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2.
Dis Colon Rectum ; 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35239526

RESUMO

BACKGROUND: Both transanal hemorrhoidal dearterialization and vessel sealing device hemorrhoidectomy are safe and well tolerated for grade III-IV hemorrhoid treatment. The first is associated with a shorter need of postoperative analgesia than vessel sealing device hemorrhoidectomy. Whether one of them is superior regarding long-term results remains unclear. OBJECTIVE: The objective was to compare long-term results after transanal hemorrhoidal dearterialization and vessel sealing device hemorrhoidectomy. DESIGN: A multicenter randomized clinical trial was conducted. SETTING: This study was conducted at 6 centers. PATIENTS: Patients aged ≥18 years with grade III-IV hemorrhoids were included in the study. INTERVENTIONS: Patients were randomly assigned to transanal hemorrhoidal dearterialization (n=39) or vessel sealing device hemorrhoidectomy (n = 41). MAIN OUTCOME MEASURES: The primary outcome was hemorrhoid symptom recurrence assessed by a specific questionnaire 2 years postoperatively. Secondary outcomes included long-term complications, reoperations, fecal continence, patient's satisfaction, and quality of life. RESULTS: Five of the 80 patients included in the study were lost to follow-up. Thirty-six patients randomized to transanal hemorrhoidal dearterialization and 39 randomized to vessel sealing device hemorrhoidectomy were included in the long-term analysis. The differences between mean baseline and mean 2-year score in the two groups were similar (-11.0, SD 3.8 vs -12.5, SD 3.6; p = 0.080). Three patients in the transanal hemorrhoidal dearterialization group underwent supplementary procedures for hemorrhoid symptoms, compared with none in the vessel sealing device hemorrhoidectomy group (p = 0.106). Four patients in the vessel sealing hemorrhoidectomy group and none in the transanal hemorrhoidal dearterialization group experienced chronic opened wound (p = 0.116). No differences were found in terms fecal continence (p = 0.657), patient's satisfaction (p = 0.483) and quality of life. LIMITATIONS: No stratification for hemorrhoid grade and power calculation based on the main outcome trial but not on the end-point of this long-term study. CONCLUSIONS: Transanal hemorrhoidal dearterialization with mucopexy is associated with similar hemorrhoid symptom recurrence than vessel sealing device hemorrhoidectomy at two years. See Video Abstract at http://links.lww.com/DCR/B933. TRIAL REGISTRATION: clinicaltrials.gov (NCT02654249).

4.
Dis Colon Rectum ; 2022 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-35348529

RESUMO

BACKGROUND: In the past few years, positive circumferential resection margin has been found to be an indicator of advanced disease with high risk of distant recurrence rather than of local recurrence. OBJECTIVE: The objective was to analyze the prognostic impact of circumferential resection margin on local recurrence, distant recurrence, and survival rates in patients with rectal cancer. DESIGN: This was a multicenter, propensity score-matched analysis 2:1 comparing positive and negative circumferential resection margin. SETTINGS: The study was conducted at 5 high-volume centers in Spain. PATIENTS: Patients who underwent total mesorectal excision with a curative intent for middle-low rectal cancer between 2006 and 2014 were included. Clinical and histological characteristics were used for matching. MAIN OUTCOME MEASURES: The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. RESULTS: The unmatched initial cohort consisted of 1599 patients; 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with negative circumferential margin and 78 with positive circumferential margin). The median follow-up period was 52.5 months (22.0-69.5). Local recurrence was significantly higher in patients with positive circumferential margin (33.3% vs 11.5%; HR 3.2; 95% CI: 1.83-5.43; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; HR 1.09; 95% CI: 0.78-1.90; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; HR 1.09; 95% CI: 0.92-1.78; p = 0.14). Disease-free survival was lower in patients with positive circumferential margin (36.1% vs 52.3%; HR 1.5; 95% CI: 1.05-2.06; p = 0.026). LIMITATIONS: This study was limited by its retrospective design. The different neoadjuvant treatment options were not been included in the propensity score. CONCLUSIONS: Positive circumferential resection margin is associated with higher local recurrence rate and worse disease-free survival in comparison with negative circumferential resection margin. However, positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950.

