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2.
BMC Cancer ; 20(1): 759, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795358

RESUMO

BACKGROUND: Few studies have examined gender differences in the clinical management of rectal cancer. We examine differences in stage at diagnosis and preoperative radiotherapy in rectal cancer patients. METHODS: A prospective cohort study was conducted in 22 hospitals in Spain including 770 patients undergoing surgery for rectal cancer. Study outcomes were disseminated disease at diagnosis and receiving preoperative radiotherapy. Age, comorbidity, referral from a screening program, diagnostic delay, distance from the anal verge, and tumor depth were considered as factors that might explain gender differences in these outcomes. RESULTS: Women were more likely to be diagnosed with disseminated disease among those referred from screening (odds ratio, confidence interval 95% (OR, CI = 7.2, 0.9-55.8) and among those with a diagnostic delay greater than 3 months (OR, CI = 5.1, 1.2-21.6). Women were less likely to receive preoperative radiotherapy if they were younger than 65 years of age (OR, CI = 0.6, 0.3-1.0) and if their tumors were cT3 or cT4 (OR, CI = 0.5, 0.4-0.7). CONCLUSIONS: The gender-specific sensitivity of rectal cancer screening tests, gender differences in referrals and clinical reasons for not prescribing preoperative radiotherapy in women should be further examined. If these gender differences are not clinically justifiable, their elimination might enhance survival.

5.
Rev. esp. enferm. dig ; 111(7): 519-529, jul. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190098

RESUMO

Introducción: el objetivo de este estudio es comparar los resultados oncológicos (recidiva local, metástasis y supervivencia global) del Proyecto Docente del Cáncer de Recto de la Asociación Española de Cirujanos (Proyecto Vikingo [PV]) en Cataluña con los obtenidos en el resto de comunidades autónomas (CC. AA.). Métodos: la base de datos del PV incluye 4.508 pacientes operados con una resección curativa entre marzo de 2006 y diciembre de 2010 (1.163 en Cataluña y 3.345 en el resto de España), provenientes de los primeros 59 hospitales incluidos en el PV con un seguimiento mínimo de cinco años. Resultados: la incidencia acumulada a cinco años de recidiva local en Cataluña fue del 8% (IC 95%: 6,4-9,9); de metástasis, del 17,7% (IC 95%: 15,4-20,2); y de supervivencia global, del 75% (IC 95%: 72,4-77,7). La incidencia de recidiva local en el resto de CC. AA. fue del 7% (IC 95%: 6,2-8,2); de metástasis, del 22,3% (IC 95%: 20,7-23,9); y de supervivencia global, del 71% (IC 95%: 69,4-72,9). La intervención de Hartmann, la perforación intraoperatoria y la afectación del margen circunferencial fueron las variables asociadas con recurrencia tumoral en el PV. Conclusión: los resultados observados en el Proyecto del Cáncer de Recto entre Cataluña y el resto de comunidades son homogéneos


Introduction: the goal of this study was to compare the oncological results (local recurrence, metastasis and overall survival) obtained by the Proyecto Docente del Cáncer de Recto of the Spanish Association of Surgeons (AEC) (Proyecto Vikingo, PV) in Catalonia versus the rest of Spanish autonomous communities. Methods: the PV database includes 4,508 patients who underwent a curative resection between March 2006 and December 2010, from the first 59 hospitals included in PV; 1,163 were from Catalonia and 3,345 were from the rest of Spain. There was a minimum follow-up of five years. Results: in Catalonia, the five-year cumulative incidence was 8% (95% CI: 6.4-9.9) for local recurrence, 17.7% (95% CI: 15.4-20.2) for metastasis and 75% (95% CI: 72.4-77.7) for overall survival. In the rest of autonomous communities, these figures were 7% (95% CI: 6.2-8.2) for local recurrence, 22.3% (95% CI: 20.7-23.9) for metastasis, and 71% (95% CI: 69.4-72.9) for overall survival. Variables associated with tumor recurrence in PV included Hartmann's procedure, intraoperative perforation and circumferential margin involvement. Conclusion: the results obtained by the Proyecto Docente del Cáncer de Recto were homogeneous between Catalonia and the rest of the autonomous communities


