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PURPOSE: Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury. METHODS: We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1. RESULTS: Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I2 = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I2 = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I2 = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I2 = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation. CONCLUSION: In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.
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OBJECTIVES: Colorectal endoscopic submucosal dissection (ESD) is a technically complex procedure. The scissor knife mechanism may potentially provide easier and safer colorectal ESD. The aim of this meta-analysis is to evaluate the efficacy and safety of scissor-assisted vs. conventional ESD for colorectal lesions. METHODS: A search strategy was conducted in MEDLINE, Embase, and Lilacs databases from January 1990 to November 2023 according to PRISMA guidelines. Fixed and random-effects models were used for statistical analysis. Heterogeneity was assessed using I2 test. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of five studies (three retrospective and two randomized controlled trials, including a total of 1575 colorectal ESD) were selected. The intraoperative perforation rate was statistically lower (risk difference [RD] -0.02; 95% confidence interval [CI] -0.04 to -0.01; P = 0.001; I2 = 0%) and the self-completion rate was statistically higher (RD 0.14; 95% CI 0.06, 0.23; P = 0.0006; I2 = 0%) in the scissor-assisted group compared with the conventional ESD group. There was no statistical difference in R0 resection rate, en bloc resection rate, mean procedure time, or delayed bleeding rate between the groups. CONCLUSION: Scissor knife-assisted ESD is as effective as conventional knife-assisted ESD for colorectal lesions with lower intraoperative perforation rate and a higher self-completion rate.
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PURPOSE: American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS: We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS: Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS: The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Neoplasias Colorretais , Indígenas Norte-Americanos , Neoplasias do Colo do Útero , Feminino , Adulto , Humanos , Indígena Americano ou Nativo do Alasca , Acessibilidade aos Serviços de Saúde , New Mexico , Detecção Precoce de Câncer , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Pessoal de SaúdeRESUMO
El cáncer colorrectal (CCR) es un problema de salud prevalente y significativo a nivel mundial, especialmente en países desarrollados. Este estudio tuvo como objetivo evaluar la tasa de mortalidad por CCR en Chile en los últimos 25 años. Se llevó a cabo un estudio descriptivo ecológico utilizando datos públicos de mortalidad desde 1997 hasta 2022, que incluyeron un total de 50.944 defunciones. Los resultados revelaron que el cáncer de colon representó la mayoría de los casos (72,15%) donde el colon sigmoide fue el sitio más afectado. La tasa de mortalidad promedio fue de 11,19 por cada 100.000 habitantes, mostrando un aumento significativo a lo largo del tiempo. El análisis por edad indicó una mayor carga de mortalidad en individuos de 75 a 90 años. Se observó disparidades de género, con predominio de muertes femeninas hasta el año 2019. El análisis de la tasa ajustada por región reveló diferencias no significativas en las tasas de mortalidad, siendo Valparaíso y Magallanes y Antártica Chilena las regiones con tasas más altas para el cáncer de colon y el cáncer de recto, respectivamente. Estos hallazgos contribuyen a nuestra comprensión de la epidemiología del CCR en Chile y enfatizan la necesidad de intervenciones específicas en prevención primaria y screening para reducir la mortalidad por esta enfermedad.