6.
Surgery ; 172(1): 74-82, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35168815

RESUMO

BACKGROUND: Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. METHODS: This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. RESULTS: A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. CONCLUSION: Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Obstrução Intestinal , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
7.
Surg Endosc ; 36(1): 196-205, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33439344

RESUMO

BACKGROUND: Combined-Endoscopic-Laparoscopic-Surgery (CELS) was developed for benign colonic polyps, endoscopically unresectable, to avoid segmental colectomy. This observational study aims to compare surgical outcomes of endoscopically unresectable colonic polyps treated laparoscopically before and since the institutional introduction of CELS. Primary endpoint was postoperative morbidity and mortality; secondary endpoints were time of hospitalization and histopathological findings. METHODS: Charts of all patients with preoperative diagnosis of benign colonic tumors, treated laparoscopically at our institution from 1/2010 to 2/2020 were reviewed. Patients with polyps (1) affecting ileocecal valve, (2) occupying > 50% of the circumference, (3) ≥ 3 endoscopically unresectable polyps, (4) inflammatory bowel disease, (5) polyps within diverticular area post diverticulitis, (6) rectal polyps (7) foreseen impossibility of laparoscopy (8) preoperatively biopsy proven invasive adenocarcinoma were excluded. Group I consists of all patients potentially treatable by CELS but operated by laparoscopic colonic resection as CELS was not yet institutionally established. Group II includes all patients treated with CELS (since 11/2017). RESULTS: One hundred-fifteen consecutive patients were reviewed. Applying exclusion criteria, twenty-three patients form group I and twenty-three group II (female 30.4%, median age 68 years). Groups distributed homogenously for age, BMI (body mass index) and polyps´ localization with most polyps (60.4%) localized in right colon; group II patients had significantly higher American Society of Anesthesiologists (ASA) score. Median operating time, hospital stay and morbidity were significantly less in group II. Postoperative morbidity occurred overall in 14 patients (30.4%), mostly Clavien-Dindo class I-II (26.1%) and significantly less in group II (p = 0.017), Clavien-Dindo III-IV distributed equally (one patient each group) without postoperative mortality. Definitive histopathology showed invasive adenocarcinoma in 8.3% without differences between groups. Two patients with invasive adenocarcinoma after CELS were advised for oncological resection. CONCLUSION: CELS is safe and efficient to treat complex, benign colonic polyps by a complete minimal invasive laparoscopic approach. CELS showed better surgical outcomes with less morbidity, no mortality and appropriate pathological results avoiding unnecessary laparoscopic surgery with intestinal anastomosis.


Assuntos
Pólipos do Colo , Laparoscopia , Idoso , Estudos de Coortes , Colectomia/métodos , Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Feminino , Humanos , Laparoscopia/métodos , Estudos Retrospectivos
8.
Dis Colon Rectum ; 65(2): 207-217, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34636779

