Pattern of rectal cancer recurrence following potentially curative surgical treatment

Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between June 2003 and July 2021. After applying the exclusion criteria to 305 patients, 166 patients were analyzed. Global recurrence was found in 18.7% of them, while 7.8% have had local recurrence. Recurrences were diagnosed from 5 to 92 months after the surgical procedure, with a median of 32.5 months. Follow-up varied from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years and shows a 5-year survival rate of only 5%. In around 50% of cases, recurrence is local, confined to the pelvis. This study was consonant with the literature in most aspects evaluated, although a high rate of local recurrence remains a challenge in seeking better surgical outcomes. (AU)

Una mirada al cáncer colorrectal en Chile: aproximación individualizada de las cifras para el periodo 2016-2021 / A look at colorectal cancer in Chile: Individual approximation of the figures for the period 2016-2021

Introducción: El cáncer colorrectal (CCR) es la tercera enfermedad maligna más frecuente en el mundo y suele estudiarse como un solo concepto, a pesar de las diferencias entre las neoplasias que lo conforman. Dada la falta de trabajos actualizados, se ha realizado esta revisión epidemiológica para aproximarse a su verdadera magnitud en la población chilena. Materiales y Métodos: Este estudio es de carácter observacional, descriptivo, longitudinal y retrospectivo. Analizó las tasas de mortalidad a nivel nacional y regional entre 2016-2021 por cáncer de colon, unión rectosigmoidea y recto, utilizando datos de acceso público. Los criterios de inclusión consideraron todas las defunciones por las neoplasias mencionadas registradas en el DEIS, mientras que los criterios de exclusión corresponden a aquellas que por las mismas causas no fueron registradas o sucedieron fuera del período de estudio. No se requirió consentimiento informado ni revisión por parte de un comité de ética. Resultados: Se evidencia un aumento de las defunciones por cáncer de colon, principalmente en la zona centro-sur del país, sin una predilección significativa de género. Aunque la mortalidad por otras neoplasias estudiadas ha aumentado, no ha sido en igual cuantía. Discusión: La mortalidad por cáncer de colon es superior a la de otras neoplasias estudiadas, destacando la zona centro-sur del país, sin una tendencia específica por sexo en los fallecimientos. Esto podría explicarse por fallas en los mecanismos diagnósticos o diferencias en los hábitos alimenticios. Se necesitarían estudios adicionales para confirmar estas observaciones.

Introduction: Colorectal cancer (CRC) is the third most frequent malignant disease in the world, and although it is usually studied as a single entity (rectum-colon), the differences between both neoplasms are quantitatively significant. Therefore, in view of the lack of updated studies, this epidemiological review has been carried out to approximate its real magnitude in the Chilean population. Materials and Methods: Observational, descriptive, longitudinal, and retrospective study, where mortality rates were analyzed at the national and regional level, between 2016-2021, due to colon cancer. For this, publicly accessible data was used. Therefore, informed consent or review by an ethics committee was not required. Results: During the period studied, there is evidence of a clear rising trend in mortality rates, contributed mainly by the central-southern area of the country, without significant gender predilection. The mortality rate contributed by rectum and union neoplasm isn't significant enough like the colon ones. Discussion: Through this review, the systematic growth that this pathology has experienced in national mortality and its predilection for specific geographical areas are evident. The explanation for this could range from failures in diagnostic care mechanisms to marked differences in diet habits; more studies would be needed to confirm it.

Cirugía radical del cáncer del recto localmente avanzado: análisis comparativo de la cirugía laparoscópica con la cirugía abierta / Radical surgery for locally advanced rectal cancer: comparative analysis of laparoscopic surgery with open surgery

Resumen Introducción: El tratamiento estándar del cáncer del recto localmente avanzado (CRLA) actual es multimodal. La cirugía mínimamente invasiva es factible en el manejo de este tumor, aunque existe controversia sobre sus resultados alejados. Objetivo: Comparar los resultados inmediatos y alejados de una serie laparoscópica (CL) con una serie de cirugía convencional (CA) intervenidos por CRLA. Materiales y Método: Revisión retrospectiva de ambas técnicas de abordaje en un periodo de 14 años. Se analiza la morbilidad, los resultados patológicos, la recidiva local y la sobrevida a largo plazo. Para estimar las curvas de sobrevida se utilizó el método de Kaplan-Meier. Para comparar las curvas de sobrevida se usó el test de log-rank. Resultados: Se compara 163 pacientes intervenidos por CL con 164 operados mediante CA. Ambos grupos resultaron equivalentes en cuanto a las variables demográficas, morbilidad perioperatoria y estadios patológicos finales, salvo un menor tiempo de hospitalización en el grupo CL (p = 0,007). Los tumores bajos recibieron radioterapia preoperatoria en el 90% de los casos. La recidiva local global y la sobrevida a largo plazo no muestran diferencias de acuerdo al tipo de abordaje. Al excluir los pacientes con una lesión en el recto superior se aprecia que los tumores de recto bajo tienen peor pronóstico, independiente de la técnica empleada (p = 0,007). Conclusiones: La CL es equivalente a la CA en el manejo multimodal del CRLA. La inclusión de tumores del recto superior tiende a mejorar artificialmente los resultados de la cirugía en cuanto a recidiva local y sobrevida global.

Introduction: Total mesorectal excison and preoperative radiotherapy are important components of multimodal treatment in patients with a low locally advanced rectal cancer. Short-term results of laparoscopic surgery has proven to be safe but oncological results are unclear. Aim: To compare short-term and oncologic outcomes of laparoscopic and open resection of locally advanced rectal cancer operated on in the same period. Materials and Method: A total of 327 patientes with rectal cancer treated by open and laparoscopic curative surgery were retrospectively reviewed. Long-term follow up was compared using Kaplan-Meier curves and survival data were tested by log rank test. Results: Demographic data, levels of carcinoembryonaric antigen, perioperative morbidity and pathologic stages were similar in both groups, except for less inhospital time in laparoscopic group (p = 0.007). Over 90% of middle and low tumors recived preoperative radiotherapy. Local recurrence and overall survival shows no difference between both groups. Low and middle rectal cancer showed worst prognosis than tumors of the high rectum, no matter of type of surgery (p = 0.007). Conclusions: Laparoscopic surgery is non-inferior to open resection for pathological and oncological outcomes. It's not convenient to include on trials lesions located in the high rectum, usually treated with primary surgery as colon cancer.