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Retais/epidemiologia , Metástase Neoplásica , Neoplasias Retais/patologia , Recidiva Local de Neoplasia/patologia , Avaliação de Programas e Projetos de Saúde
6.
Rev Esp Enferm Dig ; 111(7): 519-529, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31081668

RESUMO

INTRODUCTION: the goal of this study was to compare the oncological results (local recurrence, metastasis and overall survival) obtained by the Proyecto Docente del Cáncer de Recto of the Spanish Association of Surgeons (AEC) (Proyecto Vikingo, PV) in Catalonia versus the rest of Spanish autonomous communities. METHODS: the PV database includes 4,508 patients who underwent a curative resection between March 2006 and December 2010, from the first 59 hospitals included in PV; 1,163 were from Catalonia and 3,345 were from the rest of Spain. There was a minimum follow-up of five years. RESULTS: in Catalonia, the five-year cumulative incidence was 8% (95% CI: 6.4-9.9) for local recurrence, 17.7% (95% CI: 15.4-20.2) for metastasis and 75% (95% CI: 72.4-77.7) for overall survival. In the rest of autonomous communities, these figures were 7% (95% CI: 6.2-8.2) for local recurrence, 22.3% (95% CI: 20.7-23.9) for metastasis, and 71% (95% CI: 69.4-72.9) for overall survival. Variables associated with tumor recurrence in PV included Hartmann's procedure, intraoperative perforation and circumferential margin involvement. CONCLUSION: the results obtained by the Proyecto Docente del Cáncer de Recto were homogeneous between Catalonia and the rest of the autonomous communities.

7.
J Surg Case Rep ; 2019(3): rjz079, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30911369

RESUMO

Laparoscopy has gained importance in the abdominal emergency surgery field. Acute appendicitis is one of the major indications for emergency surgery, being laparoscopy the gold standard approach. We report a case of a 39-years-old female presenting with acute kidney injury (AKI) after laparoscopy. Differential diagnosis was considered with prerenal AKI etiology due to sepsis and low fluid input, however this was ruled out due to absence of electrolyte imbalance and no correlation with septic parameters. Laparoscopy CO2 pneumoperitoneum can potentially lead to multiple organ failure, including renal. Laparoscopy induced AKI is related with both hormonal stimuli for renal vasoconstriction and increased intra-abdominal pressure, causing hypoxemia and tubular renal injury. In conclusion, very few cases of laparoscopy induced AKI in young patients with no previous renal disease have been reported. Surgeons must consider this complication in the differential diagnosis of postoperative AKI.

8.
J. coloproctol. (Rio J., Impr.) ; 39(1): 90-93, Jan.-Mar. 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-984640

RESUMO

ABSTRACT Purpose: Treatment of persistent anal fistula implies a major challenge for surgeons, with risk of additional recurrence and potential continence impairment. We present a non-surgical treatment based on irrigation with silver nitrate 1% solution. Methods: This is a prospective study including patients with persistent anal fistula after surgery, who were treated with silver nitrate 1% solution irrigation from May 2015 to March 2017. Patients with evidence of abscess, presence of >1 external opening and those with bowel inflammatory disease were excluded. 3-5 cc of silver nitrate 1% solution were instilled through a catheter. The procedure was repeated on a weekly basis, conducting a maximum of 7 sessions per patient. Results: 18 patients (13 male, 72.2%) with a median age of 48 years old (IQR 41-55) were treated using silver nitrate 1% solution. A median of 5 sessions per patient was performed (IQR 3-6). The median follow-up period was 18 months (IQR 9-25). After the described period 8 patients' (44.4%) presented complete resolution of the fistula, 2 patients' (11.2%) were classified as partial healing and in 8 patients' (44.4%) the treatment was considered to fail. 6 patients' experienced self-limited pain during instillation, with persistence up to 24 h in 2 of them. Conclusions: Treatment with silver nitrate 1% solution is a minimally invasive procedure, with a favourable safety profile, that can be performed in an outpatients' basis achieving a complete healing rate of 44.4%. Therefore, this method should be considered for the treatment of recurrent or persistent anal fistula.


