RESUMO

BACKGROUND: Primary tumor sidedness (PTS) is an independent prognostic factor in patients with metastatic colorectal cancer (CRC), with a worse prognosis for right-sided tumors. There are limited data on the prognostic impact of PTS in stage III CRC. The main objective of this study was to analyze the prognostic impact of PTS in stage III CRC. PATIENTS AND METHODS: A retrospective and uni-institutional cohort study was performed in an oncology reference center. Patients with stage III CRC treated with a 5-fluorouracil and oxaliplatin-based chemotherapy regimen (mFLOX regimen) from October 2007 to February 2013 were included. The primary outcome was the probability of overall survival (OS) at 5 years stratified by PTS. Secondary outcomes were the probability of disease-free survival (DFS) at 5 years and an analysis of the prognostic impact of clinical and molecular biomarkers. Kaplan‒Meier curves were used, and Cox models were used to evaluate prognostic factors associated with OS and DFS. RESULTS: Overall, 265 patients were evaluated. Transverse colon tumors, multicentric tumors, and undetermined primary subsites were excluded, resulting in 234 patients classified according to PTS: 95 with right sidedness (40.6%) and 139 with left sidedness (59.4%). The median follow-up time was 66 months [interquartile range (IQR): 39-81]. The 5-year OS probabilities for right-sided and left-sided tumors were 67% (95% CI: 58%-77%) and 82% (75%-89%), respectively [hazard ratio (HR): 2.02, 95% CI: 1.18-3.46; P = .010]. The 5-year probabilities of DFS for right-sided and left-sided tumors were 58% (49%-69%) and 65% (58%-74%), respectively (HR: 1.29, 0.84-1.97; P = 0.248). CONCLUSION: These data suggest that there may be a worse prognosis (inferior OS at 5 years) for resected right-sided stage III CRC patients treated in the real world. However, these data need to be confirmed by prospective studies with a larger number of participants.

Assuntos

RESUMO

Intestinal lipomas can occur anywhere in the gastrointestinal tract, and these tumors are more frequent in the colon. By being largely asymptomatic, colonic lipomas are usually found incidentally, as findings in colonoscopy examinations, in association with biopsy. Endoscopic or surgical resection is the therapeutic option, depending on the size of the tumor, its location, and the presence or absence of symptoms. In this study, we present a case of a 59-year old woman, with a descending colon lipoma histologically diagnosed only after surgical resection of the lesion. The approach was adopted according to the patient's clinical picture (intestinal bleeding, vomiting and weight loss), in addition to the occlusion of 80% of the colonic lumen observed in a colonoscopy.

Os lipomas intestinais podem ocorrer em qualquer parte do trato gastrointestinal, sendo mais frequente no cólon. Por serem em grande parte assintomáticos, os lipomas colônicos são usualmente encontrados acidentalmente como achados de exame de colonoscopia associada à biópsia. Como opções de tratamento, há a ressecção endoscópica ou cirúrgica, a depender do tamanho do tumor, sua localização e presença (ou não) de sintomas. Nesse relato, é apresentado um caso de uma mulher de 59 anos com lipoma de cólon descendente, diagnosticado histologicamente apenas após ressecção cirúrgica da lesão. A conduta foi adotada pelo quadro clínico de enterorragia, vômitos e perda ponderal, além da oclusão de 80% da luz do cólon observada em exame de colonoscopia.

Assuntos

RESUMO

The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Signet ring cell histology represents ~1% of colon adenocarcinomas and is associated with young patients and a poor clinical outcome. The present study describes a case of descending colo-colonic intussusception caused by signet ring cell carcinoma in a 27-year-old male. The patient presented with a history of intermittent left upper-quadrant abdominal pain for more than six months without any evident etiology. A computed tomography scan of the abdomen revealed left-sided colo-colonic intussusception. Upon laparotomy, a left hemicolectomy was performed according to intraoperative frozen-section pathology. Post-operative pathological evaluation revealed signet ring cell carcinoma invasion of the serosa, and 31.8% (7/22) of the regional lymph nodes were positive for cancerous cells. The post-operative course was uneventful and the patient was discharged on the tenth post-operative day.

