Epidemiological Profile of Patients with Colorectal Cancer from a Hospital in Rio Grande do Sul, Brazil / Perfil epidemiológico de pacientes com câncer colorretal de um Hospital no Rio Grande do Sul, Brasil

Abstract Objective The present study describes the epidemiological profile of patients with colorectal cancer (CRC) from the Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brazil, between January 1, 2007 and December 31, 2016. Method Retrospective analysis of secondary data of 1,001 patients from the Hospital Cancer Registry. Results Most subjects were Caucasianmales, with a mean age of 63.68 years old. The majority of patients had incomplete elementary education and were married. In addition, 44.5% of the patients had a family history of cancer. Most subjects with a positive past or current history of alcohol intake or smoking were male. The diagnosis was mostly based on anatomopathological findings, with a predominance of adenocarcinomas and upper rectum and distal colon localization. Most lesions were in advanced stages, and the liver was the most common site for metastasis. The predominant treatment was surgery with neoadjuvant/adjuvant therapy. After the first treatment, 49.0% of the patients reported complete remission. The survival rate was 78.8% in 10 months. Conclusion The present research analyzed the profile of CRC patients.

Resumo Objetivo Descrever o perfil de pacientes com câncer colorretal (CCR) no Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil, de 01 de janeiro de 2007 a 31 de dezembro de 2016. Método Análise retrospectiva de dados secundários de 1.001 pacientes obtidos através do Registro Hospitalar de Câncer. Resultados Evidenciou-se predomínio do sexo masculino, com média de idade de 63,68 anos, majoritariamente caucasianos. O grau escolar prevalente foi fundamental incompleto e o estado civil foi casado. Um total de 44,5% dos pacientes tinha histórico familiar de neoplasia. Em relação ao consumo de álcool/cigarro, dentre os que faziam ou já fizeram uso, a maioria era homem. O diagnóstico foi majoritariamente por meio anatomopatológico, com predomínio de adenocarcinoma e localização no reto superior e no cólon distal, ocorrendo mais comumente em estágios avançados, com a metástase hepática sendo a mais presente. O tratamento predominante foi cirurgia com adjuvância/neoadjuvância. Após o primeiro tratamento, 49,0% dos pacientes apresentaram remissão completa. A sobrevida foi de 78,8% em 10 meses. Conclusão A presente pesquisa possibilitou a análise do perfil dos pacientes com CCR.

Sobrevida de pacientes com câncer colorretal em um Cancer Center / Survival of patients with colorectal cancer in a cancer center

ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

RESUMO CONTEXTO: Estudos hospitalares recentes têm demonstrado aumento da sobrevida do câncer colorretal e melhor sobrevida para mulheres, jovens e pacientes diagnosticados em estágio precoce da doença. OBJETIVO: Descrever a sobrevida global e analisar os fatores prognósticos de pacientes tratados para câncer colorretal em um centro de oncologia. MÉTODOS: Foram incluídos pacientes com diagnóstico de adenocarcinoma de cólon e reto entre 2000 e 2013, identificados no Registro Hospitalar de Câncer do A.C.Camargo Cancer Center. A sobrevida global aos 5 anos foi estimada pelo método de Kaplan-Meier e os fatores prognósticos foram avaliados pelo modelo de Cox. As razões de risco (HR) são relatadas com intervalos de confiança (IC) de 95%. RESULTADOS: Dos 2.279 casos de câncer colorretal analisados, 58,4% eram de cólon. A taxa de sobrevida global aos 5 anos para pacientes com câncer colorretal foi de 63,5% (65,6% e 60,6% para câncer de cólon e retal, respectivamente). O risco de óbito foi elevado para pacientes na faixa etária de 50-74 anos (HR=1,24; IC95% =1,02-1,51) e ≥75 anos (HR=3,02; IC95% =2,42-3,78), para pacientes com câncer retal (HR=1,37; IC95% =1,11-1,69) e para aqueles cujo tratamento foi iniciado >60 dias após o diagnóstico (HR=1,22; IC95% =1,04-1,43). O risco diminuiu para pacientes diagnosticados em períodos recentes (2005-2009 HR=0,76; IC95% =0,63-0,91; 2010-2013 HR=0,69; IC95% =0,57-0,83). CONCLUSÃO: A sobrevida dos pacientes com câncer colorretal é maior naqueles em estágio inicial e com início do tratamento antes dos 60 dias.. Idade acima de 70 anos foi fator independente preditivo de mau prognóstico. A sobrevida global aumentou para todos os pacientes tratados no período de 2000-2004 a 2010-2013.