RESUMO Objetivo: O tratamento da fístula anal persistente é um grande desafio para os cirurgiões, com risco de recorrência adicional e potencial comprometimento da continência. Os autores apresentam um tratamento não cirúrgico baseado na irrigação com solução de nitrato de prata a 1%. Métodos: Este foi um estudo prospectivo incluindo pacientes com fístula anal persistente após a cirurgia que foram tratados com irrigação com solução de nitrato de prata a 1% entre maio de 2015 e março de 2017. Pacientes com evidência de abscesso, presença de mais de uma abertura externa e aqueles com doença inflamatória intestinal foram excluídos. Usando um cateter, instilou-se 3 a 5 cc. de solução de nitrato de prata a 1%. O procedimento foi repetido semanalmente, em um máximo de sete sessões por paciente. Resultados: Um total de 18 pacientes (13 homens, 72,2%) com idade mediana de 48 anos (IQR 41-55) foram tratados com solução de nitrato de prata a 1%. Uma mediana de cinco sessões por paciente foi realizada (IQR 3-6). A mediana do período de acompanhamento foi de 18 meses (IQR 9-25). Após o período descrito, oito pacientes (44,4%) apresentaram resolução completa da fístula, dois pacientes (11,2%) foram classificados como cicatrização parcial e em oito pacientes (44,4%) o tratamento falhou. Seis pacientes apresentaram dor autolimitada durante a instilação, que persistiu por até 24 horas em dois deles. Conclusões: O tratamento com solução de nitrato de prata a 1% é um procedimento minimamente invasivo, com perfil de segurança favorável, que pode ser realizado em regime ambulatorial, atingindo taxa de cura completa de 44,4%. Portanto, este método deve ser considerado para o tratamento da fístula anal recorrente ou persistente.


Assuntos
Humanos , Masculino , Feminino , Nitrato de Prata/uso terapêutico , Fístula Retal/tratamento farmacológico , Irrigação Terapêutica , Anti-Infecciosos Locais/uso terapêutico
9.
Rev. chil. cir ; 71(1): 29-34, feb. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-985375

RESUMO

Resumen Introducción: La gastrectomía vertical (GV) y el by-pass gástrico (BPG) son los procedimientos más utilizados en el tratamiento de la obesidad. El objetivo de este trabajo es comparar ambas técnicas tanto en pérdida ponderal como en mejoría de las comorbilidades asociadas. Materiales y Método: Estudio observacional ambispectivo de los pacientes sometidos a BPG y GV desde enero de 2011 hasta diciembre de 2013. Se ha analizado la pérdida de peso y de IMC, la tasa de éxito, la reganancia de peso, el impacto en las comorbilidades asociadas y la morbimortalidad de ambas técnicas. Resultados: 172 pacientes fueron intervenidos (92 BPG y 80 GV). El BPG presenta mejores resultados en cuanto a pérdida de peso y mejoría de las comorbilidades. El grupo GV presenta mayor reganancia de peso. Ambos procedimientos presentan resultados similares en cuanto a morbimortalidad.


Introduction: Sleeve gastrectomy (SG) and gastric bypass (GBP) are the most commonly used procedures in the treatment of obesity. The objective of this paper is to compare these two techniques in regard to weight loss and improvement of the associated comorbidities. Material and Method: An ambispective observational study of patients undergoing GBP and SG from January 2011 to December 2013. Weight loss, BMI, success rate, weight regain, impact on associated comorbidities and morbimortality of both techniques were analysed. Results: 172 patients underwent operations (92 GBP and 80 SG). GBP had better results in regard to weight loss and improvement of comorbidities. The SG group had greater weight regain. The two procedures had similar results in regard to morbimortality.


