RESUMO
Introducción. La utilización de sutura mecánica en la anastomosis esofagoyeyunal es una técnica que si bien se ha impuesto sobre la sutura manual por sus mejores resultados, no está exenta de complicaciones. Queremos valorar si el tamaño del cartucho que se utiliza en estas suturas puede influir en la aparición de complicaciones locales. Pacientes y método. Se ha realizado un estudio prospectivo observacional en 151 pacientes gastrectomizados por adenocarcinoma gástrico. En todos los casos se practicó una gastrectomía total y una anastomosis esofagoyeyunal con sutura circular mecánica. El objetivo del estudio ha sido analizar la posible asociación entre el tamaño del cartucho empleado en la sutura y una serie de complicaciones intraoperatorias y postoperatorias a corto-medio plazo. Resultados. En 93 pacientes se utilizó un cartucho de 25 mm, y se registraron 12 complicaciones: 2 pacientes con desgarro de la pared esofágica, un caso de pinzamiento de la pared mesentérica, seis fugas anastomóticas, tres estenosis y una hemorragia en el área de la línea de sutura. En 54 pacientes se utilizó un cartucho de 28 mm, y se registraron 10 complicaciones: desgarro de la pared esofágica en un paciente, pinzamiento de la pared mesentérica en 3 casos durante la intervención quirúrgica y en la fase postoperatoria, dos estenosis y cuatro fugas anastomóticas. Conclusiones. No se encontró ninguna relación entre estas complicaciones y el tamaño del cartucho (AU)
Assuntos
Humanos , Gastrectomia/efeitos adversos , Técnicas de Sutura/efeitos adversos , Complicações Intraoperatórias , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Neoplasias Gástricas/cirurgiaRESUMO
Pre-surgery serum levels of CA 72-4, CEA and CA 19-9 were quantified by the enzyme immunoassay method in 167 patients with histological diagnosis of gastric adenocarcinoma and in 92 patients with an endoscopic diagnosis of benign gastric pathology. CA 72-4 showed a better correlation between its serum levels and the different clinical stages of the disease than CEA and CA 19-9. At the individual study of stages I-II, CA 72-4 proved positive in 36.9% of patients while CEA and CA 19-9 appeared positive in 10.8% and 8.6%, respectively. In the ROC curve, at a specificity of 95%, the sensitivities of CA 72-4, CEA and CA 19-9 were 59.8%, 21% and 26.3% respectively. The discriminatory capacity of the test (area under the ROC curve +/- SD) was 0.86 +/- 0.03 in the case of CA 72-4, 0.52 +/- 0.03 for CEA and 0.58 +/- 0.03 for CA 19-9. In conclusion, in our series and with regard to CEA and CA 19-9, CA 72-4 shows better sensitivity and discriminatory capacity. CEA and CA 19-9 do not provide significant benefits when combined with CA 72-4 due to the good results obtained with the later marker alone.
Assuntos
Adenocarcinoma/sangue , Antígenos Glicosídicos Associados a Tumores/sangue , Biomarcadores Tumorais/sangue , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Curva ROC , Neoplasias Gástricas/sangue , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/patologiaRESUMO
In order to evaluate the usefulness of CA 72-4 tumour-associated antigen assay in colorectal carcinoma, we have studied 70 patients with benign colorectal diseases and 127 patients with colorectal cancer at different stages. The results were compared with those obtained by CEA and CA 19-9. No significant differences were found in any of the stages according to Dukes' classification when comparing stages A, B and C. However, there were differences with CEA (P < 0.001), CA 19-9 (P < 0.001) and CA 72-4 (P < 0.001) when comparing stages A, B and C with stage D. In the ROC curve, at a specificity of 95%, the sensitivities of CEA, CA 19-9 and CA 72-4 were 46.4%, 20.5% and 40.1%, respectively. In conclusion, CA 72-4 showed better sensitivity and specificity scores than CA 19-9. CEA increased individual sensitivity from 46.4% to 59.8% when combined with CA 72-4, showing a decrease of merely 0.9% in specificity.
Assuntos
Antígenos Glicosídicos Associados a Tumores/sangue , Biomarcadores Tumorais/sangue , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
The relationship between survival after surgical resection of colorectal carcinoma, and perioperative blood transfusion was studied retrospectively. "Curative" surgery was performed in 164 cases of colorectal cancer--stages B and C--, 72 of them received red-cell concentrates perioperatively. Multiple regression analysis did not show any deleterious effect of blood transfusion on the survival of the surgically treated patients (P = 0.941). The volume of the blood derivative received neither seems to influence their outlook. As it was expected a higher rate of transfusion occurred among rectal cancer patients. Mechanisms and factors involved in this controverted issue are discussed and literature is widely reviewed.