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.

Programa multicéntrico de cribado de cáncer colorrectal en Chile / Results of a multicentric colorectal cancer screening program in Chile

Background: Colorectal Cancer Screening Programs (CRCSP) are widely accepted in developed countries. Unfortunately, financial restrictions, low adherence rate and variability on colonoscopy standardization hamper the implementation of CRCSP in developing countries. Aim: To analyze a multicentric pilot model of CRCSP in Chile. Material and Methods: A prospective model of CRCSP was carried out in three cities, from 2012 to 2015. The model was based on CRC risk assessment and patient education. Health care personnel were trained about logistics and protocols. The endoscopy team was trained about colonoscopy standards. A registered nurse was the coordinator in each center. We screened asymptomatic population aged between 50 and 75 years. Immunological fecal occult blood test (FIT) was offered to all participants. Subjects with positive FIT underwent colonoscopy. Results: A total of 12,668 individuals were enrolled, with a FIT compliance rate of 93.9% and 2,358 colonoscopies were performed. Two hundred and fifty high-risk adenomas and 110 cancer cases were diagnosed. One patient died before treatment due to cardiovascular disease, 74 patients (67%) underwent endoscopic resection and 35 had surgical treatment. Ninety one percent of patients had an early stage CRC (0-I-II). Among colonoscopy indicators, 80% of cases had an adequate bowel preparation (Boston > 6), cecal intubation rate was 97.7%, adenoma detection rate was 36.5%, and in 94.5% of colonoscopies, withdrawal time was adequate (> 8 min). Conclusions: This CRCS pilot model was associated to a high rate of FIT return and colonoscopy quality standards. Most CRCs detected with the program were treated by endoscopic resection.

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.

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

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.

Analysis of gene expression EGFR and KRAS, microRNA-21 and microRNA-203 in patients with colon and rectal cancer and correlation with clinical outcome and prognostic factors

Abstract Purpose: To evaluate the expression of EGFR, KRAS genes, microRNAs-21 and 203 in colon and rectal cancer samples, correlated with their age at diagnosis, histological subtype, value of pretreatment CEA, TNM staging and clinical outcome. Methods: Expression of genes and microRNAs by real time PCR in tumor and non-tumor samples obtained from surgical treatment of 50 patients. Results: An increased expression of microRNAs-21 and 203 in tumor samples in relation to non-tumor samples was found. There was no statistically significant difference between the expression of these genes and microRNAs when compared to age at diagnosis and histological subtype. The EGFR gene showed higher expression in relation to the value of CEA diagnosis. The expression of microRNA-203 was progressively lower in relation to the TNM staging and was higher in the patient group in clinical remission. Conclusions: The therapy of colon and rectum tumors based on microRNAs remains under investigation reserving huge potential for future applications and clinical interventions in conjunction with existing therapies. We expect, based on the exposed data, to stimulate the development of new therapeutic possibilities, making the treatment of these tumors more effective.

A socialização da medicina na era do adhemarismo / The socialization of medicine in the era of São Paulo Governor Adhemar de Barros

A análise observa as conexões entre o processo de profissionalização dos médicos paulistas e políticas de saúde do governo estadual de Adhemar de Barros em São Paulo (1947-1951), em meio a amplas mudanças na área de saúde denominadas pelos médicos paulistas “socialização da medicina”. Reconhecemos aspectos ambivalentes para o profissionalismo médico diante desse governo populista, como: a luta médica pela equiparação ante os advogados servidores públicos estaduais; a criação de uma secretaria de saúde estadual; e certos elos contraditórios entre a área de saúde adhemarista e a ideologia e a organização profissionais da medicina paulista. Nesse particular, o artigo aprofunda a análise de manifestações ideológicas de importantes lideranças médicas paulistas.

