Calidad asistencial y seguimiento de los pacientes operados por cáncer colorrectal en un Hospital de Paysandú, Uruguay / Quality of care and follow-up of patients operated on forcolorectal cancer at the Paysandú Hospital, Uruguay

Introducción: el cáncer colorrectal (CCR) es la segunda causa de muerte dentro de las enfermedades neoplásicas. El pronóstico individual está signado por el estadio de la enfermedad al momento del diagnóstico y la posibilidad de realizar un tratamiento curativo. Este también depende de la estratificación post quirúrgica y de la aparición de complicaciones ulteriores. El objetivo del seguimiento es diagnosticar la recidiva en un estadio potencialmente curable y detectar otros cánceres primarios. Objetivo: realizar una valoración de la calidad de la cirugía colorrectal y el seguimiento de los pacientes operados de CCR en nuestro hospital. Diseño: estudio descriptivo, observacional, retrospectivo. Material y métodos: se analizaron todos los pacientes con CCR operados en el servicio de cirugía del Hospital de Paysandú entre enero de 2017 y diciembre de 2020. Se describen diversas variables que influyen en la calidad quirúrgica y se analizan las relacionadas al seguimiento post operatorio dividiendo a los pacientes en 3 grupos, seguimiento completo, perdidos y sin datos de seguimiento. Resultados: se incluyeron 39 pacientes, con una edad media de 68 años. El 28% se diagnosticaron en estadio IV, con porcentajes bajos en estadios tempranos. Hubo 57% de cirugías de urgencia y 43% electivas. La causa más frecuente de urgencia fue la oclusión intestinal (36,6%). La tasa de dehiscencia anastomótica fue 16,6% y la de mortalidad 15,3%. Solo el 33% de los pacientes tuvieron seguimiento completo. Conclusión: existe un déficit en la atención y el seguimiento de los pacientes operados por CCR en nuestro hospital. Se impone la creación de un equipo específico en el área de coloproctología, así como un protocolo de seguimiento unificado para mejorar estos resultados. (AU)

Introduction: colorectal cancer (CRC) is the second cause of death among neoplastic diseases. The individual prognosis is determined by the stage of the disease at the time of diagnosis and the possibility of curative treatment. This also depends on the postsurgical stratification and the appearance of subsequent complications. The goal of follow-up is to diagnose recurrence at a potentially curable stage and detect other primary cancers. Objective: to carry out an evaluation of the quality of colorectal surgery and the follow-up of patients operated on for CRC in our hospital. Design: descriptive, retrospective observational study. Material and methods: all patients with CRC operated on in the surgery service of the Paysandú Hospital between January 2017 and December 2020 were analyzed. Variables that influence surgical quality are described and those related to postoperative follow-up are analyzed by dividing patients in 3 groups, complete follow-up, lost to follow-up and without follow-up data. Results: Thirty-nine patients were included, with a mean age of 68 years. Twenty-eight percent were diagnosed in stage IV, with low percentages in early stages. There were 57% emergency procedures and 43% elective proceduress. The most common cause of emergency was intestinal obstruction (36.6%). The anastomotic dehiscence rate was 16.6% and the mortality rate was 15.3%. Only 33% of patients had complete follow-up. Conclusion: there is a deficit in the care and follow-up of patients undergoing CRC surgery in our hospital. The creation of a specific team in the area of coloproctology is required, as well as a unified monitoring protocol to improve these results. (AU)

Surgical roles in the management of metachronus para-aortic lymph node recurrence and synchronous para-aortic lymph node metastasis in colorectal cancer patients

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)

Impact of the Covid-19 pandemic on colorectal cancer surgery in Madrid

Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)

Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings / Trinta anos do serviço de atenção à saúde da pessoa ostomizada de Juiz de Fora e região

ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

RESUMO Objetivo: elaborar o perfil epidemiológico dos pacientes estomizados atendidos no Serviço de Atenção à Saúde da Pessoa Ostomizada de Juiz de Fora e região (SASPO/JF) e quantificar tanto as patologias que levaram à confecção, quanto as complicações presentes nas estomias. Método: realizado estudo retrospectivo com análise de 496 prontuários de pacientes cadastrados no SASPO/JF ao longo de 30 anos e que permaneciam em atendimento no serviço em junho de 2018. Foram consideradas as seguintes variáveis: idade, sexo, patologia que levou à confecção do estoma, tipo, caráter temporal, localização e complicações das estomias. Resultados: 53,43% dos pacientes eram do sexo masculino e 46,57% do sexo feminino. A média de idade entre os homens foi de 56,24 anos e entre as mulheres foi de 58,40 anos. Oito pacientes apresentaram dois tipos de estomias simultaneamente e o total de 504 estomias foi distribuído da seguinte forma: 340 colostomias (67,46%), 117 ileostomias (23,21%) e 47 urostomias (9,33%). Além disso, 47,65% das colostomias e 76,92% das ileostomias foram temporárias, enquanto todas as urostomias foram permanentes. Em 70,24% dos casos, o motivo para confecção do estoma foi a neoplasia maligna. Foram encontrados 277 estomas com uma ou mais complicações (54,96%). Conclusão: as estomias predominaram em pacientes com mais de 50 anos e o principal diagnóstico que levou à confecção dos estomas foi a neoplasia maligna. As ileostomias apresentaram maior percentual de complicações do que as colostomias e urostomias e, para todos os tipos de estomas, a complicação mais frequente foi a dermatite.