Colorectal cancer (CRC) is a prevalent and significant health problem worldwide, especially in developed countries. The aim of this study was to evaluate the CRC mortality rate in Chile in the last 25 years. An ecological descriptive study was carried out using public mortality data from 1997 to 2022, which included a total of 50,944 deaths. The results revealed that colon cancer represented the majority of cases (72.15%) where the sigmoid colon was the most affected site. The average mortality rate was 11.19 per 100,000 individuals, showing a significant increase over time. The analysis by age showed a greater burden of mortality in individuals from 75 to 90 years. Gender disparities were observed, with a predominance of female deaths until 2019. The analysis of the rate configured by region revealed non-significant differences in mortality rates, with Valparaíso and Magallanes and Antártica Chilena being the regions with the highest rates for colon and rectal cancer, respectively. These findings contribute to our understanding of the epidemiology of CRC in Chile and emphasize the need for specific interventions in primary prevention and screening to reduce mortality from this disease.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias Retais/mortalidade , Neoplasias Retais/epidemiologia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/epidemiologia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/epidemiologia , Chile/epidemiologia , Epidemiologia DescritivaRESUMO
BACKGROUND: Tumor-associated macrophages (TAM) are known to facilitate colorectal cancer (CRC) growth. High macrophage infiltration in thymidine phosphorylase (TYMP) expressing CRC may correspond to poor prognosis. The prognostic impact of the expression CD163, a receptor associated with TAM, and TYMP in stroma, respectively, tumor tissue is not yet established. The aim of this study was to identify the potential associations between TYMP and CD163 expression levels and relapse-free survival (RFS) of patients with stage II CRC, and if microdissection is of importance. METHODS: Stage II CRC patients, radically resected with relapse (n = 104), were matched to patients with a 5-year relapse-free follow-up (n = 206). Gene expression of TYMP and CD163 was analyzed in snap-frozen tumor tissues and in microdissected formalin-fixed tumor tissues separated into tumor epithelium and stroma. RESULTS: TYMP expression was high in poorly differentiated tumors, right-sided CRC, and tumors with high microsatellite instability CD163-expressing macrophages near tumor epithelial cells had high expression in poorly differentiated and T4 tumors. High TYMP expression in tumor epithelial cells was in the multivariate analyses associated with shorter relapse-free survival (hazard ratio 1.66; 95% confidence interval: 1.09-2.56; p < 0.05). CONCLUSIONS: TYMP expression in tumor epithelial cells was associated with RFS and emphasizes the need for tissue microdissection. Additional studies are needed to establish whether TYMP and CD163 could add clinically relevant information to identify high-risk stage II patients that could benefit from adjuvant chemotherapy.
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Antígenos CD , Antígenos de Diferenciação Mielomonocítica , Neoplasias Colorretais , Timidina Fosforilase , Antígenos CD/genética , Antígenos de Diferenciação Mielomonocítica/genética , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/patologia , Humanos , Recidiva Local de Neoplasia/patologia , Prognóstico , Receptores de Superfície Celular , Timidina Fosforilase/genéticaRESUMO
ABSTRACT Background Endoscopic mucosal resection (EMR) is an easy-to-use treatment option for superficial colorectal lesions, including lesions ≥20 mm. Objective To evaluate the effectiveness of EMR. Methods We evaluated 430 lesions removed by EMR in 404 patients. The lesions were analyzed according to their morphology, size, location, and histology. Lesions <20 mm were resected en bloc, whereas lesions ≥20 mm were removed by piecemeal EMR (p-EMR). Adverse events and recurrence were assessed. Results Regarding morphology, 145 (33.7%) were depressed lesions, 157 (36.5%) were polypoid lesions and 128 (29.8%) were laterally spreading lesions, with 361 (84%) lesions <20 mm and 69 (16%) ≥20 mm. Regarding histology, 413 (96%) lesions were classified as neoplastic lesions. Overall, 14 (3.3%) adverse reactions occurred, most commonly in lesions removed by p-EMR (P<0.001) and associated with advanced histology (P=0.008). Recurrence occurred in 14 (5.2%) cases, more commonly in lesions removed by p-EMR (P<0.001). Conclusion EMR is an effective technique for the treatment of superficial colorectal lesions, even of large lesions.
RESUMO Contexto Ressecção endoscópica da mucosa (REM) é uma opção fácil para o tratamento das lesões superficiais do cólon e reto, inclusive para as lesões ≥20 mm de diâmetro. Objetivo Avaliar a efetividade da REM. Métodos Este estudo prospectivo observacional avaliou 430 lesões ressecadas por REM em 404 pacientes. As lesões foram analisadas de acordo com a morfologia, tamanho, localização e histologia. Lesões <20 mm foram removidas em bloco, enquanto lesões ≥20 mm foram ressecadas em piecemeal REM (p-REM). Eventos adversos e recorrência foram avaliados. Resultados Quanto à morfologia, 145 (33,7%) eram lesões deprimidas, 157 (36,5%) eram lesões polipoides e 128 (29,8%) eram lesões que se espalham lateralmente, com 361 (84%) lesões <20 mm e 69 (16%) ≥20 mm. Em relação à histologia, 413 (96%) foram classificadas como lesões neoplásicas. Globalmente tivemos 14 (3,3%) de reações adversas, mais presente nas lesões ≥20 mm removidas por p-REM (P<0,001) e associadas com histologia avançada (P=0,008). A recorrência ocorreu em 14 (5,2%) casos, sendo mais observada em lesões removidas por p-REM (P<0,001). Conclusão REM é uma técnica efetiva para o tratamento das lesões colorretais superficiais, até mesmo para as grandes lesões.