The article analyzes how the process of the professionalization of physicians in São Paulo related to healthcare policy under the administration of São Paulo governor Adhemar de Barros (1947-1951) during a period of broad change in the realm of health known by São Paulo physicians as the “socialization of medicine.” Medical professionalism confronted certain ambivalences under this populist administration, including doctors’ struggle to achieve pay equal to that of state public attorneys; the establishment of a state health department; and some contradictory ties between the area of health under Adhemar and the professional ideology and organization of medicine in São Paulo. The article undertakes a more in-depth analysis of the ideological manifestations of important leaders in the state’s medical community.

Using computed tomography colonography in patients at high risk of colorectal cancer - a prospective study in a university hospital in South America

OBJECTIVES: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer. METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence. RESULTS: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv. CONCLUSION: It was possible to institute an efficient computed ...

Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil / Panorama de las hospitalizaciones por condiciones sensibles de la atención primaria en la ciudad de cotia / Panorama das Internações por Condições Sensíveis à Atenção Primária no município de Cotia

Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC), in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61%) by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.



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Objetivo Describir el perfil de las Hospitalizaciones por Condiciones Sensibles de la Atención Primaria (HCSAP), en el municipio de Cotia, entre 2008 y 2012. Método Estudio ecológico, exploratorio, longitudinal con un enfoque cuantitativo. Los datos sobre HCSAP, por grupo de edad y sexo, se obtuvieron del Departamento del Sistema Único de Salud. Para el análisis de los datos se utilizaron estadísticas descriptivas. Resultados Durante el período, hubo 46.676 admisiones, excluyendo entregas, 7.753 (16,61%) por HCSAP. Las principales causas fueron las enfermedades cerebrovascular, 16,96%, insuficiencia cardíaca, 15,50%, hipertensión arterial 10,80% y infección del riñón y las vías urinarias, el 10,51%. Cuanto al género, HCSAP ocurrió mayormente en los hombres. Un mayor número de HCSAP en grupos de edades extremas, especialmente en los ancianos. Conclusión Las enfermedades crónicas predominan entre las principales causas de HCSAP y no hubo diferencia significativa entre los sexo.
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Objetivo Descrever o perfil das Internações por Condições Sensíveis à Atenção Primária (ICSAP), no Município de Cotia, entre 2008 e 2012. Método Estudo ecológico, exploratório, longitudinal, de abordagem quantitativa. Dados sobre as ICSAP, segundo a faixa etária e sexo, foram obtidos no Departamento de Informática do Sistema Único de Saúde. Para a análise dos dados foi utilizada a estatística descritiva. Resultados No período, houve 46.676 internações, excluindo os partos, sendo 7.753 (16,61%) por ICSAP. As principais causas foram: doenças cerebrovasculares, 16,96%; insuficiência cardíaca, 15,50%; hipertensão, 10,80%; e infecção do rim e trato urinário, 10,51%. Quanto ao sexo, as ICSAP ocorreram predominantemente nos homens. Houve maior número de ICSAP nos extremos das faixas etárias, especialmente nos idosos. Conclusão As doenças crônicas predominaram entre as principais causas de ICSAP e não houve diferença importante entre os sexos. .

Descriptive analysis of and overall survival after surgical treatment of lung metastases / Analise descritiva e sobrevida global do tratamento cirurgico das metastases pulmonares

OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases. .

OBJETIVO: Descrever características demográficas, resultados operatórios, complicações pós-operatórias e taxa de sobrevida global em pacientes com metástases pulmonares tratados cirurgicamente. MÉTODOS: Análise retrospectiva de 119 pacientes submetidos a um total de 154 cirurgias de ressecção de metástase pulmonar entre 1997 e 2011. RESULTADOS: Do total de 119 pacientes, 68 (57,1%) eram do sexo masculino, e 108 (90,8%) eram brancos. A mediana de idade foi de 52 anos (variação, 15-75 anos). Nessa amostra, 63 pacientes (52,9%) apresentaram comorbidades, sendo as mais frequentes hipertensão arterial sistêmica (69,8%) e diabetes (19,0%). Tumores primários colorretais (47,9%) e musculoesqueléticos (21,8%) foram os principais sítios de origem das metástases. Aproximadamente 24% dos pacientes foram submetidos a mais de uma ressecção das lesões, e 71% fizeram tratamento adjuvante prévio à metastasectomia. A taxa de recidiva de metástase pulmonar foi de 19,3%. A mediana do intervalo livre de doença foi de 23 meses. A principal via de acesso usada foi toracotomia (78%), e o tipo de ressecção mais frequente foi em cunha e segmentectomia (51%). O índice de complicações pós-operatórias foi de 22% e o de mortalidade perioperatória foi de 1,9%. As taxas de sobrevida global em 12, 36, 60 e 120 meses foram, respectivamente, de 96%, 77%, 56% e 39%. A análise de Cox confirmou que complicações nos primeiros 30 dias pós-operatórios associaram-se a pior prognóstico (hazard ratio = 1,81; IC95%: 1,09-3,06; p = 0,02). CONCLUSÕES: O tratamento cirúrgico das metástases pulmonares oriundas de diferentes sítios tumorais é efetivo e seguro, com boa sobrevida global, especialmente nos casos com um menor número de lesões ...

