ABSTRACT
Introducción: En Cuba, 20 por ciento de la población tiene 60 años y más, y la probabilidad de adquirir cáncer colorrectal es del cuatro al seis por ciento a lo largo de la vida, lo que constituye un problema social. Objetivo: Determinar la relación entre el cáncer colorrectal en el adulto mayor en la comunidad con ciencia, tecnología y sociedad. Métodos: Se realizó un estudio de intervención y desarrollo con la estrategia de autocuidado en adultos mayores con cáncer colorrectal en la comunidad en el Policlínico Dr. Rudesindo Antonio García del Rijo; del municipio y provincia de Sancti Spíritus, en el periodo 2007-2017. Variables: nivel de información de los médicos, estado de salud, autocuidado y el alivio del dolor en los adultos mayores con cáncer colorrectal. Se trabajó con la totalidad de la población, 116 adultos mayores con cáncer colorrectal y 37 médicos. Se utilizó estadística descriptiva de cada variable mediante tablas, con frecuencias absoluta y relativa como medida de resumen. Resultados: Se instruyó a los pacientes y se logró el alivio del dolor en un 76,72 por ciento, mejoró el autocuidado en un 50 por ciento y el estado de salud fue aceptable en un 44,82 por ciento. La sobrevida se comportó en los pacientes que estuvieron desde su diagnóstico en la estrategia de autocuidado de cinco a siete años. Conclusiones: El cáncer colorrectal en la población adulta mayor constituye un problema de ciencia, tecnología y sociedad(AU)
Introduction: In Cuba, 20 percent of the population is 60 years old and over. The probability of getting colorectal cancer throughout life is four to six percent. This is of social problem. Objective: To determine the relationship between colorectal cancer in community older adults with science, technology and society. Methods: An intervention and development study was carried out at Dr. Rudesindo Antonio García del Rijo Polyclinic from Sancti Spíritus Municipality, Sancti Spíritus Province, in the period 2007-2017, with the self-care strategy in community older adults with colorectal cancer. The variables were level of information of physicians, health status, self-care and pain relief in older adults with colorectal cancer. We worked with the entire population: 116 older adults with colorectal cancer and 37 physicians. Descriptive statistics of each variable were used through tables, using absolute and relative frequencies as summary measure. Results: The patients were instructed and pain relief was achieved in 76.72 percent, self-care improved in 50 percent and the health status was acceptable in 44.82 percent. Survival manifested in patients who were, from the time of their diagnosis, part of the self-care strategy for five to seven years. Conclusions: Colorectal cancer in the older adults' population is a problem of science, technology and society(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aged , Colorectal Neoplasms/epidemiology , Science, Technology and Society , CubaABSTRACT
Introdução: A colonoscopia é um instrumento padrão ouro para triagem e identificação precoce do câncer colorretal. Embora relativamente segura, está sujeita a complicações, como a perfuração de cólon, vinculando-se com altas taxas de morbidade e mortalidade. Objetivos: Avaliar a prevalência de perfuração intestinal em realização de colonoscopias entre os anos de 2012 e 2017 no Hospital Regional Hans Dieter Schmidt, em Joinville-SC e traçar um perfil dos sujeitos que sofreram perfuração, fatores de risco associados, caracterização do exame (diagnóstico ou terapêutico) e seus respectivos desfechos clínicos. Métodos: Estudo quantitativo, descritivo, retrospectivo e transversal, com coleta de dados realizada por análise de prontuários eletrônicos, resultados de colonoscopias e laudos anatomopatológicos. Resultados: Entre 2012 e 2017 foram realizadas 898 colonoscopias, sendo registradas 9 perfurações (1,00%), sendo 4 em mulheres e 5 em homens. Destas, 8 (0,89%) foram com intuito diagnóstico e 1 (0,11%) teve objetivo terapêutico. As faixas etárias variavam entre 46 e 76 anos, sendo a hipertensão arterial sistêmica (55,55%) e a realização de cirurgias prévias (55,55%) os fatores de risco mais encontrados. Os diagnósticos das perfurações foram realizados por meio de laparotomia, e o tratamento foi realizado conjuntamente ao diagnóstico. Cinco casos evoluíram a óbito após a realização do tratamento, um para sepse e outro para peritonite fecal. Conclusão: Perfurações secundárias a exame de colonoscopia apesar de escassas, porém cursar com complicações graves, como sepse, peritonite fecal e até mesmo óbito.