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OBJECTIVES: This study aims to determine the optimal proportion for different chemotherapy schemes in patients with metastatic colorectal cancer who have undergone surgical resection in Colombia. METHODS: A linear programming model was used to quantify the optimal proportion of the chemotherapy schemes that maximize quality-adjusted life-years (QALYs). The model was evaluated in 6 different scenarios using parametric and dynamic optimization with different budget restriction constraints. The results were compared to the current mixture of schemes used in our country. RESULTS: The results show that 63%, 37%, and 0.8% of the population should receive the FOLFOXIRI scheme (fluorouracil + leucovorin + oxaliplatin + irinotecan), FOLFIRI (irinotecan + leucovorin + fluorouracil), and FOLFIRI plus cetuximab, respectively. With these proportions, 8734 QALYs and universal coverage of the population are obtained. In an optimistic scenario (high QALYs, low costs, and budget of $40 million), the entire population should receive the FOLFIRI scheme. A pessimistic scenario (low QALYs, high costs, and budget of $15 million) would benefit only 46% of the population with the fluorouracil plus leucovorin scheme. In the other 3 scenarios with higher budget constraints, 52%, 69%, and 86% of the population should receive FOLFIRI, respectively. Dynamic optimization revealed that FOLFIRI and FOLFOX (oxaliplatin + leucovorin + fluorouracil) schemes are more likely to generate higher QALYs with lower costs and a limited budget. CONCLUSIONS: The current use of chemotherapy schemes is not optimal. An increasing proportion of FOLFIRI, FOLFOX, and FOLFOXIRI should be used more often as schemes to treat metastatic colorectal cancer in Colombia.
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Neoplasias do Colo , Neoplasias Colorretais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/uso terapêutico , Colômbia , Neoplasias do Colo/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , HumanosRESUMO
The objective of the present study was to evaluate the effect of probiotic VSL#3 isolated or associated with a yacon-based product (synbiotic) on oxidative stress modulation and intestinal permeability in an experimental model of colorectal carcinogenesis. Forty-five C57BL/6J mice were divided into three groups: control (standard diet AIN-93 M); probiotic (standard diet AIN-93 M and multispecies probiotic VSL#3, 2.25 × 109 CFU), and synbiotic (standard diet AIN-93 M with yacon-based product, 6% fructooligosaccharides and inulin, and probiotic VSL#3, 2.25 × 109 CFU). The experimental diets were provided for 13 weeks. The probiotic and the yacon-based product showed antioxidant activity, with the percentage of DPPH radical scavenging equal to 69.7 ± 0.4% and 74.3 ± 0.1%, respectively. These findings contributed to reduce hepatic oxidative stress: the control group showed higher concentration of malondialdehyde (1.8-fold, p = 0.007 and 1.5-fold, p = 0.035) and carbonylated protein (2-fold, p = 0.008 and 5.6-fold, p = 0.000) compared to the probiotic and synbiotic groups, respectively. Catalase enzyme activity increased 1.43-fold (p = 0.014) in synbiotic group. The crypt depth increased 1.2-fold and 1.4-fold with the use of probiotic and synbiotic, respectively, compared to the control diet (p = 0.000). These findings corroborate the reduction in intestinal permeability in the probiotic and synbiotic groups, as measured by the percentage of urinary lactulose excretion (CON: 0.93 ± 0.62% × PRO: 0.44 ± 0.05%, p = 0.048; and CON: 0.93 ± 0.62% × SYN: 0.41 ± 0.12%, p = 0.043). In conclusion, the probiotic and synbiotic showed antioxidant activity, which contributed to the reduction of oxidative stress markers. In addition, they protected the mucosa from damage caused by chemical carcinogen and reduced intestinal permeability. PRACTICAL APPLICATION: The relationship between intestinal health and the occurrence of various organic disorders has been demonstrated in many studies. The use of probiotics and prebiotics is currently one of the main targets for modulation of intestinal health. We demonstrated that the use of a commercial mix of probiotic bacteria (VSL#3) isolated or associated with a yacon-based prebiotic, rich in fructooligosaccharides and inulin, is able to reduce the oxidative stress and intestinal permeability in a colorectal carcinogenesis model. These compounds have great potential to be used as a food supplement, or as ingredients in the development of food products.
