ABSTRACT
ABSTRACT Introduction: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. Methods: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. Results: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). Conclusions: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.
RESUMO Objetivo: fístula anastomótica (FA) após colectomia para câncer colorretal (CCR) é complicação grave. Esta revisão sistemática e meta-análise avaliou os fatores de risco pré-operatórios para FA em pacientes submetidos à colectomia. Métodos: a pesquisa bibliográfica abrangeu 15 anos e 9 meses (1 de janeiro de 2005 - 19 de outubro de 2020), sendo utilizadas as plataformas PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC e Web of Science. O critério de inclusão foram estudos transversais, coorte e caso-controle em fatores de risco pré-operatórios para FA (desfecho). A escala Newcastle-Ottawa foi usada para avaliação de viés dos estudos. A metanálise envolveu o cálculo dos efeitos de tratamento para cada estudo individualmente incluindo odds ratio (OR), risco relativo (RR) e intervalo de confiança de 95% (IC95%) com construção de modelo de efeitos aleatórios, para avaliar o impacto de cada variável (p<0,05). Resultados: foram selecionados 39 estudos transversais, 21 coortes e quatro casos-controle. A metanálise identificou 14 fatores de risco para FA em pacientes com CCR após colectomia, que são sexo masculino (RR=1,56; IC 95%=1,40-1,75), tabagismo (RR=1,48; IC 95%=1,30-1,69), alcoolismo (RR=1,35; IC 95%=1,21-1,52), diabetes mellitus (RR=1,97; IC 95%=1,44-2,70), doenças pulmonares (RR=2,14; IC 95%=1,21-3,78), doença pulmonar obstrutiva crônica (RR=1,10; IC 95%=1,04-1,16), doença coronariana (RR=1,61; IC 95%=1,07-2,41), doença renal crônica (RR=1,34; IC 95%=1,22-1,47), altas notas na escala ASA (RR=1,70; IC 95%=1,37-2,09), cirurgia abdominal prévia (RR=1,30; IC 95%=1,04-1,64), cirurgia de emergência (RR=1,61; IC 95%=1,26-2,07), quimioterapia neoadjuvante (RR=2,16; IC 95%=1,17-4,02), radioterapia (RR=2,36; IC 95%=1,33-4,19) e quimiorradioterapia (RR=1,58; IC 95%=1,06-2,35). Conclusões: importantes fatores de risco pré-operatórios para FA colorretais em pacientes com CCR foram identificados com base nas melhores pesquisas baseadas em evidências e esse conhecimento deve influenciar decisões relacionadas ao tratamento.
ABSTRACT
Dietary habits have been associated with variations in the risk of colon disorders, either its increase or decrease. Colon-specific approaches showed their potential to target and treat colon cancers and inflammatory diseases, but they vary in success rates for local recurrence, disease-free survival, and overall survival. Also, chemotherapies and radiotherapies have been applied as the surgical adjuvant treatments. The significant role of exogenously administered Lactobacilli in reducing toxin-producing bacteria in the gut and increases the longevity of the host, led to the coining of the term ‘probiotics’. The evidence on the effects of inulin and oligofructose on colonization, translocation of pathogens and the prevention of intestinal diseases make them suitable candidates to treat colon disorders. Among potentially protective foods, growing attention has been dedicated to functional foods comprising probiotics, such as Lactobacilli or Bifidobacteria, and prebiotics such as fructooligosaccharides or fructans, as their consumption may treat inflammatory bowel diseases, like ulcerative colitis, crohn’s disease as well as experimentally induced colon cancer in mammals. The readily apparent synergy of concomitantly using beneficial microorganisms and nutritive materials that support their growth led to the term “synbiotics” to describe foods or supplements that combine both probiotics and prebiotics. Various potential mechanisms are addressed in the present paper. This article discusses the real value of dietary components, which offers practical information to help patients as well as health professionals. Furthermore, article has focused on the possible value of probiotics, prebiotics and synbiotics in treatment and maintenance therapy of colonic ailments.