RESUMO

Foi realizado estudo morfométrico do cólon descendente de 15 eqüinos hígidos, nove fêmeas e seis machos, submetidos a enterorrafias aposicionais com fio de poliglactina 910 ou com cianoacrilato. Os animais foram distribuídos aleatoriamente em cinco grupos de três animais cada e sacrificados aos três, sete, 14, 35 e 70 dias de pós-operatório para colheita dos segmentos intestinais operados e posterior processamento histológico de rotina. A análise morfométrica foi feita em microscópio óptico adaptado a um sistema de análise de imagens, onde se quantificou o infiltrado inflamatório, mediante contagens de neutrófilos, eosinófilos, macrófagos, linfócitos e plasmócitos, não sendo observadas diferenças (P>0,05) entre as enterorrafias. Houve diferenças significativas entre os dias de pós-operatório para as contagens de neutrófilos, eosinófilos, macrófagos e linfócitos. Também se mensuraram as espessuras das regiões operadas (cicatriz) e das áreas contíguas não operadas (controle), registrando-se diferenças entre os dias de pós-operatório e as regiões (P<0,05), mas não entre as enterorrafias. O fio de poliglactina 910 e o cianoacrilato apresentam a mesma eficácia para serem usados em enterorrafias aposicionais do cólon descendente de eqüinos.(AU)

A morphometric study was carried out in descending colon of 15 healthy horses, nine females and six males, submitted to appositional suture techniques with polyglactin 910 or with cyanoacrilate. The animals were randomly distributed in five groups of three animals each and sacrificed on postoperative days 3, 7, 14, 35 or 70 in order to collect the operated intestinal segments. The morphometric evaluation was done with an optic microscope adapted to an image analysis system, where was counted the inflammatory infiltrated, through neutrophils, eosinophils, macrophages, lymphocytes and plasmacytes counting. No difference (P>0.05) was observed between the two suture techniques. There were significant differences between postoperative days related to the counting of neutrophils, eosinophils, macrophages and lymphocytes. It was also measured the thickness of operated regions (scar) and non operated nearby areas (control); it registered differences between the postoperative days and the regions (P<0.05), but not between the sutures. The polyglactin 910 and the cyanoacrilate showed the same efficacy to be used in appositional enterorrhaphies in equine descending colon.(AU)

Assuntos

RESUMO

We studied the effects of a severely hypoproteic diet on the quantitative aspects of the myenteric plexus of the descending colon of young rats. Eighteen rats were divided into two groups, one of them being fed with a chow having 26% protein (control) and the other with a chow having 4% protein, balanced for minerals and vitamins, during 12 weeks. The whole-mounts of the descending colon had their myenteric neurons stained either with Giemsa or NADPH diaphorase. The rats from the experimental group had deficits of body weight (54.23%) and area of the descending colon (48.14%); additionally, we observed that there was no alteration in the total number of neurons of the colon, but a decrease in the number of NADPH-diaphorase positive neurons (37.80%). The implications of these results concerning the priority that some cellular types may have when nutrients are less available are discussed.

Estudiamos los efectos crónicos de una dieta severamente hipoproteica sobre los aspectos cuantitativos del plexo mientérico del colon descendente de ratones jóvenes. 18 ratones fueron divididos en dos grupos, a uno de estos grupos se le dió ración con contenido proteico del 26% (control) y al otro, ración con contenido proteico del 4%. Se mantuvo el balance vitamínico y mineral, durante 12 semanas. Elaboramos los preparados de membrana del colon descendente y marcamos las neuronas del plexo mientérico con Giemsa y NADPH-diaforasa. Los ratones del grupo experimental presentaron déficit de peso corporal (54,23%) y del área del colon descendente (48,14%); además, observamos que no hubo alteración en el número total de neuronas en todo el colon; sin embargo, hubo una disminución en la marcación de neuronas NADPH-diaforasa positivas (37,80%). Los resultados son discutidos, respecto a la prioridad que ciertos tipos celulares pudiesen tener, con la menor disponibilidad de nutrientes.