Falla de sutura en cirugía colorrectal. Factores de riesgo y manejo terapéutico / Anastomotic failure in colorectal surgery. Risk factors and therapeutic management

Introducción: La dehiscencia anastomótica (DA) es una complicación de la cirugía colorrectal que determina alta morbimortalidad y peor pronóstico oncológico. El objetivo de este estudio es analizar su relación con factores de riesgo y describir su manejo terapéutico. Métodos: Estudio retrospectivo, observacional y analítico. Se incluyeron resecciones colorrectales de coordinación por patología neoplásica maligna con anastomosis primaria, entre enero de 2015 y noviembre de 2018. Resultados: Ciento doce pacientes cumplieron con los criterios de inclusión. La tasa de DA fue 17% y la mortalidad 15%. El tamaño tumoral se asoció de forma estadísticamente significativa con un mayor riesgo de falla de sutura. Discusión: Nuestros resultados son similares a los reportados en la literatura, destacándose una alta proporción de DA tempranas y por lo tanto de reintervención y detransitación. Conclusiones: El manejo de la DA es un reto terapéutico y debe ajustarse a muchos parámetros, siendo uno de los más importantes la experiencia del cirujano. (AU)

Introduction: Anastomotic dehiscence (AD) is a complication of colorectal surgery that determines high morbidity and mortality and a worse oncological prognosis. The objective of this study is to analyze its relationship with risk factors and describe its therapeutic management. Material and Methods: Retrospective, observational and analytical study. Colorectal resections with primary anastomosis for malignant neoplastic pathology performed between January 2015 and November 2018 were included. Results: One hundred and twelve patients met the inclusion criteria. The AD rate was 17% and mortality 15%. Tumor size was statistically significantly associated with an increased risk of AF. Discussion: Our results are similar to those reported in the literature, highlighting a high proportion of early AD and therefore of re-intervention and intestinal diversion. Conclusions: The management of AD is a therapeutic challenge, and must be adjusted to many parameters, one of the most important being the surgeon's experience. (AU)

Resultados de la aplicación del Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en el tratamiento quirúrgico del cáncer colorrectal en el Hospital Nacional Edgardo Rebagliati - EsSalud / Results of the application of the Protocol for Improved Recovery in Surgery (PREMEC) in the surgical treatment of colorectal cancer at the Edgardo Rebagliati National Hospital - EsSalud

RESUMEN Introducción: La mejora en la atención de salud se ha visto reflejada en la obtención de mejores resultados de los indicadores de calidad. Desde hace mucho tiempo diversos programas buscan disminuir las complicaciones y la estancia postoperatoria. En el servicio de cirugía colorrectal se ha implementado un programa denominado Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en pacientes con diagnóstico de cáncer colorrectal. Objetivo: El objetivo del presente estudio fue presentar los resultados con la implementación del PREMEC. Materiales y método: Estudio observacional de dos cohortes. Se estudiaron 516 pacientes. Una es la cohorte histórica (antes del protocolo) conformada por pacientes operados con cirugía resectiva de colon y recto mediante abordaje abierto entre enero del 2017 y noviembre del 2018. La otra cohorte prospectiva estuvo conformadas por pacientes que fueron manejados de acuerdo al PREMEC desde diciembre del 2018 hasta marzo del 2020. Esta cohorte se dividió en dos grupos según el abordaje quirúrgico, abierto y laparoscópico. Se compararon los grupos entre sí, teniendo en cuenta las variables de estancia postoperatoria, complicaciones, mortalidad, reoperaciones y readmisiones. Resultados: Los grupos fueron similares en edad, sexo, estadio del cáncer y cirugía realizada. La estancia hospitalaria en el grupo antes del protocolo fue 13,86 (DS 7,86) días, en el grupo PREMEC abordaje abierto fue 10,62 (DS 5,4) días y el grupo PREMEC abordaje laparoscópico de 6,86 (DS 2,7) días. A nivel de las complicaciones en el grupo PREMEC se demostró la disminución de las fugas anastomóticas, Infecciones de Sitio Operatorio (IS0) e íleo postoperatorio. No se encontró diferencias en la mortalidad, reoperaciones y readmisiones. Conclusión: La implementación del PREMEC logró disminuir la estancia postoperatoria, las fugas anastomóticas, ISO e íleo postoperatorio, sin incremento de la mortalidad, reoperaciones y readmisiones.

ABSTRACT Introduction: Improvement in health care is reflected in achieving better results in quality indicators. For quite some time several programs have pursued a reduction of complications and length of stay. A program called Protocol for Improved Recovery in Surgery (PREMEC) has been implemeted at the colorectal surgery service. Objective: The objective of this study is to show results of the implementation of PREMEC. Materials and methods: This is an observational study of two cohorts, 516 patients were included. One is a historic cohort (before the protocol) comprised by patients who underwent resective colonic and rectal surgery through an open approach from January 2017 to November 2018. The other prospective cohort includes patients treated under the PREMEC program from December 2018 through to March 2020. This cohort was divided into two groups according to the surgical approach, open and laparoscopic. All groups were compared regarding postoperative length of stay, complications, mortality and readmissions. Results: Groups were similar in age, sex, cancer staging and type of surgery. Length of stay was 13.86 days (SD 7.86 days) for the pre-PREMEC group, 10.62 days (SD 5.4 days) for the PREMEC open group and 6.86 days (SD 2.7 days) for the PREMEC laparoscopic group. As for complications the PREMEC group showed a decrease in anastomotic leaks, Surgical Site Infection (SSI) and postoperative ileus. No differences were found regarding mortality, reoperations and readmissions. Conclusion: Implementation of the PREMEC program attained a decrease in length of stay, anastomotic leaks, SSI and postoperative ileus with no increase in mortality, reoperations or readmissions.