câncer diagnosis. Though it is a relatively safe exam, it is not free of complications, such as colon perforation, which presents a high morbimortality rate. Objectives: Investigate the prevalence of perforation in subjetcs who went through colonoscopy in the Regional Hospital Hans Dieter Schmidt, located in Joinville (SC) during 2012-2017 and their epidemiologic profile, including risk factors, exam intention (therapeutic or diagnosis) and respective outcomes. Methods: Cross-sectional, descriptive, quantitative and retrospective study, whose data were collected from medical registers of colonoscopy outcomes and anatomopathologic reports. Results: During 2012-2017 period, 898 colonoscopies were conducted and 9 perforations (1,00%) cases were observed, four in men and five in women. Among those, eight (0,89%) aimed diagnosis and one (0,11%) was therapeutic. Age of subjects who suffered perforation ranged from 46 to 76 years and systemic arterial hypertension and previous surgery were the most present risk factors (55,55% each). Perforation cases were detected by laparotomy and the management was instituted right after diagnosis. Five cases resulted in death after treatment, one progressed to sepsis and other to fecal peritonitis. Conclusion: Perforation due to colonoscopy, though rare, might progress to serious complications, like sepsis, fecal peritonitis and even death.
ABSTRACT
Antecedentes: La cirugía laparoscópica colorrectal continúa en camino de convertirse en el abordaje de elección para el tratamiento de la patología colorrectal benigna y maligna. Sin embargo, su aplicabilidad aún es baja y está mayormente limitada a grandes centros urbanos. Objetivo: analizar la factibilidad de un programa de cirugía laparoscópica colorrectal en un centro de comunidad rural. Como objetivo secundario, comparar los resultados con la cirugía abierta convencional Material y métodos: se analizó una base de datos prospectiva de todos los pacientes operados de forma electiva y consecutiva entre junio de 2012 y diciembre de 2016. Se empleó un criterio de alta estandarizado. Los pacientes fueron divididos en dos grupos según la cirugía fuese laparoscópica (grupo A) o convencional (grupo B). El análisis de variables se realizó con los métodos de Chi cuadrado y T-test según corresponda. Resultados: se realizaron 129 resecciones colorrectales con una proporción de varones del 60% y una mediana de edad de 64 años. El 83% pertenecía a comunidades vecinas. Hubo un 35% de pacientes ASA I, 56% ASA II y 9% ASA III. La distancia promedio del lugar de residencia fue 75 km con una superficie de distribución de 24 000 km2. La mediana de internación fue de 4 días. La aplicabilidad de la laparoscopia fue del 74% con una tasa de conversión del 6%. Ambos grupos fueron similares en términos de sexo, IMC, diagnóstico, ASA, proporción de ASA III-IV, antecedentes clínicos y quirúrgicos, así como también distancia de su lugar de residencia. El grupo A presentó una media de edad menor que el grupo B (61 años vs. 69 años; p < 0,01). No se observaron diferencias en términos de tipo de cirugía y tiempo operatorio. La morbilidad posoperatoria fue 18% y la tasa de readmisión fue del 4%, sin diferencias entre grupos. Conclusiones: la cirugía laparoscópica colorrectal puede ser realizada en un centro rural con bajo índice de readmisión y complicaciones y resultados comparables a los de la cirugía abierta convencional.
Of benign tumors and colorectal cancer. However, its use is low and limited to large urban centers. Objective: The aim of this study was to analyze the feasibility of a laparoscopic colorectal surgery program in a rural community center. The secondary outcome was to compare these results with those of conventional open surgery. Material and methods: We analyzed a prospective data base of all the patients undergoing scheduled and consecutive surgery between June 2012 and December 2016. A standardized discharge criterion was used. The patients were divided into two groups: laparoscopic surgery (group A) and conventional surgery (group B). The variables were analyzed with the chi-square test or Student's t test, as applicable. Results: A total of 129 colorectal resections were performed; median age was 64 years, 60% were men and 83% belonged to neighbor communities. The ASA physical status classification system was grade 1 in 35% of the patients, grade 2 in 56% and grade 3 in 9%. The average distance between patients' place of residence was of 75 km comprising an area of 24,000 km2. Patients were hospitalized for a median of 4 days. The applicability of laparoscopy was 74% with a conversion rate of 6%. There were no significant differences in sex, BMI, diagnosis, ASA grade, proportion of ASA grade 3-4 patients, clinical history, previous surgeries and distance from the place of residency. Compared to group B, patients in group A were younger (61.6 years vs. 69 years; p < 0.01). There were no differences in terms of type of surgery and surgery duration. Postoperative morbidity was 18% and the readmission rate was 4%, with no differences between the groups. Conclusions: Laparoscopic colorectal surgery can be performed in a rural center with low readmission rate and complications; these results are similar to those of conventional open surgery.