Sobrevida de pacientes com câncer colorretal em um Cancer Center / Survival of patients with colorectal cancer in a cancer center

ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

RESUMO CONTEXTO: Estudos hospitalares recentes têm demonstrado aumento da sobrevida do câncer colorretal e melhor sobrevida para mulheres, jovens e pacientes diagnosticados em estágio precoce da doença. OBJETIVO: Descrever a sobrevida global e analisar os fatores prognósticos de pacientes tratados para câncer colorretal em um centro de oncologia. MÉTODOS: Foram incluídos pacientes com diagnóstico de adenocarcinoma de cólon e reto entre 2000 e 2013, identificados no Registro Hospitalar de Câncer do A.C.Camargo Cancer Center. A sobrevida global aos 5 anos foi estimada pelo método de Kaplan-Meier e os fatores prognósticos foram avaliados pelo modelo de Cox. As razões de risco (HR) são relatadas com intervalos de confiança (IC) de 95%. RESULTADOS: Dos 2.279 casos de câncer colorretal analisados, 58,4% eram de cólon. A taxa de sobrevida global aos 5 anos para pacientes com câncer colorretal foi de 63,5% (65,6% e 60,6% para câncer de cólon e retal, respectivamente). O risco de óbito foi elevado para pacientes na faixa etária de 50-74 anos (HR=1,24; IC95% =1,02-1,51) e ≥75 anos (HR=3,02; IC95% =2,42-3,78), para pacientes com câncer retal (HR=1,37; IC95% =1,11-1,69) e para aqueles cujo tratamento foi iniciado >60 dias após o diagnóstico (HR=1,22; IC95% =1,04-1,43). O risco diminuiu para pacientes diagnosticados em períodos recentes (2005-2009 HR=0,76; IC95% =0,63-0,91; 2010-2013 HR=0,69; IC95% =0,57-0,83). CONCLUSÃO: A sobrevida dos pacientes com câncer colorretal é maior naqueles em estágio inicial e com início do tratamento antes dos 60 dias.. Idade acima de 70 anos foi fator independente preditivo de mau prognóstico. A sobrevida global aumentou para todos os pacientes tratados no período de 2000-2004 a 2010-2013.

Adjuvant chemotherapy in locally advanced rectal cancer: deciding on the optimal strategy

ABSTRACT Background: Neoadjuvant therapy, followed by surgery, reduces the risk of local relapse in rectal cancer, but approximately 30% will relapse with distant metastases, highlighting the importance of adjuvant chemotherapy (aCT). Objective: The objective of the study was to study two regimens of adjuvant treatment in patients with locally advanced rectal cancer and analyze their efficacy and toxicity. Methods: Between January 2009 and December 2016, 193 patients with Stage II-III rectal cancer who had received neoadjuvant therapy were included by consecutive non-probability sampling. The decision to administer aCT, as well as the specific regimen, was at the discretion of the medical oncologist. Disease-free survival (DFS) and overall survival (OS) were calculated. Results: The mean DFS was 84.85 (95% confidence interval [CI]: 79-90) months in 164 patients receiving aCT, compared to 57.71 (95% CI: 40-74) months in 29 who did not receive aCT (p < 0.001). Then, mean OS was 92.7 (95% CI: 88-97) months and 66.18 (95% CI 51-81) months, respectively (p < 0.001). DFS was 83.6 (95% CI: 76-91) months in 74 patients receiving adjuvant 5-fluorouracil (5-FU), and 82.9 (95% CI: 75-90) months in 90 receiving 5-FU plus oxaliplatin (p = 0.49). OS was 87 (95% CI: 80-94) versus 93.65 (95% CI: 88-99) months, respectively (p = 0.76). The multivariate analysis identified aCT hazard ratio (HR) 0.30 (95% CI: 0.1-0.46), perineural invasion HR 3.36 (95% CI: 1.7-6.5), and pathological complete response HR 0.10 (95% CI; 0.01-0.75) as independent markers of DFS. Conclusions: In our study, aCT was associated with longer DFS and OS. 5-FU plus oxaliplatin showed greater toxicity with no added benefit in DFS or OS.

Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica / Long-term results of patients with adenocarcinoma of the lower rectum treated with anterior intersphinteric ultra-low-resection

INTRODUCCIÓN: La resección anterior ultrabaja interesfintérica (RAUBIE), permite preservar la función esfinteriana en pacientes seleccionados con cáncer de recto (CR). No obstante, puede producir alteraciones en la función evacuatoria y esfinteriana. OBJETIVO: Analizar los resultados oncológicos y funcionales luego de una RAUBIE. MATERIAL Y MÉTODO: Estudio observacional, analítico, transversal, durante el período 2007 a 2016. Criterios de inclusión: Pacientes sometidos a RAUBIE por CR con intención curativa. Todos los pacientes tuvieron un seguimiento el año 2017. Para la evaluación funcional se usó la escala de Jorge-Wexner, LARS y Kirwan. Análisis estadístico: Estadística descriptiva y método de Kaplan-Meier. RESULTADOS: De 21 pacientes; catorce (67%) fueron varones, edad promedio: 59 años. Ubicación tumoral: 4 cm (2-6 cm) del margen anal. Dieciocho (85,7%) pacientes recibieron neoadyuvancia. Todos los márgenes quirúrgicos distales y radiales fueron negativos. Un paciente (4,8%) tuvo metástasis a distancia y no hubo recurrencia locorregional. Con una mediana de seguimiento de 76,3 (9,8-126,8) meses, la sobrevida global y libre de enfermedad a 5 años fue de: 100% y 95% (IC: 90,1-99,9%), respectivamente. Con una mediana de seguimiento de 90 meses (21,7-124,2); se realizó la evaluación funcional a 15/21 pacientes. El puntaje de Jorge-Wexner tuvo una mediana de 13 (4-17) puntos, la escala de LARS de 34 puntos y en la escala de Kirwan, cuatro pacientes (26,7%) mostraron una buena función (Kirwan I-II). CONCLUSIÓN: Si bien los resultados oncológicos de los pacientes sometidos a una RAUBIE son satisfactorios, se debería tomar en cuenta los resultados funcionales al momento de proponer esta alternativa quirúrgica.