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas / Mucosectomia em lesões do cólon e reto: procedimento seguro e eficaz mesmo em pacientes com lesões maiores que 2 cm e em carcinomas

CONTEXT: Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. OBJECTIVES: To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. METHODS: A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique. Complications and recurrence were analyzed. Patients were followed up for 18 months. RESULTS: There were 83 (48.2 percent) superficial lesions, 57 (33.1 percent) depressed lesions, 44 (25.6 percent) laterally spreading tumors, and 45 (26.2 percent) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0 percent) lesions were located in the rectum, 68 (39.5 percent) in the left colon, and 80 (46.5 percent) in the right colon (transverse, ascending, and cecum). There were 167 (97.1 percent) neoplasms: 142 (82.5 percent) adenomatous lesions, 24 (14.0 percent) intramucosal carcinomas, and 1 (0.6 percent) invasive carcinoma. En bloc resection was performed in 158 (91.9 percent) cases and piecemeal resection in 14 (8.1 percent). Bleeding occurred in 5 (2.9 percent) cases. Recurrence was observed in 4.1 percent (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). CONCLUSIONS: Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

CONTEXTO: A mucosectomia endoscópica é uma técnica minimamente invasiva para o tratamento de neoplasias de cólon e reto, inclusive carcinomas precoces, de diferentes tamanhos e aspectos morfológicos. OBJETIVO: Avaliar a segurança, a eficácia, os resultados e a recurrência das lesões após mucosectomia. MÉTODOS: Entre maio de 2003 e maio de 2009 um total de 172 lesões em 156 pacientes foi incluído no estudo. Todas as lesões tinham padrão de criptas sugestivo de neoplasias (III-V), segundo a classificação de Kudo, com o diagnóstico feito por colonoscópios com magnificação de imagens e índigo-carmin. As lesões foram avaliadas quanto à macroscopia, tamanho, localização e histopatologia. Lesões com até 20 mm foram removidas em bloco e as maiores que 20 mm pela técnica de piecemeal. Complicações e recurrência foram analisadas. O seguimento foi de 18 meses. RESULTADOS: Este estudo identificou 83 (48,2 por cento) lesões superficiais, sendo 57 (33,1 por cento) deprimidas, além de 44 (25,6 por cento) lesões de espraiamento lateral e 45 (26,2 por cento) protrusas. O tamanho médio foi de 11,5 ± 9,6 mm (2-60 mm) e a idade média de 61,6 ± 12,5 anos (34-93 anos). No reto estavam 24 (14 por cento) lesões, 68 (39,5 por cento) no cólon esquerdo e 80 (46,5 por cento) no cólon direito (transverso, ascendente e ceco). Foram 167 (97,1 por cento) neoplasias, sendo 142 (82,5 por cento) lesões adenomatosas, 24 (14,0 por cento) carcinomas intramucosos e 1 (0,6 por cento) carcinoma invasivo. Foram tratadas em bloco 158 (91,9 por cento) lesões e 14 (8,1 por cento), por piecemeal. Houve cinco casos (2,9 por cento) de sangramento. A recurrência foi de 4,1 por cento (5/122) e associada a lesões maiores que 20 mm (P<0,01), à técnica piecemeal (P<0,01), à neoplasia avançada (P = 0,01) e ao carcinoma quando comparado ao adenoma (P = 0,04). CONCLUSÕES: A mucosectomia endoscópica de lesões colorretais é procedimento seguro, eficaz, com baixo índice de complicações e recidiva local. A recidiva de lesão é associada a lesões maiores que 20 mm e aos carcinomas.

