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BACKGROUND: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. MATERIALS AND METHODS: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann's procedure (HP). Postoperative complications and clinical outcomes were assessed. RESULTS: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. CONCLUSION: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.

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ABSTRACT Background: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. Materials and Methods: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann's procedure (HP). Postoperative complications and clinical outcomes were assessed. Results: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. Conclusion: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.

RESUMO Introdução: embora a preservação do trânsito intestinal seja um dos objetivos principais na cirurgia do câncer retal, a anastomose colorretal pode ser considerada um procedimento de altíssimo risco, particularmente para pacientes com múltiplas comorbidades. Nosso objetivo foi avaliar as taxas de complicações cirúrgicas em pacientes com câncer retal de acordo com o tipo de procedimento a que foram submetidos. Materiais e Métodos: esta coorte incluiu todos os pacientes com câncer retal submetidos a ressecção eletiva em hospital universitário de referência ao longo de 16 anos. Houve três grupos de estudo de acordo com o tipo de operação realizada: (1) ressecção retal com anastomose, sem estoma desfuncionalizante (ED); (2) ressecção retal com anastomose e ED; e (3) procedimento de Hartmann (PH). Avaliamos as complicações pós-operatórias e os resultados clínicos. Resultados: estudamos 402 pacientes. O grupo 3 tinha 118 pacientes, estes sendo significativamente mais idosos (>10 anos), com pontuações mais altas no Índice de Comorbidade de Charlson e mais frequentemente classificados como ASA ≥ 3 do que os pacientes dos outros dois grupos. Sessenta e sete pacientes (16,7%) apresentaram complicações de Clavien-Dindo grau ≥ III, correspondendo à incidência de 11,8%, 20,9% e 14,4% nos grupos 1, 2 e 3, respectivamente (p = 0,10). Vinte e nove pacientes (7,2%) apresentaram complicações sépticas graves, necessitando reoperação, com incidência de 10,8%, 8,2% e 2,5% nos grupos 1, 2 e 3, respectivamente (p = 0,048). Vinte e um por cento dos pacientes do grupo 2 não foram submetidos ao fechamento do estoma após acompanhamento de 24 meses. Conclusão: o PH foi associado à menor incidência de reoperação por complicações sépticas intra-abdominais. Este procedimento continua sendo uma opção para pacientes com alto potencial de desenvolver complicações cirúrgicas graves.

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INTRODUCTION: Sepsis is a systemic inflammatory response to suspected or confirmed infection. Clinical evaluations are essential for its early detection and treatment. Blood cultures may take as long as 2 days to yield a result and are not always reliable. However, recent studies have suggested that neutrophil CD64 expression may be a sensitive and specific alternative for the diagnosis of systemic infection. OBJECTIVE: The objective of the study was to analyze the difference in CD64 values between subjects with systemic inflammatory response syndrome (SIRS), suspected or confirmed sepsis, who meet diagnostic criteria for SIRS upon arriving at an emergency department. MATERIALS AND METHODS: This was a prospective observational cohort study, an accuracy study of CD64 prospectively evaluated. The sample consisted of 109 patients aged 18 years with criteria for SIRS on arrival to emergency department. CD64 expression was measured within 6 h of hospital admission and once again after 48 h. RESULTS: ROC curve analysis suggested that a cutoff of 1.45 for CD64 expression could diagnose sepsis with a sensitivity of 0.85, a specificity of 0.75, an accuracy of 82.08%, a positive predictive value of 0.96, a negative predictive value of 0.38 and a positive likelihood ratio of 3.33. The area under the curve was 0.83. CONCLUSION: CD64 seems to be a useful, sensitive, and specific biomarker in discriminating between SIRS and sepsis.