Cirugía robótica colorectal, en un hospital de comunidad cerrada: experiencia inicial leído en sesión SACP, 11 de octubre de 2019 / Colorectal robotic surgery in a closed community hospital: initial experience read in SACP session, october 11, 2019

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.

Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.

Resultados de un programa de recuperación mejorada (PRM) en cirugía colorrectal: efectos en la estadía hospitalaria / Shortening of hospital length of stay after the implementation of an Enhanced Recovery Program for elective colorectal surgery

Resumen Introducción Los Programas de Recuperación Mejorada (PRM) en cirugía colorrectal disminuyen las complicaciones y acortan la estadía hospitalaria. La implementación de un PRM representa un desafío en nuestro sistema de salud público, dado la alta demanda y recursos limitados. Objetivo Evaluar el efecto en la estadía hospitalaria (EH) posterior a la implementación de un PRM en cirugía colorrectal electiva en un hospital público. Materiales y Método Estudio retrospectivo, que incluyó pacientes entre 15 y 85 años operados electivamente de resecciones colorrectales en un hospital público entre 1 de enero de 2015 y 31 de diciembre de 2016. Se compararon dos grupos: 1) total de pacientes operados electivamente 1 año posterior a la implementación del PRM (post-PRM) y 2) total de pacientes operados electivamente un año previo a la implementación de PRM (pre-PRM), en términos de EH, reingresos, complicaciones y mortalidad a 30 días. Se realizó análisis de tiempo a evento para comparar la EH entre ambos grupos. Resultados Un total de 144 pacientes fueron incluidos: 92 en el grupo post-PRM y 52 en el grupo pre-PRM. No hubo diferencias clínicas entre ambos grupos. La mediana de EH en el grupo post-PRM fue 2 días menor que en el grupo control (5 vs 7 días, test de log-rank, p = 0,03). No hubo diferencia en complicaciones, reingresos ni mortalidad. Conclusión La implementación de un PRM en cirugía colorrectal electiva en un hospital público se asocia a una disminución de la EH sin aumento de morbimortalidad.

Background Enhanced Recovery Programs (ERP) in colorectal surgery has proved to decrease complications and shorten hospital stay. The implementation of an ERP could be a difficult task in a high-demanding public health system with limited resources. Aim Evaluate the effect on length of stay (LOS) after the implantation of an ERP for colorectal surgery in a resource-limited public hospital. Materials and Method This retrospective study included patients aged 15-85 years who underwent elective colorectal surgery at a resource-limited public hospital in Chile between January 1, 2015 and December 31, 2016. We compared two groups: (1) total number of patients operated electively after 1-year of ERP implementation (post-ERP group) and (2) total number of patients electively operated 1-year previous ERP (pre-ERP group) in terms of LOS, readmissions, complications, and 30-day mortality. A time to event analysis was performed to evaluate differences in LOS. Results A total of 144 patients were included in this study: 92 in the post-ERP group and 52 in the pre-ERP group. There were no clinical differences between groups. The median LOS in the post-ERP group was 2 days lower than that in the control group (5 vs 7 days, log-rank test p = 0.03). There were no differences in complications, readmissions, and 30-day mortality. Conclusions The implementation of an ERP for colorectal surgery in a resource-limited hospital was associated with decreased LOS without increasing morbidity.

Morbidade e mortalidade no fechamento de estomas: revisão de 10 anos / Morbidity and mortality of stoma closure: a 10-year review

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)

Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)

Evaluación de factores de riesgo asociados a dehiscencia anastomótica en cirugía colorrectal: análisis multivariado de 748 pacientes / Evaluation of the risk factors associated with anastomotic dehiscence in colorectal surgery: multivariate analysis of 748 pacients

INTRODUCCIÓN: La dehiscencia anastomótica (DA) es una complicación severa en cirugía colorrectal con una incidencia que oscila entre 2 y 19%. La literatura internacional muestra numerosos estudios sobre la identificación de factores de riesgo (FR), mientras que en la nacional existen solo dos series que analizan esta complicación. OBJETIVO: Realizar una caracterización descriptiva de resultados institucionales y establecer la tasa de DA, sus factores de riesgo asociados y la mortalidad. MATERIALES Y MÉTODO: Serie de casos no concurrente, cuya muestra son pacientes consecutivos intervenidos de patología colorrectal con anastomosis primaria con o sin ostoma derivativo entre los años 2004 y 2016. Se realiza modelo de regresión logística univariable y multivariable. RESULTADOS: Se obtuvieron 748 pacientes, 50,5% mujeres, media de edad fue 56,2. Las indicaciones quirúrgicas más frecuentes fueron cáncer colorrectal en 381 (50,9%) pacientes y enfermedad diverticular en 163 (21,8%). La DA fue de 5,6% (42/748) y la mortalidad fue de 2% (15/748), siendo de 1% para los electivos (7/681). En el análisis univariado encontramos que los FR que tuvieron significancia estadística fueron la albúmina (p < 0,001), altura anastomosis (p < 0,001), transfusión (p < 0,001), localización (colon derecho > izquierdo) (p = 0,011), mientras que en el análisis multivariado fueron la albúmina (p = 0,002) con un OR 3,64 (IC 95% 1,58-8,35) y transfusión (p = 0,015) con un OR 7,15 (IC 95% 1,46-34,91). CONCLUSIÓN: Nuestra serie es la más grande reportada en Chile, con resultados similares a estudios internacionales y nacionales. Establecemos que la hipoalbuminemia y la presencia de transfusiones intraoperatorias se asocian a alta tasa de DA.