RESUMO

BACKGROUND: The clinical value of transanal total mesorectal excision is debated. OBJECTIVE: This study aimed to compare short- and medium-term effects of transanal versus anterior total mesorectal excision for rectal cancer. DESIGN: This was a multicenter retrospective cohort study. SETTING: The study included all Catalonian public hospitals. PATIENTS: All patients receiving transanal or anterior total mesorectal excision (open or laparoscopic) for nonmetastatic primary rectal cancer in 2015 to 2016 were included. MAIN OUTCOME MEASURES: Data on vital status were collected to March 2019. Between-group differences were minimized by applying propensity score matching to baseline patient characteristics. Competing risk models were used to assess systemic and local recurrence along with death at 2 years, and multivariable Cox regression was used to assess 2-year disease-free survival. Results are expressed with their 95% CIs. RESULTS: The final subsample was 537 patients receiving total mesorectal excision (transanal approach: n = 145; anterior approach: n = 392). Median follow-up was 39.2 months (interquartile range, 33.0-45.8). Accounting for death as a competing event, there was no association between transanal total mesorectal excision and local recurrence (matched subhazard ratio 1.28, 95% CI 0.55-2.96). There were no statistical differences in the comparative rate of local recurrence (transanal: 1.77 per 100 person-years, 95% CI 0.76-3.34; anterior: 1.37 per 100 person-years, 95% CI 0.8-2.15) or mortality (transanal: 3.98 per 100 person-years, 95% CI 2.36-6.16; anterior: 2.99 per 100 person-years, 95% CI 2.1-4.07). Groups presented similar 2-year cumulative incidence of local recurrence (4.83% versus 3.57%) and disease-free survival (HR, 1.33; 95% CI 0.92-1.92). LIMITATIONS: We used data only from the public system, the study is retrospective, and data on individual surgeons are not reported. CONCLUSION: These population-based results support the use of either the transanal, open, or laparoscopic approach for rectal cancer in Catalonia. See Video Abstract at http://links.lww.com/DCR/B744.ESCISIÓN MESORRECTAL TOTAL TRANSANAL VERSUS ESCISIÓN MESORRECTAL TOTAL ANTERIOR PARA EL CÁNCER DE RECTO: UN ESTUDIO POBLACIONAL CON EMPAREJAMIENTO DE PUNTAJE DE PROPENSIÓN EN CATALUÑA, ESPAÑA. ANTECEDENTES: Se debate el valor clínico de la escisión mesorrectal total transanal. OBJETIVO: Comparar los efectos a corto y mediano plazo de la escisión mesorrectal total transanal versus anterior para el cáncer de recto. DISEO: Este fue un estudio de cohorte retrospectivo multicéntrico. AJUSTE: El estudio incluyó a todos los hospitales públicos de Cataluña. PACIENTES: Todos los pacientes no metastásicos que recibieron escisión mesorrectal total anterior o transanal (abierta o laparoscópica) por cáncer de recto primario en 2015-16. PRINCIPALES MEDIDAS DE VALORACION: Los datos sobre el estado vital se recopilaron hasta marzo de 2019. Las diferencias entre los grupos se minimizaron aplicando el emparejamiento de puntajes de propensión a las características iniciales del paciente. Se utilizaron modelos de riesgo competitivo para evaluar la recurrencia sistémica y local junto con la muerte a los dos años, y la regresión de Cox multivariable para evaluar la supervivencia libre de enfermedad a dos años. Los resultados se expresan con sus intervalos de confianza del 95%. RESULTADOS: La submuestra final fue de 537 pacientes que recibieron escisión mesorrectal total (abordaje transanal: n = 145; abordaje anterior: n = 392). La mediana de seguimiento fue de 39,2 meses (rango intercuartílico 33,0-45,8). Teniendo en cuenta la muerte como un evento competitivo, no hubo asociación entre la escisión mesorrectal total transanal y la recurrencia local (cociente de subriesgo apareado 1,28, 0,55-2,96). No hubo diferencias estadísticas en la tasa comparativa de recurrencia local (transanal: 1,77 por 100 personas-año, 0,76-3,34; anterior: 1,37 por 100 personas-año, 0,8-2,15) o mortalidad (transanal: 3,98 por 100 personas-año, 2,36-6,16; anterior: 2,99 por 100 personas-año, 2,1-4,07). Los grupos presentaron una incidencia acumulada de dos años similar de recidiva local (4,83% frente a 3,57%, respectivamente) y supervivencia libre de enfermedad (índice de riesgo 1,33, 0,92-1,92). LIMITACIONES: Utilizamos datos solo del sistema público, el estudio es retrospectivo y no se informan datos sobre cirujanos individuales. CONCLUSIONES: Estos resultados poblacionales apoyan el uso del abordaje transanal, abierto o laparoscópico para el cáncer de recto en Cataluña. Consulte. Video Resumen en http://links.lww.com/DCR/B744. (Traducción- Dr. Francisco M. Abarca-Rendon).


Assuntos
Adenocarcinoma/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Espanha
9.
Cir Esp (Engl Ed) ; 99(10): 716-723, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34776408

RESUMO

The oral cavity represents the gateway to the complex digestive system, so the knowledge of the exact mechanisms that link them is vitally important. Recently, oral and dental pathologies have been studied as potential risk factors for pathologies linked to lifestyle habits. Therefore, it could be considered as an interesting preventive way. We conducted a narrative review with a thorough bibliographic search on MEDLINE and SCOPUS, including international studies related to oral healthcare and gastrointestinal neoplasms, published between 2015 and 2020. The primary aim of this revision is to analyze the association between oral healthcare and carcinogenic gastrointestinal processes, providing a possible future preventive strategy for dental care. Moreover, we intend to raise awareness about the importance of oral healthcare as a new paradigm and study variable in the global health care system.