Assuntos
Humanos , Masculino , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Derivação Gástrica/mortalidade , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/mortalidade , Obesidade Mórbida/cirurgia , Anastomose em-Y de Roux/métodos , Perda de Peso , Resultado do Tratamento , Assistência Perioperatória
10.
World J Gastroenterol ; 24(45): 5144-5153, 2018 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-30568391

RESUMO

AIM: To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS: Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint. RESULTS: Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS. CONCLUSION: PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.


Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Exenteração Pélvica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Período Perioperatório , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Qualidade de Vida , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
12.
Cir Esp ; 96(4): 226-233, 2018 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29606350

RESUMO

INTRODUCTION: Currently, there is growing interest in analyzing the results from surgical units and the implementation of quality standards in order to identify good healthcare practices. Due to this fact, the Spanish Association of Coloproctology (AECP) has developed a unit accreditation program that contemplates basic standards. The aim of this article is to evaluate and analyze the specific quality indicators for the surgical treatment of colorectal cancer, established by the program. Data were collected from colorectal units during the accreditation process. METHODS: We analyzed prospectively collected data from elective colorectal surgeries at 18 Spanish coloproctology units during the period 2013-2017. Three main and four secondary quality indicators were considered. Colon and rectal surgeries were analyzed independently; furthermore, results were compared according to surgical approach. RESULTS: A total of 3090 patients were included in the analysis. The global anastomotic leak rate was 7.8% (6.6% colon vs 10.6% rectum), while the surgical site infection rate was 12.6% (11.4% colon vs 14.8% rectum). Overall 30-day mortality was 2.3%, and anastomotic leak-related mortality was 10.2%. There were higher surgical site infection and mortality rates in the patients operated by open approach, however there was no difference in the anastomotic leak rate when compared with minimally invasive approaches. CONCLUSIONS: The evaluation of these results has determined optimal quality indices for the units accredited in the treatment of colorectal cancer. Furthermore, it allows us to establish realistic references in our country, thereby providing a better understanding and comparison of outcomes.


Assuntos
Neoplasias Colorretais/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Acreditação , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/normas , Feminino , Unidades Hospitalares , Humanos , Masculino , Estudos Prospectivos , Espanha
13.
Cir. Esp. (Ed. impr.) ; 96(4): 226-233, abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173188

RESUMO

INTRODUCCIÓN: Actualmente existe un creciente interés por analizar los resultados de salud en las unidades quirúrgicas, implementando estándares de calidad que permitan dilucidar buenas prácticas asistenciales. Con este motivo la Asociación Española de Coloproctología desarrolló un programa de acreditación de unidades, teniendo en cuenta unos estándares básicos. El objetivo de este artículo es evaluar y analizar los indicadores de calidad específicos del tratamiento quirúrgico del cáncer colorrectal establecidos en el programa, en varias unidades en proceso de acreditación. MÉTODOS: Se analizaron los datos recogidos de forma prospectiva de la cirugía programada colorrectal en 18 unidades de coloproctología durante los años 2013 a 2017. Se consideraron 3 indicadores de calidad principales y 4 secundarios, analizando de forma independiente la cirugía de colon y de recto. Además se compararon los resultados según el abordaje quirúrgico. RESULTADOS: Se incluyeron para el análisis un total de 3.090 pacientes. La tasa global de fuga anastomótica fue de 7,8% (6,6% colon vs 10,6% en el recto), mientras que la de infección de herida quirúrgica fue de 12,6% (11,4% colon vs 14,8% en el recto). La mortalidad global a los 30 días fue de un 2,3%, siendo la relacionada con fuga anastomótica de un 10,2%. Se evidenció una mayor incidencia de infecciones y muertes en los pacientes con abordaje abierto, pero no hubo diferencias en la tasa de dehiscencia con respecto a abordajes mínimamente invasivos. CONCLUSIONES: Los resultados de este estudio determinan índices de calidad óptimos de las unidades acreditadas en el tratamiento del cáncer colorrectal, y además nos permite establecer referencias realistas en nuestro país, que ayudarán a una mejor comparación de resultados