INTRODUCTION: Anastomotic leakage (AL) is a severe complication in colorectal surgery, its incidence ranges from 2 to 19%. In international literature, we found numerous studies on the identification of risk factors (RF), while in the national there are only two series that analyze this complication. AIM: Perform a descriptive characterization of institutional results and establish the AL rate, its associated risk factors and mortality. MATERIALS AND METHOD: Non-concurrent series of cases, whose sample is consecutive patients operated for colorectal pathology with primary anastomosis with or without a derivative ostoma between 2004 and 2016. Univariate and multivariable logistic regression model was performed. RESULTS: There were 748 patients, 50.5% women, mean age was 56.2. The most frequent surgical indications were colorectal cancer in 381 (50.9%) patients and diverticular disease in 163 (21.8%). The AL was 5.6% (42/748) and the mortality was 2% (15/748), being 1% for the electives (7/681). In the univariate analysis, we found that the RF that had statistical significance were albumin (p < 0.001), anastomosis height (p < 0.001), transfusion (p < 0.001), location (right colon > left) (p = 0.011), while that in the multivariate analysis were albumin (p = 0.002) with an OR 3.64 (IC 95% 1.58-8.35) and transfusion (p = 0.015) with an OR 7.15 (IC 95% 1.46-34.91). CONLUSION: Our series is the largest reported in Chile, with similar results to international and national studies. We establish that hypoalbuminemia and the presence of intraoperative transfusions are associated with a high rate of AL.

Outcomes of elderly patients undergoing emergency surgery for complicated colorectal cancer: a retrospective cohort study

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

Quality of life of persons with permanent colostomy: a phenomenological study / Qualidade de vida de pessoas com colostomia permanente: um estudo fenomenológico

ABSTRACT Objectives: To describe the experiences of persons with permanent colostomy regarding their quality of life. Methods: The study design used descriptive phenomenology following the approach of Collaizzi. There were 12 participants who qualified using purposive sampling based on the inclusion criteria.The data generated were in-depth interviews. Analysis and interpretation used verbatim descriptions. Results: The research data revealed seven themes, namely: limitation in daily living activities, limitations in marital relations and social relationship with others, negative feelings about having the colostomy, financial difficulties, increasing demands of living with colostomy, changes in the needs of rest, physical and expectation of complications, and hoping to live a normal life after colostomy. Conclusion: This study revealed that persons with permanent colostomy experience difficulties and limitations pertaining to daily living activities, including marital and social relations. Importantly, they experience psychological concerns, e.g. having negative feelings about ways of living their lives, including financial difficulties and adjusting to new ways of living. However, there is always the hope to live a normal life. This study provides an understanding of the quality of life of persons with permanent colostomy, allowing nurses to provide appropriate nursing care.

RESUMO Objetivos: Descrever as experiências de pessoas com colostomia permanente quanto à qualidade de vida. Métodos: O desenho do estudo utilizou a fenomenologia descritiva seguindo a abordagem de Collaizzi. Havia 12 participantes que se qualificaram usando amostragem intencional com base nos critérios de inclusão. Os dados gerados foram entrevistas detalhadas. A análise e a interpretação usaram descrições literais. Resultados: Os dados da pesquisa revelaram sete temas, a saber: limitação nas atividades da vida diária, limitações nas relações conjugais e relação social com os outros, sentimentos negativos sobre a colostomia, dificuldades financeiras, crescentes demandas de viver com colostomia, mudanças nas necessidades de repouso, físicas e expectativa de complicações, e esperança de viver uma vida normal após a colostomia. Conclusão: Este estudo revelou que pessoas com colostomia permanente apresentam dificuldades e limitações relativas às atividades da vida diária, incluindo relações conjugais e sociais. É importante destacar que têm preocupações psicológicas, p.ex., sentimentos negativos sobre formas de viver suas vidas, incluindo dificuldades financeiras e adaptação a novas formas de viver. No entanto, há sempre a esperança de viver uma vida normal. Este estudo fornece uma compreensão da qualidade de vida de pessoas com colostomia permanente, possibilitando aos enfermeiros fornecer cuidados de enfermagem apropriados.