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Antioxidantes/farmacologia , Neoplasias Colorretais/prevenção & controle , Intestinos/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/farmacologia , Probióticos/farmacologia , Simbióticos/administração & dosagem , Animais , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , PermeabilidadeRESUMO
Barbados is an island in the Eastern Caribbean that is reported to have the 8th highest incidence of colorectal cancer (CRC) worldwide. However, these figures are based only on estimates, and there is little available epidemiological data collected from Barbadians with CRC. The present study sought to collect epidemiologic data from patients in Barbados diagnosed with CRC. This information is considered important to shape national public health policies. For this purpose, hospital admission registers at all tertiary care facilities in Barbados were retrospectively audited over a four-year period from January 1, 2014 to December 31, 2018 to identify patients who underwent operative treatment for CRC. The following data were extracted: Age, sex, ethnicity, the location of the primary tumour and tumour stage. Descriptive statistical analyses were generated using SPSS version 21.0. The results revealed that there were 97 patients with CRC at a mean age of 64.9 years (SD ±12.2) and a male preponderance (1.3:1). The majority (93.8%) were from the African diaspora. Only 18.5% of diagnoses were made at (opportunistic) screening. Consequently, two thirds of the patients had advanced-stage disease at diagnosis. The disease staging of the patients was as follows: Stage 0 (1%), stage I (10.3%), stage II (23.7%), stage III (38.1%) and stage IV (26.8%). Right-sided primary tumours were most common (44.3%), followed by left-sided (41.2%) and rectal lesions (14.4%). Women were significantly more likely to have right-sided lesions (55 vs. 45%) and males were more likely to have rectal lesions (77 vs. 23%). On the whole, the present study highlights the need to implement a national screening programme in this high-risk population of African origin with a predominantly right-sided distribution of CRC primary tumours. This is reinforced by the fact that 10% of patients will be diagnosed before the age of 50 years with more aggressive disease.
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Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05-0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was -0.02 (with a 95% CI between -0.04 and -0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.
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OBJECTIVES: Serrated polyps, which are considered to be precursors of colorectal carcinoma, include hyperplastic polyps, sessile serrated adenomas and traditional serrated adenomas. With the exception of hyperplastic polyps, all of these lesions must be removed. This study sought to examine whether underwater endoscopic mucosal resection is a safe and effective technique for treating serrated polyps. METHODS: Cases in which patients were submitted for underwater endoscopic mucosal resection and histologically diagnosed with sessile serrated adenoma were prospectively registered. RESULTS: The median patient age was 54.5 years (range, 48 to 72 years), and the patients included 4 men (28.5%) and 10 women (71.5%). One lesion (6.2%), 10 lesions (62.5%), 1 lesion (6.2%), 3 lesions (18.8%) and 1 lesion (6.2%) were found in the cecum, the ascending colon, the hepatic flexure, the transverse colon and the descending colon, respectively. The median lesion size was 20 mm (range, 10 to 35 mm). Eight lesions (50%) were removed en bloc, and the remaining eight lesions (50%) were removed using a piecemeal technique. None of the cases were complicated by perforation or delayed bleeding. CONCLUSION: Underwater resection could be a feasible, safe and effective alternative for the resection of sessile serrated adenomas.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/cirurgia , Pólipos do Colo/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Colorretais/patologia , Pólipos do Colo/patologia , Estudos Prospectivos , Colonoscopia , Detecção Precoce de CâncerRESUMO
INTRODUCTION: Hispanics in New Mexico are diagnosed with more later-stage colorectal cancer (CRC) than non-Hispanic Whites (NHW). Our study evaluated the interaction of race/ethnicity and risk factors for later-stage III and IV CRC among patients in New Mexico. METHOD: CRC patients ages 30 to 75 years ( n = 163, 46% Hispanic) completed a survey on key explanatory clinical, lifestyle, preventive health, and demographic variables for CRC risk. Adjusted logistic regression models examined whether these variables differentially contributed to later-stage CRC among NHW versus Hispanics. RESULTS: Compared with NHW, Hispanics had a higher prevalence of later-stage CRC ( p = .007), diabetes ( p = .006), high alcohol consumption ( p = .002), low education ( p = .003), and CRC diagnosis due to symptoms ( p = .06). Compared with NHW, Hispanics reporting high alcohol consumption (odds ratio [OR] = 7.59; 95% confidence interval [CI] = 1.31-43.92), lower education (OR = 3.5; 95% CI = 1.28-9.65), being nondiabetic (OR = 3.23; 95% CI = 1.46-7.15), or ever smokers (OR = 2.4; 95% CI = 1.03-5.89) were at higher risk for late-stage CRC. Adjusting for CRC screening did not change the direction or intensity of the odds ratios. CONCLUSION: The ethnicity-risk factor interactions, identified for late-stage CRC, highlight significant factors for targeted intervention strategies aimed at reducing the burden of later-stage CRC among Hispanics in New Mexico with broad applicability to other Hispanic populations.