INTRODUCTION: Intersphinteric resection (ISR) allows preserve sphincter function in selected patients with rectal cancer (RC). Notwithstanding, it can produce alterations in defecation. AIM: To analyze the oncological and functional results after an ISR. MATERIAL AND METHOD: Observational, analytical, cross-sectional study, in the period 2007-2016. Inclusion criteria: Patients submitted to ISR by RC with curative intention. All the patients had a follow-up in 2017. Analysis of functional evaluation were performed by Jorge-Wexner, LARS and Kirwan scale. Statistical analysis: Descriptive statistics and Kaplan-Meier method. RESULTS: Of 21 patients; Fourteen (67%) were male, average age: 59 years. Tumor location: 4 cm (2-6 cm) from anal verge. Eighteen (85.7%) patients received neoadjuvant therapy. All distal and radial margins were negative. One patient (4.8%) had distant metastases and there was no locoregional recurrence. With a median follow-up of 76.3 (9.8-126.8) months, the 5-year global and disease-free survival was: 100% and 95% (CI: 90.1-99.9%), respectively. With a median follow-up of 90 months (21.7-124.2); Functional evaluation was performed on 15/21 patients. The Jorge-Wexner score had a median of 13 (4-17) points, the LARS scale of 34 points and in Kirwan scale, four patients (26.7%) showed good function (Kirwan I-II). CONCLUSION: The oncological results of patients undergoing ISR are satisfactory, however, functional results should be taken into account when proposing this surgical procedure.

Calidad oncológica en cirugía del cáncer de recto / Oncologic quality of the surgical resection in rectum cancer / Qualidade oncológica na cirurgia de câncer de reto

Introducción: el pronóstico del cáncer de recto depende, entre otros factores, de la calidad oncológica de la resección quirúrgica, entre los que se deben incluir la correcta disección del mesorrecto y un adecuado número de ganglios linfáticos. Objetivos: describir los principales factores que determinan la calidad de la cirugía de resección por cáncer de recto en la Clínica Quirúrgica 2 del Hospital Maciel. Pacientes y método: 36 pacientes operados de coordinación en el período 2012 a 2016. Resultados: la disección mesorrectal fue completa en el 60% de los casos, y en más del 50% se obtuvo un número aceptable de ganglios linfáticos. Discusión: la calidad oncológica de la cirugía por cáncer de recto depende de mútiples factores, entre los que destacamos el volumen anual de cirugías, la experiencia del equipo, factores del paciente (sexo, índice de masa corporal) y de la enfermedad (topografía baja, estadio, respuesta a la neoadyuvancia). Conclusiones: los resultados obtenidos pueden considerarse oncológicamente satisfactorios.

Introduction: The prognosis of rectal cancer depends, among other factors, on the oncologic quality of the surgical resection, including the correct dissection of the meso-rectum and adequate lymph node dissection Objectives: to describe the prognostic factors present in rectal cancer resections at the Surgical Clinic 2 of the Maciel Hospital. Patients and methods: 36 patients underwent coordinated surgery procedures between 2012 and 2016. Results: meso-rectal dissection was complete in 60% of the cases, and an acceptable number of lymph nodes were obtained in over 50% of cases. Discussion: the quality of oncologic surgery for rectal cancer depends on several factors, being it possible to highlight the number of surgeries per year, the team's experience, patient's factors (sex, body mass index) and disease (low topography, stage, response to neoadyuvancy), among others. Conclusions: the results obtained can be considered oncologically satisfactory.

Introdução: o prognóstico do câncer de reto depende, entre outros fatores, da qualidade oncológica da ressecção cirúrgica, da correta dissecção mesorretal e do número adequado de gânglios linfáticos obtidos. Objetivos: descrever os principais fatores que determinam a qualidade da cirurgia de ressecção por câncer de reto na Clínica Quirúrgica 2 do Hospital Maciel. Pacientes e métodos: 36 pacientes operados em cirurgias eletivas no período 2012­2016. Resultados: a dissecção mesorretal foi completa em 60% dos casos, e em mais de 50% um número aceitável de gânglios linfáticos foi obtido. Discussão: a qualidade oncológica da cirurgia por câncer de reto depende de múltiplos fatores entre os quais destacamos o volume anual de cirurgias, a experiência da equipe cirúrgica, os fatores do paciente (sexo e índice de massa corporal) e da enfermidade (topografia baja, estádio, resposta à terapia neoadjuvante). Conclusões: os resultados obtidos podem ser considerados satisfatórios do ponto de vista oncológico.

Oncological outcomes in extended time intervals between preoperative chemoradiotherapy with capecitabine and surgery in operable rectal adenocarcinoma / Resultados oncológicos en intervalos extendidos de tiempo entre quimioradioterapia preoperatoria con capecitabina y cirugía en adenocarcinoma rectal operable

Objective: To assess whether extended time intervals (8-12, 13-20 and >20 weeks) between the end of neoadjuvant chemoradiotherapy and surgery affect overall survival, disease-free survival. Materials and methods: Retrospective study in 120 patients with rectal adenocarcinoma without evidence of metastasis (T1-4/N0-2/M0) at the time of diagnosis that underwent surgery with curative intent after neoadjuvant chemoradiotherapy with capecitabine and obtained R0 or R1 resection between January 2010 to December 2014 at the National Cancer Institute of Peru. Dates were evaluated by Kaplan-Meier method, log- rank test and Cox regression analysis. Results: Of the 120 patients, 70 were women (58%). The median age was 63(26-85) years. All received neoadjuvant chemoradiotherapy. No significant difference was found between the association of the median radial (0.6, 0.7 and 0.8 cm; p=0.826) and distal edge (3.0, 3.5 and 4.0 cm; p=0.606) with time interval groups and similarly the mean resected (18.8, 19.1 and 16.0; p=0.239) and infiltrated nodules (1.05, 1.29 and 0.41); p=0.585). The median follow-up time of overall survival and desease free survival was 40 and 37 months, respectively. No significant differences were observed in overall survival (79.0%, 74.6% and 71.1%; p=0.66) and disease-free survival (73.7%, 68.1% and 73.6%; p=0.922) according to the three groups studied at the 3-year of follow-up. Conclusions: We found that widening the time intervals between the end of neoadjuvant chemoradiotherapy and surgery at 24 weeks does not affect the overall survival, disease-free survival and pathological outcomes. It allows to extend the intervals of time for future studies that finally will define the best time interval for the surgery