Assuntos
Neoplasias Gastrointestinais , Saúde Bucal , Neoplasias Gastrointestinais/epidemiologia , Humanos , Boca , Fatores de Risco
10.
Int J Surg ; 96: 106171, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774727

RESUMO

BACKGROUND: COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery. MATERIAL AND METHODS: Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study. MAIN OUTCOME: 30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (ß estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI). RESULTS: 4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); ß value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82). CONCLUSION: The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.


Assuntos
COVID-19 , Humanos , Complicações Pós-Operatórias , Curva ROC , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2 , Índice de Gravidade de Doença
12.
JAMA Surg ; 156(9): 865-874, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34190968

RESUMO

Importance: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Observations: Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. Conclusions and Relevance: The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.


Assuntos
Idade de Início , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Adulto , Humanos , Incidência , Pessoa de Meia-Idade , Fatores de Risco
13.
Cir Esp (Engl Ed) ; 2021 Jun 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34144811

RESUMO

The oral cavity represents the gateway to the complex digestive system, so the knowledge of the exact mechanisms that link them is vitally important. Recently, oral and dental pathologies have been studied as potential risk factors for pathologies linked to lifestyle habits. Therefore, it could be considered as an interesting preventive way. We conducted a narrative review with a thorough bibliographic search on MEDLINE and SCOPUS, including international studies related to oral healthcare and gastrointestinal neoplasms, published between 2015 and 2020. The primary aim of this revision is to analyze the association between oral healthcare and carcinogenic gastrointestinal processes, providing a possible future preventive strategy for dental care. Moreover, we intend to raise awareness about the importance of oral healthcare as a new paradigm and study variable in the global health care system.

14.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592888

RESUMO

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Assuntos
COVID-19 , Doenças do Sistema Digestório , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Controle de Infecções , Complicações Pós-Operatórias , Tempo para o Tratamento , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/mortalidade , Doenças do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências/epidemiologia , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/métodos , Tratamento de Emergência/mortalidade , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Mortalidade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Medição de Risco/métodos
15.
Surgeon ; 19(3): e53-e58, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32972853

RESUMO

OBJECTIVE: to assess the epidemiology and features of de novo surgical diseases in patients admitted with COVID-19, and their impact on patients and healthcare system. SUMMARY BACKGROUND DATA: Gastrointestinal involvement has been described in COVID-19; however, no clear figures of incidence, epidemiology and economic impact exist for de-novo surgical diseases in hospitalized patients. METHODS: This is a prospective study including all patients admitted with confirmed SARS-CoV-2 rT-PCR, between 1 March and 15 May 2020 at two Tertiary Hospitals. Patients with known surgical disease at admission were excluded. Sub-analyses were performed with a consecutive group of COVID-19 patients admitted during the study period, who did not require surgical consultation. RESULTS: Ten out of 3089 COVID-19 positive patients (0.32%) required surgical consultation. Among those admitted in intensive care unit (ICU) incidence was 1.9%. Mortality was 40% in patients requiring immediate surgery and 20% in those suitable for conservative management. The overall median length of stay (LOS) of patients admitted to ICU was longer in those requiring surgical consultation compared with those who did not (51.5 vs 25 days, p = 0.0042). Patients requiring surgical consultation and treatment for de-novo surgical disease had longer median ICU-LOS (31.5 vs 12 days, p = 0.0004). A median of two post-surgical complications were registered for each patient undergoing surgery. Complication-associated costs were as high as 38,962 USD per patient. CONCLUSIONS: Incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery.


Assuntos
COVID-19/complicações , Gastroenteropatias/epidemiologia , Custos de Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Idoso , COVID-19/mortalidade , COVID-19/cirurgia , Cuidados Críticos , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Taxa de Sobrevida , Resultado do Tratamento
17.
Eur J Surg Oncol ; 47(2): 276-284, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32950316

RESUMO

INTRODUCTION: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. METHOD: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II. RESULTS: Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ±â€¯chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. CONCLUSION: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.


