%) cases. Apical enterotomy closure was performed by linear stapler in 54% and linear cutting stapler in 46%. Apical staple line reinforcement or imbrication suturing was used in 26.3%. The overall postoperative complication rate was 28.9%. The anastomotic leak rate was 2.6%. Independent predictors of complications after laparoscopic right colectomy were older age (OR 1.03, 95%CI 1-1.06; P = 0.01), extended colectomy (OR 2.76, 95%CI 1.07-7.08; P = 0.035) and emergency surgery (OR 4.5, 95%CI 1.3-14.9; P = 0.014). A 100-mm linear cutting stapler was an independent protective factor against postoperative complications (OR 0.3, 95%CI 0.18-0.85; P = 0.019). Stapler height and closure technique of apical enterotomy did not affect postoperative complications. CONCLUSION: Independent predictors of complications after laparoscopic right colectomy were older age, extended colectomy and emergency surgery. Using a 100 mm stapler was an independent protective factor against postoperative complications.

A national cancer database analysis of the clinicopathologic characteristics and outcomes of appendiceal malignant mesenchymal tumors.

The present study aimed to assess the characteristics and outcomes of appendiceal malignant mesenchymal tumors. This was a retrospective case-series study of patients with appendiceal malignant mesenchymal tumors in the national cancer database (2005-2019). The main outcomes were overall survival (OS) and short-term mortality. 53 patients (40 GISTs and 13 sarcomas) were included. 92.6% of GIST patients had stage I disease and 76.9% of GISTs were ≤2 cm. Most appendiceal GISTs were treated with appendectomy or partial colectomy whereas half of patients with appendiceal sarcoma underwent hemicolectomy or subtotal colectomy. Only one short-term mortality was recorded in the sarcoma group. One-third of patients with sarcoma had positive surgical margins versus 5.1% of patients with GISTs. GIST patients had longer median OS (117.1 vs 54.8 months) than sarcoma patients.

Characteristics, treatment, and outcomes of anal versus rectal squamous cell carcinoma, a retrospective cohort study.

BACKGROUND: Although squamous cell carcinoma is the most common malignancy of the anal canal, it rarely affects the rectum. The present study aimed to assess the differences in characteristics, treatments, clinical and pathologic outcomes, and survival between anal and rectal squamous cell carcinoma. METHODS: The United States National Cancer Databases (2004-2020) of anal canal and rectal cancer were used for this retrospective cohort analysis. Patients with anal or rectal squamous cell carcinoma were included in the analysis. The study's primary outcome was overall survival, and secondary outcomes were 30-day and 90-day mortality, 30-day readmission, and positive resection margins. RESULTS: The present study included 76,830 patients with anal squamous cell carcinoma and 7,908 with rectal squamous cell carcinoma. Patients with anal squamous cell carcinoma presented more often with early clinical stage I and stage II disease (50.4% vs 45.9%, P < .001) and less often with stage IV disease (6.5% vs 15.1%, P < .001). Anal squamous cell carcinomas were more often treated with upfront surgery than were rectal squamous cell carcinomas (37.7% vs 19.7%, P < .001), whereas rectal squamous cell carcinomas were more often treated with chemoradiation therapy alone (68.3% vs 59.8%, P < .001). Anal squamous cell carcinomas were treated more often with local excision (33.4% vs 15.8%, P < .001) than rectal squamous cell carcinoma. Anal squamous cell carcinoma was associated with a higher incidence of positive resection margins (41.9% vs 32.8%, P < .001). The 30-day and 90-day mortality rates were higher after surgery for rectal squamous cell carcinoma than for anal squamous cell carcinoma (1.5% vs 0.4% and 4.1% vs 1.6%, respectively, P < .001). Anal squamous cell carcinoma had longer median overall survival (145.3 vs 90.3 months, P < .001) than rectal squamous cell carcinoma. CONCLUSION: Patients with anal squamous cell carcinoma presented more often with early-stage disease and less often with distant metastasis and were more often treated with upfront surgery, mainly local excision. Anal squamous cell carcinoma was associated with lower 30-day and 90-day mortality and longer overall survival than rectal squamous cell carcinoma.

Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Repair of Post-partum Rectovaginal Fistulas-A Single-Center Experience.

INTRODUCTION: Rectovaginal fistulas (RVFs) account for approximately 40% of anorectal complications from obstetrical trauma. Treatment can be challenging requiring multiple surgical repairs. Interposition of healthy transposed tissue (lotus or Martius flap or gracilis muscle) has been used for recurrent RVF. We aimed to review our experience with gracilis muscle interposition (GMI) for post-partum RVF. METHODS: A retrospective analysis of patients who underwent GMI for post-partum RVF from February 1995 to December 2019 was undertaken. Patient demographics, number of prior treatments, comorbidities, tobacco use, postoperative complications, additional procedures, and outcome were assessed. Success was defined as absence of leakage from the repair site after stoma reversal. RESULTS: Six of 119 patients who underwent GMI did so for recurrent post-partum RVF. Median age was 34.2 (28-48) years. All patients had at least 1 previously failed procedure [median: 3 (1-7)] including endorectal advancement flap, fistulotomy, vaginoplasty, mesh interposition, and sphincteroplasty. All patients underwent fecal diversion prior to or at initial procedure. Success was achieved in 4/6 (66.7%) patients; 2 underwent further procedures (1 fistulotomy and 1 rectal flap advancement) for a final 100% success rate as all ileostomies were reversed. Morbidity was reported in 3 (50%) patients, including wound dehiscence, delayed rectoperineal fistula, and granuloma formation in one each, all managed without surgery. There was no morbidity related to stoma closure. CONCLUSIONS: Gracilis muscle interposition is a valuable tool for recurrent post-partum RVF. Our ultimate success rate in this very small series was 100% with a relatively low morbidity rate.

The Characterization and Outcomes of Colorectal Malignancy in Patients ≤40 Years of Age: A Single-Center Experience.

BACKGROUND: Implementation of screening modalities has led to a decreased incidence of colorectal malignancies. Unfortunately, overall incidence has remained unchanged as cases have increased in patients below the suggested screening age. Therefore, we evaluated characteristics and oncological outcomes of malignancies in patients ≤40 years of age. METHODS: Single-center retrospective analysis of prospectively collected data of malignancies in patients ≤40 years evaluated in our institution between 2010 and 2016. Basic descriptors for demographic, clinical, histologic, and genetic data were collected. Disease-free survival (DFS) and 5-year overall survival (OS) were compared for patients between 30-40 years and <30 years. RESULTS: Fifty-six patients ≤40 years were identified, 44 of whom (96.5%) had adenocarcinomas. Most common malignancy location was the rectum (64.3%). Despite aggressive tumor characteristics such as moderate/poor differentiation (88.6%), lymphovascular invasion (26.8%), perineural invasion (21.4%), and advanced tumor stage T3/T4 (60.7%), OS rate was 94.6%. Both age groups had similar oncologic characteristics. There was a trend toward worse OS (2/11 and 1/45, P = .06) but not for DFS (7/11 and 15/43, P = .18) in patients <30 years of age compared to 30-40 years. There were no differences in OS (3/44 vs 0/88, P = .44) or DFS (17/42 vs 3/8, P = .80) between sporadic vs non-sporadic malignancies, respectively. CONCLUSIONS: Patients ≤40 years of age with malignancy have advanced tumor stages and aggressive tumor characteristics at diagnosis. Although there is higher OS risk for patients <30 compared to those aged 30-40 years, no differences were found for DFS between these two groups.

Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Risk factors for local recurrence of large gastrointestinal lesions after endoscopic mucosal resection.