Objetivo: Evaluar si los intervalos de tiempo extendidos (8-12, 13-20 y >20 semanas) entre el fin de la quimioradioterapia neoadyuvante y la cirugía afectan la sobrevida global, y la sobrevida libre de enfermedad. Material y métodos: Estudio retrospectivo de 120 pacientes con adenocarcinoma rectal sin evidencia de metástasis (T1-4/N0-2/M0) al momento del diagnóstico que se sometieron a cirugía con intención curativa luego de quimioradioterapia neoadyuvante con capecitabina y tuvieron resección R0 o R1 entre enero 2010 y diciembre 2014 en el Instituto Nacioanal de Enfermedades Neoplásicas de Perú. El análisis se hizo con el método de Kaplan-Meier, la prueba log-rank y la regresión de Cox. Resultados: De 120 pacientes, 70 fueron mujeres (58%). La mediana de la edad fue 63 años (26-85 años). Todos recibieron quimioradioterapia neoadyuvante. No hubo diferencia significativa entre la asociación de las medianas de los bordes radial (0,6, 0.7 y 0,8 cm; p=0,826) y distal (3,0, 3,5 y 4,0 cm; p=0,606) con los intervalos de tiempo de los grupos y similarmente con la media de los ganglios resecados (18,8, 19,1 y 16,0; p=0,239) e infiltrados (1,05, 1,29 y 0,41; p=0,585). No se observaron diferencias significativas en sobrevida global (79,0%, 74,6% y 71,1%; p=0,66) y sobrevida libre de enfermedad (73,7%, 68,1% y 73,6%; p=0,922), en los tres grupos estudiados a 3 años de seguimiento. Conclusiones: Encontramos que aumentar los intervalos de tiempo entre el fin de la quimioradioterapia neoadyuvante y la cirugía hasta 24 semanas no afecta la sobrevida global, sobrevida libre de enfermedad ni los desenlaces patológicos. Esto permitiría extender los intervalos de tiempo en estudios futuros para definir el mejor intervalo de tiempo para la cirugía

Incidence and mortality from colon and rectal cancer in Midwestern Brazil / Incidência e mortalidade por câncer de cólon e reto no Centro-Oeste do Brasil

ABSTRACT: Objective: To describe the incidence and mortality rates from colon and rectal cancer in Midwestern Brazil. Methods: Data for the incidence rates were obtained from the Population-Based Cancer Registry (PBCR) according to the available period. Mortality data were obtained from the Mortality Information System (SIM) for the period between 1996 and 2008. Incidence and mortality rates were calculated by gender and age groups. Mortality trends were analyzed by the Joinpoint software. The age-period-cohort effects were calculated by the R software. Results: The incidence rates for colon cancer vary from 4.49 to 23.19/100,000, while mortality rates vary from 2.85 to 14.54/100,000. For rectal cancer, the incidence rates range from 1.25 to 11.18/100,000 and mortality rates range between 0.30 and 7.90/100,000. Colon cancer mortality trends showed an increase among males in Cuiabá, Campo Grande, and Goiania. For those aged under 50 years, the increased rate was 13.2% in Campo Grande. For those aged over 50 years, there was a significant increase in the mortality in all capitals. In Goiânia, rectal cancer mortality in males increased 7.3%. For females below 50 years of age in the city of Brasilia, there was an increase of 8.7%, while females over 50 years of age in Cuiaba showed an increase of 10%. Conclusion: There is limited data available on the incidence of colon and rectal cancer for the Midwest region of Brazil. Colon cancer mortality has generally increased for both genders, but similar data were not verified for rectal cancer. The findings presented herein demonstrate the necessity for organized screening programs for colon and rectal cancer in Midwestern Brazil.

RESUMO: Objetivo: Descrever o perfil do câncer de cólon e reto no Centro-Oeste do Brasil. Métodos: Os dados de incidência foram obtidos dos Registros de Câncer de Base Populacional (RCBP) de acordo com o período disponível. Dados sobre os óbitos foram obtidos do Sistema de Informação em Mortalidade (SIM). As taxas de incidência e mortalidade foram calculadas por gênero e grupos etários. As tendências de mortalidade foram analisadas pelo software Joinpoint. Os efeitos de idade-período-coorte foram calculados no software R. Resultados: As taxas de incidência do câncer de cólon variaram de 4,49 a 23,19/100.000, e a mortalidade, de 2,85 a 14,54/100.000. A incidência do câncer de reto variou de 1,25 a 11,18/100.000; a mortalidade, de 0,30 a 7,90/100.000. As tendências de mortalidade por câncer de cólon mostraram um aumento entre homens em Cuiabá, Campo Grande e Goiânia. Para aqueles abaixo dos 50 anos, o aumento foi de 13,2% em Campo Grande. Para aqueles acima dos 50 anos, houve um aumento significante em todas as capitais. Em Goiânia, a mortalidade por câncer de reto em homens aumentou 7,3%. Para mulheres abaixo dos 50 anos em Brasília, o aumento foi de 8,7%, enquanto que para mulheres acima dos 50 anos em Cuiabá foi de 10%. Conclusão: Os dados de incidência do câncer de cólon e reto no Centro-Oeste do Brasil são limitados. A mortalidade por câncer de cólon tem aumentado para ambos os sexos, mas o mesmo não foi verificado para câncer de reto. Os resultados demonstram a necessidade de programas organizados de rastreamento para esta neoplasia no Centro-Oeste.

