Avaliação de programa de seguimento pós-alta com inteligência artificial para monitorar sinais e sintomas de pacientes em pós-operatório de cirurgias colorretais oncológicas / Evaluation of a post-discharge follow-up program with artificial intelligence to monitor signs and symptoms of patients in the postoperative period of oncological colorectal surgeries

INTRODUÇÃO: Cirurgias colorretais são procedimentos complexos, associados a maiores taxas de complicações e readmissões que procedimentos realizados em outros sítios cirúrgicos. Atualmente, medidas padronizadas visando à recuperação precoce de pacientes submetidos a cirurgias colorretais são adotadas com o objetivo de reduzir o tempo de internação hospitalar. A redução do tempo de internação, entretanto, apesar de ser considerada um desfecho positivo, pode propiciar risco de atraso de diagnóstico e deterioração clínica já que as complicações, geralmente acontecem fora do ambiente hospitalar, dificultando a avaliação e acompanhamento destes pacientes. OBJETIVO: O objetivo do presente estudo foi desenvolver um plano de seguimento pós-alta eletrônico, acessível em smartphones, para monitorar remotamente os sinais e sintomas de pacientes em pós-operatório de cirurgias colorretais, avaliando os desfechos de taxa de admissão no setor de emergência e taxa de complicações graves (Clavien-Dindo 3 a 5), no período de quinze dias de pós-operatório. MATERIAL E MÉTODOS: O projeto foi desenvolvido em duas etapas, sendo a primeira a estruturação da Jornada Digital, com a criação de plataforma com algoritmo para identificação de sintomas e direcionamento de condutas e a segunda a validação do programa em um estudo piloto. Foram incluídos no estudo pacientes a serem submetidos a cirurgias colorretais oncológicas, com idade entre 18 e 80 anos. O estudo foi conduzido nas dependências do A.C.Camargo Cancer Center. O monitoramento dos pacientes e o reporte de sinais e sintomas pelos pacientes foram realizados via plataforma de monitoramento remoto, utilizando-se de smartphone ou computador. RESULTADOS: No estudo piloto, em cada uma das três fases de avaliação dos dados obtidos, algoritmo e instrumento para coleta de dados foram reestruturados, visando atingir maior sensibilidade e especificidade na detecção de complicações pela plataforma, bem como maior satisfação dos pacientes em acompanhamento. A capacidade de detecção de complicações aumentou a cada fase de análise e ajuste, sendo que após a terceira e última fase de ajustes tivemos 45(71,4%) eventos adversos reportados, sendo que destes, 12(19%) foram sintomas classificados como graves. Nessa amostra , a solução digital foi capaz de identificar 3(4,8%) complicações reais com sensibilidade de 75%, especificidade de 84%, acurácia de 83%, valor preditivo positivo de 25% e valor preditivo negativo de 98%. Tivemos ainda , 5(7,9%) erros de preenchimentos detectados e 1(1,6%) complicações não detectadas pela plataforma, por erro de preenchimento do questionário de avaliação diária. A nossa taxa de reinternação por indicação da plataforma, nessa amostra foi de 2(3,2%) e de admissão na emergência, considerando encaminhamento ou não da plataforma foi de 8(12,7%). A adesão completa ao programa de monitoramento foi de 83%, com nota NPS variando de 69 a 95, sendo a maior nota obtida na última fase de avaliação. CONCLUSÃO: A plataforma digital criada mostrou-se segura, com altas taxas de adesão e boa aceitação pelos pacientes, mas ainda precisa ser ajustada com a intenção de reduzir custos de encaminhamento e admissão no setor de emergência.

INTRODUCTION: Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently, standardized procedures aim the early recovery of patients treated for colorectal surgeries in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE: The aim of the present study was to develop a mobile health app , accessible on smartphones, to remotely monitor the signs and symptoms of patients in the postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a fifteen-day postoperative period. METHODS: The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS: In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION: The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department

Treatment of obstructive colorectal cancer / 中华胃肠外科杂志

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.

Chinese expert consensus on the diagnosis and surgical treatment of rectal prolapse (2022 edition) / 中华胃肠外科杂志

Surgery is currently the only cure for rectal prolapse. Standardized preoperative evaluation and appropriate selection of surgical methods are crucial to the outcome of rectal prolapse surgery. With the development of a series of clinical studies in China and abroad, transabdominal surgery (such as ventral mesh fixation) and transperineal (anal) surgery (such as Altemeier surgery) have been widely recognized. Precise preoperative assessment of rectal prolapse and appropriate selection of surgical approaches has important clinical value in reducing postoperative recurrence rates and surgical-related complications. However, the current rectal prolapse assessment system needs to be improved, and the choice of surgical procedures remains controversal. To guide the diagnosis and surgical treatment of patients with rectal prolapse in China, nationwide specialists of colorectal and pelvic floor surgery have been organized by the of Chinese Medical Doctor Association Anorectal Branch, the Pelvic Floor Surgery Committee, and Clinical Guidelines Committee. Experts have conducted rounds of discussions on the core content of standardized diagnosis and surgical treatment for rectal prolapse, and jointly formulated the "Chinese expert consensus on the diagnosis and surgical treatment of rectal prolapse (2022)". We hope that this consensus will provide useful resources for the colorectal and pelvic floor surgeons, and promote the standardization of diagnosis and surgical treatment for the rectal prolapse in China.

Relación entre estado funcional y complicaciones quirúrgicas en adultos mayores varones con cáncer / The Relationship between Functional Status and Surgical Complications in Male Older Adults with Cancer

Introducción: La pérdida de funcionalidad es una condición común en adultos mayores con cáncer y la decisión de intervenir quirúrgicamente depende de las comorbilidades y estado funcional. Objetivo: Determinar la asociación entre el estado funcional y complicaciones quirúrgicas en adultos mayores varones con cáncer en el Centro Médico Naval. Métodos: Se realizó un estudio de tipo cohorte retrospectiva, análisis secundario de una base de datos de adultos mayores varones con cáncer, seguidos por dos años y atendidos en el Centro Médico Naval del Perú. Las variables fueron: complicaciones quirúrgicas, estado funcional, comorbilidades, síndromes geriátricos y tipo de cáncer. Resultados: Se evaluó a 385 participantes, edad promedio de 79,69 años (desviación estándar = 4,55). El 39,74 por ciento (n =153) presentó complicaciones quirúrgicas, con una asociación a la presencia de comorbilidades, presencia de dos o más síndromes geriátricos 69,93 por ciento (n =107), dependencia funcional para actividades básicas 51,63 por ciento (n =79) y dependencia funcional para actividades instrumentales 35,95 por ciento (n = 55). De acuerdo con la frecuencia de complicaciones según el tipo de neoplasia se encontró más frecuente para cáncer colorrectal en un 46,41 por ciento (n = 71). Conclusiones: Existe una asociación significativa entre la dependencia funcional y complicaciones quirúrgicas, por lo que es importante no solamente para el tratamiento quirúrgico sino también farmacológico, considerar el estado funcional del paciente para un tratamiento favorable y por lo tanto un mejor pronóstico(AU)

