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Introducción: El cáncer colorrectal es un problema de salud creciente en el mundo, el aumento en la expectativa de vida de las poblaciones, el continuo mejoramiento de las técnicas de tamizaje y la búsqueda activa de casos, son las razones por las cuales cada año se informa un aumento en el número global de casos diagnosticados con cáncer. Objetivo: Caracterizar a los pacientes operados de cáncer colorrectal tratados con quimioterapia. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal, en pacientes atendidos en la consulta multidisciplinaria de cáncer colorrectal. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la conformaron 55 pacientes tratados con quimioterapia adyuvantes por cáncer colorrectal. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: En cuanto a la relación sexo y edad, se observó una mayor frecuencia del grupo de 70-79 años y en el sexo femenino. Según la localización topográfica existió predominio en colon sigmoides con 33 pacientes para un 60 % de la muestra estudiada. La variante histológica adenocarcinoma moderadamente diferenciado fue la de mayor presentación. Predominaron los pacientes en estadio IIIa de la enfermedad. El esquema de quimioterapia usado con mayor frecuencia fue el Folfox. Conclusiones: En la muestra, la mayoría de los pacientes estuvieron incluidos en el grupo etáreo entre 70-79 años de edad. La localización topográfica más frecuente fue el colon sigmoide y el tipo histológico, el adenocarcinoma moderadamente diferenciado. Predominaron los pacientes en el estadio IIIa y el tratamiento con quimioterapia adyuvante más utilizado fue el esquema de Folfox.
Introduction: Colorectal cancer is a growing health problem in the world, the increase in the life expectancy of populations, the continuous improvement of screening techniques and the active search for cases, are the reasons why an increase in the global number of cases diagnosed with cancer is reported each year. Objective: To characterize the patients operated on for colorectal cancer treated with adjuvant chemotherapy. Methods: An observational, descriptive, cross-sectional study was carried out in patients seen at the multidisciplinary colorectal cancer clinic. The universe was made up of all the patients who attended the consultation in that period, the sample at the authors' criteria was made up of 55 patients treated with adjuvant chemotherapy for colorectal cancer. The primary source of the investigation was given by the clinical history. Results: Regarding the relationship between sex and age, a higher frequency was observed in the group of 70-79 years and in the female sex. Regarding the topographic location, there was a predominance in the sigmoid colon with 33 patients for 60% of the sample studied. The moderately differentiated adenocarcinoma histological variant was the one with the highest presentation. Patients in stage IIIa of the disease were more frequent. The most frequently used chemotherapy regimen was Folfox. Conclusions: In the sample, most of the patients were included in the age group between 70-79 years of age. The most frequent topographic location was the sigmoid colon and the histological type was moderately differentiated adenocarcinoma. Patients in stage IIIa predominated and the most widely used adjuvant chemotherapy treatment was the Folfox regimen.
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RESUMEN Introducción: el cáncer colorrectal se desarrolla a partir de lesiones precursoras a nivel del colon, recto y ano, siendo responsable del 16,9 % de todas las muertes por cáncer y en los hombres es la tercera neoplasia maligna más común a nivel mundial. Objetivo: caracterizar a los pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá Paraguay en el periodo entre 2015 y 2018. Metodología: estudio observacional descriptivo, retrospectivo de corte transversal. Se utilizaron fichas de pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá Paraguay en el periodo entre 2015 y 2018. Resultados: del total de las 26 fichas de pacientes revisadas, el 70 % fue de sexo masculino y el rango etario más común fue entre 60 - 71 años (52 %); el tipo histológico de cáncer más frecuente fue el adenocarcinoma moderadamente diferenciado 78 %, el estadio más común fue adenocarcinoma de tipo II A (clasificación de la American Joint Committe on Cancer (AJCC-TNM) 65 %, presentó metástasis a distancia 3,81 % y la ubicación de cáncer más frecuente fue el recto 34,78 %. El motivo de consulta más frecuente fue hemorragia 70 %, la complicación más común fue la dehiscencia y no hubo óbitos. Conclusión: el mayor porcentaje de pacientes pertenece al sexo masculino y al grupo etario de mayores a 60 años, fue frecuente el adenocarcinoma moderadamente diferenciado y el estadio más común de tipo II A, la ubicación más frecuente fue el recto y motivo de consulta fue hemorragia (rectorragia)., por lo cual se deberían implementar medidas para la prevención de esta patología.