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Neoplasias Colorretais/etnologia , Disparidades nos Níveis de Saúde , Hispânico ou Latino , População Branca , Adulto , Idoso , Consumo de Bebidas Alcoólicas , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Diabetes Mellitus , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , New Mexico/epidemiologia , Razão de Chances , Fatores de Risco , FumarRESUMO
RESUMEN La endometriosis es una enfermedad benigna definida como la implantación y proliferación extrauterinas de tejido similar al endometrio (glandular y estroma), lo que causa una respuesta inflamatoria crónica y adherencias que distorsionan la anatomía. El compromiso extragonadal es raro, pero los informes de endometriosis intestinal han aumentado de forma sustancial; los sitios afectados principalmente son el colon sigmoides y el recto; el compromiso aislado del ciego es raro y lo es aún más en una mujer posmenopáusica sin uso de terapia de reemplazo hormonal. Presentamos el caso de una mujer posmenopáusica con una obstrucción intestinal sugestiva quirúrgicamente de neoplasia del ciego, pero cuyo examen patológico reveló endometriosis.
SUMMARY Endometriosis is a benign disease defined as the extra-uterine implantation and proliferation of tissue similar to endometrium (glands and stroma), causing a chronic inflammatory response and adhesions that distort anatomy. The extra-gonadal involvement is rare, but reports of intestinal endometriosis have increased substantially, mainly affecting the sigmoid colon and rectum; isolated involvement of the cecum is rare, even more so in a postmenopausal woman without use of hormone replacement therapy. We report the case of a postmenopausal woman with intestinal obstruction surgically suggestive of malignancy; however, pathological examination revealed endometriosis.
RESUMO Endometriose no ceco de uma mulher pósmenopáusica. Reporte do caso e revisão da literatura A endometriose é uma doença benigna definida como a implantação e proliferação extrauterinas de tecido similar ao endométrio (glandular e estroma), o que causa uma resposta inflamatória crónica e aderências que distorciam a anatomia. O compromisso extragonadal es raro, mas os relatórios de endometriose intestinal há aumentado de forma substancial; os lugares afetados principalmente são o colón sigmoides e o ânus; o compromisso isolado do ceco é raro e ainda mais numa mulher pós-menopáusica sem uso de terapia de substituição hormonal. Apresentamos o caso de uma mulher pós-menopáusica com uma obstrução intestinal sugestiva cirurgicamente de neoplasia do ciego, mas cujo exame patológico revelou endometriose.
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Humanos , Feminino , Pessoa de Meia-Idade , Doenças do Ceco , Pós-Menopausa , Endometriose , Neoplasias ColorretaisRESUMO
As neoplasias colorretais (pólipos e câncer) são na maioria das vezes diagnosticadas e em algumas ocasiões ressecadas endoscopicamente, fato que mostra claramente a importância da detecção precoce através de programas de rastreio adequados que são capazes de mudar o prognostico da doença. O objetivo do presente estudo se baseia em analisar as indicações e os achados de exames colonoscópicos realizados pelo Serviço de Coloproctologia do Hospital Universitário da Universidade Federal de Santa Catarina. Estudo transversal que avaliou 1271 prontuários de pacientes submetidos à colonoscopia entre os anos de 2003 à 2014 no HU-UFSC. Dados foram obtidos através da aplicação de instrumento de coleta de dados elaborado pelo autor. Foram excluídos pacientes com impossibilidade de acesso aos laudos anatomopatológicos. Os resultados foram avaliados descritivamente e após, foram utilizados testes de associação. O sexo masculino representou 69,3% dos participantes, 63,49% com a idade superior a 50 anos, a alteração do hábito intestinal representou 15,8% das indicações, e os pólipos 33,1% dos achados colonoscópios. 17,2% dos pólipos apresentavam tamanho entre 0-0,5cm, e 8,4% estavam no sigmoide. A hemorragia digestiva baixa (HDB) apresentou maior prevalência em pacientes menores de 50 anos com 20,58%, e a alteração do hábito intestinal nos pacientes maiores de 50 anos com 16,9%. O pólipo adenomatoso tubular representou 9,5% das neoplasias. A prevalência de neoplasias foi maior nos pacientes sintomáticos com idade superior a 50 anos.