Assuntos
Previsões , Margens de Excisão , Estadiamento de Neoplasias , Neoplasias Retais/terapia , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Retais/diagnóstico , Neoplasias Retais/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento , Adulto Jovem
18.
ANZ J Surg ; 91(1-2): E25-E31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32255271

RESUMO

BACKGROUND: Stage 2 colonic cancer comprises a heterogeneous group of patients with a spectrum of disease, from invasion of the sub-serosa to tumour perforation into visceral peritoneum/adjacent organs. This study evaluates the post-operative outcomes and prognostic factors of patients with both emergency and elective presentations of stage 2 colonic cancer treated with curative intent. METHODS: Retrospective analysis of a prospectively maintained database of adult patients (emergency and elective) who underwent curative surgery for stage 2 colonic cancer in a single tertiary referral centre between 2007 and 2016 was conducted. Multivariate analysis was performed to identify prognostic factors. Measured variables included demographics, complications, histology, disease-free survival and overall survival (OS). RESULTS: A total of 428 patients with stage 2 colonic cancer received curative surgical resection, and negative resection margins were achieved in all cases: T3 group (stage 2A): 316 (73.8%); T4a group (stage 2B): 78 patients (18.2%); and T4b group (stage 2C): 34 (8%). There were 187 (45.7%) post-operative complications, 32 (7.5%) anastomotic leaks and eight (1.9%) 30-day mortalities. Eighty patients (19.3%) died during the follow-up. During the follow-up period, 45 patients developed recurrence (all distant). Multivariate analysis identified age >70 years, American Society of Anesthesiologists grades III-IV and male gender as factors associated with poor OS, while recurrence was higher in those aged over 70 years and with stages 2B-2C disease. CONCLUSION: Surgical morbidity in patients with stage 2 colonic cancer who have undergone curative surgery is high. Older and more co-morbid patients have poorer OS. Stages 2B and 2C colon cancer patients have worse prognosis than those with stage 2A regarding recurrence. Future larger data sets are required to determine the role of transmural spread as a prognostic factor.


Assuntos
Neoplasias do Colo , Recidiva Local de Neoplasia , Adulto , Idoso , Estudos de Coortes , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
20.
BMC Cancer ; 20(1): 1164, 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33246428

RESUMO

BACKGROUND: Preoperative chemoradiotherapy with capecitabine is considered as a standard of care for locally advanced rectal cancer. The "Tratamiento de Tumores Digestivos" group (TTD) previously reported in a randomized Ph II study that the addition of Bevacizumab to capecitabine-RT conferred no differences in the pre-defined efficacy endpoint (pathological complete response). We present the follow-up results of progression-free survival, distant relapse-free survival, and overall survival data at 3 and 5 years. METHODS: Patients (pts) were randomized to receive 5 weeks of radiotherapy (45 Gy/25 fractions) with concurrent Capecitabine 825 mg/m2 twice daily, 5 days per week with (arm A) or without (arm b) bevacizumab (5 mg/kg once every 2 weeks). RESULTS: In our study, the addition of bevacizumab to capecitabine and radiotherapy in the neoadjuvant setting shows no differences in pathological complete response (15.9% vs 10.9%), distant relapse-free survival (81.0 vs 80.4 and 76.2% vs 78.2% at 3 and 5 years respectively), disease-free survival (75% vs 71.7 and 68.1% vs 69.57% at 3 and 5 years respectively) nor overall survival at 5-years of follow-up (81.8% vs 86.9%). CONCLUSIONS: the addition of bevacizumab to capecitabine plus radiotherapy does not confer statistically significant advantages neither in distant relapse-free survival nor in disease-free survival nor in Overall Survival in the short or long term. TRIAL REGISTRATION: EudraCT number: 2009-010192-24 . Clinicaltrials.gov number: NCT01043484 .


Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Adenocarcinoma/patologia , Bevacizumab/administração & dosagem , Capecitabina/administração & dosagem , Quimiorradioterapia , Feminino , Humanos , Masculino , Intervalo Livre de Progressão , Neoplasias Retais/patologia
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