ABSTRACT Introduction: colorectal cancer develops from precursor lesions in the colon, rectum and anus, being responsible for 16,9 % of all deaths from cancer and in men it is the third most common malignant neoplasm worldwide. Objective: to characterize postoperative colorectal cancer patients of the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018. Methodology: descriptive, retrospective, cross-sectional observational study. Cards of postoperative colorectal cancer patients from the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018 were used. Results: of the total of the 26 patient files reviewed, 70 % were male and the most common age range was between 60 - 71 years (52 %); the most frequent histological type of cancer was moderately differentiated adenocarcinoma 78 %, the most common stage was adenocarcinoma type II A (classification of the American Joint Committee on Cancer (AJCC-TNM) 65 %, present distant metastases 3,81 % and the most frequent location of cancer was the rectum 34,78 % .The most frequent reason for consultation was hemorrhage 70 %, the most common complication was dehiscence and there were no deaths. Conclusion: the highest percentage of patients belongs to the male sex and to the age group over 60 years old, moderately differentiated adenocarcinoma was frequent and the most common stage was type II A, the most frequent location was the rectum and the reason for consultation was hemorrhage (rectorrhagia), for which measures must be implemented to prevent this pathology.
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Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%. .
Contexto O câncer colorretal é o segundo câncer mais prevalente no mundo e, o fígado é o principal local das metástases. A ressecção cirúrgica da metástases hepáticas colorretais proporciona a única possibilidade de cura e as melhores chances de sobrevida a longo prazo. Objetivos Avaliar os resultados do tratamento cirúrgico e identificar fatores associados ao prognóstico da doença em pacientes com metástases hepáticas sincrônicas de câncer colorretal submetidos à ressecção. Métodos Estudo retrospectivo de 59 pacientes submetidos à ressecção de metástases hepáticas sincrônicas do câncer colorretal, visando à identificação de fatores relacionados ao prognóstico. Foram estudadas a sobrevida atuarial e sobrevida livre de doença, conforme as variáveis. Resultados A mortalidade e morbidade pós-operatórias foram de 3,38%, e 30,50%, respectivamente. A sobrevida livre de doença estimada em 5 anos foi de 23,96%, e a sobrevida tardia, no mesmo período, foi de 38,45%. O valor do antígeno cárcino-embrionário igual ou superior a 50 ng/mL e o número de metástases maior que três representaram fatores prognósticos limitantes da sobrevida livre de doença, porém sem interferir na sobrevida tardia. Pacientes com metástases hepáticas e doença extra-hepática, submetidos à ressecção, não apresentaram sobrevida livre de doença acima de 20 meses, porém sem significância e sem impacto na sobrevida a longo prazo. Nenhum dos fatores prognósticos estudados interferiu na sobrevida tardia, porém não foi observada sobrevida além de 40 meses em pacientes com mais de três metástases hepáticas. Conclusões Apesar do valor do antígeno ...
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Carcinoembryonic Antigen/blood , Colorectal Neoplasms/mortality , Hepatectomy , Liver Neoplasms/mortality , Prognosis , Retrospective Studies , Survival Analysis , Time FactorsABSTRACT
Objective To investigate the correlation between expression of human telomerase reverse transcriptase (hTERT) mRNA in peripheral blood and postoperative recurrence and prognosis in the patients with advanced colorectal cancer (CRC).Methods The preoperative and 1 month postoperative quantitative expression of hTERT mRNA in peripheral blood in 85 patients with advanced CRC were detected with real-time fluorescence quantitative real-time fluorescence quantitative polymerase chain reaction (RTPCR).The quantitative expression of hTERT mRNA in peripheral blood in 30 normal controls were also detected.The postoperative prognosis was followed-up,and the quantitative expression of hTERT mRNA in peripheral blood in the patients with recurred CRC and the patients without recurred CRC were detected repeatedly.The factors that affected the preoperative hTERT mRNA expression were analyzed.The relationship was investigated between the hTERT mRNA expression levels and postoperative recurrence and prognosis in the patients with advanced CRC.Results The hTERT mRNA expression levels in peripheral blood in advanced CRC group were significantly higher than those in the normal controls [(6.22 ±5.85)2-△△Ct vs (0.45 ±0.27)2-△△Ct,(P ＜0.01)],and were significantly decreased at the time point of 1 month after the operation (P ＜ 0.01).The hTERT mRNA expression levels in the postoperative recurred CRC group were significantly higher than those in the 1 month postoperation group and no recurrence CRC group [(5.07 ± 2.87)2-△△Ct vs (1.83 ± 1.08)2-△△Ct,(2.15 ± 1.49)2-△△Ct,(P ＜0.01)].Univariate analysis revealed that preoperative high hTERT mRNA expression levels in peripheral blood were related to the differentiated degree of tumor,tumor size,lymph node metastasis ratio,and liver metastasis (P ＜ 0.05 or P ＜ 0.01).Multivariate logistic regression analysis revealed that differentiated degree of the tumor,lymph node metastasis,and liver metastasis were independent risk factors for the elevation of preoperative hTERT mRNA expression in the advanced CRC.Elevated preoperative hTERT mRNA expression was positively related to the postoperative recurrence rate,and was negatively related to postoperative survival rate.Conclusions Preoperative hTERT mRNA expression levels in peripheral blood were related to the important pathologic features in patients with advanced CRC,and might be a valuable prognostic factor.Postoperatively elevated hTERT mRNA expression in peripheral blood was related to recurrence of advanced CRC.