Introduction: Loss of functionality is a common condition in older adults with cancer, while any decision to intervene surgically depends on comorbidities and functional status. Objective: To determine the association between functional status and surgical complications in male older adults with cancer at Centro Médico Naval. Methods: A retrospective cohort-type study was carried out, with secondary analysis of a database of male older adults with cancer followed up for two years and treated at Centro Médico Naval of Peru. The variables were surgical complications, functional status, comorbidities, geriatric syndromes and type of cancer. Results: A number of 385 participants were assessed. Their mean age was 79.69 years (standard deviation: 4.55). 39.74 percent (n=153) presented surgical complications, with an association to the presence of comorbidities, the presence of two or more geriatric syndromes in 69.93 percent (n=107), functional dependence for basic activities in 51.63 percent (n=79), and functional dependence for instrumental activities in 35.95 percent (n=55). Regarding the frequency of complications according to type of neoplasm, the most frequent occurrence was that of colorectal cancer, accounting for 46.41 percent (n=71). Conclusions: There is a significant association between functional dependence and surgical complications, a reason why it is important, not only in surgical but also in pharmacological treatment, to consider the functional status of the patient in view of a favorable treatment and, therefore, a better prognosis(AU)

Ovarian metastasis from colorectal adenocarcinoma / Metástase ovariana de adenocarcinoma colorretal

Introduction: Ovarian metastases of gastrointestinal origin, also called Krukenberg tumors, have a guarded prognosis. Physicians need to look for alternatives in diagnosis and treatment for this clinical condition in order to improve the outcome of the patients. Objectives: To report the experience of the authors in the treatment of these patients, and to perform a review of the literature on the epidemiology, clinical presentation, diagnosis, treatment, and prognosis for ovarian metastases from colorectal cancer. Methods: We collected clinical information regarding the patients treated for ovarian metastasis from colorectal adenocarcinoma at our coloproctology service, and performed a search on the PubMed database using the terms colorectal cancer, ovarian metastasis, Krukenberg tumor and surgery. Conclusion: Large abdominal tumors are the most frequent presentation of ovarian metastasis from colorectal cancer. The diagnosis is based on a histopathological analysis, levels of carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125), and immunohistochemical studies for the cytokeratin 20 (CK20), caudal-type homeobox 2 (CDX2) and vilina markers. Citoreductive surgical procedures are the most promising approach to treatment, with the highest impact on overall survival. The prognosis is negatively influenced by the extent of the metastasis, by citoreductive surgical procedures with persistence of macro- or microscopic foci of the disease, and by low scores on the general well-being index of the patient. (AU)

Introdução: As metástases ovarianas de tumores gastrointestinais, também chamadas de tumores de Krukenberg, são neoplasias de prognóstico reservado. Exigem conhecimento de alternativas diagnósticas e terapêuticas para garantir melhora da sobrevida das pacientes. Objetivos: Relatar a experiência dos autores no tratamento dessas pacientes, e fazer uma revisão da literatura sobre a epidemiologia, apresentação clínica, diagnóstico, tratamento e prognóstico das metástases ovarianas do câncer colorretal. Métodos: Foi realizada uma coleta de informações clínicas de pacientes tratados por metástases ovarianas de adenocarcinoma colorretal em nosso serviço de coloproctologia, em conjunto com uma pesquisa na base de dados PubMed com os termos colorectal cancer, ovarian metastasis, Krukenberg tumor, e surgery. Conclusão: Volumosas massas abdominais constituem a principal apresentação clínica da doença. As alternativas diagnósticas incluem a avaliação histopatológica, a identificação dos níveis de antígeno cárcino-embriônico (ACE) e de antígeno de câncer 125 (CA-125), e exame imunoistoquímico de espécimes cirúrgicos para os marcadores citoqueratina 20 (CK20), homeobox 2 do tipo caudal (CDX2), e vilina. O tratamento citorredutor completo demonstrou o maior impacto na sobrevida dos pacientes. O prognóstico é influenciado negativamente pela extensão da doença metastática, por cirurgia citorredutiva com persistência focos microscópicos ou macroscópicos da doença, e baixo escore de índice de bem-estar geral do paciente. (AU)

Relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis / 浙江大学学报·医学版

To investigate the relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis. Tissue specimens were collected from 363 patients who were diagnosed as colorectal cancer by clinical and pathological examination in Wuhu Second People's Hospital from June 2015 to June 2020. Fifty-six patients were colorectal cancer complicated with schistosomiasis (CRC-S) and 307 patients were colorectal cancer not complicated with schistosomiasis (CRC-NS). The clinical and pathological data of the patients were analyzed to explore the relationship between chronic schistosomiasis and colorectal cancer. Immunohistochemistry and Western blotting were used to detect the distribution and expression of SIK2 in colorectal cancer specimens. The relationship between SIK2 and lymph node metastasis of CRC-S was analyzed. The rate of lymph node metastasis in CRC-S group was significantly higher than that in CRC-NS group (62.5% vs. 47.2%, <0.05). In CRC-S patients with lymph node metastasis, schistosome eggs were distributed mainly in tumor tissues (25/35, 71.4%), while in patients with CRC-S without lymph node metastasis, schistosome eggs were distributed mainly in paracancerous tissues (17/21, 81.0%) (14.243, <0.01). The SIK2 was mainly located in cytosol, and its expression in tumor tissues was higher than that in paracancerous tissues. Compared with CRC-NS patients, the expression of SIK2 in CRC-S patients was significantly increased; the expression of SIK2 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis; and the expression of SIK2 in patients with schistosome eggs in cancer tissues was higher than that in patients with schistosome eggs in paracancerous tissues (all <0.01). Lymph node metastasis is more likely to be occurred in colorectal cancer patients with schistosomiasis, especially in those with schistosome eggs in tumor tissues. The expression of SIK2 may be correlated with chronic schistosomiasis, egg distribution and lymphatic metastasis.