Assuntos

RESUMO

Morphometrical study was performed to compare the healing process of the descending colon in horses, submitted to two distinctive enterorrhaphies, appositional and inverting patterns. Fifteen healthy horses were used. Surgical intervention was accomplished in the left flank, under inalatory anesthesia. The enterotomies were done in the antimesenteric teniae of descending colon and, the enterorrhaphies, with polyglactin 910 number 0. The horses were randomly distributed in five groups of three animals each, submitted to euthanasia on postoperative period of three, seven, 14, 21 and 35 days and, intestinal segments were removed for morphometric evaluation. Using an image analysis system the numbers of neutrophils, mononuclears and eosinophils were count around of suture material in the two enterorrhaphies. There was difference (P = 0.05) among enterorrhaphies in the neutrophils count, were was increased in the appositional pattern. Mononuclears count showed difference (P = 0.01) in the interaction among the postoperative days and enterorrhaphies. No differences (P > 0.05) were observed in eosinophils count. It was concluded that the inflammation was lesser in the inverting enterorrhaphy, being the preferential option for use in this organ.

A pesquisa foi conduzida com o objetivo de comparar duas técnicas de enterorrafias no cólon descendente de eqüinos, uma aposicional e outra invaginante, utilizando-se de avaliações morfométricas. As intervenções cirúrgicas foram executadas em 15 eqüinos adultos sadios, pelo flanco esquerdo, sob anestesia geral inalatória. As enterotomias foram realizadas na tênia antimesentérica do cólon descendente e as enterorrafias foram feitas com fio de poliglactina 910 n° 0. Os eqüinos foram distribuídos aleatoriamente em cinco grupos de três animais cada e submetidos à eutanásia aos três, sete, 14, 21 e 35 dias de pós-operatório para colheita de segmentos intestinais dos locais das enterorrafias para análise morfométrica. Com o auxílio de analisador de imagens, foram contados os números de neutrófilos, células mononucleares e eosinófilos ao redor do fio de sutura. Na contagem de neutrófilos, houve diferença (P = 0,05) entre as enterorrafias, com maior número na aposicional. Quanto aos mononucleares, observou-se diferença (P = 0,01) na interação entre os dias de pós-operatório e as enterorrafias. Não foram observadas diferenças (P > 0,05) na contagem de eosinófilos. Concluiu-se que a enterorrafia invaginante causou reação inflamatória de menor intensidade que a aposicional, sendo a opção preferencial para uso neste órgão.

RESUMO

Morphometrical study was performed to compare the healing process of the descending colon in horses, submitted to two distinctive enterorrhaphies, appositional and inverting patterns. Fifteen healthy horses were used. Surgical intervention was accomplished in the left flank, under inalatory anesthesia. The enterotomies were done in the antimesenteric teniae of descending colon and, the enterorrhaphies, with polyglactin 910 number 0. The horses were randomly distributed in five groups of three animals each, submitted to euthanasia on postoperative period of three, seven, 14, 21 and 35 days and, intestinal segments were removed for morphometric evaluation. Using an image analysis system the numbers of neutrophils, mononuclears and eosinophils were count around of suture material in the two enterorrhaphies. There was difference (P = 0.05) among enterorrhaphies in the neutrophils count, were was increased in the appositional pattern. Mononuclears count showed difference (P = 0.01) in the interaction among the postoperative days and enterorrhaphies. No differences (P > 0.05) were observed in eosinophils count. It was concluded that the inflammation was lesser in the inverting enterorrhaphy, being the preferential option for use in this organ.

A pesquisa foi conduzida com o objetivo de comparar duas técnicas de enterorrafias no cólon descendente de eqüinos, uma aposicional e outra invaginante, utilizando-se de avaliações morfométricas. As intervenções cirúrgicas foram executadas em 15 eqüinos adultos sadios, pelo flanco esquerdo, sob anestesia geral inalatória. As enterotomias foram realizadas na tênia antimesentérica do cólon descendente e as enterorrafias foram feitas com fio de poliglactina 910 n° 0. Os eqüinos foram distribuídos aleatoriamente em cinco grupos de três animais cada e submetidos à eutanásia aos três, sete, 14, 21 e 35 dias de pós-operatório para colheita de segmentos intestinais dos locais das enterorrafias para análise morfométrica. Com o auxílio de analisador de imagens, foram contados os números de neutrófilos, células mononucleares e eosinófilos ao redor do fio de sutura. Na contagem de neutrófilos, houve diferença (P = 0,05) entre as enterorrafias, com maior número na aposicional. Quanto aos mononucleares, observou-se diferença (P = 0,01) na interação entre os dias de pós-operatório e as enterorrafias. Não foram observadas diferenças (P > 0,05) na contagem de eosinófilos. Concluiu-se que a enterorrafia invaginante causou reação inflamatória de menor intensidade que a aposicional, sendo a opção preferencial para uso neste órgão.