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ObjectiveTo evaluate the efficacy and safety of two different adjuvant chemotherapy regimens of 5-FU/LV and FOLFOX4 in patients who suffered from colorectal cancer after having radical surgery.MethodsBy 123 patient who had colorectal cancer and received radical surgery from December 2005,to May 2007 were enrolled in this using retrospective analysis.68 cases received 5 FU/LV chemotherapy regimens and 35 cases received FOLFOX4 chemotherapy regimens.The results of survival rate and side effects were compared between the two groups.ResultsThe survival rates within 3 years of 5-FU/LV and FOLFOX were 77.3％ and 80％ respectively.There was no significant differences between two chemotherapy regimens ( x2 =1.26,P =0.28).The main side effects included anorexia,nausca/vomiting,alopecia and et al.However there was no significant difference in adverse reactions of two groups ( P ＞0.05 ).Conclusions5-FU/LV and FOLFOX4 were effective and safe chemotherapy regiments for patients with colorectal cancer after having radical surgery,and the side effects were acceptable in these two groups.
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CONTEXT: Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at "Fundação Pio XII", in Barretos-SP, Brazil, between 1999 and 2003. OBJECTIVE: To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. METHODS: Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. RESULTS: In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (P<0,001), extended surgery (P<0.001) and intervention with radical intent (P<0.001) were considered significant. In the multivariate analysis using logistic regression, intervention with radical intent (OR = 10.249, P<0.001, 95 percent CI = 3.071-34.212) and abdominoperineal amputation (OR = 3.096, P = 0.04, 95 percent CI = 1.445-6.623) were considered to be independently significant. CONCLUSION: This investigation allows the conclusion that radical intervention and the abdominoperineal procedure in the surgical treatment of colorectal adenocarcinoma are risk factors for requiring intraoperative blood transfusion.
OBJETIVO: Identificar fatores de risco de indicação de transfusão sanguínea intraoperatória em doentes submetidos a tratamento cirúrgico por adenocarcinoma colorretal. MÉTODOS: Estudo retrospectivo, tipo caso-controle, realizado na Fundação Pio XII, em Barretos, SP, utilizando-se base de dados de prontuários de 383 pacientes admitidos entre 1999 e 2003. Utilizou-se teste exato de Fischer ou qui ao quadrado para variáveis dicotômicas e t de Student para variáveis contínuas, na análise univariada, adotando-se nível de significância de 10 por cento (P<0,10); na análise multivariada foi aplicado o teste de regressão logística múltipla, com nível de significância de 5 por cento (P<0,05); as razões de chances e os respectivos intervalos de confiança de 95 por cento foram calculados. RESULTADOS: Nas análises univariadas foram consideradas significantes as variáveis altura (P = 0,06), glicemia (P = 0,05), antecedente de cirurgia abdominal ou pélvica (P = 0,031), operação abdominoperineal (P<0,001), cirurgia ampliada (P<0,001) e intervenção com intuito radical (P<0,001). Na análise multivariada por regressão logística foram considerados independentemente significantes, quando analisadas em conjunto, intervenção com intuito radical (OR = 10,249, P<0,001, IC95 por cento = 3,071-34,212) e amputação abdominoperineal (OR = 3,906, P = 0,04, IC95 por cento = 0,151-0,692). CONCLUSÃO: Esta investigação permitiu concluir que a intervenção radical e o procedimento abdominoperineal, no tratamento cirúrgico do adenocarcinoma colorretal, constituem fatores de risco independentes para a transfusão sanguínea intraoperatória.
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Female , Humans , Male , Middle Aged , Blood Transfusion , Colorectal Neoplasms/surgery , Intraoperative Care , Neoplasm Staging , Retrospective Studies , Risk FactorsABSTRACT
(0.05)). Multivariate analysis revealed that adjuvant radiotherapy and histology of tumor significantly affected the prognosis(P=(0.045) and P=(0.009), respectively). Whereas loco-regional control was only significantly affected by adjuvant radiotherapy(P=(0.000)). CONCLUSION: Adjuvant radiotherapy and histology of tumor are the important prognostic factors in the rectal cancer patients after treatment with multimodality therapy based on surgery.