Espiritualidade e qualidade de vida relacionada à saúde de pessoas com câncer colorretal avançado / Spirituality and quality of life related to the health of people with advanced colorectal cancer

Introdução: A espiritualidade refere-se ao que dá sentido à vida e pode estar ou não ligada a religião. Compõe a integralidade do indivíduo e pode interferir no tratamento e enfrentamento da doença. Exerce uma função importante na qualidade de vida relacionada à saúde de pessoas com câncer e pode ser alterada com o avanço da doença e a proximidade da morte. Objetivo: Identificar a relação entre o bem-estar espiritual, a qualidade de vida relacionada à saúde de pessoas com diagnóstico de câncer colorretal avançado (estadiamento clínico III e IV) e analisar se existem correlações entre espiritualidade, ansiedade e depressão e o desempenho funcional desta população. Método: Trata-se de estudo desenvolvido com metodologia quantitativa, delineamento transversal e amostragem aleatória simples. Foram aplicadas as escalas Functional Assessment of Chronic Illness Therapy-Group (FACT-G), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-SP 12), Escala Karnosfky Performance Status (KPS) e Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HAD), em pessoas com diagnósticos de câncer colorretal avançado em tratamento ambulatorial no setor de Proctologia e na Central de Quimioterapia em um hospital público, universitário, de grande porte, localizado no interior do Estado de São Paulo. Foram convidadas 72 pessoas para participar do estudo, que preencheram os critérios de inclusão, no decorrer dos meses de novembro de 2019 à março de 2020, sendo o N final constituído por 60 participantes. Resultados: O bem estar funcional apresentou correlação positiva com o escore total e os domínios de significado, paz e fé do FACT-SP12; foi possível identificar correlação negativa entre os participantes que não apresentaram prática religiosa e o domínio da fé. De acordo com a análise dos boxplots, a mediana dos participantes que não possuíam prática religiosa foi inferior nos domínios de paz e fé. A funcionalidade leva a melhora do bem estar espiritual e a falta da prática religiosa interfere de forma negativa na fé e na paz. Conclusão: A espiritualidade influencia na qualidade de vida de pessoas com câncer colorretal avançado. Há necessidade de que a equipe de saúde considere estes aspectos e proporcione o cuidado espiritual às pessoas adoecidas e seus familiares

Introduction: Spirituality refers to what gives meaning to life and may or may not be connected to religion. It composes the integrality of the individual and can interfere in the disease's treatment and confrontation. It plays an important role in the quality of life related to the health of people with cancer and can change along with disease's progression and imminent death. Objective: Identify the relationship between spiritual well-being and quality of life related to the health of people diagnosed with advanced colorectal cancer (clinical staging III e IV) and analyze if there are correlationships between spirituality, anxiety and depression and the functional performance of this population. Method: Study developed with quantitative methodology, cross-sectional design and random sampling. The scales applied were Functional Assessment of Chronic Illness Therapy-Group (FACT-G), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-SP 12), Escala Karnosfky Performance Status (KPS) e Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HAD), in individuals diagnosed with advanced colorectal cancer in outpatient treatment of Proctology sector and Chemotherapy Center at a large public university hospital, located in the country side of State of São Paulo. 72 people that met the inclusion criteria were invited to participate in the study during the months of November 2019 to March 2020, with the final N being 60 participants. Results: Functional well-being presented a positive correlationship with the total score and the domains of meaning, peace and faith of FACT-SP12; It was possible to identify negative correlation between participants who did not present religious practice and domain of faith. According to the analysis of the boxplots, the median of participants who did not have religious practice was lower in the domains of peace and faith. Functionality leads to the improvement of spiritual well being and the lack of religious practice interferes negatively with faith and peace. Conclusion: Spirituality influences the quality of life of individuals with advanced colorectal cancer. Health care team need to consider these aspects and provide spiritual care to ill people and their familie

Long-term survival analysis after endoscopic stenting as a bridge to surgery for malignant colorectal obstruction: comparison with emergency diverting colostomy

The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. Objective: In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery. Methods: This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group.. Results: The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center. Conclusions: No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.

Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Differentiation between stercoral perforation and colorectal cancer perforation

SUMMARY OBJECTIVE: To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS: From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS: The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION: Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

RESUMO OBJETIVO: Determinar os sinais de CT associados à perfuração estercoral e perfuração do câncer colorretal. MÉTODOS: De maio de 2003 a fevereiro de 2015, todos os pacientes cirurgicamente e patologicamente confirmados com perfuração estercoral (n = 8, idade média de 68,3 anos) ou perfuração de câncer de cólon (n = 11, idade média de 66,3 anos) foram revisados retrospectivamente por dois radiologistas certificados por placa cegados ao diagnóstico comprovado. Os seguintes achados CT foram avaliados e gravados para cada paciente: espessura da parede do cólon distal adjacente ao local da perfuração, padrão de espessamento e realce da parede do cólon, comprimento da parede intestinal espessada, presença de fecaloma, grau de dilatação do cólon proximal e inflamação pericolônica ou presença de abscesso pericolônico e número de linfonodos pericolônicos aumentados. Esses achados foram correlacionados com o diagnóstico patológico. RESULTADOS: A espessura média da parede colônica distal adjacente ao local de perfuração foi de 13,6 mm em pacientes com perfuração de câncer colorretal e 5,1 mm com perfuração estercoral, que foi estatisticamente diferente. Houve uma correlação significativa entre a perfuração do câncer colorretal e o espessamento da parede excêntrica (p < 0,01). Os achados de CT de espessamento de parede aprimorada em camadas (p < 0,01) e presença de fecaloma no cólon proximal (p < 0,01) foram achados significativos para perfuração estercoral. Os pacientes com câncer colorretal apresentaram mais linfonodos pericolônicos (média 2,27, p < 0,05). CONCLUSÃO: O fecaloma no cólon proximal e o espessamento da parede que aumenta a camada adjacente ao local da perfuração são provavelmente devidos à perfuração estereocálica. O espessamento da parede intestinal excêntrica na porção distal do local da perfuração com muitos gânglios linfáticos pericolônicos aumentados é provavelmente a perfuração do câncer colorretal.