Aplicabilidad del Colon Leakage Score como predictor de filtración anastomótica en cirugía de cáncer colorrectal / Applicability of the Colon Leakage Score as an anastomotic leakage predictor in colorectal cancer surgery

Introducción: La filtración anastomótica (FA) en cirugía colorrectal aumenta la morbimortalidad. La identificación de factores de riesgo y la creación de un modelo predictivo ayudaría en la decisión de crear un ostoma desfuncionalizante, hecho que, actualmente, recae en el criterio del cirujano. Dekker creó el Colon Leakage Score (CLS) estableciendo criterios objetivos. Objetivo: Establecer el CLS en pacientes intervenidos por cáncer de colon izquierdo y recto en Clínica INDISA, estableciendo valores de corte locales, su sensibilidad y especificidad. Pacientes y Método: Corresponde a un estudio de pruebas diagnósticas, cuya intervención es la aplicación del CLS comparándolo con la presencia de filtración anastomótica (gold standard), definida por criterios clínicos y radiológicos. Se utilizó análisis de curvas ROC, índice de Youden y regresión logística. Resultados: De 180 pacientes, hubo FA en 12 (6,6%). La media de CLS en quienes hubo FA fue de 11,5 y en quienes no hubo FA de 6,9 (p = 0,0001). El área bajo la curva para predicción de FA con el CLS fue de 0,829 (IC 95% 0,69-0,96), con un valor de corte de 11, sensibilidad de 67% y especificidad de 89%. En el análisis de regresión logística, el OR para la predicción de FA utilizando el CLS fue de 1,48 (IC 95% 1,22-1,79 p < 0,001). Conclusión: El CLS es una herramienta que permite predecir el riesgo de FA en pacientes intervenidos por cáncer de colon izquierdo y recto. Ante un valor mayor o igual a 11 se debería crear un ostoma protector, generando un cambio en la práctica clínica.

Introduction: Anastomotic filtration increases morbidity and mortality in colorrectal surgery. Identification of risk factors and creation of a predictive model would help the decision of creating a defunctionalizing ostoma, that currently is taken by the surgeon. Dekker created de Colon Leakege Score (CLS) with objective criteria. Objective: Establish CLS in patients that underwent left colon and rectum surgery with cancer diagnosis in Clinica INDISA, define the local cutting value, it's specificity and sensibility. Patients and Methods: Corresponds to a diagnostic test's study, that intervention is CLS application, comparing with the presence of anastomotic filtration (gold standard), defined by clinical and radiologic criteria. For the analysis, ROC curves, Youden's index and logistic regression. Results: From 180 patients, anastomotic filtration was present in 12 (6.6%). Average CLS score in patients with anastomotic filtration was 11.5 and in those without anastomotic filtration was 6.9 (p = 0.0001). Area under the curve for anastomotic filtration prediction using CLS was 0.829 (CI 95% 0.69-0.96) with a cutting value of 11, 67% of sensibility and 89% of specificity. Logistic regression analysis, OR for anastomotic filtration prediction using CLS was 1.48 (CI 95% 1.22-1.79 p < 0.001). Conclusion: CLS is a tool that permits predicting anastomotic filtration risk in patients that underwent left colon and rectum surgery. With a CLS value equal or more than 11, we should create a protective ostoma, generating a clinical practice local change.

Tumores neuroendocrinos primarios de colon y recto / Primary neuroendocrine tumors of the colon and rectum

Resumen Introducción La clasificación y el manejo de los tumores neuroendocrinos (TNEs) han cambiado drásticamente en la última década. Se realiza un análisis crítico del manejo de los TENs colorrectales primarios intervenidos en nuestro centro a la luz de la nueva clasificación. Material y Método Análisis retrospectivo de los resultados del tratamiento quirúrgico radical de este tipo de lesiones en un período de 15 años. Resultados Se trata de 10 pacientes, con un promedio de 56 años (extremos 48-76), 6 ubicados cercanos a la válvula ileocecal (VIC) que se presentaron con un cuadro de obstrucción intestinal incompleto y tres en el recto (2 pólipos) y un pólipo en colon sigmoides. La cirugía efectuada incluye cuatro resecciones anteriores y seis colectomías derechas (con resección de una metástasis hepática en 1 caso). La mediana de seguimiento fue de 78,3 meses (extremos 8-180), durante el cual dos pacientes fallecen por metástasis a distancia. Conclusión Los TNEs ubicados en el colon habitualmente se presentaron como grandes masas tumorales cercanos a la VIC, lo que proporcionalmente no ocurre con las lesiones del rectosigmoides que son diagnosticados más precozmente como pólipos o lesiones submucosas. Algunos tumores de bajo grado muestran un compromiso avanzado en la pared y/o los linfonodos regionales lo que justifica la resección radical y/o la quimioterapia adyuvante. A la luz de esta experiencia, es necesario complementar el grado del tumor OMS 2010 (Ki-67 y número de mitosis) con el estadio TNM para caracterizar adecuadamente los TNEs, lo que influye en el manejo multidisciplinario.

Background The nomenclature and staging classification of neuroendocrine tumors (NETs) has changed drastically in the past decade. Objective To do a critical analysis of management of colorectal NETs in our institution in the light of the new classification. Methods We retrospectively reviewed the records of consecutive patients operated on with radical intention due to a colorectal NET in the last 15 years. Results There were 10 patients, median age was 56 years (range 48-76), six of them located near the ileocecal valve, three in the rectum (2 of them polyps) and one polyp in the sigmoid colon. Surgical procedure included four anterior resections and six right colectomy (one with hepatic resection). The median follow up was 78.3 months (range 8-180). Two patients died due to metastatic disease. Conclusion NETs located near de ileocecal valve were diagnosed usually as a big tumor with obstructing symptoms, while NETs of the rectum and sigmoid colon more frequently were detected as polyps or submucosal lesions. Some low grade TENs may invade the colonic wall and/or have metastasis in the regional lymph nodes and those cases need radical resection and/or adjuvant therapy. Combine the grade (Ki-67 and number and/or number of mitosis) of 2010 WHO classification with TNM showed prognostic value for classification and staging colorectal NETs with important therapeutic implications.