Colorrectal neoplasm (polyps and cancer), can evidently be detected and resected before its malignancy and spread, a fact expressly shows the importance of early detection through screening programs that are able to change the disease's prognosis. Analyze the indications and findings of colonoscopy performed by Unit of Coloproctology, University Hospital, Federal University of Santa Catarina. Cross-sectional study that evaluated medical records of 1271 patients who underwent colonoscopy between 2003 to 2014 at HU-UFSC. Data were obtained by applying a data collection instrument developed by the authors. Patients whit inaccessibility of pathological reports were excluded. Data were analyzed descriptively and after tests of association were used. Males represented 69,3%, 63,49% age over 50 years, change in intestinal habit represented 15,8% and polyps was 33,1% found colonoscopies. 17,2% of polyps had size between 0-0,5cm and 8,4% were localized on sigmoid. Lower gastrointestinal bleeding had higher prevalence in patients under 50 years with 20,58% and change in intestinal habit in patients older than 50 years with 16,9%. The tubular adenomatous polyp represented 9.5% of neoplasms. The prevalence of neoplasm was higher in symptomatic patients older than 50 years.
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BACKGROUND AND AIM: Several studies suggest that non-polypoid lesions (NPL) show higher aggressiveness than polypoid lesions, particularly depressed lesions. The present study aimed to assess the prevalence of NPL and the presence of advanced histology in a Brazilian population. METHODS: Two thousand and sixty-seven superficial neoplastic lesions diagnosed in 1135 patients were analyzed. Lesions were classified as polypoid and non-polypoid (flat and depressed) types, and evaluated for site, size, and histology (adenoma with grade of dysplasia, or early cancer). RESULTS: Prevalence of NPL was 46.5%. NPL predominated in the right colon (62.9%), whereas polypoid lesions were detected mainly in the left colon (53.2%) (P < 0.001). NPL had a 34% higher probability of occurring in the right colon than polypoid lesions (P < 0.001). NPL were smaller than polypoid lesions (P = 0.03). There were 208 lesions >10 mm, of which 40 (19.2%) had advanced histology: 13% (18/138) of polypoid lesions; 27.3% (18/66) of flat lesions; and 100% (4/4) of depressed lesions (P < 0.001). Among 1859 neoplasms ≤10 mm, only 18 (1%) had advanced histology, and 15 of them were depressed lesions (P < 0.001). Advanced histology was more commonly detected in NPL than in polypoid lesions (P = 0.007), with significant difference in size (P < 0.001). NPL showed more advanced histology than polypoid lesions (OR 2.06; P = 0.01), especially depressed lesions (OR 36.35; P < 0.001). Among all neoplasms, the prevalence of depressed lesions was 2.2%. CONCLUSION: NPL showed high prevalence and higher aggressiveness than polypoid lesions, especially the depressed type.
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Adenoma/epidemiologia , Adenoma/patologia , Colonoscopia/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Pólipos do Colo/epidemiologia , Pólipos do Colo/patologia , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Retrospectivos , Distribuição por SexoRESUMO
BACKGROUND: The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. AIM: To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. METHOD: Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. RESULTS: The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. CONCLUSION: The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer. .
RACIONAL: O câncer de reto é o agravo mais frequente para a indicação do estoma abdominal definitivo. Apesar dos avanços no tratamento cirúrgico, a amputação abdominoperineal ainda é a operação indicada mais efetiva nesta indicação com invasão de esfíncter e de canal anal, o que impõe aos pacientes colostomia abdominal definitiva, condição que altera a imagem corporal e grande repercussão na qualidade de vida. OBJETIVO: Avaliar a técnica de amputação abdominoperineal mais colostomia perineal com irrigação como alternativa à colostomia abdominal definitiva. MÉTODO: Análise retrospectiva de prontuário médico de cinquenta e cinco pacientes submetidos à amputação abdominoperineal do reto mais colostomia perineal no período de 1989 a 2010. RESULTADOS: A média de idade foi de 58 anos sendo 40% em homens e 60% em mulheres. Em 94,5% dos pacientes a indicação cirúrgica foi por câncer de reto. Em alguns foram confeccionadas três válvulas, em outros duas e nos demais não foi confeccionada nenhuma válvula. As complicações foram: prolapso mucoso, necrose do segmento abaixado e estenose. CONCLUSÃO: A técnica de amputação abdominoperineal mais colostomia perineal é boa opção terapêutica no arsenal do tratamento cirúrgico do câncer de reto. .
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colostomia/métodos , Doença de Crohn/cirurgia , Períneo/cirurgia , Neoplasias Retais/cirurgia , Abdome , Estudos Retrospectivos , Resultado do TratamentoRESUMO
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 ...
