Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.

Unusual finding after resection of rectal adenocarcinoma: report of two cases / Achado incomum após ressecção de adenocarcinoma do reto: relato de dois casos

Pelvic recurrence after resection of rectal adenocarcinoma is a feared complication and is associated with a worse prognosis and low resectability rates. The differential diagnosis is difficult, as biopsy is seldom performed preoperatively. We report two cases of desmoid pelvic tumor after resection of rectal adenocarcinoma. Therapeutic options and literature review are described.

O aparecimento de tumor pélvico após ressecção de adenocarcinoma de reto é complicação temida e está associado à pior prognóstico e baixos índices de ressecabilidade. O diagnóstico diferencial é difícil, pois o diagnóstico histológico usualmente não é realizado no pré-operatório. São relatados dois casos em que houve o aparecimento de tumor pélvico após a ressecção de adenocarcinoma de reto, com diagnóstico histológico de tumor desmóide. As condutas adotadas e revisão da literatura são descritas.

Chagasic megacolon and large bowel neoplasms: case series and literature review

There is a clear association between chagasic megaesophagus and the esophageal cancer. On the other hand, the association between chagasic megacolon and intestinal neoplasm is uncommon. There are only a few cases described in literature. We selected two cases of colorectal adenocarcinoma associated with adenoma from 2000 to 2011, which are added to the four patients already described by this group. The mean age of the patients, was 68.5 years. Both had been submitted to surgical resection of the neoplasm. Survival rates ranged and were directly related to tumor staging at the time of diagnosis. In this context, we report our case series and reviwed the corresponding literature, especially the clinical and epidemiological aspects of this rare association. (AU)

Há uma clara associação entre megaesôfago por doença de Chagas e o câncer esofágico. Ao contrário, tal relação, entre megacólon chagásico e neoplasias do intestino grosso é, reconhecidamente, incomum. Existem poucos casos relatados na literatura. Destacamos, entre 2000 e 2011, dois casos, sendo ambos adenocarcinomas colorretais e associados a adenomas, que se somam aos outros quatro já descritos por este grupo. A média de idade dos pacientes, foi de 68,5 anos. Todos foram submetidos à ressecção cirúrgica da neoplasia. A sobrevida foi variável e diretamente relacionada ao estádio do tumor no momento do diagnóstico. Dentro desse contexto, relatamos essa série de casos e revisamos a literatura correlata, com relação aos aspectos clínicos e epidemiológicos dessa rara associação. (AU)

Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica / Local recurrence of rectal cancer: surgical approach

A recidiva pélvica após ressecção cirúrgica do câncer do reto varia de 3 por cento a 35 por cento em cinco anos. A condição é de difícil manejo, sendo discutível o melhor tratamento. A radioterapia e quimioterapia podem ser utilizadas como métodos paliativos, e os melhores resultados podem ser conseguidos com a cirurgia radical. OBJETIVO: Avaliar os doentes que foram submetidos à cirurgia por recidiva pélvica no Hospital das Clínicas da Unicamp, pelo Grupo de Coloproctologia. CASUÍSTICA E MÉTODO: Entre 1999 e 2007, 26 doentes com recidiva pélvica após cirurgia para ressecção de câncer do reto foram avaliados. Dados clínicos, estadiamento oncológico, cirurgia realizada inicialmente, ressecabilidade cirúrgica da recidiva e seguimento foram analisados. RESULTADOS: A cirurgia inicial mais comum foi a retossigmoidectomia com anastomose colorretal (46,1 por cento). Cinco de 26 doentes apresentavam perfuração tumoral na primeira cirurgia. Linfonodos positivos foram encontrados em 53,8 por cento dos casos, e 69,2 por cento eram T3 ou T4. Com relação à abordagem da recidiva local, a principal cirurgia realizada foi amputação abdominoperineal do reto. A cirurgia foi considerada radical em 42,3 por cento dos 26 doentes. A ressecção do tumor foi possível em 65,4 por cento. O seguimento médio foi de 29,4 meses, com sobrevida global de 34,6 por cento. CONCLUSÃO: Aproximadamente dois terços dos casos com recidiva local puderam ser submetidos à ressecção visando cura, com melhora na sobrevida. Esta abordagem cirúrgica deve ser encorajada em hospitais que possuem grupos multidisciplinares especializados, para a melhora da qualidade de vida de doentes selecionados.

Local recurrence after rectal cancer resection varies between 3 to 35 percent in five years. The condition has difficult management, and little is known about the best treatment. Radiotherapy and chemotherapy can be used as paliative methods, and the best results are achieved with radical resection. PURPOSE: To evaluate patients submitted to surgery for pelvic recurrence by the Coloproctology Unit at Clinical Hospital of Unicamp. METHODS AND PATIENTS: Between 1999 and 2007, 26 consecutive patients with locally recurrence after rectal cancer surgery were evaluated. According to clinical data, tumor stage at the first surgery, recurrence ressecability and follow-up were analyzed. RESULTS: The most common initial surgery was retossigmoidectomy with colorectal anastomosis (46,1 percent). Of the 26 patients, five had tumor perforation at the first surgery. Positive lynphnodes were found in 53,8 percent and 69,2 percent were classified as T3 or T4 staging. In relation to surgery for local recurrence, the principle was abdominoperineal amputation of the rectum. Radical surgery was performed in 42,3 percent of the cases. The resection of the tumor was possible in 65,4 percent. The mean follow-up period was 29,4 months, with an overall survival of 34,6 percent. CONCLUSION: Approximately two-thirds of patients with locally recurrent rectal cancer can be submitted for surgical resection, improving survival. This surgical intervention should be encouraged in hospitals with multidisciplinary teams to improve quality of life in selected patients.