ABSTRACT
Introducción: Metaanálisis internacionales muestran que la cirugía laparoscópica presenta mejores resultados postoperatorios que la cirugía abierta en el manejo del cáncer de colon. La tendencia en Panamá es la transición a la cirugía laparoscópica; sin embargo, no existen estudios que comparen ambas técnicas quirúrgicas. Objetivo: Comparar los resultados postoperatorios de las colectomías electivas abiertas y laparoscópicas por cáncer de colon en el Complejo Hospitalario Dr. Arnulfo Arias Madrid, de enero de 2015 a diciembre de 2019. Metodología: Se realizó un estudio observacional, transversal, correlacional causal (analítico), retrospectivo mediante la revisión de expedientes clínicos de los pacientes operados de colectomías electivas abiertas y laparoscópicas por cáncer de colon en el Complejo Hospitalario Doctor Arnulfo Arias Madrid, de enero de 2015 a diciembre de 2019. Resultados: De 87 casos estudiados, 45 correspondían a cirugía abierta y 42 a cirugía laparoscópica. Encontramos que el abordaje abierto se asocia a una mayor mortalidad intrahospitalaria (χ² 4.951, p 0.026), mortalidad a los 30 días postoperatorios (χ² 6.014, p 0.014), íleo postoperatorio (χ² 5.803, p 0.015), fuga de anastomosis (χ² 12.833, p 0.0003) y dehiscencia de herida quirúrgica (χ² 7.105, p 0.007) que el laparoscópico. El riesgo relativo de infección con abordaje abierto es 8.9 veces mayor que con abordaje laparoscópico [RR = 8.865 (95% IC = 1.058 74.286) p=0.044]. Conclusiones: La epidemiología del cáncer colorrectal en nuestra institución se asemeja a la de la literatura mundial. Nuestros resultados incentivan a implementar la cirugía mínimamente invasiva para brindar mejores resultados. (provisto por Infomedic International)
Introduction: International meta-analyses show that laparoscopic surgery has better postoperative results than open surgery in the management of colon cancer. The trend in Panama is the transition to laparoscopic surgery; however, there are no studies comparing both surgical techniques. Objective: To compare the postoperative results of elective open and laparoscopic colectomies for colon cancer at the Complejo Hospitalario Dr. Arnulfo Arias Madrid, from January 2015 to December 2019. Methodology: An observational, cross-sectional, causal correlational (analytical), retrospective, retrospective study was conducted by reviewing clinical records of patients who underwent elective open and laparoscopic colectomies for colon cancer at the Complejo Hospitalario Doctor Arnulfo Arias Madrid, from January 2015 to December 2019. Results: Of 87 cases studied, 45 corresponded to open surgery and 42 to laparoscopic surgery. We found that the open approach was associated with higher in-hospital mortality (χ² 4.951, p 0.026), 30-day postoperative mortality (χ² 6.014, p 0. 014), postoperative ileus (χ² 5.803, p 0.015), anastomotic leak (χ² 12.833, p 0.0003) and surgical wound dehiscence (χ² 7.105, p 0.007) than laparoscopic. The relative risk of infection with open approach is 8.9 times higher than with laparoscopic approach [RR = 8.865 (95% CI = 1.058 - 74.286) p=0.044]. Conclusions: The epidemiology of colorectal cancer in our institution resembles that of the world literature. Our results encourage the implementation of minimally invasive surgery to provide better results. (provided by Infomedic International)
ABSTRACT
Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.
Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.
Subject(s)
Humans , Female , Adenocarcinoma/diagnosis , COVID-19 , Intestinal Perforation , Adenocarcinoma/surgery , Intestinal NeoplasmsABSTRACT
Resumen ANTECEDENTES: El embarazo ectópico abdominal es una alteración poco frecuente, pero con alta tasa de morbilidad y mortalidad materno-fetal-neonatal. Para establecer el diagnóstico se requiere un alto grado de sospecha y casi siempre se efectúa durante el procedimiento quirúrgico. Es el único tipo de embarazo ectópico que puede llegar a término. CASO CLÍNICO: Paciente de 35 años, con antecedente obstétrico de dos cesáreas, que acudió al servicio médico por dolor abdominal de larga evolución, con varios meses de amenorrea, sin control prenatal. El dolor fue inicialmente adjudicado a una hernia umbilical, pero ante su persistencia se reexaminó a la paciente y se encontró una masa abdominal, por lo que se sospechó embrazo ectópico. El ultrasonido abdominal y la resonancia magnética confirmaron el embarazo de término, que finalizó mediante laparotomía. Se decidió dejar la placenta in situ, debido al riesgo de hemorragia por su remoción. Tanto el neonato como la madre fueron dados de alta en buenas condiciones después de dos semanas de estancia hospitalaria, con posterior seguimiento. CONCLUSIONES: Aunque el embarazo ectópico abdominal es una alteración poco frecuente, es importante saber qué debe hacerse de acuerdo con las semanas de gestación, debido al incremento reciente en su incidencia y a la alta tasa de complicaciones, con la finalidad de preservar el bienestar materno-fetal y la fertilidad femenina.
Abstract BACKGROUND: Abdominal pregnancy is a rare clinical entity with a high risk for both the mother and the product. It's diagnosis requires a high level of suspicion, being usually made during the surgical management of the case. It is the only type of ectopic pregnancy that can reach term. CLINICAL CASE: A 35 year-old patient, with two previous cesarean deliveries, who presents with chronic abdominal pain, without prenatal consultations and with several months of amenorrhea. The pain is initially atributted to an umbilical hernia, but due to it's persistence she is re-examined, finding an abdominal mass and raising suspicion of a possible ectopic pregnancy. She's sent to a hospital in western Mexico, where she undergoes abdominal examination with ultrasound and magnetic resonance, which shows a full term abdominal pregnancy, for which a laparotomy is performed. The placenta is left in situ, due to the high risk of hemorrhage associated with it's removal. Both the newborn and the mother are released from the hospital in good conditions after two weeks of stay, with subsequent follow-up. CONCLUSIONS: Despite it being a rare condition, it's important to be acquainted with the proper management according to the gestational age of the pregnancy due to the recent rise in it's incidence, as well as it's particularly high rate of complicactions, in order to preserve the wellbeing of both patients when possible, as well as maternal fertility.