Outcomes of elderly patients undergoing emergency surgery for complicated colorectal cancer: a retrospective cohort study

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

Desnutrição e complicações clínicas em pacientes cirúrgicos com doença colorretal / Malnutrition and clinical outcomes in surgical patients with colorectal disease

ABSTRACT BACKGROUND: Malnutrition is a frequent condition among hospitalized patients and a factor of increased risk of postoperative complication. OBJECTIVE: This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease. METHODS: This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis. RESULTS: Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively. CONCLUSION: Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.

RESUMO CONTEXTO: A desnutrição é uma condição frequente entre pacientes hospitalizados e é um fator de risco para complicações pós-operatórias. OBJETIVO: Este estudo tem como objetivo avaliar o impacto da desnutrição sobre o ângulo de fase (AF), a distribuição de água corporal e complicações clínicas em pacientes cirúrgicos com doença colorretal. MÉTODOS: Trata-se de um estudo retrospectivo realizado em um hospital universitário terciário com 40 pacientes admitidos eletivamente. Na avaliação pré-operatória, foram realizadas a avaliação subjetiva global e análise de bioimpedância elétrica com a finalidade de determinarem o estado nutricional, AF, água extracelular (AEC), água intracelular (AIC) e água corporal total (ACT). Na avaliação pós-operatória, o tempo de internação hospitalar e a presença de complicações graves, segundo a classificação de Clavien-Dindo, foram determinados. O melhor ponto de corte do AF para o rastreamento de desnutrição foi obtido a partir da análise da curva ROC. RESULTADOS: Dezessete (42,5%) pacientes foram diagnosticados como desnutridos e 23 (57,5%), como bem nutridos de acordo com a avaliação subjetiva global. Doze (30,0%) pacientes desenvolveram complicações pós-operatórias graves. O grupo desnutrido apresentou menores valores de albumina sérica (P=0,012), hematócrito (P=0,026) e AF (P=0,002); enquanto que as relações de AEC/AIC (P=0,019) e AEC/ACT (P=0,047) estiveram elevadas. Além disso, 58,8% dos pacientes desnutridos desenvolveram complicações pós-operatórias graves em comparação a 8,7% dos pacientes bem nutridos. A desnutrição foi fator preditivo independente para o desenvolvimento de complicações pós-operatórias graves (OR=15,00, IC: 2,63-85,68; P=0,002). O melhor ponto de corte do AF obtido foi 6.0º (AUC=0,82; P=0,001) com sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 76,5%, 87,0%, 81,3% e 83,4%, respectivamente. CONCLUSÃO: A desnutrição foi fator preditivo para o desenvolvimento de complicações graves em pacientes submetidos à cirurgia eletiva coloproctológica de grande porte. Além disso, a desnutrição foi associada a menores valores de AF e maior proporção de AEC. O AF forneceu boa acurácia no rastreamento da desnutrição, sugerindo seu uso como potencial marcador de desnutrição.

Desenvolvimento de modelo de xenoenxerto ortotópico de metástase hepática de câncer colorretal em camundongo imunodeficiente / Development of patient-derived orthotopic xenografts from metastatic colorectal cancer in nude mice

Metástases hepáticas são a maior causa de morte em pacientes com câncer colorretal. Apesar dos tratamentos através de cirurgia e quimioterapia, o prognóstico destes pacientes permanence desfavorável. Portanto, há uma grande necessidade de se desenvolver novas estratégias terapêuticas, através da utilização de um bom modelo animal. Enxertos derivados de Paciente (PDX), são modelos pré-clínicos que representam com acurácia a individualidade do câncer humano. A doença metastática pode também ser reprodizida através da implantação ortotópica do tumor no orgão correspondente no camundongo. Testes com diferentes tratamentos baseados na assinatura genética do tumor podem ser realizados no modelo pré-clínico contribuindo no tratamento do paciente. O objetivo deste trabalho foi desenvolver um modelo de enxerto tumoral de metástase hepática de cancer colorretal, a partir de fragmento tumoral fresco implantado no parênquima hepático de camundongos atímicos nude. Nós reproduzimos com sucesso tumores metastáticos de pacientes para camundongos, e propagamos em três passagens de camundongos. As características morfológicas e imuno-histoquímicas demonstraram que os enxertos recriaram a arquitetura tumoral e expressaram as proteínas de reparo MLH1, MSH2, MSH1, e PMS2. Após a primeira passagem o tempo de crescimento tumoral variou de 153-281 dias para 27-99 dias sem perda de identidade tumoral. Doença linfoproliferativa pós-transplante foi observada em um caso. Este piloto obteve sucesso em estabelecer institucionalmente a plataforma pré-clínica PDX permitindo estudar novas estratégias terapêuticas, progressão da doença, biomarcadores e resposta a tratamento

Liver metastasis is the major cause of death for patients with colorectal cancer. Despite treatment with surgery and chemotherapy, patient outcomes are quite unfavorable. Thus, there is an urgent need to develop new treatment strategies, with the associated establishment of good animal models. Patient-derived xenografts (PDX) are preclinical models that accurately represent the individuality of human cancer. Metastatic disease can also be modeled using orthotopic implantation to the corresponding mouse organ to test various treatments based on individualized gene signatures of the human tumor, and results can inform clinical decision-making. The objective of this study was develop metastatic colorectal tumors in athymic nude mice, implanting fresh tumor fragments into mouse liver parenchyma. We successfully propagated metastatic tumors from patients in mice, serially implanted in second and third-generation mice. Morphologic and immunohistochemical characteristics indicate that xenografts recreate the tumor architecture and mismatch repair gene expression for MLH1, MSH2, MSH1, and PMS2. After tumor implantation during first passage, the time of tumor growth decreased from 150 to 250 days to 30 to 100 days, without loss of tumor identity. Post-transplantation lymphoproliferative disease was observed in one case. This pilot study was successful in establishing the institutional PDX preclinical platform to study new therapeutic strategies, disease progression biomarkers, and treatment responsiveness

Ressonância magnética com difusão para a avaliação da resposta terapêutica de metástases hepáticas de câncer colorretal em pacientes submetidos à quimioterapia de 1ª e 2ª linhas associada à Cetuximabe ou Bevacizumabe / Early prediction of pathological response using MR diffusion weighted imaging in patients with breast cancer submitted to neoadjuvant chemotherapy