INTRODUCTION: Currently, there is growing interest in analyzing the results from surgical units and the implementation of quality standards in order to identify good healthcare practices. Due to this fact, the Spanish Association of Coloproctology (AECP) has developed a unit accreditation program that contemplates basic standards. The aim of this article is to evaluate and analyze the specific quality indicators for the surgical treatment of colorectal cancer, established by the program. Data were collected from colorectal units during the accreditation process. METHODS: We analyzed prospectively collected data from elective colorectal surgeries at 18 Spanish coloproctology units during the period 2013-2017. Three main and four secondary quality indicators were considered. Colon and rectal surgeries were analyzed independently; furthermore, results were compared according to surgical approach. RESULTS: A total of 3090 patients were included in the analysis. The global anastomotic leak rate was 7.8% (6.6% colon vs 10.6% rectum), while the surgical site infection rate was 12.6% (11.4% colon vs 14.8% rectum). Overall 30-day mortality was 2.3%, and anastomotic leak-related mortality was 10.2%. There were higher surgical site infection and mortality rates in the patients operated by open approach, however there was no difference in the anastomotic leak rate when compared with minimally invasive approaches. CONCLUSIONS: The evaluation of these results has determined optimal quality indices for the units accredited in the treatment of colorectal cancer. Furthermore, it allows us to establish realistic references in our country, thereby providing a better understanding and comparison of outcomes


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Infecções/epidemiologia , Sociedades/organização & administração , Estudos Prospectivos , Cirurgia Colorretal/métodos , Cirurgia Colorretal/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Neoplasias do Colo/cirurgia
15.
Cir. Esp. (Ed. impr.) ; 95(10): 577-587, dic. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-169988

RESUMO

Introducción: El objetivo de este estudio observacional, prospectivo, multicéntrico y multinivel ha sido evaluar los resultados oncológicos (recidiva local, metástasis y supervivencia global) del Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos (AEC) 10 años después de su inicio, comparando los resultados con los registros escandinavos. Métodos: La base de datos del proyecto docente de la AEC incluye hasta la fecha a 17.620 pacientes, de los cuales 4.508 fueron operados con una resección potencialmente curativa entre marzo de 2006 y diciembre de 2010. Todos ellos son provenientes de los primeros 59 hospitales incluidos en el proyecto, y por tanto seguidos al menos durante 5 años, y constituyen el objeto del presente estudio. Resultados: La incidencia acumulada de recidiva local fue 7,3 (IC 95%: 8,2-6,5), la de metástasis fue 21,0 (IC 95%: 22,4-19,7) y la de supervivencia global, 72,3 (IC 95%: 80,3-77,6). El análisis de regresión multinivel, con la variable hospital como un efecto aleatorio, mostró una variación significativa entre los hospitales para las variables de resultado oncológico: supervivencia general, recidiva local y metástasis (Delta2=0,053). Conclusiones: Este estudio indica que los resultados observados en el Proyecto del Cáncer de Recto de la AEC son inferiores a los observados en los registros de Escandinavia a los que tratamos de emular y que ello es atribuible a la variabilidad de la práctica en algunos centros (AU)