Subject(s)
Laparoscopy/methods , Colorectal Surgery/methods , Rural Population , Retrospective Studies , Laparoscopy/statistics & numerical data , Colectomy/methods , Colorectal Surgery/statistics & numerical dataABSTRACT
La metástasis hepática de origen colorrectal se presenta con frecuencia al diagnosticar el tumor primario, aunque también puede aparecer tiempo después de haber resecado el cáncer. Anteriormente, la afección metastásica era considerada inoperable; sin embargo, los adelantos en la cirugía y la quimioterapia durante los últimos años constituyen opciones terapéuticas eficaces. El tratamiento multidisciplinario de los pacientes, unido a las nuevas técnicas y terapias medicamentosas, han revolucionado la terapéutica de la enfermedad hepática metastásica y ofrecen al afectado una mayor supervivencia, así como mejor calidad de vida. Sobre la base de tales reflexiones, se revisó la bibliografía médica con el propósito de abordar consideraciones importantes relacionadas con los tratamientos quirúrgico y médico de la metástasis antes citada.
The hepatic metastasis of colorrectal origin is frequently presented when diagnosing the primary tumor, although it can also appear time after removing the cancer. Some time ago, the metastatic disorder was considered inoperable; however, the breakthroughs in the field of surgery and chemotherapy during the last years constitute effective therapeutic options. The multidisciplinary treatment of the patients, along with the new medicine techniques and therapies, have revolutionized the therapy of the metastatic hepatic disease and offer to the affected patient a greater survival, as well as better life quality. On the basis of such reflections, the medical literature was reviewed with the purpose of approaching important considerations related to the surgical and medical treatments of the metastasis above mentioned.
Subject(s)
Colorectal Neoplasms , Liver Cirrhosis/surgery , Neoplasm MetastasisABSTRACT
Las enfermedades inflamatorias intestinales representan una patología de alta morbilidad. Esto debido a que se asocia a mayor su riesgo de desarrollo de neoplasias tanto colorrectales como colangiocarcinoma, desarrollo de complicaciones como fístulas, abscesos, estenosis intestinales espontáneas o postoperatorias y estenosis biliares en aquellas asociadas a colangitis esclerosante primaria. El rol del endoscopista avanzado en este grupo de pacientes se encuentra en la vigilancia de ambas neoplasias y en el tratamiento endoscópico de las complicaciones ya mencionadas. En relación a la vigilancia de cáncer colorrectal, existen distintas recomendaciones internacionales respecto a los intervalos y las técnicas de vigilancia, situándose la cromoendoscopia como método de elección emergente en los últimos años. Es importante destacar la publicación del uso de nueva nomenclatura para los hallazgos colonoscópicos durante la vigilancia del cáncer colorectal, abandonando los conceptos de DALM o lesiones o masas asociadas a displasia, lesiones tipo adenoma o no adenomatosas.
Inflammatory bowel diseases represent a high morbidity pathology given their high risk of developing both colorectal cancer and cholangiocarcinoma, besides the development of fistulas, abscesses, spontaneous or postoperative intestinal stenosis and biliary strictures in patients diagnosed with primary sclerosant cholangitis. The advanced endoscopist's rol in this group of patients lies within surveillance of both neoplasms and the endoscopic treatment of complications already mentioned. In relation to surveillance of colorectal cancer, there are various international recommendations regarding surveillance intervals and techniques, with chromoendoscopy emerging as a method of choice in recent years. It is important to highlight the use of new nomenclature for colonoscopic findings during surveillance, abandoning concepts as DALM, adenoma-like lesions or non adenoma-like lesions.