BACKGROUND: Endoscopic mucosal resection (EMR) is the primary treatment modality for superficial gastrointestinal mucosal lesions > 2 cm. However, the procedure carries some risk of complications including bleeding, perforation, and local recurrence. This study aimed to examine factors associated with EMR outcomes, especially in terms of local recurrence. METHODS: This study retrospectively evaluated patients who underwent EMR and full closure with prophylactic clips for upper and lower gastrointestinal lesions > 2 cm at Cleveland Clinic Florida, between January 2013 and December 2018 with follow-up endoscopic evaluation for recurrence. RESULTS: A total of 2031 endoscopic polypectomy cases were examined; 307 EMR procedures among 271 patients (52% were female, mean age 65.6 ± 11.1 years) who satisfied the inclusion criteria were included in the study. There were no perforations reported. The rate of post-polypectomy delayed bleeding was 1.6%, and the local recurrence rate in this cohort was 7.1%. Recurrent cases were successfully endoscopically managed. In the multivariate regression analysis, age > 70 years (OR = 3.20, 95% CI 1.17-8.76, p = .023), body mass index (OR = 1.12, 95% CI 1.03-1.23 p = .008), and lesion size ≥ 35 mm (OR = 11.51, 95% CI 3.54-37.40, p = < .001) were independent predictors for recurrence. CONCLUSIONS: Age > 70 years, increased lesion size, and obesity were found to be independent predictors of local recurrence among EMR procedures for gastrointestinal lesions > 2 cm. However, there is a need for larger-scale studies on this topic.

Gracilis Muscle Interposition for Treatment of Complex Anal Fistula: Experience With 119 Consecutive Patients.

BACKGROUND: Treatment of complex anal fistula is challenging, often mandating multiple procedures. The gracilis muscle has been used to treat perineal fistulas and to repair perineal defects. OBJECTIVE: This study aims to report the results of gracilis muscle interposition for complex anal fistula, including prognostic factors for success. DESIGN: This is a retrospective analysis of a prospective database for patients who underwent gracilis muscle interposition for complex anal fistula from 2000 to 2018. SETTING: Patient demographics, operative data, and postoperative outcome were obtained from medical records. Office visits were used for follow-up. PATIENTS: All patients who underwent gracilis muscle interposition for complex anal fistula were included. Patients who underwent gracilis muscle interposition for reasons other than complex anal fistula were excluded. MAIN OUTCOME MEASURES: The primary outcome measured was the healing of complex anal fistula following gracilis muscle interposition and following additional procedures, when needed. RESULTS: A total of 119 patients (60 men, 59 women; median age: 56 (21-85) years) were included. The initial success rate of gracilis muscle interposition was 42%; the final success rate if additional procedures were undertaken was 92%. Overall success rate was 32.2% in women and 51.6% in men. Univariate analysis revealed that sex (p = 0.0315) and bed rest >3 days (p = 0.0078) were significant poor prognostic factors for failure, whereas the multivariate logistic regression model showed that length of bed rest >3 days was a significant poor prognostic factor for failure. In the female subgroup, multivariate analysis showed that bed rest ≥3 days was a significant poor prognostic factor, whereas in the male population there was no significant prognostic factor. LIMITATION: This study was limited by its retrospective nature and the heterogeneity of patients. CONCLUSION: Although initial success is <50%, the ultimate success after gracilis muscle interposition and other subsequent procedures is >90%. Patients must be preoperatively counseled that additional procedures will probably be required to achieve successful fistula closure. Furthermore, prolonged bed rest should be avoided after gracilis muscle interposition. See Video Abstract at http://links.lww.com/DCR/B551. INTERPOSICIN DEL MSCULO GRACILIS PARA EL TRATAMIENTO DE LA FSTULA ANAL COMPLEJA EXPERIENCIA CON PACIENTES CONSECUTIVOS: ANTECEDENTES:El tratamiento de la fístula anal compleja es un desafío que a menudo requiere de múltiples procedimientos quirúrgicos. El músculo gracilis se ha utilizado para tratar fístulas y reparar defectos perineales.OBJETIVO:Informar los resultados de la interposición del músculo gracilis para la fístula anal compleja, incluyendo los factores pronósticos para un tratamiento exitoso.DISEÑO:Se efectuó un análisis retrospectivo obtenido de una base de datos prospectiva para pacientes sometidos a interposición del músculo gracilis por fístula anal compleja del 2000 al 2018.METODO:Los datos demográficos de los pacientes, la información del procedimiento quirúrgico y los resultados postoperatorios se obtuvieron de los expedientes clínicos; el seguimiento se llevó a cabo por medio de visitas al consultorio.PACIENTES:Se incluyeron todos los pacientes sometidos a interposición del músculo gracilis por fístula anal compleja; Se excluyeron los pacientes que se sometieron a interposición del músculo gracilis por motivos distintos a la fístula anal compleja.CRITERIOS DE EVALUACION DE LOS RESULTADOS:Curación de una fístula anal compleja después de la interposición del músculo gracilis y procedimientos adicionales, cuando fueron necesarios.RESULTADOS:Se estudiaron un total de 119 pacientes [60 hombres, 59 mujeres; con media de edad de 56 (21-85) años]. La tasa de éxito inicial de la interposición del músculo gracilis fue del 42%; La tasa de éxito final cuando realizaron procedimientos adicionales fue del 92%. La tasa de éxito global fue del 32,2% en mujeres y del 51,6% en hombres. El análisis univariado reveló que el género (p = 0,0315) y el reposo en cama > 3 días (p = 0,0078) en forma significativa fueron factores de pronóstico bajo para el fracaso, mientras que el modelo de regresión logística multivariable mostró que la duración del reposo en cama> 3 días fue un factor de pronóstico significativamente bajo para fracaso. En el subgrupo de mujeres, el análisis multivariado mostró que el reposo en cama ≥3 días fue un factor de pronóstico significativamente bajo, mientras que en la población masculina no hubo un factor pronóstico significativo.LIMITACIÓN:Carácter retrospectivo y heterogenicidad de los pacientes.CONCLUSIÓN:Aunque el éxito inicial es <50%, el éxito final después de la interposición del músculo gracilis y otros procedimientos posteriores es > 90%. Se debe aconsejar a los pacientes antes de la operación que probablemente se requieran procedimientos adicionales para lograr el cierre exitoso de la fístula. Además, debe evitarse el reposo prolongado en cama después de la interposición del músculo gracilis. Consulte Video Resumen en http://links.lww.com/DCR/B551.