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

PURPOSE: In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS: We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS: We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION: Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

Evaluation of treatment response and tissue necrosis as prognostic indicators following neoadjuvant chemoradiotherapy in rectal cancer patients

BACKGROUND/AIMS: The objective of this study was to assess the prognostic roles of treatment response and tissue necrosis after chemoradiotherapy (CRT) in locally advanced rectal cancer. METHODS: A total of 243 patients with locally advanced rectal cancer who underwent neoadjuvant CRT were included. Three treatment response groups were classified by their pathological stage results: complete treatment response (CTR), intermediate treatment response (ITR), and poor treatment response (PTR). Three tissue necrosis groups were classified based on tissue pathological results: complete necrosis response (CNR), intermediate necrosis response (INR), and poor necrosis response (PNR). RESULTS: Overall survival (OS) and recurrence-free survival (RFS) rate at three years were 74.5% and 61.3%, respectively. The 3-year OS rates of the CTR, ITR, and PTR groups were 83.7%, 75.9%, and 69.7%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 69.0%, and 52.1%, respectively (p < 0.001). The 3-year OS rates of the CNR, INR, and PNR groups were 83.7%, 80.6%, and 61.8%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 68.9%, and 44.3%, respectively (p < 0.001). When compared to CTR/CNR, PTR/PNR was strongly related to an increased risk of recurrence (hazard ratio [HR], 5.53; 95% confidence interval [CI], 2.01 to 15.23 vs. HR, 6.37; 95% CI, 2.29 to 17.74, respectively) in univariate Cox regression. Both PTR and PNR were strongly associated with shorter RFS and OS when compared with CTR and CNR in the multivariate Cox regression. CONCLUSIONS: Tissue necrosis is an equally important prognostic marker as treatment response for oncologic outcomes in locally advanced rectal cancer.

Long-term Outcomes of Laparoscopic versus Open Surgery for Rectal Cancer: A Singlecenter Retrospective Analysis / 대한소화기학회지

BACKGROUND/AIMS: Laparoscopic surgery has been proven to be an effective alternative to open surgery in patients with colon cancer. However, data on laparoscopic surgery in patients with rectal cancer are insufficient. The aim of this study was to compare the long-term outcomes of laparoscopic and open surgery in patients with rectal cancer. METHODS: A total of 307 patients with rectal cancer who were treated by open and laparoscopic curative resection at Kosin University Gospel Hospital (Busan, Korea) between January 2002 and December 2011 were reviewed retrospectively. RESULTS: Regarding treatment, 176 patients underwent an open procedure and 131 patients underwent a laparoscopic procedure. The local recurrence rate after laparoscopic resection was 2.3%, compared with 5.7% after open resection (p=0.088). Distant metastases occurred in 6.9% of the laparoscopic surgery group, compared with 24.4% in the open surgery group (p or =75 years vs. < or =60 years), preoperative staging, surgical approach (open vs. laparoscopic), elevated initial CEA level, elevated follow-up CEA level, number of positive lymph nodes, and postoperative chemotherapy affected overall survival and disease free survival. However, in multivariate analysis, the surgical approach apparently did not affect long-term oncologic outcome. CONCLUSIONS: In this study, long-term outcomes after laparoscopic surgery for rectal cancer were not inferior to those after open surgery. Therefore, laparoscopic surgery would be an alternative operative tool to open resection for rectal cancer, although further investigation is needed.

Valor pronóstico de la respuesta patológica a la radioquimioterapia preoperatoria en el cáncer de recto bajo localmente avanzado / Prognostic value of pathological response to chemo radiotherapy of locally advanced low rectal cancer

Background: preoperative chemo radiotherapy improves the prognosis of locally advanced low rectal cancer and induces a pathological response in the tumor, which may have prognostic value. Aim: to assess the results of rectal cancer treatment according to the degree of pathological response of the tumor after chemo radiotherapy. Patients and Methods: all patients with a locally advanced rectal cancer located within 11 cm of the rectal margin, subjected to preoperative chemo radiotherapy followed by surgical treatment in a period of 13 years, were included. Pathological response was classified as complete, intermediate and poor. The tumor was staged according to TNM 2002 classification. Survival was analyzed with Kaplan Meier curves and Cox regression. Results: patients were followed for a mean of 50 months (range 18-156). Exclusive and global local relapse was observed in 3 and 9.6 percent of patients, respectively. Pathological response was complete in 13 patients (none died), intermediate in 23 (three died) and poor in 68 (22 died). Global five years survival was 74 percent. There was a concordance of 0.64 between survival and pathological response. The concordance between survival and TNM classification was 0.69. Conclusions: the pathological response of the tumor to chemo radiotherapy has a good concordance with prognosis, although it is not superior to the final pathological status.

Introducción: la radioquimioterapia (RQT) preoperatoria en el manejo del cáncer de recto bajo localmente avanzado mejora el control locoregional y es capaz de inducir en el tumor una respuesta patológica (RP) variable que podría tener implicancia pronóstica. El objetivo de este estudio es evaluar el grado de RP inducida por la RQT y comparar los resultados oncológicos de acuerdo al grado de RP luego de RQT neoadyuvante. Pacientes y Método: se incluyen todos los pacientes con un tumor de recto localmente avanzado por debajo de los 11 cm al margen anal sometidos a RQT seguida de cirugía radical con intención curativa en un período de 13 años. La RP fue categorizada como completa, intermedia y pobre. Para la etapificación patológica se utilizó la clasificación TNM 2002. Las curvas de sobrevida fueron estimadas según Kaplan-Meier, se empleó el modelo de regresión de Cox para el análisis multivariado y los coeficientes de concordancia fueron evaluados según el estadístico C de Harrell y el K de Gonen-Heller. Resultados: seguimiento promedio 50 meses (extremos 18-156). La recidiva local exclusiva fue 3 por ciento y la recidiva local global fue 9,6 por ciento. La RP fue completa en 13 pacientes (no fallecidos), Intermedia (ypT1-T2N0) en 23 (3 fallecidos) y fue pobre (ypT3/T4 y/o LN+) en 68 (22 fallecidos). Sobrevida global a 5 años 74 por ciento. Hubo una fuerte correlación entre la sobrevida y la RP, con un coeficiente de concordancia (0,64) ligeramente inferior al coeficiente de la etapificación patológica definitiva de acuerdo al TNM (0,69). Conclusión: el grado de RP es un marcador que se correlaciona bien con el pronóstico oncológico con un índice de concordancia de 0,69 cuando se asocia con la localización del tumor, aunque no supera al estadio patológico final que alcanza un valor de 0,74.