Introduction: The objective of this observational, prospective, multicenter and multilevel study was to evaluate the oncological outcomes (local recurrence, metastasis and overall survival) of the Rectal Cancer Project of the Spanish Association of Surgeons (AEC) 10 years after its initiation, comparing the results with Scandinavian registries. Methods: The AEC teaching project database includes 17,620 patients to date, of which 4,508 were operated on with a potentially curative resection between March 2006 and December 2010. All of them come from the first 59 hospitals included in the project, and therefore followed for at least 5 years, and are the subject of the present study. Results: The cumulative incidence of local recurrence was 7.3 (95% CI: 8.2-6.5), metastasis 21.0 (CI 95%: 22.4-19.7) and overall survival 72.3 (CI 95%: 80.3-77.6). The multilevel regression analysis with the hospital variable as a random effect, showed a significant variation among the hospitals for the cancer outcome variables: general survival, local recurrence and metastasis (Delta2=0.053). Conclusions: This study indicates that the results observed in the AEC’ Rectal Cancer Project are inferior than those observed in the Scandinavian registries that we tried to emulate and that this is attributable to the variability of practice in some centers (AU)


Assuntos
Humanos , Neoplasias Retais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Metástase Neoplásica/terapia , Neoplasias Retais/epidemiologia , Estudos Prospectivos , Resultado do Tratamento , Análise de Sobrevida
16.
J Clin Imaging Sci ; 7: 40, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29142782

RESUMO

Arteriovenous malformations (AVM) of the inferior mesenteric artery are rare. They may be primary (congenital or idiopathic) or secondary (acquired) after trauma or of iatrogenic origin. Of the abdominal AVM, the inferior mesenteric trunk is the least commonly involved. Most reported cases are of iatrogenic origin, resulting from colon surgery. Only 17 cases have been described and published in the literature. The objective of this work is to make known a case treated in our center. We present a case of 73-year old male, who came to the emergency service with symptoms of abdominal distension, pain lasting 48 hours along with months of diarrhoea. CT scan and an abdominal CT angiography showed a massive left-sided congestive colitis due to idiopathic inferior mesenteric arteriovenous malformation. In our case, the decision was to carry out the treatment in two stages. Embolisation was performed in the first stage in order to decrease the blood flow and the risk of intraoperative bleeding, followed by resective surgery of the affected colon.

17.
Cir Esp ; 95(10): 577-587, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29037748

RESUMO

INTRODUCTION: The objective of this observational, prospective, multicenter and multilevel study was to evaluate the oncological outcomes (local recurrence, metastasis and overall survival) of the Rectal Cancer Project of the Spanish Association of Surgeons (AEC) 10 years after its initiation, comparing the results with Scandinavian registries. METHODS: The AEC teaching project database includes 17,620 patients to date, of which 4,508 were operated on with a potentially curative resection between March 2006 and December 2010. All of them come from the first 59 hospitals included in the project, and therefore followed for at least 5 years, and are the subject of the present study. RESULTS: The cumulative incidence of local recurrence was 7.3 (95% CI: 8.2-6.5), metastasis 21.0 (CI 95%: 22.4-19.7) and overall survival 72.3 (CI 95%: 80.3-77.6). The multilevel regression analysis with the hospital variable as a random effect, showed a significant variation among the hospitals for the cancer outcome variables: general survival, local recurrence and metastasis (δ2=0.053). CONCLUSIONS: This study indicates that the results observed in the AEC' Rectal Cancer Project are inferior than those observed in the Scandinavian registries that we tried to emulate and that this is attributable to the variability of practice in some centers.


Assuntos
Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Estudos Prospectivos , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Sistema de Registros , Países Escandinavos e Nórdicos , Espanha , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
18.
Cir. Esp. (Ed. impr.) ; 94(9): 531-536, nov. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-157304