RESUMO

The descending colon enterotomies in horses are necessary to remove enteroliths, foreign body and impacted material that can not be removed with conservative technique. This intestinal segment has a poor blood supply and the predisposition to post operation complications related to bacterium contamination. This trial was conducted in order to evaluate, clinically and anatomopathologically, the use of tissue adhesive of cyanoacrilate in the equine descending colon and to compare with an apposition pattern. Fifteen horses were used. Surgical intervention was done using laparotomy by the left flank, with the animals in right lateral recumbent position, under inhaler anesthesia. After exteriorization of the descending colon, two five-centimeter-long enterotomies were done, 20cm apart one from the other. The horses were randomly distributed in five groups of three animals each. After human methods of euthanasia, necropsy was done with complete examination and documentation of sutured areas of the descending colon on post operation (days 3,7,14,35 and 70), one group at each time. The butyl-2-cyanoacrilate and the suture thread poliglactin 910 both showed that they are appropriate to be used in enterorrhaphies of this organ. The suture thread poliglactin 910 caused more intense initial inflamation compared to the cyanoacrilate, and later, both caused granulomatous inflammatory of the sort of foreign body. This was observed, firstly, in the suture thread poliglactin 910 (on day seven) and starting from the day 35 around cyanoacrilate.

Em eqüinos, as enterotomias no cólon descendente são necessárias para remover enterólitos, corpos estranhos e material alimentar compactado que não podem ser removidos por técnicas conservativas. Este segmento intestinal possui um suprimento sangüíneo pobre, além de predisposição a complicações pós-operatórias relacionadas à contaminação bacteriana. Assim, este estudo foi conduzido com o objetivo de efetuar avaliações clínicas e anatomopatológicas do emprego de adesivo tecidual à base de cianoacrilato no cólon descendente de eqüinos, comparando-o a uma técnica de sutura aposicional convencional. A intervenção cirúrgica foi realizada em 15 animais posicionados em decúbito lateral direito, através de laparotomia pelo flanco esquerdo, sob anestesia geral inalatória. Após a exteriorização do cólon descendente, foram realizadas duas enterotomias de cinco centímetros de extensão cada, distanciadas 20cm uma da outra. Os animais foram aleatoriamente distribuídos em cinco tempos de observação de três animais cada e sacrificados aos três, sete, 14, 35 e 70 dias de pós-operatório. O adesivo butil-2-cianoacrilato e o fio de poliglactina 910 mostraram-se igualmente apropriados para uso em enterorrafias desse órgão, sendo que o fio de poliglactina 910 provocou inflamação inicial mais intensa que o cianoacrilato e, mais tardiamente, ambos causaram inflamação granulomatosa do tipo corpo estranho observada, primeiramente, junto ao fio de poliglactina 910 (7º dia) e, a partir do 35º dia, ao redor do cianoacrilato.

RESUMO

The descending colon enterotomies in horses are necessary to remove enteroliths, foreign body and impacted material that can not be removed with conservative technique. This intestinal segment has a poor blood supply and the predisposition to post operation complications related to bacterium contamination. This trial was conducted in order to evaluate, clinically and anatomopathologically, the use of tissue adhesive of cyanoacrilate in the equine descending colon and to compare with an apposition pattern. Fifteen horses were used. Surgical intervention was done using laparotomy by the left flank, with the animals in right lateral recumbent position, under inhaler anesthesia. After exteriorization of the descending colon, two five-centimeter-long enterotomies were done, 20cm apart one from the other. The horses were randomly distributed in five groups of three animals each. After human methods of euthanasia, necropsy was done with complete examination and documentation of sutured areas of the descending colon on post operation (days 3,7,14,35 and 70), one group at each time. The butyl-2-cyanoacrilate and the suture thread poliglactin 910 both showed that they are appropriate to be used in enterorrhaphies of this organ. The suture thread poliglactin 910 caused more intense initial inflamation compared to the cyanoacrilate, and later, both caused granulomatous inflammatory of the sort of foreign body. This was observed, firstly, in the suture thread poliglactin 910 (on day seven) and starting from the day 35 around cyanoacrilate.