Results of surgical treatment of colorectal cancer in nonagenarian patients / Resultados do tratamento cirúrgico do câncer colorretal em pacientes nonagenários

ABSTRACT Purpose: The objective of the present study was to compare the results of surgical treatment of nonagenarian patients having colorectal cancer with patients younger than 90 years. Methods: A total of 622 patients who underwent curative surgery were included in the present study. The database of the surgical service, in the period from 2007 to 2013, was used to obtain the sample. This is a descriptive, retrospective study that compared the profiles of 17 nonagenarian patients (Group I) with 605 patients younger than 90 years (Group II). The groups were compared regarding surgical complications, length of hospital stay, type of surgery performed and ASA classification. Results: The mean age between the groups was 92.2 years and 61.2 years. The mean length of hospital stay in Groups I and II was 17.3 days and 8.75 days, respectively. The surgery performed most frequently was the right colectomy, in both groups. The most common postoperative complication was sepsis (11.8%) among the nonagenarians, and paralytic ileus (4.5%) among those younger than 90 years. Laparoscopic surgery was performed on 5 out of a total of 17 patients evaluated in Group I. Among the three mortalities registered in this latter group, two were classified as ASA III and only one as ASA I. Conclusion: The results indicate that colorectal surgery may be performed in this group, with acceptable morbidity and mortality rates, in patients with low preoperative risk (ASA I/II).

RESUMO Finalidade: O objetivo do presente estudo foi comparar os resultados do tratamento cirúrgico de pacientes nonagenários portadores de câncer colorretal versus pacientes com menos de 90 anos. Métodos: O estudo envolveu 622 pacientes que foram submetidos à cirurgia curativa. Para obtenção da amostra, utilizamos o banco de dados do serviço de cirurgia, abrangendo o período de 2007-2013. Este é um estudo retrospectivo descritivo que comparou os perfis de 17 pacientes nonagenários (Grupo I) versus 605 pacientes com menos de 90 anos (Grupo II). Os grupos foram comparados para complicações cirúrgicas, duração da permanência no hospital, tipo de cirurgia realizada e classificação ASA. Resultados: A média de idade para os Grupos I e II foi, respectivamente, 92,2 e 61,2 anos. A duração média de permanência no hospital nos Grupos I e II foi, respectivamente, 17,3 dias e 8,75 dias. A cirurgia mais frequentemente realizada foi colectomia direita, nos dois grupos. A complicação pós-operatória mais comum foi sepse (11,8%) entre os nonagenários, e íleo paralítico (4.5%) entre os pacientes com menos de 90 anos. Cirurgia laparoscópica foi realizada em 5 pacientes, em um total de 17 pacientes avaliados no Grupo I. Considerando as três mortalidades registradas nesse último grupo, duas foram classificadas como ASA III e apenas uma como ASA I. Conclusão: Os resultados obtidos indicam que, nesse grupo, a cirurgia colorretal é opção válida, com percentuais aceitáveis de morbidade e mortalidade, em pacientes com baixo risco pré-operatório (ASA I/II).

Abordaje microquirúrgico transanal. Experiencia inicial. Indicaciones y resultados / Transanal microsurgical approach. Initial experience. Indications and results

Introducción: El tratamiento quirúrgico de las afecciones del recto bajo se encuentra en permanente revisión intentando mantener una adecuada función de continencia y urogenital. Una opción reciente es el abordaje microquirúrgico transanal. El objetivo del trabajo es evaluar una serie de pacientes tratados mediante dicho abordaje, analizando indicaciones, resultados inmediatos y alejados. Material y método: Se seleccionaron 41 pacientes operados en el período comprendido entre febrero de 2009 y febrero de 2015. Resultados: En 41 pacientes, las afecciones tratadas fueron: pólipos, 22; cáncer de recto, 14; estenosis de anastomosis, 2; absceso retrorrectal, 1; endometriosis, 1; poliposis adenomatosa familiar, 1. Los pacientes con pólipos llegaron a consulta: por primera vez, 15; recidivados, 4; segunda recidiva, 2; tercera recidiva, 1. Los procedimientos realizados fueron: resección local, 29; microcirugía transanal transabdominal (TATA), 6; dilatación de estenosis, 4; biopsia transrectal, 3; drenaje de absceso retrorrectal, 1; control de hemorragia, 1; colocación de stent, 1. En cáncer de recto: resección local, 7; biopsia transrectal, 2; TATA, 4; colocación de stent, 1. El tiempo operatorio promedio fue 48,6 minutos, y la estadía hospitalaria promedio 2,21 días. De los 29 pacientes en quienes se realizó resección local, fueron controlados 25 durante un período de 6 a 72 meses. Se complicaron 11 pacientes, sin mortalidad ni recidivas locales. Conclusiones: Este abordaje permite tratar lesiones del recto y último segmento del colon sigmoides. Otorga mejor visión permitiendo una disección más exacta, mejorando resultados postoperatorios inmediatos y alejados en patología benigna y maligna, minimizando la posibilidad de recidivas. (AU)