Prognosis of colorectal cancer with liver metastasis: value of a prognostic index

The objective of the present study was to explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for the selection of patients who might benefit from hepatic resection for metastatic CRC. A total of 293 patients undergoing liver resection for metastatic CRC (172 males and 80 females ranging in age from 26 to 80 years) were selected and clinical, pathological and outcome data were examined in this retrospective study. The prognostic index (PI) of the patients was calculated on the basis of results of multivariate analysis. Patients were stratified into different groups, with survival curves projected according to PI. The 1-, 3-, and 5-year overall survival rates were 58.3, 26.4, and 11.3 percent, respectively. Univariate analysis indicated that degree of primary tumor differentiation, resection margin, preoperative carcinoembryonic antigen (CEA) level, number of liver metastases, and resection of liver metastases were associated with prognosis (P < 0.05). In multivariate analysis, the last three factors were found to be independent prognostic factors. The resection of liver metastases was a favorable factor. Patients were classified into three groups according to PI, which differed significantly in survival rate (P < 0.05). The individual survival rate was evaluated based on PI. Resection of hepatic colorectal metastases may produce long-term survival and cure. The proposed PI was easy to use, was highly predictive of patient outcome, and permitted categorization of patients into treatment groups.

Linfoma de células del manto: manifestación extranodal colorrectal / Mantle-cell lymphoma: extranodal manifestation colorectal

Antecedentes: Los linfomas gastrointestinales agrupan diferentes lesiones y son objeto de permanente revisión. Se los considera de acuerdo a su histología y el estadio evolutivo, hechos que suelen guardar estrecha relación con la clínica, las conductas terapéuticas y el pronóstico. El tubo digestivo está afectado entre un 5 a 15 por ciento en los pacientes que padecen Linfoma no Hodking. El colon y recto son los sitios de menor frecuencia. Representa entre 0,2 a 0,6 por ciento de los tumores malignos colorrectales. El linfoma de células del manto es un subtipo de linfoma de células B, con una frecuencia del 5 al 10 por ciento dentro de los linfomas no Hodking. Objetivo: Presentar el caso de una manifestación colorrectal de linfoma de células del manto, sus características fisiopatológicas y sus alternativas terapéuticas. Pacientes y método: Paciente de 82 años consultó por proctorragia, diarrea crónica, pérdida de peso y mucorrea de más de tres meses de evolución. Se realizó videocolonoscopía constatándose a 10 cm del margen anal lesión mamelonada, friable, ulcerovegetante, extendida hasta sigma con múltiples pólipos sesiles y subpediculados de gran tamaño en cantidad mayor de 100, extendidos en todo el colon. El hallazgo en correlación con la clínica y la endoscopia es compatible con linfoma de células del manto en su forma de afectación extranodal gastrointestinal, y poliposis linfomatosa múltiple. Resultados: Se realizó seis esquemas de quimioterapia bajo la modalidad CHOOP (ciclofosfamida, doxirrubicina, vincristina, prednisona) conjuntamente la aplicación al comienzo de los ciclos con Rituximab (Anticuerpo monoclonal). Se realizó un control endoscópico y tomográfico demostrando remisión completa del compromiso colorrectal, ganglios mesentéricos y retroperitoneales. Se observó persistencia de masas mediastinicas intercavo-aorticas derrame pleural bilateral y dilatación cardiaca...