Subject(s)
Humans , Colorectal Neoplasms/diagnosis , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/therapy , Endoscopy, Gastrointestinal/methods , Cholangiocarcinoma/diagnosis , Colorectal Neoplasms/epidemiology , Risk Factors , Cholangiocarcinoma/epidemiologyABSTRACT
Introducción: el cáncer colorrectal ocupa la segunda causa entre las neoplasias malignas en todo el mundo y su incidencia se ha ido incrementando. En 2011, el Anuario Estadístico Cubano reportó 2 039 casos nuevos. El pronóstico de la enfermedad está en relación con el diagnóstico temprano. Objetivo: describir el comportamiento del cáncer colorrectal esporádico. Métodos: se realizó un estudio transversal en el Hospital Universitario Manuel Ascunce Domenech, Camagüey, Cuba, desde enero-2009 a diciembre-2010. La muestra estuvo constituida por 106 pacientes con este diagnóstico, por colonoscopia y biopsia, que fueron sometidos a cirugía, con el análisis anatomopatológico posterior de la pieza quirúrgica. Los datos fueron obtenidos del registro primario y procesados mediante el sistema SPSS para Windows. Resultados: aumentaron los casos con el incremento de la edad, predominó el sexo masculino (53,8 porciento) y los pacientes sin antecedentes patológicos familiares (91,5 por ciento), ni personales (76,4 por ciento). El estreñimiento (42,4 por ciento) y la enterorragia (33 por ciento) fueron las manifestaciones más frecuentes para los tumores de colon izquierdo, mientras la anemia (27,4 por ciento) y el tumor palpable (22,6 por ciento) lo fueron para los del colon derecho. Hubo mayor porcentaje de la localización anatómica en el colon izquierdo (66,1 por ciento), la variedad polipoidea (59,4 por ciento) y el adenocarcinoma (97,2 por ciento). El estadio B (62,3 por ciento), según la clasificación de Dukes fue el más representado. Conclusiones: nuestros resultados son similares a las tendencias mundiales. El cáncer colorrectal continúa siendo identificado en estadios avanzados, por eso debe ser considerada la implementación de estrategias de escrutinio para reducir la incidencia y la mortalidad
Introduction: the colorectal cancer holds the second place among the malignant neoplasias worldwide and its incidence is growing. The Cuban Statistical Annals of 2011 reported 2 039 new cases. The prognosis depends on early diagnosis. Objective: to describe the behavior of the colorectal cancer. Methods: a cross-sectional study was made in Manuel Ascunce Domenech university hospital in Camagüey, Cuba, from January 2009 to December 2010. The sample was made up of 106 patients diagnosed by colonoscopy and biopsy. The surgical sample was subjected to the anatomical and pathological analysis. The data were taken from the primary register and processed in Windows-based SPSS system. Results: the number of cases raised as the age increased, males (53.8 percent) and the patients without family history (91.5 percent) or personal history (76.4 percent) of this pathology predominated. Constipation (42.4 percent) and rectal bleeding (33 percent) were the most frequent manifestations of left colon tumors, whereas anemia (27.4 percent) and palpable tumor (22.6 percent) were those of the right colon tumor. The highest percentage of tumors was located in the left colon (66.1 percent); the polypoid variety (59.4 percent) and adenocarcinoma (97.2 percent) prevailed. The staging B accounted for 62.3 percent of cases according to Dukes' classification. Conclusions: these results agree with the international trends. The colorectal cancer continues to be identified at advanced stages, so the implementation of screening strategies to reduce the incidence and the mortality rates must be considered
Subject(s)
Humans , Colorectal Neoplasms/epidemiology , Cross-Sectional Studies/methodsABSTRACT
Tem sido demonstrado que o número de linfonodos obtidos em peças cirúrgicas de câncer colorretal é fundamental para o adequado estadiamento da doença e, consequentemente, para a obtenção de melhores resultados oncológicos. A percepção de diferenças no número de linfonodos dissecados em peças cirúrgicas de câncer colorretal pelos mesmos cirurgiões em hospitais diferentes motivou este estudo. O objetivo do presente estudo foi avaliar se há diferença no número de linfonodos e em determinados parâmetros histopatológicos em peça cirúrgica de pacientes com câncer colorretal operados por dois cirurgiões que atuam tanto em hospital universitário, como em hospital privado. MÉTODO: Foram avaliados retrospectivamente 122 pacientes, obtendo-se dados relativos a tipo de instituição (universitária versus privada), aspectos demográficos, estadiamento, localização do tumor, tipo de operação, via de acesso (aberta versus laparoscópica ), indicação de radioterapia, número de linfonodos dissecados, número de linfonodos positivos e negativos, assim como o tipo histológico, presença de invasões vascular, linfática e perineural e resposta linfocítica). RESULTADOS: Sessenta e cinco pacientes foram operados em instituição universitária e 57, em instituição privada. Não houve diferença entre os grupos quanto à idade, gênero, estadiamento, localização do tumor, indicação de radioterapia e tipo de operação. A via laparoscópica foi mais comum na instituição universitária. A mediana de linfonodos dissecados foi de 25 (P25-75: 15-34) na instituição universitária versus 15 (P25-75;12-17) (p<.0001). A média de linfonodos positivos foi de três na instituição universitária e de um na privada. O achado de 12 ou mais linfonodos foi mais comum em instituição universitária (55/64 versus 40/58; p=.024). A presença da informação de invasões linfática, vascular e perineural foi mais comum na instituição universitária. CONCLUSÃO: Mantendo a mesma técnica cirúrgica e com população...