Tratamento cirúrgico da doença pilonidal: meta-análise dos principais procedimentos adotados mundialmente / Surgical treatment of pilonidal disease: meta-analysis of the main procedures adopted worldwide

OBJETIVO: Analisar e comparar os diversos procedimentos cirúrgicos descritos para o tratamento da doença pilonidal. MÉTODO: Foram selecionados 34 trabalhos publicados em revistas indexadas, totalizando 8698 doentes operados. Realizou-se meta-análise para comparação das sete principais técnicas cirúrgicas descritas na literatura, quanto aos resultados em relação à recidiva e ao tempo de cicatrização no pós-operatório. RESULTADOS: Do total de doentes estudados, houve recidiva em 230 doentes (2,6 por cento). O tempo de cicatrização no pós-operatório foi significantemente maior no grupo de excisão sem sutura. As recidivas foram estatisticamente semelhantes nos métodos: excisão sem sutura, marsupialização, incisão e curetagem, excisão e retalho e técnica de Karidakys. Os métodos que apresentaram maior índice de recidiva (estatisticamente significante - p<0,001) foram: excisão e sutura primária e o método de Bascom. CONCLUSÕES: Conclui-se, por esse estudo, que os resultados em relação à recidiva são estatisticamente semelhantes em todos os métodos, com exceção da excisão e sutura primária e da técnica de Bascom, que apresentaram recidivas mais freqüentes. O tempo de cicatrização foi maior nos indivíduos operados pela técnica de excisão sem sutura primária.

BACKGROUND: This study intends to analyse and compare several surgical procedures described for the treatment of pilonidal disease. METHODS: Thirty-four published articles were selected, totalizing 8698 surgically treated patients. A meta-analysis was performed to compare seven main surgical techniques described in literature, in terms of recurrence rates and postoperative healing time. RESULTS: From the total number of patients, 230 of them (2,6 percent) presented with recurrences. The postoperative healing time was significantly longer in the group of excision without suture. The recurrence rate was statistically similar between the following techniques: excision without suture, marsupialization, incision and curettage, excision with flap and the Karidakys procedure. Procedures that had higher rates of recurrence (statistically significant - p<0,001) were the excision with primary suture and the Bascom procedure. CONCLUSION: This study concludes that the results in terms of recurrence rate are statistically similar between most procedures, with the exception of excision with primary suture and the Bascom procedure. The healing time was higher in the patients treated by excision without suture.