RESUMO

OBJETIVO: Los objetivos del trabajo fueron determinar los factores asociados a una estancia postoperatoria (EP) prolongada en pacientes con resección intestinal por enfermedad de Crohn (EC) con un protocolo de rehabilitación multimodal (RM). MÉTODOS: Se incluyó a los pacientes intervenidos entre enero de 2013 y diciembre de 2015 por EC. Para la RM se siguió un protocolo de 8 puntos. Las variables estudiadas fueron: edad, sexo, EP, ASA, localización y patrón de la EC, presencia de enfermedad perianal, índice de Harvey-Bradshaw, resección previa, tipo de cirugía actual (mínimamente invasiva vs. laparotomía) y Clavien-Dindo. Se realizó un estudio inferencial para identificar los factores asociados a una EP > de 6 días y un modelo logístico multivariante. RESULTADOS: Se intervino a 52 pacientes. La EP mediana fue de 8 días (RI: 5-11). En el análisis univariante, la localización (L1 vs. L2-3), el patrón (B2 vs. B3), la existencia de enfermedad perianal, la cirugía previa, el tipo de cirugía realizada, el Harvey-Bradshaw y el grado de Clavien-Dindo se asociaron todos ellos con una EP inferior o superior a 6 días. El modelo parsimonioso que mejor ajusta para predecir una EP >6 días es el que contiene la variable Harvey-Bradshaw (OR: 6,49; IC 95%: 1,46-28,8) y el tipo de cirugía efectuado (OR: 0,23; IC 95%: 0,05-0,95). CONCLUSIONES: La estancia prolongada tras cirugía resectiva por EC se relaciona más con el tipo o gravedad de la enfermedad y de cirugía realizada que con otras características del paciente. Los pacientes con EC requieren una buena coordinación entre prehabilitación, RM y transferencia de cuidados postoperatorios


OBJECTIVE: The aim of this study was to determine factors associated with a prolonged postoperative stay (PS) in patients operated on with bowel resection for Crohn's disease (CD) included in an enhanced recovery program (ERP). METHODS: We included patients operated on for CD between January 2013 and December 2015. ERP was organized following an 8-point protocol. Variables studied were: age, sex, PS, ASA, location and type of CD, presence of perianal disease, Harvey-Bradshaw index, previous resection, type of surgery (minimally invasive vs. laparotomy) and Clavien Dindo. An inferential study was performed to identify factors related with a PS > 6 days and multivariate analysis. RESULTS: A total of 52 patients were operated on. The median PS was 8 days (IR: 5-11). In the univariate analysis, location (L1 vs. L2-3), type (B2 vs. B3), presence of perianal disease, prior surgery, type of surgery performed, Harvey-Bradshaw index and Clavien-Dindo were associated with a PS > or< than 6 days. The model that best adjusts to predict a PS > 6 days contained the variable Harvey-Bradshaw (OR: 6,49; 95% CI: 1,46-28,8) and the type of surgery (OR: 0,23; 95%CI: 0,05-0,95). CONCLUSION: A prolonged postoperative stay after bowel resection for CD is more related to the type or severity of the disease and the type of surgery performed, than with other patient factors. Patients with CD need good coordination between prehabilitation, ERP and postoperative management


Assuntos
Humanos , Doença de Crohn/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Terapia Combinada/métodos , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Distribuição por Idade e Sexo , Estudos Retrospectivos
19.
Cir Esp ; 94(9): 531-536, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27771094

RESUMO

OBJECTIVE: The aim of this study was to determine factors associated with a prolonged postoperative stay (PS) in patients operated on with bowel resection for Crohn's disease (CD) included in an enhanced recovery program (ERP). METHODS: We included patients operated on for CD between January 2013 and December 2015. ERP was organized following an 8-point protocol. Variables studied were: age, sex, PS, ASA, location and type of CD, presence of perianal disease, Harvey-Bradshaw index, previous resection, type of surgery (minimally invasive vs. laparotomy) and Clavien Dindo. An inferential study was performed to identify factors related with a PS> 6 days and multivariate analysis. RESULTS: A total of 52 patients were operated on. The median PS was 8 days (IR: 5-11). In the univariate analysis, location (L1 vs. L2-3), type (B2 vs. B3), presence of perianal disease, prior surgery, type of surgery performed, Harvey-Bradshaw index and Clavien-Dindo were associated with a PS>or< than 6 days. The model that best adjusts to predict a PS> 6days contained the variable Harvey-Bradshaw (OR: 6,49; 95% CI: 1,46-28,8) and the type of surgery (OR: 0,23; 95%CI: 0,05-0,95). CONCLUSION: A prolonged postoperative stay after bowel resection for CD is more related to the type or severity of the disease and the type of surgery performed, than with other patient factors. Patients with CD need good coordination between prehabilitation, ERP and postoperative management.