O câncer colorretal é a terceira neoplasia maligna mais comum, sendo o fígado um órgão comumente acometido por metástases. Portanto, uma avaliação acurada do envolvimento hepático é vital para o planejamento do tratamento. O prognóstico dos. pacientes com câncer colorretal metastático mudou drasticamente nos últimos anos,. principalmente devido aos novos agentes citotóxicos e biológicos. À medida que se. caminha para melhor compreensão do uso destes medicamentos na prática clínica, observa-se a necessidade de identificar biomarcadores relacionados ao prognóstico.. A ressonância magnética (RM) com difusão é uma ferramenta promissora para o. diagnóstico e avaliação da resposta. Objetivos: Avaliar a efetividade do monitoramento da resposta terapêutica ao tratamento quimioterápico em pacientes. portadores de adenocarcinoma colorretal metastático, em tratamento de 1ª (primeira). linha ou 2ª (segunda) linha com Folfox ou Folfiri e anticorpos monoclonais. (Bevacizumabe ou Cetuximabe), utilizando-se a ressonância magnética com a técnica de difusão através da análise quantitativa do coeficiente de difusão aparente (ADC) e verificar a correlação com o método RECIST. Materiais e Métodos: Estudo prospectivo, onde foram recrutados pacientes adultos portadores de câncer colorretal metastático ao diagnóstico ou recidivado, atendidos no Departamento de Oncologia Clínica do A.C. Camargo Cancer Center no período de um ano, os quais foram submetidos ao tratamento quimioterápico de 1ª e 2ª linhas para doença metastática com Folfox ou Folfiri associado a anticorpo monoclonal (Cetuximabe ou Bevacizumabe). Foi realizado um exame de ressonância magnética do abdome superior com difusão pré-tratamento e exames adicionais ao final do 4º, 8º e 12º ciclos de quimioterapia, para avaliação de resposta das lesões hepáticas metastáticas ao tratamento proposto. Foi realizada conjuntamente a avaliação das metástases hepáticas pelo método RECIST para comparação com a avaliação quantitativa obtida pela Ressonância Magnética com difusão através do ADC. Resultados: Nove pacientes foram avaliados neste estudo. A média de idade dos pacientes foi 57,2 anos (dp=13,8), sendo a idade mínima de 34 e a máxima de 80 anos, com 5 pacientes do sexo feminino e 4 do sexo masculino. O Folfox foi utilizado em 6 pacientes e o Folfiri em 3 pacientes, sendo 6 pacientes de 1ª linha e 3 de 2ª linha de tratamento. Quanto ao Anticorpo monoclonal, 5 pacientes fizeram uso do Cetuximabe e 4 usaram o Bevacizumabe. O número de metástases hepáticas observadas em um mesmo. paciente variou de 1 até 8 lesões, com um total de 24 lesões analisadas. O tamanho. médio das lesões foi de 36,6 mm (± 21,1 mm). Seis (66,7%) dos 9 pacientes tiveram. resposta parcial (RP), 2 (22,2%) foram classificados como doença estável (DE) e 1. paciente (11,1%) apresentou progressão de doença (PD). Nenhum caso de resposta completa (RC) foi observado no follow-up. Correlação RECIST e ADC: Baseado na avaliação das lesões pelo método RECIST, as lesões foram agrupadas como respondedoras quando houve resposta completa (RC) e resposta parcial (RP) e como não respondedoras quando houve progressão de doença (PD) e doença estável (DE), para comparação com a avaliação pelo ADC. Seis pacientes responderam à quimioterapia e 3 pacientes não responderam. Em relação às lesões, 14 lesões responderam ao tratamento e 10 lesões não responderam. Na análise entre as lesões que responderam e as que não responderam ao tratamento quimioterápico de acordo com o padrão de resposta pelo RECIST não foi observada significância estatística em relação ao ADC basal (p=0,940 (após o 4º ciclo) e p=0,909 (após o 8º ciclo)). Não foi observada diferença estatística na análise das variações após o 4º ciclo de quimioterapia (p=0,245 e percentual com p=0,144), como também não observamos correlação entre a redução final do tamanho tumoral e o valor do ADC basal(p=0,869). Identificamos o melhor ponto de corte (cutoff) de ADC entre as lesões que responderam à quimioterapia e as que não responderam ao tratamento. O cutoff de ADC absoluto foi de 0,05 x 10-3 mm²/sec (AUC=0,66), e o cutoff de ADC percentual foi de 3,8% (AUC=0,70). Considerando-se o Cutoff de ADC percentual de 3,8%, não observamos significância estatística entre as lesões que responderam e as que não responderam à quimioterapia (p=0,057. Conclusões: A RM com difusão, por meio da análise quantitativa do ADC, demonstrou ser um método útil para monitorizar as lesões hepáticas de câncer colorretal metastático em tratamento com quimioterapia. A variação de ADC correlacionou-se com o RECIST, sendo que o aumento do ADC esteve associado com a redução do tamanho das lesões (resposta parcial/respondedores). No entanto, não houve significância estatística, muito provavelmente devido à amostragem limitada. Conseguimos identificar um ponto de. corte através da curva ROC que poderá ser validado em estudos posteriores com uma. maior casuística