Long term (five-year) survival following radical surgical treatment plus adjuvant chemotherapy (FAM) in advanced gastric cancer: a controlled study

Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate

Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report

Relata-se um caso de paciente com adenocarcinoma gastrico com indicacao de gastrectomia. O ato operatorio transcorreu sem anormalidades. Foi realizada gastrectomia subtotal paliativa, pois encontrou-se linfonodos para-aorticos comprometidos pela neoplasia, confirmado pelo exame anatomo-patologico de congelacao realizado no decorrer da intervencao. Ao fim da confeccao da gastroentero-anastomose o paciente passou a apresentar bradicardia intensa: 38 batimentos por minuto (bpm), hipotensao arterial, alteracoes do tracado do eletrocardiograma (Supra-desnivelamento do segmento ST) e parada cardiaca. Realizadas as manobras de ressucitacao com sucesso temporario, ja que a seguir o paciente apresentou novo colapso circulatorio, sendo novamente recuperado, finalmente a terceira parada cardiaca foi irreversivel e constatou-se o obito intra-operatorio

Avaliaçäo da hernioplastia protética atensional no tratamento das hérnias inguinais / Valuation of prosthetic tensionless inguinal hernioplasty in the treatment of inguinal hernias

Apresentam-se 76 pacientes operados devido a hérnias inguinais, com o uso rotineiro de telas de polipropilene colocadas sobre a fascia transversalis, em correção sem tensão, através de uma inguinotomia transversa pequena (média de 6cm). Doze pacientes foram operados bilateralmente, perfazendo 88 intervenções. Entre as intervenções, cinquenta foram sobre hérnias inguinais indiretas (56,8 por cento), 15 sobre hérnias associadas diretas e indiretas (17,1 por cento), e 23 sobre hérnias diretas (26,1 por cento). Praticamente não houve queixas de dor à exceção da dor superficial. Não houve nenhum caso de infecção ou rejeição. Nenhum paciente referiu sentir a sua presença. Após dois dias, os pacientes foram liberados de qualquer tipo de restrição física ou esportiva. Não há qualquer evidência sugestiva de recidiva. Tempo médio de seguimento de trinta meses. Discute-se a técnica empregada. A HIPA é técnica fácil, rápida, de custo baixo, não exige anestesia geral nem materiais especiais, com baixos índices de recidiva e, por não implicar suturas sob tensão, permite restabelecimento pronto, com mínima dor e sem restrições físicas

Colecistectomia videolaparoscópica nos pacientes com cirurgia abdominal prévia: técnicas e cuidados necessários para sua realizçäo / Laparoscopic cholecystectomy in patients with previous abdominal surgery: care and technique for its realization

A colecistectomia é o tratamento de eleiçao para a colelitíase. O advento do método laparoscópico trouxe grande contribuiçao a esse tratamento. As contra-indicaçoes do método laparoscópico vêm mostrando progressivas modificaçoes desde seu início. A operaçao prévia sobre o abdome superior, contra-indicaçao relativa na época da introduçao do método laparoscópico, é dificuldade contornável hoje, desde que observadas algumas normas técnicas específicas. O conhecimento dessas técnicas e a experiência da equipe cirúrgica sao fatores fundamentais para o sucesso e a segurança na realizaçao do procedimento laparoscópico em doente com operaçao prévia sobre o abdome superior.

Colecistectomia por incisäo mínima na colecistite aguda / Cholecystectomy with minimal incision in acute cholecystitis

Os autores apresentam sua experiência com a colecistectomia associada à exploraçäo radiográfica das vias biliares através de incisäo mínima (minilaparotomia) efetuada em 35 doentes portadores de colecistite aguda. O tempo cirúrgico foi curto (média 55min.) e a permanência hospitalar breve, recebendo os doentes alta em três a cinco dias. A cirurgia é realizada sob visäo direta, com equipamento de baixo custo. Nao houve nenhuma complicaçäo no grupo estudado e ótimo resultado estético foi obtido. Concluem que a colecistectomia por minilaparotomia é procedimento seguro e aplicável à maioria dos casos de colecistite aguda também.