Increase incomeaand mortality of colorrectal cancer in Brazil, 2001-2009

Context Several international studies have observed a correlation between the improvement of socio-demographic indicators and rates of incidence and mortality from cancer of the colon and rectum. Objective The objective of this study is to estimate the correlation between average per capita income and the rate of colorectal cancer mortality in Brazil between 2001 and 2009. Methods We obtained data on income inequality (Gini index), population with low incomes (½ infer the minimum wage/month), average family income, per capita ICP and mortality from colon cancer and straight between 2001-2009 by DATASUS. A trend analysis was performed using linear regression, and correlation between variables by Pearson's correlation coefficient. Results There was a declining trend in poverty and income inequality, and growth in ICP per capita and median family income and standardized mortality rate for colorectal cancer in Brazil. There was also strong positive correlation between mortality from this site of cancer and inequality (men r = -0.30, P = 0.06, women r = -0.33, P = 0.05) income low income (men r = -0.80, P<0.001, women r = -0.76, P<0.001), median family income (men r = 0.79, P = 0.06, women r = 0.76, P<0.001) and ICP per capita (men r = 0.73, P<0.001, women r = 0.68, P<0.001) throughout the study period. Conclusion The increase of income and reducing inequality may partially explain the increased occurrence of colorectal cancer and this is possibly due to differential access to food recognized as a risk factor, such as red meat and high in fat. It is important therefore to assess the priority of public health programs addressing nutrition in countries of intermediate economy, as is the case of Brazil. .

Contexto Diversos estudos internacionais têm observado uma correlação entre a melhora dos indicadores sociodemográficos e as taxas de incidência e mortalidade por câncer de cólon e reto. Objetivo O objetivo do presente estudo é estimar a correlação entre renda média per capita e a taxa de mortalidade por câncer colorretal no Brasil entre 2001 e 2009. Métodos Obteve-se os dados de desigualdade de renda (índice de Gini), população que vive com baixa renda (inferir a ½ salário mínimo/mês), renda média familiar, PIB per capita e taxa de mortalidade por câncer de cólon e reto entre 2001 e 2009 através do DATASUS. A análise de tendência foi realizada através do método de regressão linear, e a correlação entre as variáveis através do coeficiente de correlação de Pearson. Resultados Observou-se tendência ao declínio da pobreza e da desigualdade de renda, e incremento no PIB per capita e na renda média familiar e na taxa de mortalidade padronizada de câncer de cólon e reto no Brasil. Observou-se, ainda, correlação fortemente positiva entre a mortalidade por este sítio de câncer e desigualdade (homens r = -0,30, P = 0,06; mulheres r = -0,33, P = 0,05) de renda baixa renda(homens r = -0,80, P<0,001; mulheres r = -0,76, P<0,001), renda média familiar (homens r = 0,79, p = 0,06; mulheres r = 0,76, P<0,001) e PIB per capita (homens r = 0,73, P<0,001; mulheres r = 0,68, P<0,001) em todo o período estudado. Conclusão O incremento da renda e a redução da desigualdade podem parcialmente explicar o aumento da ocorrência do câncer de cólon e reto e isso possivelmente se deve ao acesso diferenciado ...

Metastasis de mesotelioma como causa de tumor retrorrectal / Malignant mesothelioma metastasis as a retrorectal tumor

Comunicamos el caso de un paciente masculino de 58 años, con antecedente de mesotelioma maligno en tratamiento oncológico, quien presentó un tumor en el espacio retrorrectal el cual fue operado, constatándose posteriormente metástasis de mesotelioma. Debido a la infrecuencia del caso se realiza una revisión de la literatura médica nacional e internacional actualizada sobre el tema.

We report a case of a 58 year old male patient, wilh a malignant mesothelioma, with oncological treatment, who presented a tumor in the space retrorectal which was operated. Afterwards it was found out as a metastasis of that lesion. Duc to the infrequency of the case, a revision of the latest national and international medical literature was done.

Locally advanced colorectal cancer: results of surgical treatment and prognostic factors / Câncer colorretal localmente avançado: resultados do tratamento cirúrgico e fatores prognósticos

OBJECTIVES: To evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer. METHODS: Cohort study including 679 colorectal cancer patients treated from 1997 to 2007. Clinical, surgical and histological data were analyzed. RESULTS: Ninety patients (females 61 percent; median age 59 years) were treated for locally advanced carcinomas (13.2 percent), either in the colon (66 percent) or rectum (34 percent). Extended resections most commonly involved the small bowel (19.8 percent), bladder (16.4 percent), uterus (12.9 percent) and ovaries (11.2 percent). Postoperative morbidity and mortality occurred in 23 (25.6 percent) and 3 (3.3 percent) patients, respectively. Survival and recurrence analysis among 76 R0 (84.4 percent) procedures revealed a 60 percent 5-year survival and 34 percent local recurrence rates. Survival curves demonstrated reduced rates for rectal location (45 percent vs 65 percent), tumor depth (50 percent for T4 vs 75 percent for T3), vascular/ lymphatic/perineural invasion (35 percent vs 80 percent) and lymph node metastasis (35 percent vs 80 percent). CONCLUSIONS: Locally advanced carcinomas were found in 13.2 percent of patients. Survival rates were negatively affected by rectal location and adverse histological features. Number of involved organs and neoplastic adhesions did not influenced chances of survival. A radical R0 extended resection was achieved in a high proportion of cases, resulting in a 60 percent cancer-free survival under acceptable operative risks.