Colorectal cancer is the third most common malignancy, and the liver is an organ commonly affected by metastases. Therefore, an accurate assessment of liver involvement is vital for treatment planning. The prognosis of patients with metastatic colorectal cancer has changed dramatically in recent years, mainly due to new cytotoxic and biological agents. In order to better understand the use of these drugs in clinical practice, there is a need to identify biomarkers related to prognosis. Magnetic resonance imaging (MRI) with diffusion is a promising tool for the diagnosis and assessment of response. Objectives: To evaluate the effectiveness of the monitoring of the therapeutic response to chemotherapy treatment in patients with metastatic colorectal adenocarcinoma, in treatment of 1st (first) line or 2nd (second) line with Folfox or Folfiri and monoclonal antibodies (Bevacizumab or Cetuximab) using magnetic resonance imaging using the technique of diffusion through of the quantitative analysis of the apparent diffusion coefficient (ADC) and verify the correlation with the RECIST method. Materials and Methods: Prospective study conducted adult patients with metastatic colorectal cancer diagnosis or relapsed, assisted in the Department of Clinical Oncology of AC Camargo Cancer Center during one year, which underwent chemotherapy 1st and 2nd lines for metastatic disease with Folfox or Folfiri associated with monoclonal antibody (Cetuximab or Bevacizumab). We performed a magnetic resonance examination of the upper abdomen pretreatment and additional exams at the end of the 4th, 8th and 12th cycles of chemotherapy, to evaluate the response of metastatic liver lesions to the proposed treatment. It was performed jointly evaluating the liver metastases by RECIST method for quantitative comparison with the evaluation obtained by MRI with diffusion through ADC. Results: Nine patients were evaluated in this study. The mean age of the patients was 57.2 years (sd = 13.8), with a minimum age of 34 and a maximum of 80 years, with 5 female patients and 4 male. The Folfox was used in 6 patients and Folfiri in 3 patients, being 6 patients of 1st line and 3 of 2nd line of treatment. Regarding the use of the monoclonal antibody, 5 patients were using Cetuximab and 4 used Bevacizumab. The number of liver metastases in the same patient observed varied from one (1) to 8 lesions with a total of 24 lesions analyzed. The average size of the lesions was 36.6 mm (± 21.1 mm). Six (66.7%) of the 9 patients had partial response (PR), 2 (22.2%) were classified as stable disease (SD) and 1 patient (11.1%) presented disease progression (PD). No case of complete response (CR) was observed at follow-up. Correlation RECIST and ADC: Based on the evaluation of the lesions by the RECIST method, the lesions were grouped as responders when there was complete response (CR) and partial response (PR) and as no responders when there was disease progression (PD) and stable disease (SD), for comparison with the evaluation by the ADC. Six patients responded to chemotherapy and 3 patients did not respond. Regarding the lesions, 14 lesions responded to the treatment and 10 lesions did not respond. In the analysis between the lesions that responded and those that did not respond to the chemotherapy treatment according to the response pattern by the RECIST, no statistical significance was observed in relation to baseline ADC (p = 0.940 (after the 4th cycle) and p = 0.909 (after the 8th cycle)). No statistical difference was observed in the analysis of the variations after the 4th cycle of chemotherapy (p = 0.245 and percentage with p = 0.144), nor did we observe a correlation between final reduction of tumor size and baseline ADC (p = 0.869). We identified the best ADC cut-off between the lesions that responded to chemotherapy and those that did not respond to treatment. The absolute ADC cut-off was 0.05 x 10-3 mm²/sec (AUC = 0.66), and the percentage ADC cut-off was 3.8% (AUC = 0.70). Considering the Cut-off of ADC percentage of 3.8%, we did not observe statistical significance between the lesions that responded and those that did not respond to chemotherapy (p = 0.057). Conclusions: MRI, with its quantitative analysis of ADC, has been shown to be a useful method to monitor hepatic changes of the metastatic in treatment with chemotherapy. The variation in ADC correlated with RECIST, and the increase in ADC was associated with the reduction of lesion size (partial response / responders). However, there was no statistical significance, most likely due to limited sampling. We were able to identify a cutoff point through the ROC curve that could be validated in later studies with a larger casuistry

The effect of therapeutic listening on anxiety and fear among surgical patients: randomized controlled trial / O efeito da escuta terapêutica na ansiedade e medos de pacientes cirúrgicos: ensaio clínico aleatorizado / El efecto de la escucha terapéutica sobre la ansiedad y los miedos de pacientes quirúrgicos: ensayo clínico aleatorizado

ABSTRACT Objective: To investigate the effect of therapeutic listening on state anxiety and surgical fears in preoperative colorectal cancer patients. Method: A randomized controlled trial with 50 patients randomly allocated in the intervention group (therapeutic listening) (n = 25) or in the control group (n = 25). The study evaluated the changes in the variables state anxiety, surgical fears and physiological variables (salivary alpha-amylase, salivary cortisol, heart rate, respiratory rate and blood pressure). Results: In the comparison of the variables in the control and intervention groups in pre- and post-intervention, differences between the two periods for the variables cortisol (p=0.043), heart rate (p=0.034) and surgical fears (p=0.030) were found in the control group, which presented reduction in the values ​​of these variables. Conclusion: There was no reduction in the levels of the variables state anxiety and surgical fears resulting from the therapeutic listening intervention, either through the physiological or psychological indicators. However, the contact with the researcher during data collection, without stimulus to reflect on the situation, may have generated the results of the control group. Clinical Trial Registration: NCT02455128.

RESUMO Objetivo: Investigar o efeito da escuta terapêutica sobre a ansiedade estado e os medos relacionados à cirurgia em pacientes no pré-operatório de cirurgia de câncer colorretal. Método: Ensaio clínico, aleatorizado e controlado, realizado com 50 pacientes que foram aleatoriamente designados para o grupo intervenção (escuta terapêutica) (n=25) ou para o grupo controle (n=25). O estudo avaliou as mudanças nos níveis de ansiedade das variáveis ansiedade estado, medos relacionados à cirurgia e variáveis fisiológicas (alfa-amilase salivar, cortisol salivar, frequência de pulso, frequência respiratória e pressão arterial). Resultados: Na comparação das variáveis nos grupos controle e intervenção nos momentos pré e pós-intervenção, constataram-se diferenças entre os momentos no grupo controle para as variáveis cortisol (p=0,043), frequência de pulso (p=0,034) e medos relacionados à cirurgia (p=0,030), com redução dos valores dessas variáveis. Conclusão: Não houve redução nos níveis das variáveis ansiedade estado e medos relacionados à cirurgia decorrente da realização da escuta terapêutica, seja por meio dos indicadores fisiológicos ou psicológicos. Contudo, o acolhimento dado pela pesquisadora na coleta de dados, sem estímulo reflexivo à situação, pode ter gerado os resultados do grupo controle. Registro de Ensaio Clínico: NCT02455128.