Introduction: The surgical treatment of conditions located at the low rectum is in constant review, triying to maintain proper urogenital and continence function. One of the most recent options is the transanal microsurgical. The aim of this paper is to analyze a series of patients treated with this approach, its indications, immediate and long term results. Material and Methods: 41 patients were analyzed retrospectively in the period between February 2009 and February 2015. Results: In these patients, treated conditions were polyps: 22; rectal cancer: 14; anastomotic stricture: 2; retrorectal abscess: 1; endometriosis: 1; familial adenomatous polyposis: 1. Patients affected with polyps reached the first consultation in 15 opportunities; 4 on first recurrence; 2 with second recurrence; 1 with third recurrence. The procedures were 29 local resections; 6 transanal transabdominal resections (TATA); 4 dilations of stenosis; 3 transrectal biopsies; 1 retrorectal abscess drainage; 1 hemorrhage control; 1 stent placement. In rectal cancer were: 7 local resection; 2 transrectal biopsies; 4 TATA; 1 stent placement. Mean operative time was 48.6 minutes and mean hospital stay was 2.21 days. Of the 29 patients in whom local resection was performed, 25 were controlled for a period of 6 to 72 months. 11 patients were complicated; no deaths or local recurrences were registered. Conclusions: This approach allows to treat lesions located throughout the rectum and the last segment of sigmoid colon. A better insight is obtained allowing a more accurate dissection, thus improving the immediate and remote postoperative results and minimizes the possibility of recurrence, particularly when it comes to benign conditions. (AU)

Reducción de la morbilidad postoperatoria en el cáncer colorrectal programado: inmunonutrición oral preoperatoria / Reduction of postoperative morbidity in programmed colorectal cancer: Preoperative oral immunonutrition

Resumen Objetivo: Valorar la eficacia de la administración preoperatoria de inmunonutrición oral en pacientes con cáncer colorrectal resecable, en términos de reducción de la incidencia de complicaciones infecciosas posquirúrgicas. Material y métodos: Estudio prospectivo y aleatorizado. Se reclutaron 84 pacientes. En el grupo inmunonutrido (SÍ IN) se administró de forma preoperatoria Impact© Oral durante 8 días (3 envases al día), con respecto del grupo no inmunonutrido (NO IN), que únicamente recibió dieta normal, sin suplementos. Resultados: Del total de pacientes, el 40,5% (17) de los NO IN presentaron complicaciones infecciosas frente a un 33,3% (14) de los SÍ IN. En los pacientes con cáncer rectal NO IN, un 50% (8) tuvieron complicaciones infecciosas menores frente a un 13,6% (3) de los SÍ IN, (p = 0,028). En la regresión logística, la variable proteínas totales en el quinto día posquirúrgico (OR: 2,8 [IC 95%: 1,3-6,3], p = 0,012) fue independiente en relación con la aparición de complicaciones infecciosas. Específicamente, la variable fuga anastomótica se comportó como factor de riesgo en el desarrollo de infección de herida, con una OR de 4,5 (IC 95%: 1,3-16,1) (p = 0,033). Discusión: La desnutrición en los pacientes oncológicos susceptibles de cirugía se traduce en un incremento en la morbimortalidad postoperatoria de los mismos. La utilización de fórmulas enterales con inmunonutrientes en estos sujetos puede atenuar dicha morbilidad, a expensas de la disminución de complicaciones infecciosas. Conclusión: En nuestro análisis, los pacientes NO IN presentaron con mayor frecuencia complicaciones infecciosas posquirúrgicas, sobre todo el subgrupo de pacientes con cáncer rectal.

Abstract Purpose: Assess the efficacy of preoperative administration of oral immunonutrition in patients with resectable colorectal cancer, in terms of reducing the incidence of postoperative infectious complications. Material and methods: Prospective randomized study. A total of 84 patients were recruited. To the group YES IN, Impact© Oral was preoperatively administered for 8 days (3 bricks a day), whereas the NOT IN group only received normal diet, without supplements. Results: Of all patients, 40.5% (17) in the NOT IN group suffered infectious complications against 33.3% (14) in the YES IN group. Among patients with rectal cancer in the NOT IN group, 50% (8) suffered minor infectious complications, compared with 13.6% (3) among those in the YES IN group (P = .028). Using logistic regression, the variable total protein on the fifth postoperative day [OR: 2.8 (95% CI: 1.3 to 6.3) (P = .012)] showed a statistically significant relationship with the occurrence of infectious complications. Specifically, anastomotic leak variable behaved as a risk factor in the development of surgical site infection, with an OR of 4.5 (95% CI: 1.3 to 16.1) (P = .033). Discussion: Malnutrition in cancer patients suitable for surgery results in an increase in postoperative morbidity and mortality. The use of enteral formulas with immunonutrients in these subjects can attenuate this morbidity, decreasing infectious complications. Conclusion: In our analysis, the NOT IN group suffered more postoperative infectious complications, particularly the subset of patients with rectal cancer.