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma/patologia , Colonografia Tomográfica Computadorizada/métodos , Neoplasias Colorretais/patologia , Brasil , Colectomia/métodos , Colo/patologia , Pólipos do Colo/patologia , Colonoscopia/métodos , Hospitais Universitários , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Reto/patologia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. OBJECTIVE: To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. METHODS: This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. RESULTS: A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). CONCLUSIONS: Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.
Antecedentes: la cirugía laparoscópica para tratar pacientes con cáncer colorrectal ha sido ampliamente aceptada y difundida en todo el mundo. Sin embargo, dependiendo de la experiencia en este abordaje los resultados quirúrgicos y oncológicos a corto plazo pueden variar. En nuestra población existen pocos estudios que comparan los resultados de esta técnica con los de la cirugía abierta. Objetivos: determinar la superioridad de la técnica laparoscópica o abierta en cirugía de cáncer colorrectal. Material y métodos: estudio retrospectivo y comparativo de pacientes operados con técnica abierta o laparoscópica por cáncer de colon y recto entre 1999 y 2011 en nuestro centro. Resultados: se incluyeron 47 pacientes intervenidos de manera convencional y 35 por laparoscopia. El tiempo operatorio fue menor en el grupo de cirugía abierta (p= 0.008). No se encontraron diferencias en: sangrado intraoperatorio (p= 0.3980), número de ganglios resecados (p= 0.27), inicio de la vía oral (p= 0.31), tiempo de estancia hospitalaria (p= 0.12), y dolor referido por el paciente (p= 0.19). En el grupo de cirugía laparoscópica se requirieron menos dosis de analgésicos (p= 0.04) y menor necesidad de catéter epidural para analgesia postoperatoria (p= 0.01). Las tasas de morbilidad (p= 0.44) y mortalidad (p= 0.39) fueron similares en ambos grupos. Conclusiones: la cirugía laparoscópica es equiparable a la técnica abierta en cuanto a estándares oncológicos y resultados técnicos. Este trabajo demuestra que en nuestro hospital la cirugía laparoscópica en pacientes con cáncer de colon y recto es tan segura como la cirugía abierta.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia Epidural/estatística & dados numéricos , Analgésicos/uso terapêutico , Perda Sanguínea Cirúrgica , Tumor Carcinoide/cirurgia , Colectomia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/mortalidade , Laparoscopia/estatística & dados numéricos , Laparotomia/mortalidade , Laparotomia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Suspeita-se da Síndrome de Lynch (SL) a partir da história pessoal e familial do indivíduo. Posteriormente, os dados histopatológicos, imuno-histoquímicos e moleculares podem ser utilizados para aprimorar o diagnóstico da doença. Entretanto, um grande desafio no diagnóstico da Síndrome de Lynch é a baixa acurácia dos critérios clínicos utilizados. OBJETIVOS: Avaliar a frequência de SL em pacientes submetidos a tratamento cirúrgico por câncer colorretal e com história familial de câncer. Avaliar quais dos critérios clínicos e/ou moleculares seriam mais informativos no diagnóstico desta Síndrome na população brasileira. PACIENTES E MÉTODOS: Estudaram-se 458 casos de câncer colorretal (CCR), do Serviço de Coloproctologia do Departamento de Gastroenterologia do Hospital das Clínicas - FMUSP, de janeiro de 2005 a dezembro de 2008. História familial (HF) positiva para CCR ocorreu em 118 pacientes. Promoveu-se a revisão das lâminas para critérios histopatológicos de MSI (diretrizes de Bethesda), avaliação imuno-histoquímica (IHC) para as proteínas MLH1, MSH2, MSH6, PMS2, através do complexo avidina-biotina-peroxidase e instabilidade de microssatélites (MSI) (BAT-25, BAT-26, NR-21, NR-24 e MONO-27). Realizada a análise da mutação somática para o BRAF em todos os casos com MSI positiva. RESULTADOS: Dos 118 pacientes com HF, 61 (51,69%) preencheram pelo menos um dos critérios de Bethesda revisados. 36 eram do sexo feminino (59%), média de idade de 53,2 anos. Nove (14,7%) pacientes apresentaram todos os critérios de Amsterdam I. Cinquenta e dois tumores localizaram-se no cólon esquerdo. Os componentes histopatológicos de MSI incluíram: linfócitos intratumoral (47,5%), característica expansiva do tumor (29,5%) e o componente mucinoso (27,8%) (componentes histopatológicos de MSI instável) em 44 (72%). A IHC estava alterada em oito (13%) e a MSI em 12 pacientes (20%). Houve associação entre os critérios de Amsterdam I e MSI e na IHC com MLH1 e PMS2. Houve associação entre...