OBJETIVOS: Avaliar a incidência, os resultados operatórios e os fatores prognósticos relacionados aos tumores colorretais localmente avançados. MÉTODOS: A população deste estudo foi constituída por 679 pacientes com câncer colorretal tratados entre 1997 e 2007. Dados clínicos, cirúrgicos e histológicos foram analisados. RESULTADOS: Noventa pacientes (mulheres 61 por cento; idade media 59 anos) foram tratados por câncer colorretal localmente avançados (13.2 por cento) no cólon (66 por cento) ou no reto (34 por cento). As ressecções alargadas mais frequentemente envolveram o intestino delgado (19.8 por cento), bexiga (16.4 por cento), útero (12.9 por cento) e ovários (11.2 por cento). Houve morbidade e mortalidade pós-operatórias em 23 (25.6 por cento) e 3 (3.3 por cento) pacientes, respectivamente. Análise de sobrevida e recidiva entre 76 ressecções R0 (84.4 por cento) mostraram sobrevida de 5 anos em 60 por cento e índice de recidiva local em 34 por cento. As curvas de sobrevida demonstraram índices menores para localização retal do tumor (45 por cento vs 65 por cento), grau de penetração (50 por cento para T4 vs 75 por cento para T3), invasão vascular, linfática ou perineural (35 por cento vs 80 por cento) e metástases linfonodais (35 por cento vs 80 por cento). CONCLUSÕES: Carcinomas localmente avançados foram diagnosticados em 13.2 por cento dos pacientes. Os índices de sobrevida foram negativamente afetados pela localização retal e fatores histológicos adversos. O número de órgãos envolvidos e aderências neoplásicas não influenciaram as chances de cura. Foi possível realizar ressecções alargadas R0 em grande proporção de casos, resultando em sobrevida livre de doença em 60 por cento dos doentes, em condições de risco cirúrgico aceitável.

Registro multicéntrico de las modalidades de diagnóstico, estadificación y tratamiento del cáncer de recto en la Ciudad de Buenos Aires / Multicenter registry of diagnosis, staging and treatment of rectal cancer in Buenos Aires City

El diagnóstico y tratamiento de los pacientes con cáncer de recto ha cambiado notoriamente en los últimos decenios. A fin de evaluar la conducta al respecto en nuestro medio, llevamos a cabo un estudio multicéntrico retrospectivo en 18 servicios asistenciales de la Ciudad de Buenos Aires, considerando los pacientes operados entre junio de 2004 y mayo de 2007. En 397 pacientes (mediana de edad: 63.5 años) se registraron y analizaron los datos de demografía, diagnóstico, cirugía, morbimortalidad, patología, radioterapia y quimioterapia consignados en la historia clínica. Constaba el "TNM" en 253 (estadio I: 23.7%, II: 32.8%, III: 39.5%). Se realizó resonancia nuclear magnética de pelvis en 44 (11.1%). Recibieron neoadyuvancia 115 (29%). Se efectuó resección anterior en 170 (42.8%), resección ultrabaja en 95 (23.9%), amputación abdominoperineal en 76 (19.1%). Faltaron datos sobre la escisión del mesorrecto en 135 (34.0%). La mediana de ganglios linfáticos resecados fue de 13; con metástasis: 3. El margen circunferencial de resección se informó en 219 (55.2%). Se empleó quimioterapia en 123 (31%). Se presentaron en Comité de Tumores 98 (24.7% del total). La confrontación de estos resultados con los estándares internacionales muestra una morbimortalidad quirúrgica adecuada a esos estándares, al tiempo que demuestra que fue insuficiente la discusión interdisciplinaria, reducido el empleo de resonancia nuclear magnética para la estadificación, baja la utilización de neoadyuvancia y escasa la mención del tipo de resección mesorrectal efectuada. Este estudio sugiere la conveniencia de una adopción más generalizada de las pautas internacionales y la necesidad de una acción educativa en tal sentido.

Diagnosis and treatment of patients with rectal cancer has changed dramatically in recent decades. In order to assess the approach in this regard in Argentina we conducted a multicenter retrospective study in 18 health care services in Buenos Aires City, including patients operated on between June 2004 and May 2007. Data on demographics, diagnosis, surgery, pathology, radiotherapy and chemotherapy, contained in medical records, were analyzed in 397 patients (median age: 63.5 years).TNM stage was recorded in 253 (I: 23.7%, II: 32.8% and III: 39.5%). Pelvic magnetic resonance imaging (MRI) was performed in 44 patients (11.1%); 115 (29%) received neo-adjuvant therapy. Anterior resection was performed in 170 (42.8%), ultra-low resection in 95 (23.9%) and abdomino-perineal resection in 76 (19.1%) cases. There were no data regarding mesorectal excision in 135 (34.0%). The median number of lymph nodes removed was 13 and the median of nodal metastasis, 3. The circumferential resection margin was reported in 219 (55.2%) cases. Chemotherapy was used in 123 (31%) patients; the modality was postoperative in 40.6%, preoperative in 29.3% and pre plus postoperative in 30.1%. Comparing these data with international standards we observed appropriate results regarding surgical morbidity and mortality, while we found insufficient interdisciplinary discussion, low use of MRI for staging, low use of neo-adjuvant therapy, and scant mention of the type of mesorectal resection performed. This study suggests the desirability of a more widespread adoption of international standards and the need for educational action in this regard.

Complicaciones anastomóticas en cáncer de recto bajo luego de neoadyuvancia / Anastomotic complications in low rectal cancer after neoadyuvant therapy

Introducción: El tratamiento actual del cáncer de recto combina muchas veces el uso de radio-quimioterapia preoperatoria y cirugía. Algunos autores postulan que la neoadyuvancia podría provocar mayor índice de complicaciones anastomóticas, especialmente en los tumores de recto inferior. Objetivo: Evaluar la incidencia de complicaciones anastomóticas en pacientes operados por tumor de recto inferior comparando aquellos que hayan recibido neoadyuvancia con los que no la recibieron. Como objetivo secundario se evalúo la mortalidad en ambos grupos. Lugar de aplicación: Hospital General de Agudos de la Ciudad de Buenos Aires. Diseño: Análisis comparativo retrospectivo. Población y métodos: Fueron evaluados 180 pacientes con diagnóstico de cáncer de recto bajo. Sólo se seleccionaron para el análisis los tumores que fueron pasibles de resección rectal y anastomosis primaria y que estuvieran ubicados por debajo de los 12 cm. desde el margen anal en el período comprendido entre el año 2003 y 2010. Todos los pacientes fueron operados por el mismo equipo quirúrgico. Del total de 180 pacientes, 77 recibieron quimio-radioterapia preoperatoria (grupo 1), y 103 fueron operados sin tratamiento previo (grupo 2). Resultados: En el grupo 1 se registraron 5 complicaciones anastomóticas y hubo 2 casos de mortalidad, no asociada a complicación anastomótica. En el grupo 2 hubo 9 complicaciones anastomóticas y la mortalidad fue de cuatro casos, dos de ellos relacionados a dichas complicaciones. No hubo significación estadística para ninguna de estas diferencias (p=0.7797 y p=1.000 respectivamente) Conclusiones: La neoadyuvancia en cáncer de recto inferior no aumentó el número de complicaciones anastomóticas en esta serie.