Eficacia y seguridad de la resección endoscópica en pacientes con pólipos colorrectales no pediculados grandes / Efficacy and safety of endoscopic resection in patients with large non-pedunculated colorectal polyps

Introducción: Los pacientes con pólipos colorrectales no pediculados grandes (PCNP-G) han sido tradicionalmente tratados quirúrgicamente. Los avances en la endoscopía terapéutica permiten que la resección endoscópica de estas lesiones pueda ser considerada como una alternativa a la cirugía. Objetivo: Evaluar la eficacia y seguridad de la resección endoscópica en pacientes con PCNP-G. Materiales y métodos: Cohorte prospectiva multicéntrica. Se incluyeron a todos los pacientes referidos para resección endoscópica de PCNP-G entre enero del 2012 y diciembre del 2015, seguidos hasta agosto del 2016. Se obtuvieron las tasas de resecciones exitosas, de recurrencia y de complicaciones. Se analizaron los factores predictivos asociados a resección no exitosa y a recurrencia. Resultados: Se incluyeron 107 pacientes con 115 PCNP-G. La tasa de resección exitosa fue de 92%. Las complicaciones más comunes fueron el sangrado (8,7%) y la perforación (2,6%). La tasa de recurrencia fue de 7%, todas tratadas endoscópicamente con éxito. Los factores predictivos de resección no exitosa fueron una medida >50 mm de la lesión resecada y la presencia de fibrosis; y el único factor predictivo de recurrencia fue una medida >50 mm del pólipo resecado. Conclusiones: La resección endoscópica de los PCNP-G es altamente eficaz y segura

Introduction: Patients with large non-pedunculated colorectal polyps (L-NPCP) have been traditionally treated with surgery. Advances in therapeutic endoscopy allow endoscopic resection of these lesions and can be considered as an alternative to surgery. Objective: To evaluate the efficacy and safety of endoscopic resection in patients with L-NPCP. Methods: A prospective multicentric cohort. All patients referred for endoscopic resection with L-NPCP between January 2012 and December 2015, followed until August 2016, were included. Rates of successful resection, recurrence and complications were obtained. Predictive factors associated with unsuccessful resection and recurrence were analyzed. Results: 115 L-NPCP in 107 patients were included. The rate of successful resection was 92%. The most common complications were bleeding (8.7%) and perforation (2.6%). The recurrence rate was 7%, all successfully treated with a new endoscopic session. Predictors of unsuccessful resection were a measure >50 mm of the lesion and the presence of fibrosis; and the only predictor of recurrence was a size of the polyp resected >50 mm. Conclusions: Endoscopic resection of L-NPCP is very efficacious and safe

Oncology ostomized patients' perception regarding sexual relationship as an important dimension in quality of life / Um olhar dos homens estomizados intestinais oncológicos sobre a relação sexual como dimensão importante na qualidade de vida

Abstract Introduction For ostomized oncological patients, the physical body alterations affects the quality of life, as the changes in the self-concept are factors that directly affect the sexual life. Objective To analyze the perceptions of ostomized men due to intestinal cancer regarding sexual relations as an important dimension of quality of life, treated at the Ambulatory Care Program for Ostomized Patients of the Health Secretariat of the Federal District, Brazil. Methods Epidemiological-based study, of the analytical type, with a cross-sectional descriptive design, with quantitative and qualitative approach considering the content analysis. The convenience sample included 56 participants. Sociodemographic, clinical, and the WHOQOL-BREF questionnaires were used, as well as an individual interview. Data were analyzed by Microsoft Office Excel 2010 and SPSS 20.0 software. Statistical significance was set at 5%. Results The Physical, Social Relations and Environment Domains are correlated with the mean score, statistical significance (p < 0.0001), and the content analysis resulted in five categories: Ostomy, Self-Care, Acceptance, Self-concept, and Companionship. Conclusion Sexuality should be considered as a process of daily living of ostomized individuals due to intestinal cancer.

Resumo Introdução Para a pessoa estomizada intestinal oncológica o significado da alteração no corpo físico afeta a qualidade de vida, pois encontra-se com as alterações no autoconceito são fatores que dificultam diretamente o relacionamento sexual. Objetivo Analisar as percepções dos homens estomizados intestinais oncológicos quanto ao relacionamento sexual como dimensão importante na qualidade de vida, atendidos pelo Programa de Assistência Ambulatorial ao Estomizado da Secretaria de Saúde do Distrito Federal, Brasil. Métodos Estudo de base epidemiológica, de caráter analítico, com delineamento transversal e descritivo, com abordagem quantitativa e qualitativa à luz da análise de conteúdo. A amostra foi constituída por conveniência, incluídos 56 participantes. Utilizou-se os questionários sóciodemográfico, clínico, e o WHOQOL-bref e uma entrevista individual. Os dados foram analisados pelos programas Microsoft® Office Excel 2010 e SPSS 20.0. A significância estatística aceita foi de 5%. Resultados Os Domínios Físico, Relações Sociais e Meio Ambiente estão correlacionadas com o escore médio, significância estatística (p < 0,0001), a análise de conteúdo resultou em cinco categorias: Estomia, Autocuidado, Aceitação, Autoconceito e Companheirismo. Conclusão A sexualidade deve ser considerada como processo do viver cotidiano do estomizado intestinal oncológico.

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

OBJECTIVES: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer. METHODS: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155. RESULTS: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement. CONCLUSIONS: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.