ABSTRACT
La colonoscopia resulta un valioso método para el estudio de las enfermedades del colon, por lo que se realizó un trabajo descriptivo, retrospectivo con el objetivo de definir los diagnósticos colonoscópicos más frecuentes en 267 pacientes menores de 16 años, 142 del sexo masculino y 125 del femenino, a los cuales se les realizó colonoscopia en el Hospital Pediátrico Docente «William Soler¼, entre los meses de enero de 1987 a diciembre de 1996, por presentar fundamentalmente hematoquecia (80,9 %). La colonoscopia resultó normal en 86 niños y las enfermedades colónicas halladas con mayor frecuencia fueron los pólipos (27,6 %), la colitis inespecífica (21,8 %) y la hiperplasia linfoide benigna (15,7 %), y se encontraron éstas en proporción mayor en los menores de 6 años; los pólipos y la colitis inespecífica se presentaron en forma similar en uno y otro sexos, y se observó la hiperplasia linfoide en un tanto por ciento mayor en varones. Se tomó muestra para examen histológico a los 11 niños con colitis ulcerativa idiopática y a 47 con colitis inespecífica, y se apreció una alta concordancia diagnóstica colonoscopia-histología, 72,2 y 83,0 % respectivamente (p < 0,001).
Colonoscopy is a useful method to study colon diseases, therefore, a descriptive and retrospective study was conducted so as to define the most frequent colonoscopic diagnoses in 267 patients under 16, 142 males and 125 females, who underwent colonoscopy at "William Soler" Pediatric Teaching Hospital between January, 1987, and December, 1996, due mainly to hematochezia (80.9 %). Colonoscopy proved to be normal in 86 children and the colonic diseases most commonly found were polyps (27.6 %), unspecific colitis (21.8 %) and benign lymphoid hyperplasia (15.7 %), which was observed in a higher number of children under 6. The polyps and the unspecific colitis appeared in a similar way in both sexes. Men were more affected by lymphoid hyperplasia than women. A sample was taken from 11 children with ulcerative idiopathic colitis and from 47 with unspecific colitis for histological examination. It was reported a high colonoscopy-histology diagnostic concordance, 72.2 and 83.0, respectively (p<0.001).
ABSTRACT
We report a case in which CT scanning revealed lipohyperplasia of the ileocecal (IC) valve and cecum with acute inflammation and ulceration mimicking malignant neoplasm. At unenhanced CT, lesion attenuation was lower than that of back muscle, and at contrast-enhanced CT, the lesion was seen as a lobulated polypoid mass with inhomogeneous enhancement, pericecal fat infiltration, and pericecal lymphadenopathy. Although these findings mimick those of malignant neoplasm, the typical location of the mass, involving the IC valve, and the low attenuation observed at unenhanced CT, can help distinguish it from other masses.
Subject(s)
Back Muscles , Cecum , Ileocecal Valve , Inflammation , Lymphatic Diseases , Tomography, X-Ray Computed , UlcerABSTRACT
Inflammatory and ischemic bowel disease commonly involve a longer segment than a maligant lesion. The characteristic findings of inflammatory bowel disease are mucosal nodular hypertrophy and luminal narrowing. It has recently been reported, however, that the features of mucinous adenocarcinoma are similar to those of inflammatory bowel disease with long segmental involvement. After a brief review of the literature, we describe two cases of mucinous adenocarcinoma of the ascending colon associated with inflammatory disease. Because of long segmental involvement of the ascending colon, mucosal nodular hypertrophy and luminal narrowing, one of these was thought to be multiple villous adenoma with colitis, but was confirmed as mucinous adnocarcinoma. The other case, thought to be tuberculous enterocolitis, was comfirmed as tuberculous enterocolitis associated with mucinous adenocarcinoma.