Assuntos
Doença de Crohn/cirurgia , Tempo de Internação/estatística & dados numéricos , Adulto , Doença de Crohn/reabilitação , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
20.
Cir. Esp. (Ed. impr.) ; 94(3): 137-143, mar. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-150083

RESUMO

INTRODUCCIÓN: Recientemente se ha validado una escala internacional de puntuación (LARS) que cuantifica el síndrome de resección anterior (SRA). El objetivo de este estudio es conocer la incidencia y gravedad del SRA utilizando el LARS y su relación con variables seleccionadas. MÉTODOS: A todos los pacientes con resección anterior por cáncer de recto operados entre octubre de 2007 y febrero de 2014, con intención curativa y con más de un año de funcionalidad, se les envió el cuestionario LARS. Las variables estudiadas fueron: edad, sexo, tiempo transcurrido desde la cirugía, tipo de resección, vía quirúrgica, tipo de anastomosis, realización de estoma derivativo, complicación postoperatoria y régimen de radioterapia. RESULTADOS: De 195 pacientes, 136 (70%) respondieron (132 adecuadamente). El 47% de los pacientes presentaba un LARS mayor y el 34% no desarrolló SRA cuantificable. Se relacionó un LARS mayor con peor calidad de vida (p = 0,002). En el análisis univariante, la escisión mesorrectal total (ETM), la radioterapia larga y el estoma derivativo se asociaron a un LARS mayor, y la utilización de un reservorio, a uno menor. En el análisis multivariante solo el tipo de resección (p < 0,001) y la utilización de reservorio (p = 0,002) fueron factores individuales relacionados con el LARS. CONCLUSIONES: La mitad de los pacientes operados presentaron un LARS mayor y solo un tercio no presentó un SRA cuantificable. La percepción global de la calidad de vida fue significativamente peor en los pacientes con LARS mayor. La ausencia de recto (ETM) y la forma de reconstrucción anastomótica fueron los principales factores asociados a la puntuación LARS


INTRODUCTION: Recently a score (LARS) has been internationally validates that quantifies the anterior resection syndrome (ARS). The objective of this study is to know the incidence and severity of the ARS using LARS and its correlation with selected variables or risk factors. METHODS: All operated patients with anterior resection for rectal cancer between October 2007 and February 2014, with curative intention and at least one year of functionality, were sent a LARS questionnaire. The variables studied were: Age sex, time elapsed since surgery, type of surgical approach, type of anastomosis, derivative ileostomy, postoperative pelvic complication, and radiotherapy regimen. RESULTS: Out of 195 patients, 136 (70%) responded, and 132 responded properly. A total of 47% of the patients presented «severe» LARS and 34% did not develop quantifiable ARS. Quality of life was worse in the highest LARS scores (P=.002). In the univariate analysis, total mesorectal excision, long radiotherapy regimen and derivative stoma were associated to «severe» LARS and the use of a reservoir was associated with minor LARS. In multivariate analysis only the type of resection (P<.001) and the use of a reservoir (P=.002) were individual factors related to LARS. CONCLUSIONS: Half of the operated patients presented high LARS score and only a third did not provide a quantifiable ARS. The overall perception of quality of life was significantly worse in patients with more severe LARS. The absence of the rectum (total mesorectal excision) and the type of anastomosis were the main factors associated with the LARS score


Assuntos
Humanos , Masculino , Feminino , Neoplasias Retais/epidemiologia , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos , Complicações Pós-Operatórias/epidemiologia , Reto/patologia , Reto/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/normas , Procedimentos Cirúrgicos Reconstrutivos/tendências , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/normas , Avaliação de Resultado de Intervenções Terapêuticas/tendências
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