It has been demonstrated that lymph nodes harvest from surgical specimens of colorectal cancer is one of the most important features for appropriate staging of the disease and to plain the best treatment. The perception of differences in the number of harvest lymph nodes in surgical specimens of colorectal cancer by the same surgeons in different hospitals motivated this investigation. The aims of this study was to assess whether there is difference in the number of lymph nodes and some histopathological features in surgical specimens of colorectal cancer obtained by two surgeons who work both in a university hospital and in a private one. METHODS: We retrospectively evaluated 122 patients, obtaining data on the type of institution (university or private), demographic features, staging, tumor site, histological type, open or laparoscopic access, indication of radiotherapy, number of harvest lymph nodes, presence of vascular, lymphatic and neural invasions. RESULTS: Sixty-five patients were operated in a university institution and 57 in two private institutions. There was no difference between groups in terms of age, stage, tumor site, details of radiotherapy and type of operation. The laparoscopic route was more common in the university institution. The median of lymph nodes harvested was 25 (P25-75: 15-34) in the university institution and 15 in the private ones (P25-75, 12-17) (p <.0001). The finding of 12 or more lymph nodes was more common in academic institution (55/65 versus 40/57, p =. 024). The presence of information of lymphatic, vascular and perineural invasion was more common in the university institution. CONCLUSION: Keeping the same surgical technique and with comparable population of patients, there was considerable difference in the number of lymph nodes harvested between university and private institutions, as like as the report of other relevant data for the histopathological staging, which impacts indication for adjuvant...
Subject(s)
Humans , Hospitals, Private , Hospitals, University , Laparoscopy , Lymph Nodes , Neoplasm Staging , Colorectal Neoplasms/pathologyABSTRACT
El rastreo de cáncer colorrectal (CCR) cuenta con fuertes evidencias en su favor. Datos preliminares indican que a pesar de ello no se lleva a cabo con la frecuencia adecuada. Se intenta aquí determinar, dentro de un Sistema de Salud que cuenta con los recursos necesarios, los elementos que facilitan o generan barreras para concretar esta práctica preventiva, cuántos individuos lo ponen en práctica y qué predice esta conducta. Se realizó una encuesta telefónica a los afiliados de una Obra Social de empleados de la Universidad de Buenos Aires, de los que 132 completaron el cuestionario (tasa de respuesta 70%). Los elementos considerados facilitadores del rastreo obtuvieron respuestas afirmativas en el 64 a 97%, mientras que los que definían barreras un 11 a 27%. En este último grupo, una categoría diferenciada la constituía el miedo a los efectos adversos: 39%, y el sentimiento de vergüenza relacionado con los procedimientos: 30%. Un 33% de los encuestados tenían hecho un método de rastreo, mayoritariamente de sangre oculta (27), sigmoideoscopía (11) y colonoscopía (20). Una mayoría afirmó que "se haría el procedimiento si el médico se lo recomendara" (95%), o "no se lo haría excepto que su médico se lo aconseje" (87%). Contestar afirmativamente que "los médicos hacen lo mejor para los pacientes" se asoció con haberse hecho un método de rastreo de CCR, OR 1.55 (IC 95%: 1.02-2.37) p: 0.04. El grupo de individuos estudiado parece bien predispuesto para el rastreo del CCR, la recomendación médica sería aquí un determinante prominente para ponerlo en práctica.
There is strong evidence favoring colorectal cancer screening. Preliminary data suggests that it is not included in routine practice with the adequate frequency. We intended to recognize in a Health Care System (HCS) that provides the needed resources, the facilitators and barriers related with the implementation of this preventive practice, how many individuals have carried out one procedure and what this preventive activity predicts. A telephone survey was administered to a sample of affiliates from an HCS that serves employees of the University of Buenos Aires; 132 completed the questionnaire (70% response rate). Facilitators obtained an affirmative response in a 64 to 97%, and barriers from 11 to 27%. In the latter category a special subgroup (39%) was afraid of adverse events, and there was a feeling of embarrassment in others (30%); 33% of respondents had carried out a screening procedure, mainly FOBT 27, sigmoidoscopy 11 and colonoscopy 20. A majority (95%) stated that they "would do the procedure if doctors recommend it", or "not do it unless my doctor advises to do it" (87%). Answering affirmatively that "physicians will do the best for their patients" was associated with having had a CRC screening test, OR 1.55 (95% CI: 1.02-2.37) p: 0.04. Studied individuals showed good predisposition for colorectal cancer screening, but to put it into practice, medical advice seems to be a prominent determinant.