Background: Gastrointestinal Lymphomas different injuries and are grouped under constant review. They are considered according to their histology and stage of development, events that are closely related to the clinic, the therapeutic behavior and prognosis. The gastrointestinal tract is affected between 5 to 15 per cent in patients with non-Hodgkin lymphoma. The colon and rectum are less frequent sites. It represents between 0.2 and 0.6 per cent of malignant colorectal tumors. The mantle cell lymphoma is a subtype of B-cell lymphoma, with a frequency of 5 to 10 per cent in non-Hodgkin lymphoma. Objective: To present the case of a manifestation colorectal mantle cell lymphoma, pathophysiological characteristics and treatment options. Patients and methods: Patient 82 years consulting with bloody diarrhea, chronic diarrhea, weight loss and mucorrea more than three months of evolution. A colonoscopy was performed, confirmed a 10 cm from the anal injury swellings, extended to multi-sigma subpediculados sessile polyps and large in quantity greater than 100, spread throughout the colon. The finding in correlation with clinical and endoscopy is compatible with mantle cell lymphoma, as extranodal gastrointestinal involvement and multiple lymphomatous polyposis. Results: we performed six schemes in the form CHOOP chemotherapy (cyclophosphamide, doxirrubicina, vincristine, prednisone) combined the application at the beginning of the cycles with Rituximab (monoclonal antibody). We undertook a endoscopy and CT demonstrated complete remission of colorectal disease, commitment, mesenteric and retroperitoneal lymph nodes. Showed persistence of mediastinal masses, bilateral pleural effusion and cardiac dilatation. Today is free from colorectal disease and active monitoring by their serial mediastinal and their heart failure...

Resultados del tratamiento quirúrgico de las metástasis hepáticas por cáncer colorrectal / Outcome of surgical treatment of liver metastasis from colorectal cancer

Background: Surgical resection is the only treatment associated with long-term cure in patients with liver metastasis from colorectal cancer, achieving a 30% to 40% five years survival. Aim: To evaluate the results of liver resection for metastatic colorectalcancer in our centre. Patients and methods: Retrospective study. Epidemiological, perioperative and follow up data of patients undergoing liver resection for metastatic colorectalcancer between January 1990 and July 2007 were assessed. We compared the results between two periods; period 1 (1990-1997) and period 2 (1998-2007). Results: Sixty six patients aged61±12 years (46 males) underwent 75 resections. An anatomical excision was performed in 54 (72%) cases, a right hepatectomy in 18, an extended right hepatectomy in 11, a left hepatectomy in 1, and a segmentectomy in 24. In 24 (32%) patients the liver resection wassimultaneous with the colorectal cancer resection. Operative time was 221±86 min. Hospital stay was 11±5 days. Postoperative morbidity was 35% and surgical mortality was 0%. Resectionmargin was free of tumor in 53 (80%) patients. Five years overall and hepatic disease-free survival was 38% and 23%, respectively. In period 2, more anatomical resections than in period1 were performed (77% and 55%, respectively, p =0.04), without an increase in complications (35% and 34%, respectively; p =ns), but with a better five years survival (45% and 21%, respectively, p =0.04). Conclusions: Five years survival for excision of liver metastatic colorectal cancer in our center is similar to that reported abroad. During the second period there has been a trend toward more extensive resections which was associated with a better survival, without an increase in complications or mortality.

Control de calidad de 135 informes histopatológicos de carcinoma colo-rectal / Quality control of 135 surgical pathology reports of colo-rectal carcinoma

Objetivo. Evaluar la calidad del contenido en informes de especímenes quirúrgicos con carcinoma de colon y recto. Tipo de estudio. Análisis retrospectivo y observacional. Material y métodos. Informes histopatológicos de piezas quirúrgicas con carcinoma de colon y recto resecados entre 1988 y 1994. De los informes se obtuvieron variables macroscópicos e histológicas con relevancia pronóstica y de acuerdo al sistema TNM que se vaciaron a hojas de cotejo. para definir la calidad del informe, el número de variables con valore pronóstico se cuantificó en relación con 11 características macroscópicas e histológicas que idealmente deben contener. Resultados. Se analizaron 135 informes. El tipo histológico, el grado de diferenciación y la invasión local fueron las variables anotadas con mayor frecuencia. El 90 por ciento de los informes contenían las características de los ganglios linfáticos y en 85 por ciento se evaluaron macro e histológicamante los bordes quirúrgicos. Otras variables con valor pronóstico no se anotaron, v.gr. la angioinvasión se estipuló en un caso (0.7 por ciento). Conclusiones. Con el uso de la hoja de cotejo con variables estandarizadas nuestros informes de especímenes con carcinoma colo-rectal mostraron ser adecuados en 113/135 (85 por ciento) ya que tenían más de ocho variables pronósticoas. Las diferencias detectadas Fueron: 1) descripción macroscópica inadecuada; 2) carencia del grado de diferenciación en 12 por ciento; y 3) omisión del sitio anatómico en 29 por ciento