Introduction: Current treatment of rectal cancer often combined the use of preoperative chemotherapy and radiosurgery. Some authors suggest that neoadjuvant therapy may result in higher rates of anastomotic complications, especially in lower rectal tumors. Objective: To evaluate the incidence of anastomotic complications in patients undergoing surgery for lower rectal tumor by comparing those who received neoadjuvant therapy with those who did not. A secondary objective was evaluated mortality in both groups. Application site: Acute General Hospital of the City of Buenos Aires. Design: Retrospective comparative analysis. Population and methods: 180 patients were evaluated with a diagnosis of low rectal cancer. Only selected for analysis the tumors were resecable rectal and primary anastomosis and were located below 12 cm. from the anal margin in the period between 2003 and 2010. All patients were operated by the same surgical team. Of the total 180 patients, 77 received preoperative chemoradiotherapy (group 1), and 103 were operated without pretreatment (group 2). Results: In group l, there were 5 anastomotic complications and there were 2 cases of mortality, not associated with anastomotic complications. In group 2 there were 9 anastomotic complications and mortality was four cases, two of them related to these complications. There was no statistical significance for any of these differences (p = 0.7797 and p = 1.000 respectively) Conclusions: Neoadjuvant lower rectal cancer did not increase the number of anastomotic complications in this series.

Tratamento cirúrgico do adenocarcinoma de reto por laparoscopia e por acesso convencional: estudo comparativo de tempo cirúrgico, complicações pós-operatórias, radicalidade oncológica e sobrevida / Treatment of rectal adenocarcinoma by laparoscopy and conventional route: a brazilian comparative study on operative time, postoperative complications, oncological radicality and survival

OBJETIVO: Comparar duas vias cirúrgicas (laparoscópica e convencional) para o tratamento de câncer de reto no que se refere às complicações pós-operatórias, radicalidade oncológica e sobrevida. MÉTODOS: Trata-se de estudo retrospectivo com 84 pacientes com câncer retal que foram admitidos no Hospital do Câncer de Barretos entre 2000 e 2003. Somente os indivíduos que se submeteram à operações eletivas (intenção curativa) foram incluídos. A via cirúrgica foi escolhida subjetivamente e não com base na localização do tumor. RESULTADOS: O acesso laparoscópico foi utilizado por 50 por cento dos pacientes. Não houve diferença (P> 0,05) entre os dois grupos em relação à: idade, sexo, topografia, estádio, tratamento neoadjuvante e adjuvante, número de linfonodos regionais dissecados, tamanho da peça cirúrgica, margens cirúrgicas, transfusões de sangue, taxas de complicações pós-operatórias, dias de hospitalização e a taxa de sobrevida global. O tempo cirúrgico foi maior no grupo laparoscópico (mediana: 210x127,5min, P<0,001). Houve diminuição do tempo cirúrgico com o aumento do número de laparoscopias realizadas pela equipe (rho: -0,387, P=0,020). CONCLUSÃO: As vias laparoscópica e convencional, para o tratamento de câncer de reto, foram equivalentes em relação às complicações pós-operatórias, radicalidade oncológica e sobrevida. Contudo, o tempo cirúrgico foi maior no grupo da laparoscopia.

OBJECTIVE: To compare two surgical routes (laparoscopic and conventional) for the treatment of rectal cancer with regard to postoperative complications, oncological radicality and survival. METHODS: This is a retrospective study of 84 patients with rectal cancer who were admitted to the Barretos Cancer Hospital between 2000 and 2003. Only individuals who underwent elective operations with curative intent were included. The surgical approach was subjectively chosen rather than by location of the tumor. RESULTS: The laparoscopic access was used by 50 percent of patients. There was no difference (P> 0.05) between the two groups regarding age, sex, topography, staging, neoadjuvant and adjuvant treatment, number of dissected lymph nodes, size of surgical specimen, surgical margins, blood transfusions, postoperative complication rates, hospital stay and overall survival. Surgical time was longer in the laparoscopic group (median: 210x127, 5 min, P <0.001). A reduction in surgical time was noted with the increasing number of laparoscopies performed by the team (rho: -0.387, P = 0.020). CONCLUSION: The laparoscopic and conventional routes, for the treatment of rectal cancer, were equivalent with respect to postoperative complications, oncological radicality and survival. However, the operative time was longer in the laparoscopic group.

Morbimortalidad por cáncer de recto operado con técnica de miles en el Hospital EsSalud de Ica, Perú 1993-2003 / Morbimortality from rectal cancer surgery with thousands technique at the Hospital EsSalud de Ica, Peru 1993-2003

El cáncer de colon y recto, es una enfermedad frecuente, cuyo tratamiento indicado es la cirugía con carácter de curativa. La operación aceptada a nivel mundial es la resección abdominalûperineal (Miles). Se han operado 29 pacientes, 15 hombres y 14 mujeres, con edades entre 43 y 84 años. No hemos tenido ninguna muerte post operatoria y la tasa de complicaciones es de 20,6% (6/29) infecciones de la herida operatoria, la estancia hospitalaria fue de 9 a 11 días, el tiempo operatorio promedio de 3 a 4 horas, 24 pacientes sobreviven más de 5 años (82,7%) el tipo histológico más frecuente fue adenocarcinoma concordante con otros estudios publicados.

The colon and rectum cancer is a common disease, this treatment is indicated through the surgery with curative character. The surgery accepted globally is the perineal - abdominal (Miles). 29 patients have been operated, 15 men and 14 women, their ages ranged between 43 and 84. There were not any death after surgery but the rate of complications was 20.6% (6/29) infections in surgical wounds. The stay in hospital was 9 to 11 days. The average time of these operations was 3 to 4 hours, 24 patients survived more than 5 years (82.7%). The most frequent histological type was adenocarcinoma which is concordant with another published studies.