Em eqüinos, as enterotomias no cólon descendente são necessárias para remover enterólitos, corpos estranhos e material alimentar compactado que não podem ser removidos por técnicas conservativas. Este segmento intestinal possui um suprimento sangüíneo pobre, além de predisposição a complicações pós-operatórias relacionadas à contaminação bacteriana. Assim, este estudo foi conduzido com o objetivo de efetuar avaliações clínicas e anatomopatológicas do emprego de adesivo tecidual à base de cianoacrilato no cólon descendente de eqüinos, comparando-o a uma técnica de sutura aposicional convencional. A intervenção cirúrgica foi realizada em 15 animais posicionados em decúbito lateral direito, através de laparotomia pelo flanco esquerdo, sob anestesia geral inalatória. Após a exteriorização do cólon descendente, foram realizadas duas enterotomias de cinco centímetros de extensão cada, distanciadas 20cm uma da outra. Os animais foram aleatoriamente distribuídos em cinco tempos de observação de três animais cada e sacrificados aos três, sete, 14, 35 e 70 dias de pós-operatório. O adesivo butil-2-cianoacrilato e o fio de poliglactina 910 mostraram-se igualmente apropriados para uso em enterorrafias desse órgão, sendo que o fio de poliglactina 910 provocou inflamação inicial mais intensa que o cianoacrilato e, mais tardiamente, ambos causaram inflamação granulomatosa do tipo corpo estranho observada, primeiramente, junto ao fio de poliglactina 910 (7º dia) e, a partir do 35º dia, ao redor do cianoacrilato.

RESUMO

This trial was carried out in order to compare the healing process of the descending colon in horses, submitted to two distinctive suture techniques - appositional pattern and inverting pattern. Fifteen healthy horses were used and the surgical intervention was accomplished with the animals in right lateral recumbency, under inhalatory anesthesia. The abdominal cavity approach was done by the left flank, and after exteriorization of the descending colon, two enterotomies, 5cm long, and 20cm apart one from each other were done. The horses were randomly distributed into five groups of three animals each. After a humane method of euthanasia, necropsies were performed with complete inspection and documentation of the sutured areas of the descending colon on postoperative days 3, 7, 14, 21, and 35, one group at each time. At necropsy, no alterations were noticed in abdominal cavity and organs although some adhesions were observed. In nine horses adhesions at the appositional pattern suture (60.0% ± 12.6) were found. Four horses presented adhesions at the inverting suture (26.6% ± 11.4). No signs of intestinal flow impairment were found. Regarding the histopathological findings, the majority of the wounds were almost completely healed on day seven after surgery. The suture thread poliglactin 910, used in both suture types, worked well during and after surgery, but it is believed that it was the cause of the observed granulomatous inflammatory reaction.

O estudo foi conduzido com o objetivo de comparar o processo cicatricial do cólon descendente de eqüinos, quando submetido a duas técnicas de sutura, uma em plano aposicional e outra em dois planos com invaginação. Foram utilizados 15 eqüinos sadios e a intervenção cirúrgica foi realizada com os animais em decúbito lateral direito, sob anestesia geral inalatória. O acesso à cavidade abdominal foi feito pelo flanco esquerdo, e após exteriorização do cólon descendente, realizaram-se duas enterotomias de 5cm de extensão cada, distanciadas 20cm uma da outra. Os animais foram aleatoriamente distribuídos em cinco grupos de três animais cada e sacrificados aos 3, 7, 14, 21 e 35 dias pós-operatório. O exame necroscópico revelou presença de aderências nos dois padrões de sutura. Em nove eqüinos foram observadas aderências no padrão de sutura aposicional (60,0% ± 12,6) e em quatro no padrão com invaginação (26,6 % ± 11,4). Não foi verificada interferência com o trânsito intestinal em nenhum paciente. O exame histopatológico revelou regeneração da camada mucosa a partir do sétimo dia de pós-operatório em ambos os tipos de sutura. O fio de poliglactina 910 empregado nas enterorrafias do cólon descendente se mostrou resistente, de fácil manuseio e com boa capacidade para manter os nós aplicados, causando moderada reação inflamatória do tipo granulomatosa.