RESUMEN Objetivo: Investigar el efecto de la escucha terapéutica sobre la ansiedad-estado y los miedos de pacientes relativos a la cirugía de cáncer colorrectal en el preoperatorio. Método: Se trata de un ensayo clínico, aleatorizado y controlado, realizado entre 50 pacientes designados aleatoriamente para el grupo intervención (escucha terapéutica) (n=25) o para el grupo control (n=25). El estudio evaluó los cambios en los niveles de ansiedad de las variables ansiedad-estado, miedos relativos a la cirugía y variables fisiológicas (alfa-amilasa salival, cortisol salival, frecuencia cardiaca, frecuencia respiratoria y presión arterial). Resultados: Al comparar las variables entre los grupos control e intervención en los momentos pre y post-intervención, se constataron diferencias en el grupo control para las variables cortisol (p=0,043), frecuencia cardiaca (p=0,034) y miedos relacionados a la cirugía (p=0,030), con reducción de los valores de esas variables. Conclusión: No hubo reducción en los niveles de las variables ansiedad-estado y miedos relacionados a la cirugía derivado de la realización de la escucha terapéutica, ya sea mediante indicadores fisiológicos o psicológicos. Sin embargo, la acogida propiciada por la investigadora en la colecta de datos, sin estímulo reflexivo a la situación, podría haber generado los resultados del grupo control. Registro de Ensayo Clínico: NCT02455128.

Results of surgical treatment of colorectal cancer in nonagenarian patients / Resultados do tratamento cirúrgico do câncer colorretal em pacientes nonagenários

ABSTRACT Purpose: The objective of the present study was to compare the results of surgical treatment of nonagenarian patients having colorectal cancer with patients younger than 90 years. Methods: A total of 622 patients who underwent curative surgery were included in the present study. The database of the surgical service, in the period from 2007 to 2013, was used to obtain the sample. This is a descriptive, retrospective study that compared the profiles of 17 nonagenarian patients (Group I) with 605 patients younger than 90 years (Group II). The groups were compared regarding surgical complications, length of hospital stay, type of surgery performed and ASA classification. Results: The mean age between the groups was 92.2 years and 61.2 years. The mean length of hospital stay in Groups I and II was 17.3 days and 8.75 days, respectively. The surgery performed most frequently was the right colectomy, in both groups. The most common postoperative complication was sepsis (11.8%) among the nonagenarians, and paralytic ileus (4.5%) among those younger than 90 years. Laparoscopic surgery was performed on 5 out of a total of 17 patients evaluated in Group I. Among the three mortalities registered in this latter group, two were classified as ASA III and only one as ASA I. Conclusion: The results indicate that colorectal surgery may be performed in this group, with acceptable morbidity and mortality rates, in patients with low preoperative risk (ASA I/II).

RESUMO Finalidade: O objetivo do presente estudo foi comparar os resultados do tratamento cirúrgico de pacientes nonagenários portadores de câncer colorretal versus pacientes com menos de 90 anos. Métodos: O estudo envolveu 622 pacientes que foram submetidos à cirurgia curativa. Para obtenção da amostra, utilizamos o banco de dados do serviço de cirurgia, abrangendo o período de 2007-2013. Este é um estudo retrospectivo descritivo que comparou os perfis de 17 pacientes nonagenários (Grupo I) versus 605 pacientes com menos de 90 anos (Grupo II). Os grupos foram comparados para complicações cirúrgicas, duração da permanência no hospital, tipo de cirurgia realizada e classificação ASA. Resultados: A média de idade para os Grupos I e II foi, respectivamente, 92,2 e 61,2 anos. A duração média de permanência no hospital nos Grupos I e II foi, respectivamente, 17,3 dias e 8,75 dias. A cirurgia mais frequentemente realizada foi colectomia direita, nos dois grupos. A complicação pós-operatória mais comum foi sepse (11,8%) entre os nonagenários, e íleo paralítico (4.5%) entre os pacientes com menos de 90 anos. Cirurgia laparoscópica foi realizada em 5 pacientes, em um total de 17 pacientes avaliados no Grupo I. Considerando as três mortalidades registradas nesse último grupo, duas foram classificadas como ASA III e apenas uma como ASA I. Conclusão: Os resultados obtidos indicam que, nesse grupo, a cirurgia colorretal é opção válida, com percentuais aceitáveis de morbidade e mortalidade, em pacientes com baixo risco pré-operatório (ASA I/II).

Self-esteem and health-related quality of life in ostomized patients / Autoestima y calidad de vida relacionada a la salud de ostomizados / Autoestima e qualidade de vida relacionada à saúde de estomizados

ABSTRACT Objective: to assess self-esteem (SE) and health-related quality of life (HRQoL) in ostomized patients due to colorectal cancer. Method: cross sectional research with a quantitative approach. Three instruments were used for data collection: one instrument containing sociodemographic and clinical data, Rosenberg's Self-Esteem Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Results: SE and HRQoL were considered satisfactory. Significant statistical difference was found in the social function domain and marital status, ostomy duration, location, and time; global health scale and ostomy type; cognitive function and pain in the ostomy site. There was a correlation between self-esteem and all the functional scales and the global health scale. Conclusion: knowing SE and HRQoL levels, in addition to the variables that influence them, supports ostomized patients' care planning, rehabilitation, and social autonomy.

RESUMEN Objetivo: evaluar autoestima (AE) y calidad de vida relacionada a la salud (QVRS) de pacientes ostomizados por cáncer colorrectal. Método: estudio transversal con abordaje cuantitativo. Datos obtenidos mediante tres instrumentos: uno incluyendo datos sociodemográficos y clínicos; la Escala de Autoestima de Rosenberg y el European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Resultados: La AE y la QVRS fueron consideradas satisfactorias. Se verificó diferencia estadísticamente significativa entre: dominio función social y situación conyugal, duración, localización y tiempo de ostomía; escala global de salud con tipo de ostomía; función cognitiva y dolor con lugar de ostomía. Hubo correlación entre autoestima y todas las escalas funcionales y la escala global de salud. Conclusión: conocer los niveles de AE y QVRS y cómo los influyen las variables, ayuda con la planificación del cuidado, la rehabilitación y la autonomía social del ostomizado.

RESUMO Objetivo: avaliar a autoestima (AE) e a qualidade de vida relacionada à saúde (QVRS) de pacientes estomizados por câncer colorretal. Método: estudo transversal com abordagem quantitativa. Utilizaram-se três instrumentos para a coleta de dados: um contendo dados sociodemográficos e clínicos, a Escala de Autoestima de Rosenberg e o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Resultados: a AE e a QVRS foram consideradas satisfatórias. Verificou-se diferença estatisticamente significante entre: o domínio função social e situação conjugal, duração, localização e tempo de estomia; a escala global de saúde com o tipo de estomia; a função cognitiva e dor com local da estomia. Houve correlação entre a autoestima e todas as escalas funcionais e a escala global de saúde. Conclusão: conhecer os níveis de AE e QVRS, e como as variáveis que os influenciam subsidiam o planejamento do cuidado, a reabilitação e a autonomia social do estomizado.

