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Peritoneal sarcomatosis is a rare malignant disease with a poor prognosis, secondary to peritoneal dissemination of abdominopelvic soft tissue sarcomas. Its rarity, together with the characteristic histological heterogeneity and the historically poor response to systemic treatments, has prevented the establishment of widely accepted treatment criteria with curative intent. In this sense, radical cytoreductive surgery (CRS) with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC), widely used in peritoneal carcinomatosis with excellent results, have not had the same evolutionary development in patients with peritoneal sarcomatosis. A multidisciplinary working group of experts in sarcomas and peritoneal oncological surgery established a series of recommendations based on current scientific evidence for the management of peritoneal sarcomatosis, taking into account the different histological subgroups of abdominopelvic sarcomas that can cause it depending on their origin: retroperitoneal sarcomas, uterine sarcomas, and visceral/peritoneal sarcomas of GIST (gastrointestinal stromal tumor) and non-GIST origin. This article shows the results of sarcoma experts' voting on the recommendations presented during the I Ibero-American Consensus on the Management of Peritoneal Sarcomatosis, which took place during the recent celebration of the III Hispanic-Portuguese Meeting for Updates on the Treatment of Sarcomas.
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Introducción. El cáncer colorrectal es uno de los tipos de cáncer más comunes y mortales a nivel mundial. Aunque los avances médicos han mejorado el manejo, la cirugía sigue siendo fundamental. La resección anterior baja (RAB) de recto ha ganado relevancia, a pesar de que puede llevar al síndrome de resección anterior baja de recto (LARS, por sus siglas en inglés), afectando la calidad de vida. Métodos. Estudio de corte transversal con intención analítica en un centro de referencia en Medellín, Colombia. Los pacientes con cáncer de recto sometidos a RAB entre enero de 2016 y diciembre de 2022 completaron el cuestionario LARS para evaluar disfunción intestinal. Se evaluaron factores relacionados con la presencia de LARS por medio de un análisis bivariado. Resultados. De 234 pacientes elegibles, 110 (47 %) respondieron la encuesta, predominantemente mujeres (58,2 %). La edad promedio fue 62 años. Dos tercios de los pacientes recibieron neoadyuvancia y el 69 % requirieron ileostomía. La prevalencia de LARS fue 47,3 %. El 80,9 % llevaban más de 12 meses desde la cirugía o el cierre del estoma. Factores estadísticamente significativos asociados a LARS fueron edad mayor de 65 años (p=0,03), estadío patológico avanzado (p=0,02) y requerimiento de estoma (p=0,03). Conclusiones. El LARS afecta a casi la mitad de los pacientes en diferentes etapas posquirúrgicas. El LARS scorees una herramienta práctica para evaluar la función intestinal en el seguimiento del paciente. La prevalencia y los factores de riesgo identificados contribuyen a la comprensión del impacto de la cirugía conservadora del esfínter en la calidad de vida de los pacientes.
Introduction. Colorectal cancer is one of the most common and deadly types of cancer worldwide, with a high incidence of rectal cancer. Although medical advances have improved management, surgery remains crucial. Low anterior resection of the rectum (LAR) has gained significance, despite its potential to lead to low anterior resection syndrome (LARS), affecting quality of life. Methods. A cross-sectional study with analytical intent was conducted at a referral center in Medellín, Colombia. Patients with rectal cancer who underwent LAR between January 2016 and December 2022 completed the LARS questionnaire to assess intestinal dysfunction. Factors related to the presence of LARS were analyzed using bivariate analysis. Results. Of 234 eligible patients, 110 (47%) responded, predominantly women (58.2%). The average age was 62 years. Two-thirds of patients received neoadjuvant therapy and 69% required ileostomy. The prevalence of LARS was 47.3%. 80.9% had been more than 12 months post-surgery or stoma closure. Statistically significant factors associated with LARS included age over 65 years (p=0.03), advanced pathological stage (p=0.02), and stoma requirement (p=0.03). Conclusions. LARS affects almost half of the patients in various post-surgical stages. The LARS score is a practical tool for assessing intestinal function in patient follow-up. The prevalence and risk factors identified contribute to the understanding of the impact of sphincter-conserving surgery on patients' quality of life.
Assuntos
Humanos , Doenças Retais , Protectomia , Complicações Pós-Operatórias , Neoplasias Retais , Cirurgia Colorretal , Estomas CirúrgicosRESUMO
Introducción. El pilar fundamental del tratamiento del cáncer colorrectal es la cirugía, situación que expone a los pacientes a la posible presentación de complicaciones, morbimortalidad, pobre calidad de vida, recurrencia tumoral o la muerte. El objetivo de este estudio fue determinar las variables clínicas y quirúrgicas que inciden en el riesgo de la aparición de complicaciones en los pacientes con cáncer colorrectal llevados a cirugía electiva entre los años 2016 y 2019. Métodos. Estudio observacional, descriptivo, transversal y retrospectivo. Se incluyeron pacientes mayores de 18 años con cáncer colorrectal sometidos a cirugía electiva. Se realizó un análisis multivariado para determinar los factores que se relacionan con las complicaciones postquirúrgicas. Resultados. Se incluyeron 298 pacientes, 68 % mayores de 60 años, 52,3 % mujeres, 74,2 % presentaban comorbilidades y 48,3 % fueron diagnosticados en estadio III. El 48,3 % presentó complicaciones postoperatorias. De ellos, el 68,1 % no tenía tamización nutricional y el 61,8 % no tenía preparación del colon; un 55 % fueron cirugías del recto, 69,1 % de las cirugías fueron por vía laparoscópica y 71,8 % presentaron sangrado inferior a 500 ml. La mayoría de las complicaciones fueron clasificadas como Clavien-Dindo I-III. Discusión. Las características de los pacientes fueron similares a los presentados en otros estudios, aunque hubo mayor incidencia de íleo postoperatorio. El análisis multivariado mostró una mayor probabilidad de presentar una complicación en pacientes con diabetes mellitus, hipertensión arterial, falta de tamización nutricional o preparación de colon, cirugía de recto y el sangrado mayor a 500 ml
Introduction. The fundamental pillar of colorectal cancer treatment is surgery, a situation that exposes patients to the possible presentation of complications, morbidity and mortality, poor quality of life, tumor recurrence or death. The objective of this study was to determine the clinical and surgical variables that affect the risk of the appearance of complications in colorectal cancer patients taken to elective surgery between 2016 and 2019.Methods. Observational, descriptive, cross-sectional and retrospective study. Patients over the age of 18 with colorectal cancer undergoing elective surgery were included. A multivariate analysis was performed to determine the factors related to postsurgical complications. Results. We included 298 patients, 68% over 60 years of age, 52.3% women, 74.2% had comorbidities and 48.3% were diagnosed in stage III. 48.3% presented postoperative complications; of these, 68.1% had no nutritional screening, and 61.8% had no colon preparation; 55% were rectal cancer surgeries, 69.1% underwent laparoscopic surgeries, and 71.8% had bleeding less than 500 ml. Most complications were classified as Clavien Dindo I-III. Discussion. The characteristic of the patients was similar to those presented in other studies, even though we had more incidence of postoperative ileus. The multivariate analysis showed a higher probability of complications in patients with: diabetes, hypertension, lack of nutritional screening, bleeding over 500cc, lack of colon mechanical preparation and rectal cancer surgery.Patient characteristics were similar to those presented in other studies, although there was a higher incidence of postoperative ileus. The multivariate analysis showed a greater probability of presenting a complication in patients with diabetes mellitus, arterial hypertension, lack of nutritional screening, colon preparation, rectal cancer surgery, and bleeding greater than 500 ml