Lynch Syndrome is suspected due to the personal and familial history of the individual. Subsequently, histopathological, immunohistochemical and molecular data can be used to improve diagnosis of the disease. However, a major challenge in the diagnosis of Lynch Syndrome is the low accuracy of clinical criteria. OBJECTIVES: To assess the frequency of Lynch Syndrome in patients with familial cancer history submitted to colorectal cancer resection. To assess what clinical and / or molecular criteria would be the most informative in the diagnosis of this syndrome in Brazilian population. PATIENTS AND METHODS: 458 colorectal cancer (CRC) cases were studied, from the Coloproctology Unit of the Department of Gastroenterology, Hospital das Clinicas - USP, from January 2005 to December 2008. Positive family history (FH) for CRC occurred in 118 patients. The pathologic slides were reviewed for histological criteria for MSI (Bethesda guidelines), immunohistochemical analysis (IHC) for MLH1, MSH2, MSH6, PMS2 proteins, through the avidin-biotin-peroxidase complex, and microsatellite instability (MSI) (BAT-25, BAT-26, NR-21, NR-24 and MONO-27). BRAF somatic mutation was analyzed in all cases with positive MSI. RESULTS: Of the 118 patients with HF, 61 (51.69%) met at least one of the revised Bethesda criteria. Thirty-six were female (59%), and the mean age was 53.2 years. Nine (14.7%) patients presented all Amsterdam criteria I. Fifty-two tumors were located in the left colon. MSI histopathological components included: intratumoral lymphocytes (47.5%), expansive characteristics of the tumor (29.5%) and mucinous component (27.8%) (Histological unstable components of MSI) in 44 (72%). IHC was abnormal in eight (13%) and MSI in 12 patients (20%). There was an association between the Amsterdam criteria I and MSI; and between IHC with MLH1 and PMS2. There was an association with the revised Bethesda criteria with: sex, mucinous histology and Crohn's like...
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Neoplasias Colorretais , Neoplasias Colorretais Hereditárias sem Polipose , Imuno-Histoquímica , Instabilidade de Microssatélites , Guias de Prática Clínica como Assunto , Proteínas Proto-Oncogênicas B-rafRESUMO
Objetivos: Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon metastásico a quienes se les administró bevacizumab en el Instituto Nacional de Cancerología (INC). Métodos: Se revisaron 38 historias clínicas de pacientes atendidos en la consulta de Oncología Clínica del INC con diagnóstico de cáncer colorrectal metastásico entre 2010 y 2011. Resultados: La edad promedio de los pacientes que recibieron bevacizumab fue de 57 años; los principales sitios de metástasis fueron el hígado y el peritoneo. Los esquemas de quimioterapia utilizados más a menudo con bevacizumab fueron 5 fluoruracilo/leucovorina y FOLFOX. En relación con los eventos adversos por el uso de bevacizumab, este fue, en general, bien tolerado; la supervivencia mediana global de los pacientes tratados con bevacizumab fue de 17,5 meses. Conclusiones: Esta serie de casos describe las características generales de pacientes en la consulta externa del INC con cáncer colorrectal metastásico, los cuales tuvieron una buena adherencia al tratamiento con bevacizumab, y su uso estuvo asociado a una baja toxicidad con los diferentes esquemas de quimioterapia utilizados en cáncer colorrectal metastásico.
Objectives: To describe the clinical and epidemiolgical features of patients with metastatic colon cancer treated with bevacizumab at the National Cancer Institute of Colombia (NCI). Methods: Review was undertaken on 38 clinical cases of patients diagnosed for metastatic colorectal cancer and treated at the NCI Oncology Clinic from 2010 to 2011. Results: Median patient age when treated with bevacizumab was 57 years; most frequent metastatic sites were the liver and peritoneum. Most commonly used chemotherapy regimen with bevacizumab included 5 fluoruracil/leucovorin and FOLFOX. Bevacizumab was generally well tolerated, with few adverse events reported; median survival rate for patients treated with bevacizumab was 17.5 months. Conclusions: Analysis on this series of medical cases describes the general characteristics of patients treated at the NCI for metastatic colorrectal cancer whose favorable adherence to treatment with bevacizumab was linked to the low toxicity of diverse chemotherapy regimens used for metastatic colorectal cancer.