Metástase oral de adenocarcinoma de cólon: relato de caso / Oral metastasis of colon adenocarcinoma: case report

Introdução: as lesões metastáticas em boca são raras e representam menos de 1% de todas as neoplasias malignas. A mandíbula é a região mais afetada e, os tecidos moles, menos comumente, sendo a gengiva e a língua os sítios mais acometidos. Objetivo: relatar um caso clínico de um paciente portador de adenocarcinoma de cólon avançado sob cuidados paliativos, e que apresentou uma lesão metastática bucal. Método: relado de caso. Resultado e Discussão: O diagnóstico precoce de lesões metastáticas bucais é bastante desafiador para o cirurgião-dentista, uma vez que essas lesões podem manifestar-se clinicamente como lesões reacionais ou neoplasias benignas, que podem dificultar o diagnóstico precoce e seu imediato tratamento. Ressaltamos que o exame físico da boca deve ser realizado em pacientes oncológicos, que apresentam metástases em outros órgãos, no intuito de investigar a existência de lesões bucais e proporcionar um diagnóstico precoce, que possibilite melhor chance de tratamento e reabilitação mais favorável, quando o prognóstico do câncer é bom. Conclusão: nos casos avançados, o tratamento paliativo deve ser realizado para que haja melhor qualidade de vida ao paciente.

Introduction: metastatic lesions in the mouth are rare and account for less than 1% of all malignancies. The jaw is the most affected region, and the soft tissues are less commonly, with the gingiva and tongue being the most affected sites. Objective: the objective of this study is to report a case of a patient with advanced colon adenocarcinoma under palliative care and who presented with an oral metastatic lesion. Method: it is proposed a standard vase report. Result and Discussion: early diagnosis of oral metastatic lesions is quite challenging for the dental surgeon, since these lesions may manifest clinically as reactional lesions or benign neoplasms, which may make early diagnosis and immediate treatment. We emphasize that the physical examination of the mouth should be performed in cancer patients, who have metastases in other organs, in order to investigate the presence of oral lesions and provide an early diagnosis, which allows a better chance of treatment and more favorable rehabilitation, when the prognosis of cancer is good. Conclusion: in advanced cases, palliative treatment should be performed in order to have a better quality of life for the patient.

Metástasis hepática sincrónica de cáncer colorrectal / Synchronous liver metastases of colorectal cancer

El cáncer colorrectal representa 9,7% de todos los cánceres con 1,4 millones de nuevos casos diagnosticados cada año en el mundo 19-31% de los pacientes desarrollan metástasis hepáticas de cáncer colorrectal y 23-38% desarrollan enfermedad extrahepática1 15-25% se presentarán de forma sincrónica y 25-40% serán metacrónicas2.La resección quirúrgica es el único tratamiento potencial-mente curativo, en el caso de las metástasis sincrónicas, se debate si se deben resecar simultáneamente, antes o después del tumor primario.

Colorectal cancer (CRC) accounts for 9.7% of all cancers with 1.4 million new cases diagnosed each year. 19–31% of CRC patients develop colorectal liver metastases, and 23–38% develop extra-hepatic disease1 . 15-25% will be presented synchronously and 25-40% will metachronously2 . Surgical resection is the only potentially curative treatment and, in the case of synchronous metastases, the debate is whether to resect simultaneously, before or after the primary tumor.

Quality of life in stomized oncological patients: an approach of integrality from Brazilian Unified Health System / Qualidade de vida de estomizados oncológicos: uma abordagem da integralidade do SUS do Brasil

Introduction: Integrality is considered an essential constitutional doctrinal principle of SUS, being considered as a major challenge in health in Brazil. This involves practicing focusing on the quality of life of oncological stomized people. Objective: To analyze quality of life of oncological stomized people from the Health Department, the Federal District, Brazil, from the perspective of integrality of the Unified Health System in Brazil. Methods: Cross-sectional, exploratory and descriptive study with a quantitative and qualitative approach in the light of a content analysis. This was a convenience sample, including 120 patients registered in the Stomized People Program of the Health Department, the Federal District, Brazil. In this study, sociodemographic, clinical, and WHOQOL-bref questionnaires and an individual interview were used. Data were analyzed by Microsoft(r) Office Excel 2010 program and SPSS 20.0 software. Statistical significance was accepted at 5%. Results: Physical, Social Affairs, and Environment domains are correlated with the mean score, with statistically significant results (p<0.0001), the content analysis resulted in three categories: complications with the stoma, self-care, and Comprehensive health care. Conclusion: Our results highlight the need to realize the integrality as a principle at various levels of discussion and of the practice of health care for stomized oncological people.

Introdução: A integralidade é considerada um princípio doutrinário constitucional e essencial do SUS, e é apreciada como um grande desafio no âmbito da saúde no Brasil. Isto implica práticas voltadas para a qualidade de vida das pessoas oncológicas estomizadas. Objetivo: Analisar a qualidade de vida de pessoas oncológicas estomizadas da Secretária de Saúde do Distrito Federal, Brasil, sob a perspectiva da integralidade do Sistema Único de Saúde do Brasil. Métodos: Estudo transversal, exploratório-descritivo com abordagem quantitativa e qualitativa à luz da análise de conteúdo. A amostra foi constituída por conveniência, com inclusão de 120 pacientes cadastrados no Programa de Estomizados da Secretaria de Saúde do Distrito Federal, Brasil. O estudo utilizou os questionários sóciodemográfico, clínico, e o WHOQOL-bref e uma entrevista individual. Os dados foram analisados pelos programas Microsoft(r) Office Excel 2010 e SPSS 20.0. A significância estatística aceita foi de 5%. Resultados: Os Domínios Físico, Relações Sociais e Meio Ambiente estão correlacionados com o escore médio, com significância estatística (p<0,0001), e a análise de conteúdo resultou em três categorias: Complicações com a estomia, Autocuidado e Assistência integral à saúde. Conclusão: Fica evidenciada a necessidade de se perceber a integralidade como princípio em vários níveis de discussões e de prática do cuidado em saúde para pessoas oncológicas estomizadas.